2016-08-15T08:14:31-05:00 2015-09-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2014-10-01 611386016 ASHLAND NURSING HOME CORP ASHL 6063241414 2500 STATE ROUTE 5 ASHLAND KY 41102 AUTUMN MCFANN TREASURER 6063241414 2016-08-12 1 JULIUS C GREEN CPA P00350393 2159720701 2014 2016-09-27 15:27:22Z KINGSBROOK LIFECARE CENTER KRISTIE WHITLATCH 2201 LEXINGTON AVENUE ASHLAND KY 41101 15504125 0 X WWW.KINGSBROOK-LIFECARE.COM X 2002 KY PROVIDE QUALITY CARE TO PATIENTS NEEDING SHORT-TERM REHAB AND/OR LONG-TERM HEALTHCARE. 7 4 407 69 0 0 0 0 15486664 15395466 5171 7792 97700 100867 15589535 15504125 0 0 0 0 7688479 7368828 0 0 0 6786873 6657725 14475352 14026553 1114183 1477572 12525272 13233360 1170744 1062920 11354528 12170440 OUR MISSION IS TO MEET THE NEEDS OF RESIDENTS AT VARIOUS LEVELS OF CARE INCLUDING SHORT-TERM REHAB AND LONG-TERM HEALTHCARE. 0 0 12411222 15395466 KINGSBROOK PROVIDES QUALITY CARE TO PATIENTS, MEETING THE NEEDS AND DESIRES OF RESIDENTS AT VARIOUS LEVELS OF CARE, INCLUDING SHORT-TERM AND LONG-TERM CARE. KINGSBROOK IS A 147-BED NURSING FACILITY WHICH PROVIDES SKILLED NURSING SERVICES AND REHABILITATION THERAPY TO RESIDENTS DESIRING TO RETURN HOME FROM AN ACUTE CARE HOSPITAL STAY. KINGSBROOK ALSO PROVIDES NURSING SERVICES AND CARE FOR RESIDENTS ON A LONG-TERM BASIS. 12411222 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 407 1 0 0 0 0 0 0 0 0 0 0 X 7 4 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X DAVID THOMAS DIRECTOR OF FINANCE 6063241414 2500 STATE ROUTE 5 ASHLAND KY 41102 EB LOWMAN II CHAIRMAN OF THE BOARD 1.30 X X 0 0 0 KRISTIE WHITLATCH PRESIDENT 1.30 60.00 X X 0 538322 23500 AUTUMN MCFANN TREASURER 1.30 60.00 X X 0 197929 40747 SHERYL MAHANEY SECRETARY 1.30 60.00 X X 0 356877 22330 DAVID JONES DIRECTOR 0.30 6.00 X 0 0 0 WILLIE MCCULLOUGH DIRECTOR 0.30 X 0 0 0 REV JIM NICHOLS DIRECTOR 0.30 X 0 0 0 ARTHUR MOORE ADMINISTRATOR 40.00 X 135846 0 0 FRED JACKSON FORMER PRESIDENT 0.00 0.00 X 0 863956 6606 135846 1957084 93183 2 1 1 0 FUNCTIONAL PATHWAYS INC 614 MABRY HOOD ROAD KNOXVILLE TN 30368 THERAPY CONTRACTING SERVICES 1104176 MEDCARE PHARMACY 350 ARISTOCRAT DRIVE FLORENCE KY 41042 PHARMACEUTICAL SERVICES 583380 MEDICAL PARK PHARMACY PO BOX 999 LAVALETTE WV 25535 PHARMACEUTICAL SERVICES 248024 HOMETOWN CARPET OUTLET 2431 WINCHESTER AVENUE ASHLAND KY 41101 FLOORING INSTALLATION 202260 KINGS DAUGHTERS MEDICAL CENTER PO BOX 151 ASHLAND KY 41105 LABORATORY SERVICES 119697 7 NET PATIENT SERVICE REVENUE 623000 15395466 15395466 15395466 7792 7792 CAFETERIA/LAUNDRY SERVICES 722210 62671 62671 BEAUTY/BARBER SHOP 812900 31109 31109 VENDING COMMISSION/REBATES 812300 3060 3060 4027 4027 100867 15504125 15395466 0 108659 X 5944506 5171720 772786 976816 849830 126986 447506 389330 58176 29980 26083 3897 11768 10238 1530 4294 3736 558 2023940 1760828 263112 29506 25670 3836 39456 34327 5129 43861 38159 5702 517739 450433 67306 19544 17003 2541 1900 1653 247 10888 9473 1415 850973 740347 110626 176440 153503 22937 SUPPLIES 1125709 979367 146342 PHARMACY 771077 771077 PROVIDER TAX 411817 411817 BAD DEBT EXPENSE 341524 341524 247309 225104 22205 14026553 12411222 1615331 0 570002 1618624 2016997 2183520 126164 7925 66300 74654 120193 175479 16825699 9474139 7804018 7351560 1821598 1821598 12525272 13233360 1097617 878790 73127 184130 1170744 1062920 X 11354528 12170440 11354528 12170440 12525272 13233360 X 1477572 -661660 X 0 1 X 1 0 X 13481597 13419109 15020791 15486664 15395466 72803627 13481597 13419109 15020791 15486664 15395466 72803627 0 0 0 72803627 3670 2441 3806 5171 7792 22880 3670 2441 3806 5171 7792 22880 106405 110669 101520 97700 100867 517161 13591672 13532219 15126117 15589535 15504125 73343668 0.99260 0.99250 0.00030 0.00030 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CAFETERIA/LAUNDRY - 2010 AMOUNT: $ 66,174. 2011 AMOUNT: $ 68,362. 2012 AMOUNT: $ 55,460. 2013 AMOUNT: $ 58,102. 2014 AMOUNT: $ 62,671. BEAUTY/BARBER - 2010 AMOUNT: $ 29,492. 2011 AMOUNT: $ 31,795. 2012 AMOUNT: $ 29,682. 2013 AMOUNT: $ 31,447. 2014 AMOUNT: $ 31,109. VENDING COMMISSION/REBATE - 2011 AMOUNT: $ 2,206. 2012 AMOUNT: $ 1,892. 2013 AMOUNT: $ 2,964. 2014 AMOUNT: $ 3,060. OTHER - 2010 AMOUNT: $ 10,739. 2011 AMOUNT: $ 8,306. 2012 AMOUNT: $ 14,486. 2013 AMOUNT: $ 5,187. 2014 AMOUNT: $ 4,027. 0 0 0 0 0 0 0 0 1 4294 4294 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE FOLLOWING ARE ATTRIBUTABLE TO LOBBYING: KY ASSOCIATION OF HEALTH CARE FACILITIES $3,934 THE AMERICAN HEALTHCARE SERVICES ASSOCIATION $218 KY ASSOCIATION OF HOMES AND SERVICES FOR THE AGING $142 348396 348396 13061071 7150113 5910958 2577684 1819601 758083 838548 504425 334123 7351560 NURSING HOME BED LICENSES 1819300 GOODWILL - PHARMACY 2298 1821598 DUE TO KING'S DAUGHTERS MEDICAL CENTER 184130 184130 X 15162601 -341524 -341524 15504125 0 15504125 13685029 0 13685029 341524 341524 14026553 PART X, LINE 2: THE MEDICAL CENTER, KHF, KBNH, CDC, KHI, KDMT, KDMS, KDHF, AND KDOH HAVE BEEN RECOGNIZED BY THE IRS AS SECTION 501(C)(3) CHARITABLE ORGANIZATIONS. SECTION 501(C)(3) ORGANIZATIONS ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. THESE ORGANIZATIONS DO NOT ENGAGE IN SIGNIFICANT UNRELATED ACTIVITIES AND THEREFORE NO TAX IS RECORDED. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUES ON F/S -341,524. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST REVENUES ON F/S 341,524. 1 1 0 0 0 0 0 0 0 KRISTIE WHITLATCH PRESIDENT 0 450644 0 0 0 87678 0 7800 0 15700 0 561822 0 76717 AUTUMN MCFANN TREASURER 0 196685 0 0 0 1244 0 27087 0 13660 0 238676 0 0 SHERYL MAHANEY SECRETARY 0 280712 0 0 0 76165 0 7800 0 14530 0 379207 0 72093 FRED JACKSON FORMER PRESIDENT 0 23221 0 0 0 840735 0 0 0 6606 0 870562 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS DETERMINED BY ASHLAND HOSPITAL CORPORATION (RELATED ORGANIZATION) USING THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY/STUDY AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINES 4A-B FRED JACKSON RECEIVED A SEVERANCE PAYMENT OF $833,252. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: SHERYL MAHANEY - $72,093 KRISTIE WHITLATCH - $76,717 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS/DEFERRALS: AUTUMN MCFANN - $21,090 THE CEO AND VICE PRESIDENTS ARE ELIGIBLE TO RECEIVE DISCRETIONARY INCENTIVES BASED ON CERTAIN METRICS (QUALITY MEASURES, INDIVIDUAL GOALS, ETC.). THESE AWARDS ARE DETERMINED BY THE BOARD AND VESTED OVER 5-10 YEAR PERIOD IF THE INDIVIDUAL REMAINS WITH THE ORGANIZATION. THE CEO AND CERTAIN VICE PRESIDENTS, WHOSE BENEFIT IN THE QUALIFIED TAX SHELTERED ANNUITY PLAN IS LIMITED DUE TO THE IRS COMPENSATION AND BENEFIT LIMITS, RECEIVE A BENEFIT RESTORATION CONTRIBUTION UNDER THE DEFERRED ANNUITY PLAN THAT IS PAID AS A TAXABLE DISTRIBUTION TO THE PARTICIPANT ANNUALLY. FORM 990, PART VI, SECTION A, LINE 6 ASHLAND HOSPITAL CORPORATION IS THE SOLE CORPORATE MEMBER OF ASHLAND NURSING HOME CORPORATION. ASHLAND HOSPITAL CORPORATION, A 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A ASHLAND HOSPITAL CORPORATION ELECTS THE BOARD MEMBERS OF ASHLAND NURSING HOME CORPORATION ON AN ANNUAL BASIS OR UNTIL A SUCCESSOR IS NAMED. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE CONTROLLER AND THE CFO OF KING'S DAUGHTERS MEDICAL CENTER. AFTER THIS REVIEW, BUT BEFORE IT IS FILED WITH THE IRS, THE FINAL 990 WILL BE PROVIDED TO THE FULL BOARD OF DIRECTORS USING BOARD EFFECTS SOFTWARE. AN E-MAIL WITH A LINK TO THE POSTING WILL BE SENT TO EACH BOARD MEMBER ONCE THE REPORT HAS BEEN POSTED. FORM 990, PART VI, SECTION B, LINE 12C ANY EMPLOYEE, MANAGER, OR OFFICER WHO REGULARLY INFLUENCES OR MAKES DECISIONS INVOLVING THE EXPENDITURE OF FACILITY FUNDS SHALL SIGN A CONFLICT OF INTEREST STATEMENT. THE FORM SHALL BE REVIEWED YEARLY AND SHALL BE FILED IN THE HUMAN RESOURCES OFFICE. WHEN AN EMPLOYEE HAS REPORTED A POTENTIAL OR ACTUAL CONFLICT OF INTEREST TO THE IMMEDIATE SUPERVISOR, THE RESPONSIBLE MANAGER AND THE ADMINISTRATOR SHALL BE NOTIFIED OF ALL FACTS PERTAINING TO ANY POTENTIAL TRANSACTIONS. IF IT IS DETERMINED THAT A CONFLICT DOES EXIST, THEN THE EMPLOYEES SHALL BE REMOVED FROM ANY PART OF THE DECISION-MAKING PROCESS, AND SHALL HAVE NO ROLE IN THE INSTANCE WHERE THE CONFLICT OF INTEREST EXISTS. THE EMPLOYEE'S IMMEDIATE SUPERVISOR SHALL ASSUME OR ASSIGN THE AUTHORITY TO ACT ON BEHALF OF THE EMPLOYEE IN ALL ACTIONS INVOLVING THE AREA OF CONFLICT. FAILURE TO REPORT CONFLICTS OF INTEREST IS A DIRECT VIOLATION OF KINGSBROOK'S POLICY AND WILL RESULT IN DISCIPLINARY ACTION. WHEN A MANAGER OF THE FACILITY REPORTS A POTENTIAL CONFLICT, THE MANAGER SHALL REMOVE HIMSELF/HERSELF FROM ANY DISCUSSION OR VOTING REGARDING THE POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AT THE DIRECTION OF THE HUMAN RESOURCES & COMPENSATION COMMITTEE OF THE BOARD OF KING'S DAUGHTERS HEALTH SYSTEM, KDHS ENGAGED SULLIVAN COTTER AND ASSOCIATES, INC., A LEADING INDEPENDENT COMPENSATION CONSULTING COMPANY SPECIALIZING IN EXECUTIVE, EMPLOYEE AND PHYSICIAN COMPENSATION AND BENEFITS FOR THE HEALTH CARE AND NOT-FOR-PROFIT INDUSTRY, TO ASSIST IN DETERMINING COMPENSATION OF THE CEO, VICE PRESIDENTS, AND CHIEF MEDICAL OFFICERS. THIS IS AN ANNUAL PROCESS AND SULLIVAN COTTER'S MOST RECENT EXECUTIVE COMPENSATION REVIEW WAS PERFORMED IN 2015 AND REMAINS IN PROCESS. THE PRINCIPLE OBJECTIVE OF THIS STUDY WAS TO ASSEMBLE A DETAILED PROFILE OF THE CURRENT COMPENSATION LEVELS AVAILABLE TO EXECUTIVES MANAGING SIMILAR TASKS AND RESPONSIBILITIES AS MEMBERS OF THE KDHS EXECUTIVE TEAM. MOREOVER, THE OBJECTIVE WAS TO COMPILE MARKET DATA FOR EACH POSITION THAT WAS REFLECTIVE OF THE PAY LEVELS OFFERED BY INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE ORGANIZATIONS OF COMPARABLE SIZE WITH OPERATIONS IN THE UNITED STATES. THE SULLIVAN COTTER DATA COUPLED WITH THE PERFORMANCE OF THE ORGANIZATION AS WELL AS THE PERSONAL PERFORMANCE OF EACH EXECUTIVE IS THE BASIS FOR KDHS'S HUMAN RESOURCE & COMPENSATION COMMITTEE'S REVIEW AND RECOMMENDATIONS, AND THE BOARD'S REVIEW AND APPROVAL OF ANNUAL COMPENSATION INCREASES. THE PROCESS INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THIS PROCESS WAS USED TO DETERMINE COMPENSATION FOR THE FOLLOWING POSITIONS: PRESIDENT/CEO VP, CHIEF COMPLIANCE OFFICER VP, CHIEF FINANCIAL OFFICER VP, CHIEF LEGAL & REGULATORY OFFICER/GENERAL COUNSEL CHIEF MEDICAL OFFICERS VP, CHIEF STRATEGY/INFORMATION SERVICES & TECHNOLOGY OFFICER VP, EXECUTIVE DIRECTOR KING'S DAUGHTERS INTEGRATED PHYSICIANS VP, PATIENT SERVICES/CHIEF NURSING OFFICER FORM 990, PART VI, SECTION C, LINE 19 ON A QUARTERLY BASIS, THE FINANCIAL STATEMENTS ARE REPORTED TO EMMA AND MADE AVAILABLE ON THEIR WEBSITE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 98,795. MANAGEMENT AND GENERAL EXPENSES 263,112. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 361,907. PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 1,662,033. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,662,033. FORM 990, PART XI, LINE 9: PARTIAL RETURN OF INVESTMENT TO AFFILIATE -661,660. ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVE ASHLAND KY 41101 610444716 HEALTHCARE KY 501(C)(3) 3 KING'S DAUGHTERS HEALTH SYSTEM 0 KENTUCKY MEDICAL LOGISTICS INC (DBA KINGS DAUGHTERS TRANS) 425 22ND STREET ASHLAND KY 41101 264736971 MEDICAL TRANSPORT KY 501(C)(3) 9 ASHLAND HOSPITAL CORPORATION 0 KING'S DAUGHTERS HEALTH SYSTEM 2201 LEXINGTON AVE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) 11-II N/A 0 PORTSMOUTH HOSPITAL CORP 1901 ARGONNE AVE PORTSMOUTH OH 45662 453215312 HEALTHCARE OH 501(C)(3) 3 ASHLAND HOSPITAL CORPORATION 0 KENTUCKY HEART FOUNDATION 2201 LEXINGTON AVE ASHLAND KY 41101 260791997 MEDICAL RESEARCH KY 501(C)(3) 7 ASHLAND HOSPITAL CORPORATION 0 KING'S DAUGHTERS HEALTH FOUNDATION INC 2201 LEXINGTON AVE ASHLAND KY 41101 611035701 FUNDRAISING KY 501(C)(3) 11-III-FI ASHLAND HOSPITAL CORPORATION 0 CHILD DEVELOPMENT CENTER CORPORATION 2201 LEXINGTON AVE ASHLAND KY 41101 010560598 DAYCARE KY 501(C)(3) 9 ASHLAND HOSPITAL CORPORATION 0 KING'S DAUGHTERS MEDICAL SPECIALTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 264183569 PHYSICIANS KY 501(C)(3) 9 ASHLAND HOSPITAL CORPORATION 0 KENTUCKY HEART INSTITUTE 2201 LEXINGTON AVE ASHLAND KY 41101 611255904 PHYSICIANS KY 501(C)(3) 9 ASHLAND HOSPITAL CORPORATION 0 ASHLAND MEDICAL PROPERTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 611079090 RENTALS KY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1