2016-03-10T15:27:21-06:00 2015-04-30 273858252 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2014-09-01 610445826 KENTUCKY EASTER SEAL SOCIETY INC CARDINAL HILL REHABILITATION HOSPITAL KENT 8592545701 2050 VERSAILLES ROAD LEXINGTON KY 40504 GLENN NORVELL BOARD CHAIR 8592545701 2016-03-08 1 LEIGH MCKEE P00169845 8592552341 2014 2016-08-17 19:52:53Z X GARY PAYNE 2050 VERSAILLES ROAD LEXINGTON KY 40504 48325387 0 X WWW.CARDINALHILL.ORG X 1923 KY DEFINING EXCELLENCE IN PHYSICAL REHABILITATION-GIVING HOPE AND ENHANCING OUTCOMES FOR PATIENTS AND FAMILIES. 11 11 889 235 261265 -131431 1316306 1612835 60739689 40889459 1206782 1792989 236224 58243 63499001 44353526 0 0 0 0 37434879 25363717 0 0 225043 23489854 16062236 60924733 41425953 2574268 2927573 107135516 0 29861528 0 77273988 0 X CARDINAL HILL BEGAN AS A HOSPITAL FOR CHILDREN WITH POLIO IN 1950 WITH A MISSION TO BECOME ONE OF THE PREMIER POST ACUTE PROVIDERS OF PHYSICAL REHABILITATION SERVICES. IN ACCORDANCE WITH THIS GOAL, THE HOSPITAL PROVIDES TREATMENT OF SPINAL CORD INJURY, BRAIN INJURY, STROKE, ORTHOPEDIC AND NEUROLOGICAL CONDITIONS, AMPUTATION AND OTHER DISABLING OR TRAUMATIC CONDITIONS. CARDINAL HILL PROVIDES PHYSICAL REHABILITATION FOR PEOPLE NEEDING INPATIENT, OUTPATIENT AND HOME HEALTH CARE SERVICES. CARDINAL HILL ALSO PROVIDES PEDIATRIC SERVICES FOR CHILDREN FROM BIRTH THROUGH ADULTHOOD BY OFFERING CHILD CARE SERVICES, AND THERAPY FOR ANY DISABLING AND/OR TRAUMATIC CONDITION. 0 0 34077896 40628194 CARDINAL HILL BEGAN AS A HOSPITAL FOR CHILDREN WITH POLIO IN 1950. SINCE THAT TIME, IT HAS EVOLVED INTO ONE OF THE PREMIER POST ACUTE PROVIDERS OF PHYSICAL REHABILITATION SERVICES WITH 158 ACUTE BEDS AND 74 LICENSED SKILLED BEDS. TODAY, THE HOSPITAL SPECIALIZES IN THE TREATMENT OF SPINAL CORD INJURY, BRAIN INJURY, STROKE, ORTHOPEDIC AND NEUROLOGICAL CONDITIONS, AMPUTATION AND OTHER DISABLING OR TRAUMATIC CONDITIONS. CARDINAL HILL SERVES MORE THAN 9,000 CHILDREN AND ADULTS ANNUALLY FROM ALL OVER KENTUCKY AND NATIONWIDE. CARDINAL HILL PROVIDES PHYSICAL REHABILITATION FOR PEOPLE NEEDING INPATIENT, OUTPATIENT AND HOME HEALTH CARE SERVICES. CARDINAL HILL ALSO PROVIDES PEDIATRIC SERVICES FOR CHILDREN FROM BIRTH THROUGH ADULTHOOD BY OFFERING PRESCHOOL AND CHILD CARE SERVICES, AND THERAPY FOR ANY DISABLING AND/OR TRAUMATIC CONDITION.THE CARDINAL HILL HEALTHCARE SYSTEM IS A 501(C)3 ORGANIZATION GOVERNED BY THE KENTUCKY EASTER SEAL SOCIETY, INC., AN AFFILIATE OF NATIONAL EASTER SEALS SOCIETY. SERVICES INCLUDE INPATIENT HOSPITAL CARE FOR PHYSICAL REHABILITATION NEEDS AND MEDICALLY COMPLEX CLIENTS. IN ADDITION TO THE THREE INPATIENT PROGRAMS, OUTPATIENT THERAPY, PRESCHOOL, CHILDCARE, ADULT DAY HEALTH, AND RECREATIONAL PROGRAMS ARE ALSO AVAILABLE. THE HEALTHCARE SYSTEM IS ONE OF THE COMMONWEALTH'S LARGEST PROVIDERS OF PHYSICAL REHABILITATION SERVICES, WITH CORPORATE HEADQUARTERS LOCATED IN LEXINGTON, KY. 34077896 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 1 135 0 1 889 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X GARY PAYNE 8592545701 2050 VERSAILLES ROAD LEXINGTON KY 40504 J HAGAN CODELL ASST. TREASURER 1.00 X 0 0 0 MIKE KANAREK DIRECTOR 1.00 X 0 0 0 CHARLOTTE LUNDERGAN ASST. SECRETARY 1.00 X 0 0 0 GLENN NORVELL VICE CHAIR 1.00 X 0 0 0 RICHARD STURGILL SECRETARY 1.00 X 0 0 0 TED RENAKER TREASURER 1.00 X 0 0 0 PAUL HONEYCUTT DIRECTOR 1.00 X 0 0 0 KEN HILER DIRECTOR 1.00 X 0 0 0 GREGG THORNTON DIRECTOR 1.00 X 0 0 0 ROGER DALTON DIRECTOR 1.00 X 0 0 0 JIMMY NASH CHAIR 1.00 X 0 0 0 MARTIN LAUTNER CFO 39.00 1.00 X 183959 0 14470 MAUREEN COUTURE VP NURSING SERVICES UNTIL 01/16/15 40.00 X 146474 0 8956 GARY PAYNE CEO 39.00 1.00 X 384502 0 20828 DANIEL HUDSON VP THERAPY SERVICES 40.00 X 117772 0 5819 NANCY MITCHELL VP NURSING SERVICES 40.00 X 88519 0 9890 WILLIAM DUTTON PHARMACIST 40.00 X 124989 0 19758 KERRY COONEY RN NURSE 40.00 X 108472 0 9657 MICHELLE GRAYBELL DIR. ACCUTE REHAB PROGRAM 40.00 X 114738 0 6416 PAMELA HEISSENBUTTEL DIR. HOME CARE 40.00 X 109440 0 18919 VIRGINIA WURZBACK MARKETING DIRECTOR 39.00 1.00 X 114518 0 10214 1493383 0 124927 14 0 1 0 CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 SOFTWARE SERVICES 1353952 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING 799813 THE COMPETITIVE EDGE II LLC 3716 WILLOW RIDGE ROAD LEXINGTON KY 40514 TEMP STAFFING SERVICE 516847 STITES & HARBISON PLLC 250 W MAIN STREET 2300 LEXINGTON KY 40507 LEGAL SERVICE 321428 DEAN DORTON ALLEN FORD PLLC 106 WEST VINE STREET STE 600 LEXINGTON KY 40507 ACCOUNTING SERVICE 217454 10 106580 1506255 45847 1612835 PROGRAM SERVICE FEES 623000 40567355 40567355 CHILDCARE FACILITY REVENUE 624410 322104 60839 261265 40889459 539183 539183 98794 303452 -204658 -204658 -204658 4625556 154285 3525844 191 1099712 154094 1253806 1253806 143002 106580 125590 17412 17412 18731 16784 1947 1947 CAFETERIA 722210 181338 181338 RECORD TRANSCRIPTION 561000 56542 56542 MISCELLANEOUS 900009 5662 5662 243542 44353526 40628194 261265 1851232 X 825300 825300 17930180 16306178 1514986 109016 647082 611247 31255 4580 4405392 4161425 212788 31179 1555763 1369733 171925 14105 480711 1400 479311 217455 217455 5511889 3846286 1655944 9659 3143395 2711776 407806 23813 587397 499688 82217 5492 107933 48315 59618 1302037 1052179 239896 9962 2681735 2191656 469888 20191 329308 329308 PROVIDER TAX 907983 705642 188726 13615 MISCELLANEOUS EXPENSE 293647 154716 137986 945 RESIDENCY PROGRAM 215955 215955 BAD DEBT EXPENSE 155853 155853 126938 45847 98605 -17514 41425953 34077896 7123014 225043 10043349 0 0 0 10605639 0 0 0 0 516388 0 781987 0 0 0 58682353 0 21152244 0 0 0 0 5353556 0 107135516 0 -13062214 0 9227 0 38653783 0 2576008 0 1684724 0 29861528 0 X 63609187 0 9044854 0 4619947 0 77273988 0 107135516 0 X 2927573 -80201561 X X 0 1 X 1 0 X 1001327 981243 2664152 1096885 1612835 7356442 1001327 981243 2664152 1096885 1612835 7356442 2232920 5123522 366459 405407 480909 462839 637977 2353591 9710033 270789135 0.52770 0.55680 X PART II, SHORT YEAR EXPLANATION: EFFECTIVE APRIL 30, 2015, CHRH WAS SOLD TO HEALTHSOUTH CORPORATION AND SUBSIDIARIES. THE SCHEDULE A REFLECTS THE SUPPORT ACTIVITIES FROM 09/01/2014 UNTIL 04/30/2015. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 10176 0 10176 41415777 41425953 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 8426 9147 12128 10176 39877 250000 250000 250000 250000 1000000 1500000 8426 9147 12128 10176 39877 21580537 11040 -650919 2642 20938016 19079173 65362 2575867 139865 21580537 24957384 1823554 2457286 10159051 19079173 29158036 100121 1743226 6043999 24957384 31888635 102968 4735861 7569428 29158036 0.59920 0.40080 0.00000 1 0 0 PART V, LINE 4: ENDOWMENT FUNDS SUPPORT THE MISSION OF THE KENTUCKY EASTER SEAL SOCIETY, PROVIDING FACILITIES AND QUALITY CARE TO PATIENTS AND CLIENTS. ENDOWMENT FUNDS REPRESENT THE ASSETS HELD IN TRUST BY OTHERS AND RESTRICTIONS PLACED BY DONORS WITH THE GIFT. ENDOWMENT FUNDS WERE DISTRIBUTED TO KENTUCKY EASTER SEAL SOCIETY, INC (KESS) AS PART OF THE CARDINAL HILL REHABILITATION HOSPITAL'S LIQUIDATION. KESS RETAINED THE ENDOWMENT CHARACTER OF THESE FUNDS. KENTUCKY BASH 132505 55345 77160 2307 34616 29924 3300 1989 ROUNDBALL BASH 62493 33060 29433 1360 11703 17000 1000 5005 1 54584 18175 36409 5675 6779 4219 500 213 249582 106580 143002 9342 53098 51143 4800 7207 125590 17412 1 1 X 1 X 1 X 1 1 1 0 1 1 294671 143888 150783 0.00360 1227244 773816 453428 0.01090 1521915 917704 604211 0.01450 20610 0 20610 0.00050 778797 77877 700920 0.01690 103928 54544 49384 0.00120 13400 0 13400 0.00030 916735 132421 784314 0.01890 2438650 1050125 1388525 0.03340 2537 2537 0.00010 5000 5000 0.00010 7537 7537 0.00020 1 93897 14321624 11586066 2735558 X 1 1 1 1 CARDINAL HILL REHABILITATION HOSPITAL 2050 VERSAILLES ROAD LEXINGTON KY 40504 X X X INPATIENT REHAB FACILITY CARDINAL HILL REHABILITATION HOSPITAL 1 0 0 1 X X X X X X X X 13 1 0 0 1 X WWW.CARDINALHILL.ORG (UNTIL 04/30/2015) 1 13 0 1 0 1 X 100.000000000000 200.000000000000 X X 1 1 X X X X 1 X X 1 X 1 X X X 0 X X 0 0 CARDINAL HILL REHABILITATION HOSPITAL PART V, SECTION B, LINE 5: CHRH CONTRACTED WITH THE COMMUNITY AND ECONOMIC DEVELOPMENT INITIATIVE OF KENTUCKY (CEDIK) AT THE UNIVERSITY OF KENTUCKY TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN ACCORDANCE WITH THE AFFORDABLE CARE ACT. CARDINAL HILL REHABILITATION HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE NEEDS IDENTIFIED IN ITS CHNA THROUGH ITS ACTION PLAN ATTACHED TO THIS RETURN. CARDINAL HILL REHABILITATION HOSPITAL PART V, SECTION B, LINE 13B: OTHER FACTORS USED TO DETERMINE THE AMOUNTS CHARGED TO PATIENTS ARE THE NUMBER OF HOUSEHOLD MEMBERS. CARDINAL HILL REHABILITATION HOSPITAL PART V, SECTION B, LINE 18D: THE HOSPITAL FACILITY SENDS THE UNCOLLECTED AMOUNTS TO A COLLECTION AGENCY. CARDINAL HILL REHABILITATION HOSPITAL PART V, SECTION B, LINE 19D: THE HOSPITAL FACILITY SENDS THE UNCOLLECTED AMOUNTS TO A COLLECTION AGENCY. CARDINAL HILL REHABILITATION HOSPITAL PART V, SECTION B, LINE 20E: THE HOSPITAL SENDS A SERIES OF COLLECTION LETTERS PRIOR TO COLLECTION ACTIONS BY THE THIRD PARTY. THE LETTERS INCLUDE INFORMATION ON CHRH'S FINANCIAL ASSISTANCE. CARDINAL HILL REHABILITATION HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL DETERMINED THE AMOUNTS BILLED TO INDIVIDUALS, WHO DID NOT HAVE INSURANCE, BASED ON THE MEDICAID RATE. PART II, COMMUNITY BUILDING ACTIVITIES: ALL OF CARDINAL HILL'S COMMUNITY BUILDING ACTIVITIES PROMOTE HEALTH BY ENABLING INDIVIDUALS TO REACH THEIR HIGHEST POTENTIAL FOR PHYSICAL, EMOTIONAL AND MENTAL WELL-BEING. THE MOST SIGNIFICANT COMMUNITY BUILDING ACTIVITY IS THE AMPUTEE WALKING SCHOOL. THE CLINIC INTRODUCES TREATMENT APPROACHES FOR IMPROVED FUNCTION AND RETURN TO AN ACTIVE LIFESTYLE. UNDERSTANDING THE DYNAMICS OF HOW ARTIFICIAL DEVICES WORK AND HOW TO USE MUSCLES PROPERLY TO CONTROL THE DEVICES ENABLES INDIVIDUALS WITH DISABILITIES TO RUN, MOVE FROM SIDE TO SIDE, BEND DOWN, JUMP, CLIMB STAIRS AND WALK WITH MORE CONFIDENCE. INCREASED STRENGTH AND FLEXIBILITY HELP PARTICIPANTS TO OPERATE MORE EFFICIENTLY, EXPEND LESS ENERGY AND, THUS, DO MORE EACH DAY WITHOUT FATIGUE. THE SCHOOL FACILITATES ONE-ON-ONE OPPORTUNITIES BETWEEN THE PRESENTERS AND AMPUTEES AND "HANDS-ON" PARTICIPATION TECHNIQUES ASSISTED BY A TRAINED PROFESSIONAL AND/OR FAMILY MEMBER. IN ADDITION, PROFESSIONALS IN THE FIELD OF REHABILITATIVE THERAPY AND SPORTS RECEIVE A HIGH LEVEL TRAINING AND ADVANCED EXERCISES APPROPRIATE FOR USE WITH CLIENTS OF ALL AGES TO IMPROVE AMBULATING. THE CLINIC IS FREE AND OPEN TO ALL AMPUTEES AND FAMILY MEMBERS. PROFESSIONALS RECEIVE NOT ONLY TRAINING, BUT CONTINUING EDUCATION CREDITS THAT MAY BE APPLIED TO THEIR RESPECTIVE DISCIPLINES FOR LICENSURE. CHRH PROVIDES STROKE SCREENINGS AT HEALTH FAIRS THROUGHOUT THE AREA OVER THE COURSE OF THE YEAR. CHRH'S HIGHEST POPULATION OF PATIENTS IS STROKE VICTIMS. THEREFORE, AS A COMMUNITY BENEFIT, WE EDUCATE THE POPULATION ON STROKE RISKS AND PREVENTION, AND PROVIDE FREE STROKE SCREENINGS. CARDINAL HILL HOSTS AND SPONSORS SUPPORT GROUP MEETINGS TO VARIOUS COMMUNITY GROUPS. THE MEETINGS ARE OPEN TO PREVIOUS PATIENTS AND THE COMMUNITY. THE GROUPS ARE STROKE, BRAIN INJURY, PULMONARY, AND MULTIPLE SCLEROSIS SUPPORT GROUPS. CARDINAL HILL IS THE PRIMARY SPONSOR FOR THE HILL ON WHEELS BASKETBALL TEAM WHICH IS OPEN TO THE COMMUNITY. THIS WHEELCHAIR BASKETBALL TEAM COMPETES LOCALLY, REGIONALLY, AND NATIONALLY. PART III, LINE 4: A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT OF BAD DEBT EXPENSE AT COST. NO AMOUNT OF BAD DEBT EXPENSE WAS ATTRIBUTED TO PATIENTS ELIGIBLE FOR CHARITY CARE BECAUSE THE ORGANIZATION'S BAD DEBT POLICY DISTINGUISHES BETWEEN THOSE WITH THE ABILITY TO PAY BUT WILL NOT, WHO ARE CONSIDERED BAD DEBT, AND THOSE WITHOUT THE ABILITY TO PAY, WHO ARE CONSIDERED CHARITY CARE. THE ORGANIZATION'S FINANCIAL STATEMENT FOOTNOTES DO NOT DIRECTLY ADDRESS THE TREATMENT OF BAD DEBT EXPENSE, ACCOUNTS RECEIVABLE, OR AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, BUT DO DISCUSS THE PRESENTATION OF PROGRAM SERVICE FEES: PROGRAM SERVICE FEES CONSIST OF NET PATIENT SERVICE REVENUE. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED. PART III, LINE 8: MEDICARE COSTS WERE DETERMINED USING A COST-TO-CHARGE RATIO, AS INDICATED. PART III, LINE 9B: ALL SELF PAY PATIENTS ARE SENT STATEMENTS. THERE ARE A SERIES OF FIVE STATEMENTS SENT ONE PER MONTH. IF NO RESPONSE IS RECEIVED, THEN AFTER THE FIFTH STATEMENT, THEY ARE SENT TO COLLECTIONS. THE MINIMUM ACCOUNT BALANCE SENT TO COLLECTIONS IS $10. AMOUNTS UNDER $10 ARE WRITTEN OFF TO IMMATERIAL BALANCE. IF THE PATIENT REQUESTS FINANCIAL ASSISTANCE AND THE FINANCIAL WORKSHEET IS RECEIVED BACK FROM THE PATIENT, THE INCOME, EXPENSES, AND RESOURCES ARE EVALUATED, AND MANAGEMENT MAKES A DETERMINATION OF ELIGIBILITY FOR CHARITY CARE. IF DEEMED ELIGIBLE, NO FURTHER COLLECTION ACTIVITY IS TAKEN. THE RECEIVABLE IS THEN WRITTEN OFF TO CHARITY CARE. PART VI, LINE 2: IN COLLABORATION WITH HEALTHCARE ORGANIZATIONS THROUGHOUT THE STATE, CARDINAL HILL FREQUENTLY ASSESSES SERVICES PROVIDED AND THE COMMUNITY NEED FOR ADDITIONAL SERVICES. FOR EXAMPLE, KENTUCKY IS CONSIDERED TO BE IN THE "STROKE BELT" OF AMERICA, MEANING WE ARE AMONG TEN STATES WHERE THE MORTALITY RATE FROM STROKES IS HIGHER THAN THE NATIONAL AVERAGE. WE PROVIDE FREE STROKE SCREENINGS AT THE CARDINAL HILL COMMUNITY HEALTH FAIR AND LOCAL AND REGIONAL HEALTH FAIRS. PART VI, LINE 3: PATIENTS ARE INFORMED ABOUT STATE (KMA) ELIGIBILITY REQUIREMENTS. THIS MAY START AT PRE-ADMISSION SCREENING BY OUR ADMISSION FACILITATOR, OR AT ADMISSION BY OUR ADMISSION COUNSELOR, OR DURING INPATIENT OR OUTPATIENT SERVICES BY THEIR SOCIAL WORKER/CASE MANAGER. A STATEMENT THAT THE FACILITY ACCEPTS PATIENTS WITHOUT REGARD TO RACE, CREED, OR ABILITY TO PAY IS LOCATED AT THE INPATIENT ADMISSION AND OUTPATIENT FINANCIAL COUNSELOR'S OFFICES. IF THE PATIENT INDICATES INABILITY TO PAY, THEY ARE GIVEN A FINANCIAL WORKSHEET TO COMPLETE. PART VI, LINE 4: CARDINAL HILL IS LOCATED IN KENTUCKY. CHRH IS IN AN URBAN AREA, BUT SERVES A MIX OF RURAL AND URBAN PATIENTS. CHRH SERVES COUNTIES IN THE EASTERN AND SOUTHEASTERN PARTS OF KENTUCKY, MANY OF WHICH ARE DESIGNATED AS MEDICALLY UNDERSERVED AREAS. MOST OF THIS HOSPITAL'S PATIENTS ARE FROM KENTUCKY AND 18% OF CHRH'S ARE UNINSURED OR MEDICAID RECIPIENTS. CHRH IS THE ONLY FREE-STANDING REHABILITATION-SPECIFIC INPATIENT PROVIDER IN ITS PRIMARY SERVICE AREA. PART VI, LINE 5: CARDINAL HILL ORGANIZED COMMUNITY WIDE SUPPORT GROUPS FOR CAREGIVERS AND SURVIVORS OF STROKE, BRAIN INJURY, SPINAL CORD INJURY, AMPUTATION, AND FOR THOSE LIVING WITH PULMONARY DISORDERS OR DISEASE. CARDINAL HILL ALSO PROVIDES A FREE, COMMUNITY-WIDE HEALTH FAIR AND STRETCHING CLINICS BEFORE GOLF TOURNAMENTS AND 5K RUN/WALKS. PART VI, LINE 6: CARDINAL HILL HEALTHCARE SYSTEM IS AN AFFILIATE OF NATIONAL EASTER SEALS SOCIETY. EASTER SEALS HELPS INDIVIDUALS WITH DISABILITIES AND SPECIAL NEEDS, AND THEIR FAMILIES, LIVE BETTER LIVES. EASTER SEALS OFFERS A VARIETY OF SERVICES TO HELP PEOPLE WITH DISABILITIES ADDRESS LIFE'S CHALLENGES AND ACHIEVE PERSONAL GOALS THROUGH DIRECT SERVICES, ADVOCACY AND EDUCATIONAL OPPORTUNITIES. 1 X X X 1 0 0 0 0 0 0 0 0 MARTIN LAUTNER CFO 183959 0 0 0 0 0 8334 0 6136 0 198429 0 0 0 MAUREEN COUTURE VP NURSING SERVICES UNTIL 01/16/15 146474 0 0 0 0 0 26 0 8930 0 155430 0 0 0 GARY PAYNE CEO 384502 0 0 0 0 0 8638 0 12190 0 405330 0 0 0 PART I, LINE 4A PAMELA HEISSENBUTTEL, DIRECTOR OF HOME CARE, RECEIVED A SEVERANCE OF $25,000. A KENTUCKY ECONOMIC DEVELOPMENT FINANCE AUTHORITY 610600439 2010-02-12 13000000 HOSPITAL CONSTRUCTION 0 0 0 B KENTUCKY ECONOMIC DEVELOPMENT FINANCE AUTHORITY 610600439 2009-12-30 30000000 REFINANCING AND HOSPITAL CONSTRUCTION 0 0 0 A 13000000 54456 10515736 2011 0 0 0 1 B 30000000 208983 25024935 2011 0 1 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 1 1.00000 1 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 1 1.00000 1 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 SCHEDULE K 100% OF TAX EXEMPT BONDS WERE PAID OFF WITH PROCEEDS RECEIVED FROM THE SALE OF THE HOSPITAL TO HEALTHSOUTH CORPORATION. X 25 FAIR MARKET VALUE X 11274 FAIR MARKET VALUE X 9 885 FAIR MARKET VALUE X 1 60 FAIR MARKET VALUE X GENERAL MERCHANDISE AND SERVICES 26 15440 FAIR MARKET VALUE X TRAVEL, TOURS, RENTALS 16 7560 FAIR MARKET VALUE X BASKETS AND GIFT CARDS 59 4938 FAIR MARKET VALUE X CARDS AND AUTOGRAPHS 8 3525 FAIR MARKET VALUE X BOX SEATS AND TICKETS 5 765 FAIR MARKET VALUE X PRINTS 4 575 FAIR MARKET VALUE X FURNITURE AND EQUIPMENT 3 435 FAIR MARKET VALUE X TOYS, GAMES AND CRAFTS SUPPLIES 5 365 FAIR MARKET VALUE 0 1 0 PROPERTY, PLANT AND EQUIPMENT 2015-04-30 42579546 FAIR MARKET VALUE 630860407 HEALTHSOUTH CORPORATION AND SUBSIDIARIES 3660 GRANDVIEW PARKWAY SUITE 200 BIRMINGHAM AL 35243 FOR PROFIT CORPORATION CERTIFICATE OF NEED 2015-04-30 5548000 FAIR MARKET VALUE 630860407 HEALTHSOUTH CORPORATION AND SUBSIDIARIES 3660 GRANDVIEW PARKWAY SUITE 200 BIRMINGHAM AL 35243 FOR PROFIT CORPORATION NONCOMPETE AGREEMENT 2015-04-30 18000 FAIR MARKET VALUE 630860407 HEALTHSOUTH CORPORATION AND SUBSIDIARIES 3660 GRANDVIEW PARKWAY SUITE 200 BIRMINGHAM AL 35243 FOR PROFIT CORPORATION TRADE NAME 2015-04-30 780000 FAIR MARKET VALUE 630860407 HEALTHSOUTH CORPORATION AND SUBSIDIARIES 3660 GRANDVIEW PARKWAY SUITE 200 BIRMINGHAM AL 35243 FOR PROFIT CORPORATION MEDICARE 2015-04-30 180000 FAIR MARKET VALUE 630860407 HEALTHSOUTH CORPORATION AND SUBSIDIARIES 3660 GRANDVIEW PARKWAY SUITE 200 BIRMINGHAM AL 35243 FOR PROFIT CORPORATION ACCOUNTS RECEIVABLE AND OTHER CURRENT ASSETS 2015-04-30 9831867 FAIR MARKET VALUE 630860407 HEALTHSOUTH CORPORATION AND SUBSIDIARIES 3660 GRANDVIEW PARKWAY SUITE 200 BIRMINGHAM AL 35243 FOR PROFIT CORPORATION NET ASSETS 2015-04-30 80201561 NET BOOK VALUE 610444712 KENTUCKY EASTER SEAL SOCIETY INC 2050 VERSAILLES ROAD LEXINGTON KY 40504 501(C)(3) 1 1 0 0 1 0 0 1 1 1 PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: CARDINAL HILL REHABILITATION HOSPITAL (CHRH) HAS BEEN OPERATED BY KENTUCKY EASTER SEAL SOCIETY, INC. (KESS) SINCE 1950. ON 4/30/2015, THE ASSETS OF CHRH WERE SOLD TO HEALTHSOUTH CORPORATION, AN UNRELATED ENTITY, IN AN ARM'S LENGTH TRANSACTION. THE CEO, CFO, AND MOST OTHER MANAGEMENT AND EMPLOYEES TRANSITIONED FROM CHRH TO HEALTHSOUTH. VIRGINIA WURZBACK BECAME THE EXECUTIVE DIRECTOR OF KENTUCKY EASTER SEALS SOCIETY, INC. (KESS). THE BOARD OF DIRECTORS CONTINUED ON AS THE BOARD OF DIRECTORS OF KESS. NO OTHER OFFICER, DIRECTOR, OR KEY EMPLOYEE HAD A BUSINESS RELATIONSHIP WITH HEALTHSOUTH, BEFORE OR AFTER THE TRANSACTION, OTHER THAN THE EMPLOYEES WHO TRANSITIONED TO HEALTHSOUTH. CHRH'S REMAINING NET ASSETS WERE TRANSFERRED TO KESS, ITS 501(C)(3) PARENT IN COMPLETE LIQUIDATION. PART I, LINE 6C: $40,265,044 OF TAX EXEMPT BONDS WERE PAID OFF WITH PROCEEDS RECEIVED FROM THE SALE OF THE HOSPITAL TO HEALTHSOUTH CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF DIRECTORS HAVE BEEN GIVEN THE OPPORTUNITY TO REVIEW FORM 990 IN ITS ENTIRETY. ADDITIONALLY, KEY MEMBERS OF THE BOARD OF DIRECTORS HAVE REVIEWED FORM 990 WITH THE ACCOUNTING MANAGER. FORM 990, PART VI, SECTION B, LINE 12C THE ENTITY REQUIRES OFFICERS, DIRECTORS, AND TRUSTEES TO ANNUALLY REVIEW AND DISCLOSE IN WRITING TRANSACTIONS WITH THE ENTITY. FORM 990, PART VI, SECTION B, LINE 15 QUESTION 15A THE OVERSIGHT COMMITTEE, COMPRISED SOLELY OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS, SERVING AS A COMPENSATION COMMITTEE, REVIEWS COMPARABILITY AND OTHER COMPENSATION DATA OBTAINED FROM INDEPENDENT COMPENSATION DATA SOURCES TO DETERMINE THE COMPENSATION OF THE CEO. THE DELIBERATION AND DECISION OF THE CEO'S COMPENSATION IS DOCUMENTED IN THE STANDARD DOCUMENTATION OF COMPENSATION ADJUSTMENTS MAINTAINED IN PERSONNEL RECORDS. THE HUMAN RESOURCE DIRECTOR ASSISTS THE COMMITTEE IN PREPARING AND EXECUTING THE APPROPRIATE PERSONNEL AND PAYROLL RECORDS. THE HUMAN RESOURCE DIRECTOR MAINTAINS CONTROL OF THE PERSONNEL RECORDS OF THE CEO. QUESTION 15B THE CHIEF EXECUTIVE OFFICER REVIEWS COMPENSATION OF OFFICERS OF THE COMPANY. IN THE COURSE OF DETERMINING COMPENSATION FOR THE OFFICERS OF THE ORGANIZATION, THE HUMAN RESOURCE DIRECTOR REVIEWS OUTSIDE COMPETITIVE SOURCES. IN ADDITION, FORMAL, WRITTEN PERFORMANCE EVALUATIONS ARE COMPLETED ANNUALLY ON THE OFFICERS BY THE CEO. THE DELIBERATION AND DECISION OF THE OFFICER'S COMPENSATION IS DOCUMENTED IN THE STANDARD DOCUMENTATION OF COMPENSATION ADJUSTMENTS MAINTAINED IN PERSONNEL RECORDS. THE HUMAN RESOURCE DIRECTOR MAINTAINS THE OFFICERS' PERSONNEL RECORDS AND ARE UNDER HIS CONTROL AND SECURITY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST, AND AT THE DISCRETION OF THE BOARD OF DIRECTORS AND MANAGEMENT. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,846,286. MANAGEMENT AND GENERAL EXPENSES 1,655,944. FUNDRAISING EXPENSES 9,659. TOTAL EXPENSES 5,511,889. FORM 990, PART XI, LINE 9: DISTRIBUTION OF NET ASSETS TO KENTUCKY EASTER SEAL SOCIETY, INC -80,201,561. FORM 990, PART XII, QUESTION 2C THE FINANCE AND AUDIT COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, LED BY THE BOARD CHAIRPERSON, HAS AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS ON ALL MATTERS WHICH CANNOT BE DELAYED UNTIL THE NEXT REGULARLY SCHEDULED BOARD MEETING, EXCLUDING THE POWER TO AMEND ARTICLES OF INCORPORATION AND BYLAWS. ALL SUCH ACTIONS ARE THEN REPORTED TO THE BOARD OF DIRECTORS AT THE NEXT MEETING. SCHEDULE K, PART II, LINE 13 THE FACILITY WAS COMPLETED IN OCTOBER 2011, WHICH IS IN FISCAL YEAR 2012. FORM 990, PART I, LINE 5 AND PART V, LINE 2A. THE NUMBER OF W-2S ISSUED AS REPORTED ON FORM W-3, 1,535, IS NOT REPRESENTATIVE OF THE ACTUAL NUMBER OF EMPLOYEES EMPLOYED BY THE GROUP. THIS NUMBER INCLUDES MULTIPLE W-2S ISSUED TO A SINGLE EMPLOYEE DUE TO WORK IN MULTIPLE STATES OR LOCALITIES. A MORE ACCURATE REPRESENTATION OF THE TOTAL NUMBER OF EMPLOYEES DURING THE YEAR WOULD BE 889. FORM 990 THE ORGANIZATION WAS INCLUDED IN THE GROUP RETURN FOR KENTUCKY EASTER SEALS SOCIETY, INC. (KESS) IN PRIOR YEARS. THE ORGANIZATION'S ASSETS AND LIABILITIES WERE LIQUIDATED AS OF APRIL 30, 2015. KENTUCKY EASTER SEAL SOCIETY INC 2050 VERSAILLES ROAD LEXINGTON KY 40504 610444712 EXCELLENCE IN PHYSICAL REHABILITATION -GIVING HOPE AND ENHANCING OUTCOMES KY 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 KENTUCKY EASTER SEAL SOCIETY INC R 80201561 NET BOOK VALUE