2014-08-15T08:03:10-05:00 2013-09-30 232932984 PARENTEBEARD LLC 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2012-10-01 610444716 ASHLAND HOSPITAL CORPORATION ASHL 6064084000 2201 LEXINGTON AVENUE ASHLAND KY 41101 AUTUMN MCFANN 6064084000 2014-08-13 1 JULIUS C GREEN CPA JD P00350393 2159722352 2012 2015-11-30 17:44:51Z KING'S DAUGHTERS MEDICAL CENTER KRISTIE WHITLATCH 2201 LEXINGTON AVENUE ASHLAND KY 41101 522223369 0 X WWW.KDMC.COM X 1941 KY TO PROVIDE COMMUNITY HEALTHCARE SERVICES. TO CARE. TO SERVE. TO HEAL. 13 7 4064 308 267459 0 291132 374195 541522680 452296162 8154919 9778710 3480867 2775826 553449598 465224893 57393 160047 0 0 238475540 200968260 0 0 0 278657127 264662867 517190060 465791174 36259538 -566281 835789288 822243145 395652723 404817852 440136565 417425293 X TO CARE. TO SERVE. TO HEAL. 0 1 389747707 160047 452059929 COMMUNITY INFORMATION:KING'S DAUGHTERS IS NESTLED IN THE FOOTHILLS OF THE APPALACHIAN MOUNTAINS, WHERE THE KENTUCKY, OHIO, AND WEST VIRGINIA STATE LINES MEET. KDMC'S PRIMARY SERVICE AREA ENCOMPASSES SIX COUNTIES IN TWO STATES: BOYD, CARTER, GREENUP AND LAWRENCE COUNTIES IN KENTUCKY AND LAWRENCE AND SCIOTO COUNTIES IN OHIO. MORE THAN 269,000 PEOPLE (U.S. CENSUS BUREAU) LIVE IN THE SIX-COUNTY PRIMARY SERVICE AREA. WITH THE EXCEPTION OF TWO CITIES WITH POPULATIONS AROUND 20,000 THE AREA IS VERY RURAL, COVERING NEARLY 2,400 SQUARE MILES WITH A POPULATION DENSITY OF 112 PEOPLE PER SQUARE MILE. NEARLY 20.3% OF THE POPULATION LIVES IN POVERTY, COMPARED WITH 18.6% FOR KENTUCKY, 15.4% FOR OHIO AND 14.9% FOR THE NATION. MORE THAN 25% OF CHILDREN LIVE IN POVERTY. THE POPULATION IS 97% WHITE, 2% BLACK AND ALL OTHER RACES 1%. THE AVERAGE PER CAPITA INCOME IS $19,795, WELL BELOW THE LEVELS FOR KENTUCKY ($23,051), OHIO ($25,857) AND THE NATION ($28,051). IN KDMC'S PRIMARY MARKET AREA, 17% OF THOSE AGED 19-64 YEARS LACKED ANY FORM OF HEALTHCARE COVERAGE, COMPARED TO KENTUCKY-18%, OHIO-14% AND THE NATION-11%. COMMUNITY HEALTH NEEDS ASSESSMENT:DURING FISCAL YEAR 2013, KDMC CONDUCTED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT WAS CONDUCTED FOR KDMC'S PRIMARY MARKET (BOYD, CARTER, GREENUP & LAWRENCE COUNTIES, KENTUCKY AND LAWRENCE AND SCIOTO, COUNTIES, OHIO) AND SECONDARY MARKET COUNTIES FLOYD AND JOHNSON WHERE KDMC HAS A SIGNIFICANT PRESENCE. THE ASSESSMENT SHOWED:- LEADING CAUSES OF DEATH (AGE ADJUSTED) ARE PRIMARILY FROM CHRONIC DISEASES INCLUDING HEART DISEASE, CANCER, COPD AND DIABETES. IN ADDITION, UNINTENTIONAL INJURY IS ANOTHER LEADING CAUSE. THESE RATES ARE HIGHER IN THE PRIMARY AND SECONDARY MARKET COUNTIES THAN THE NATION.- RESIDENTS LIVE UNHEALTHY LIFESTYLES WITH 30% OF ADULTS SMOKING, 37% OBESE AND 37% PHYSICALLY INACTIVE. THESE RATES ARE ALL WELL ABOVE THE NATIONAL AVERAGE.- THE SERVICE AREA HAS A HIGH NUMBER OF VULNERABLE POPULATIONS, WITH SIX OF SEVEN COUNTIES SHOWING A HIGH LOW BIRTH WEIGHT RATE OF 10.5% (8.6% NATIONALLY), 17% OF THE POPULATION UNINSURED AND 32% OF CHILDREN LIVING IN POVERTY.- ENVIRONMENTAL FACTORS OFTEN CONTRIBUTE TO THE HEALTH OF THE COMMUNITY. IN THE AREA THERE ARE BARRIERS TO LIVING HEALTHY, INCLUDING LOW ACCESS TO RECREATIONAL FACILITIES, LIMITED ACCESS TO HEALTHY FOODS AND A HIGHER THAN AVERAGE NUMBER OF FAST FOOD RESTAURANTS.COMMUNITY INPUT WAS SOUGHT THROUGH FOCUS GROUPS AND SURVEYS, WITH THE FOLLOWING FINDINGS:- FOCUS GROUP PARTICIPANTS CITED, AS BARRIERS TO GOOD HEALTH, IN SCIOTO COUNTY THE FOLLOWING:- UNHEALTHY LIFESTYLES (POOR NUTRITION AND PHYSICAL INACTIVITY)- OBESITY- DRUGS AND CRIME RELATED TO DRUGS- TRANSPORTATION- RESPONDENTS TO THE HEALTH SURVEY CITED THE FOLLOWING TOP ISSUES IN THE COUNTY:- SUBSTANCE ABUSE- OBESITY- CHRONIC DISEASES CANCER, HEART DISEASE AND DIABETESA STRATEGIC PLAN HAS BEEN DEVELOPED AND APPROVED BY THE BOARD OF DIRECTORS, WHICH BEGINS IMPLEMENTATION WITH FISCAL YEAR 2014. THE PLAN PROPOSES MULTIPLE WAYS TO ADDRESS THE CHRONIC DISEASE BURDEN IN THE AREA. COMMUNITY BUILDING ACTIVITIES:KDMC SUPPORTS THE HEALTH OF THE COMMUNITY BY PROVIDING FREE AND REDUCED COST SERVICES, INCLUDING HEALTH SCREENINGS AND HEALTH EDUCATION. THESE SERVICES HELP INDIVIDUALS IDENTIFY THEIR PERSONAL HEALTH RISKS AND LEARN HOW TO IMPROVE THEIR HEALTH THROUGH LIFESTYLE CHANGE OR, WHEN NEEDED, MEDICAL INTERVENTION.COLLABORATION WITH COMMUNITY: KDMC HAS ESTABLISHED PARTNERSHIPS WITH AREA RETAILERS, HEALTH DEPARTMENTS, FACTORIES AND CHEMICAL PLANTS, CITY OF ASHLAND, LOCAL EMS SERVICES, AMERICAN RED CROSS, SUSAN G. KOMEN FOR THE CURE, FOUNDATION FOR A HEALTHY KENTUCKY, CARES (LOCAL REFERRAL AGENCY), COMMUNITY KITCHEN, SAFE HARBOR, 16 SCHOOL DISTRICTS AND NEARBY COLLEGES AND UNIVERSITIES, NAACP, ASHLAND FAIR HOUSING, SHELTER OF HOPE, ASHLAND AREA YMCA, KENTUCKY STATE POLICE, OHIO HIGHWAY PATROL, AREA SENIOR CENTERS AND MORE THAN 150 CHURCHES TO DELIVER HEALTH SERVICES AND EDUCATION TO RESIDENTS. KDMC'S COMMUNITY HEALTH TEAM GOES OUT INTO THE COMMUNITY TO MEET PEOPLE ON THEIR TIME AND IN THE PLACES THAT ARE COMFORTABLE FOR THEM SCHOOLS, MALLS, LIBRARIES, WORKSITES, GROCERY STORES AND MORE. DURING FISCAL YEAR 2013, KDMC PROVIDED THE FOLLOWING:HEALTH SCREENINGS:- STROKE (CAROTID) 135 ADULTS SERVED- CARPAL TUNNEL 272 ADULTS SERVED- GENERAL HEALTH (TOTAL CHOLESTEROL, BLOOD PRESSURE AND BLOOD SUGAR) 4,756 ADULTS SERVED- HEALTHY HEART - (TOTAL CHOLESTEROL, BLOOD PRESSURE, BLOOD SUGAR & EKG) 2,941 ADULTS SERVED- HEARING 49 ADULTS SERVED- JOINT PAIN 61 ADULTS SERVED- LUNG FUNCTION 89 ADULTS SERVED- MOBILE MAMMOGRAPHY 1,923 WOMEN SERVED- OSTEOPOROSIS 243 ADULTS SERVED- PROSTATE CANCER 160 MEN SERVED- SKIN CANCER 326 ADULTS SERVEDPATIENTS WITH ABNORMAL RESULTS FROM OUR HEALTH SCREENINGS RECEIVE A FOLLOW-UP LETTER REMINDING THEM OF THE IMPORTANCE OF SHARING THE RESULTS WITH THEIR HEALTHCARE PROVIDER. IDENTIFYING THOSE AT RISK FOR HEART AND VASCULAR DISEASE, EDUCATING THE PUBLIC ABOUT HEART ATTACK AND STROKE SIGNS AND SYMPTOMS, AND REDUCING TOBACCO USE THROUGHOUT THE REGION ARE AREAS OF FOCUS. OUR REGION HAS A HIGH INCIDENCE OF UNDIAGNOSED OR UNTREATED HEART AND VASCULAR DISEASE. HEALTH EDUCATION:- BICYCLE SAFETY - 311 ADULTS, 130 CHILDREN/YOUTH SERVED- BREAST CANCER - 2,751 ADULTS, 107 CHILDREN/YOUTH SERVED- COLON CANCER - 1,116 ADULTS, 880 CHILDREN/YOUTH SERVED- ORAL HEALTH - 27 ADULTS, 888 CHILDREN/YOUTH SERVED- DIABETES - 2,274 ADULTS, 905 CHILDREN/YOUTH SERVED- PHYSICAL ACTIVITY - 1,502 ADULTS, 1,121 CHILDREN/YOUTH SERVED- HAND HYGIENE - 1,119 ADULTS, 1,327 CHILDREN/YOUTH SERVED- HEART HEALTH - 3,853 ADULTS, 750 CHILDREN/YOUTH SERVED- NUTRITION - 3,814 ADULTS, 7,530 CHILDREN/YOUTH SERVED- PROSTATE CANCER - 1,360 ADULTS, 117 CHILDREN/YOUTH SERVED- SCHOOL BUS SAFETY - 1,222 ADULTS, 601 CHILDREN/YOUTH SERVED- SKIN CANCER - 2,280 ADULTS, 314 CHILDREN/YOUTH SERVED- STROKE - 1,964 ADULTS, 250 CHILDREN/YOUTH SERVED- TOBACCO - 2,564 ADULTS, 15,099 CHILDREN/YOUTH SERVEDOTHER SERVICES:HOSPITALITY HOUSE: FAMILIES THAT LIVE OUTSIDE OUR COMMUNITY WITH LIMITED RESOURCES (FINANCIAL, TRANSPORTATION, FAMILY SUPPORT) WHO HAVE A LOVED ONE IN CRITICAL CARE ARE REFERRED BY KDMC SOCIAL WORKERS TO THE KDMC HOSPITALITY HOUSE. GUESTS OF THE HOSPITALITY HOUSE INCLUDE ADULT FAMILY MEMBERS OR CAREGIVERS OF EITHER CRITICALLY ILL PATIENTS RECEIVING CARE AT KDMC, OR QUALIFYING OUTPATIENTS RECEIVING EXTENDED THERAPEUTIC CARE. IN NEARLY ALL CASES, GUESTS LIVE OUTSIDE A 30-MILE RADIUS OF ASHLAND. THE HOUSE DOES NOT CHARGE FAMILIES TO STAY, HOWEVER A NUMBER OF THE GUESTS MAKE A VOLUNTARY CONTRIBUTION. MORE THAN 700 FAMILY MEMBERS WERE SERVED BY THE HOSPITALITY HOUSE DURING THE YEAR.FLU SHOTS: DURING THE FISCAL YEAR, KDMC PROVIDED 405 FREE FLU SHOTS THROUGHOUT THE COMMUNITY. FLU SHOTS ARE DELIVERED THROUGH A VARIETY OF SETTINGS AND IN MULTIPLE COUNTIES SERVED BY THE MEDICAL CENTER.SPIRITUAL SERVICES: THE PASTORAL CARE SERVICE DEPARTMENT EMPLOYS ONE PART-TIME AND TWO FULL-TIME CHAPLAINS TO PROVIDE SPIRITUAL AND EMOTIONAL SUPPORT FOR OUR PATIENTS, THEIR FAMILIES AND FRIENDS AND FOR THE STAFF OF KING'S DAUGHTERS MEDICAL CENTER. ONE-ON-ONE COUNSELING AS WELL AS GROUP COUNSELING, WHICH INCLUDES GRIEF SUPPORT AND PALLIATIVE CARE FOR END-OF-LIFE PATIENTS AND THEIR FAMILIES, IS OFFERED BY THE DEPARTMENT.RESEARCH: KDMC THROUGH THE ONCOLOGY SERVICES AND THE KENTUCKY HEART FOUNDATION OFFER CUTTING EDGE RESEARCH OPPORTUNITIES TO PATIENTS AT KDMC. MORE THAN 500 PATIENTS PARTICIPATE IN RESEARCH STUDIES OFFERED AT KDMC.AFFILIATED HEALTH CARE SYSTEM ROLES:KING'S DAUGHTERS MEDICAL CENTER IS PART OF AN AFFILIATED HEALTH CARE DELIVERY SYSTEM. THE SYSTEM PROVIDES PHYSICIAN SERVICES THROUGH TWO AFFILIATES, KENTUCKY HEART INSTITUTE AND KING'S DAUGHTERS MEDICAL SPECIALTIES. BOTH AFFILIATES PROVIDE CHARITY CARE AND PARTICIPATE IN GOVERNMENT PROGRAMS. 389747707 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 441 0 1 4064 1 1 1 0 0 0 0 0 0 0 0 0 X 13 7 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X GREG WHITLOCK CONTROLLER 6064080160 2201 LEXINGTON AVENUE ASHLAND KY 41101 ADDINGTON STEPHEN 0.30 0.30 X 0 0 0 BURNETTE TOM 0.30 1.00 X 0 0 0 CANTRELL JIM 0.30 0.30 X 0 0 0 CASSIDY DAN 0.30 1.30 X 0 0 0 HAMMONDS DONALD DO 0.30 40.30 X 0 86272 22982 KANOUSE STEVE 0.30 0.30 X 0 0 0 KRIVCHENIA ALEXANDER MD 1.30 1.00 X 26687 0 0 MCCANN KIM 0.30 1.30 X 0 0 0 MECCA RAYMOND MD 0.50 0.30 X 1000 0 0 STEWART JOHN 0.30 0.50 X 0 0 0 VINCENT JOHN 0.30 1.30 X 0 0 0 JONES DAVID 1.00 5.80 X X 0 0 0 JACKSON FRED 41.00 9.00 X X 5238125 0 32860 MCDOWELL PAUL 41.00 9.00 X X 544194 0 32357 TREASURE JEFF 41.00 9.00 X 0 0 0 MAHANEY SHERYL 41.00 9.00 X 419810 0 135314 FIORET PHILIP MD 41.00 9.00 X 764484 0 140538 HIGGINS LARRY 41.00 9.00 X 472158 0 124691 WHITLATCH KRISTIE 41.00 9.00 X 563857 0 170827 BOYKIN MAYOLA MD 40.00 X 751664 0 34119 FRALEY ERIK MD 40.00 X 652344 0 17241 HOWARD-CLAUDIO CANDACE MD 40.00 X 828819 0 36227 MOTIMAYA ASH MD 40.00 X 701467 0 36121 POWELL STELLA MD 40.00 X 659659 0 31369 11624268 86272 814646 210 0 1 0 STITES & HARBISON PLLC 250 W MAIN ST 2300 LEXINGTON FINAN LEXINGTON KY 405071758 LAWYERS 2367954 TGC LLC POBOX 130 HIGHLAND MD 20777 CONSULTANTS 1532446 SPECIALTYCARE CARDIOVASCULAR RESOURCES DEPT 1614 PO BOX 11407 BIRMINGHAM AL 352461614 PERFUSIONISTS 1527178 BROWN PARKER & DEMARINIS ADVERTISING 3333 SOUTH CONGRESS AVE SUITE 305- DELRAY BEACH FL 33445 MARKETING 1231790 BLANK ROME LLP PO BOX 8500 PHILADELPHIA PA 19178 LAWYERS 1178840 41 4625 186235 183335 4625 374195 NET PATIENT SVC REV 621110 439217723 439034813 182910 PHARMACY 446110 10587271 10533948 53323 MEANINGFUL USE REVENUES 621110 2491168 2491168 452296162 10266978 32448 10234530 1486711 3818 877574 5040 609137 -1222 607915 -1222 609137 55583401 44193 55035244 1080618 548157 -1036425 -488268 -488268 CAFETERIA 722210 1669608 1669608 QUALITY INCENTIVE 900099 276979 276979 MEDICAL RECORDS 561499 113783 113783 107541 107541 2167911 465224893 452059929 267459 12523310 160047 160047 4778599 4778599 155469444 139615542 15853902 4319702 3879092 440610 25376294 22787912 2588382 11024221 9684778 1339443 4776381 1154286 3622095 120000 120000 28712 28712 628047 628047 27338282 17993639 9344643 2597769 17891 2579878 2625723 682662 1943061 1652198 1652198 7322632 2169494 5153138 605229 442652 162577 26750 22553 4197 10198828 10198828 36070883 33871451 2199432 8171355 61907 8109448 MEDICAL SUPPLIES 86381604 83076465 3305139 BAD DEBT EXPENSE 45081869 45081869 REPAIRS & MAINTENANCE 15323134 14062270 1260864 TAX (INC. PROVIDER TAX) 7622559 6960301 662258 8090912 6341986 1748926 465791174 389747707 76043467 0 40423793 10367512 37241519 13218373 70145614 66616975 1102280 889786 10105924 10012046 9157432 8047601 683042766 391034455 321972250 292008311 210416254 225954740 7528398 6259393 587059 127695824 188281349 835789288 822243145 55338396 50048707 244054896 239206332 4328274 2517625 91931157 113045188 395652723 404817852 X 440136565 417425293 440136565 417425293 835789288 822243145 X -566281 6319806 -28464797 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 28712 28712 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: $18,601: A PORTION OF THE DUES PAID TO THE KENTUCKY HOSPITAL ASSOCIATION ATTRIBUTABLE TO LOBBYING EXPENSES. $3,255: A PORTION OF THE DUES PAID TO THE AMERICAN MEDICAL REHABILITATION PROVIDERS ATTRIBUTABLE TO LOBBYING EXPENSES. $5,714: A PORTION OF THE DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION ATTRIBUTABLE TO LOBBYING EXPENSES. $1,142: A PORTION OF DUES PAID TO THE KENTUCKY MEDICAL ASSOCIATION ATTRIBUTABLE TO LOBBYING. 29356866 29356866 369542005 182528356 187013649 274431603 202957267 71474336 9712292 5548832 4163460 292008311 SELF INSURANCE FUNDS 182394 TRUSTEED FUNDS 10373519 DEFERRED FINANCING COSTS 2556018 DUE FROM RELATED PARTIES 145699218 OTHER RECEIVABLES 29461827 ACCRUED INTEREST RECEIVABLE 8373 188281349 MALPRACTICE COSTS 21638349 ACCRUED PENSION 10444000 LONG-TERM RETENTION PLAN 2139429 INTEREST RATE SWAP AGREEMENTS 12804081 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 16822926 LEASE PAYABLE 296403 ACCRUED GOVERNMENTAL SETTLEMENT 48900000 113045188 X 447448592 6319806 -24646666 -18326860 465775452 -550559 -550559 465224893 421259864 550559 550559 420709305 45081869 45081869 465791174 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE MEDICAL CENTER, KHF, KBNH, CDC, KHI, KDMT, KDMS, KDHF AND PHC 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: CHANGE IN MARKET VALUE INTEREST RATE SWAP 9,259,482. CHANGE IN MARKET VALUE SELF INSURANCE FUNDS -998,566. BAD DEBT EXPENSES (NETTED AGAINST NET PATIENT SERVICE REVENUE ON F/S) -45,081,869. PENSION LIABILITY ADJUSTMENT 12,094,731. OTHER ADJUSTMENTS 79,556. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES -882,614. CONTRIBUTIONS NETTED AGAINST EXPENSES ON F/S 332,055. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 882,614. CONTRIBUTIONS NETTED AGAINST EXPENSES ON F/S -332,055. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSES (NETTED AGAINST NET PATIENT SERVICE REVENUE ON F/S) 45,081,869. 1 1 1 X 1 X 1 1 0 1 1 13420149 13420149 0.03190 71015498 47457493 23558005 0.05600 84435647 47457493 36978154 0.08790 3653025 3653025 0.00870 200207 200207 0.00050 2321799 1946089 375710 0.00090 16210 16210 0.00000 6191241 1946089 4245152 0.01010 90626888 49403582 41223306 0.09800 82602 82602 0.00020 82602 82602 0.00020 1 14473194 0 116309597 134623888 -18314291 X 1 1 1 1 ASHLAND HOSPITAL CORPORATION

2201 LEXINGTON AVENUE ASHLAND KY 41101

X X X ASHLAND HOSPITAL CORPORATION 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X 1 0 X X X X 1 X 0 0 24 CENTER FOR ADVANCED IMAGING

2225 CENTRAL AVENUE ASHLAND KY 41101

OUTPATIENT IMAGING CENTER ASHLAND URGENT CARE

2245 WINCHESTER AVENUE ASHLAND KY 41101

URGENT CARE GRAYSON URGENT CARE

I-64 INTERCHANGE GRAYSON KY 41143

URGENT CARE IRONTON URGENT CARE

912 PARK AVENUE IRONTON OH 45638

URGENT CARE PORTSMOUTH URGENT CARE

2001 SCIOTO TRAIL PORTSMOUTH OH 45662

URGENT CARE OUTPATIENT SERVICES CENTER

480 23RD STREET ASHLAND KY 41101

PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY CATLETTSBURG FAMILY CARE CENTER

4004 LOUIS RD CATLETTSBURG KY 41129

FAMILY CARE CENTER CEDAR KNOLL FAMILY CARE CENTERPEDIATRIC

10650 US ROUTE 60 ASHLAND KY 41102

FAMILY CARE CENTER/PEDIATRICS FLATWOODS FAMILY CAREMED SPECIALTIES

1107 BELLEFONTE RD FLATWOODS KY 41139

FAMILY CARE CENTER GRAYSON MEDICAL SPECIALTIES

609 N CAROL MALONE BLVD GRAYSON KY 41143

FAMILY CARE CENTER PIKEVILLE MEDICAL SPECIALTIES

5425 N MAYO TRAIL SUITE 202 PIKEVILLE KY 41501

FAMILY CARE CENTER OLIVE HILL FAMILY CARE CENTER

391 WEST TOM T HALL BOULEVARD OLIVE HILL KY 41164

FAMILY CARE CENTER BURLINGTON FAMILY CARE CENTER

384 COUNTRY ROAD 120 SOUTH SOUTH POINT OH 45680

FAMILY CARE CENTER IRONTON FAMILY CARE CENTER

912 PARK AVENUE IRONTON OH 45638

FAMILY CARE CENTER JACKSON MEDICAL SPECIALTIES

14395 STATE ROUTE 93 JACKSON OH 45640

FAMILY CARE CENTER PORTSMOUTH MEDICAL SPECIALTIES

2001 SCIOTO TRAIL PORTSMOUTH OH 45662

FAMILY CARE CENTER PROCTORVILLE MEDICAL SPECIALTIES

6276 COUNTY ROAD 107 PROCTORVILLE OH 45669

FAMILY CARE CENTER WHEELERSBURG FAMILY CARE

8750 OHIO RIVER ROAD WHEELERSBURG OH 45694

FAMILY CARE CENTER SANDY HOOK FAMILY CARE CENTER

STATE ROUTES 7 AND 32 SANDY HOOK KY 41171

FAMILY CARE CENTER KDMC SKILLED NURSING FACILITY

2201 LEXINGTON AVENUE ASHLAND KY 41101

SKILLED NURSING KDMC INPATIENT REHABILITATION

2201 LEXINGTON AVENUE ASHLAND KY 41101

INPATIENT REHABILITATION KDMC OCCUPATIONAL MEDICINE

336 29TH STREET ASHLAND KY 41101

OCCUPATIONAL MEDICINE KDMC HOME HEALTH

10730 MIDLAND TRAIL ASHLAND KY 41101

HOME HEALTH SERVICES KDMC HOME MEDICAL EQUIPMENT

1700 WINCHESTER AVE ASHLAND KY 41101

DURABLE MEDICAL EQUIPMENT PART I, LINE 7: KDMC USED WORKSHEET 2 PROVIDED IN THE 2012 SCHEDULE H INSTRUCTIONS (FORM 990) TO CALCULATE A COST TO CHARGE RATIO. THIS RATIO WAS USED TO CALCULATE CHARITY CARE AT COST. ALL OTHER ITEMS WERE REPORTED AT NET EXPENSE. PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS INCLUDED AS SUBSIDIZED HEALTH SERVICES. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $45,081,869. PART II: TO REACH OUR COMMUNITIES AND TO PROVIDE THE BEST OUTREACH SERVICES POSSIBLE, WE PARTNER WITH A DIVERSE GROUP OF BOTH PUBLIC AND PRIVATE ENTITIES. WE HAVE ESTABLISHED PARTNERSHIPS WITH AREA RETAILERS, HEALTH DEPARTMENTS, FACTORIES, CITY OF ASHLAND, LOCAL EMS SERVICES, AMERICAN RED CROSS, SUSAN G. KOMEN FOR THE CURE, CARES, COMMUNITY KITCHEN, SAFE HARBOR, 16 SCHOOL DISTRICTS AND NEARBY COLLEGES AND UNIVERSITIES, SHELTER OF HOPE, ASHLAND AREA YMCA, AREA SENIOR CITIZENS CENTERS, AND MORE THAN 150 CHURCHES. WE SEND OUR OUTREACH TEAMS OUT INTO THE COMMUNITY TO MEET PEOPLE ON THEIR TIME AND IN THE PLACES THAT ARE COMFORTABLE FOR THEM - SCHOOLS, MALLS, CHURCHES, LIBRARIES, WORKSITES, GROCERY STORES AND MORE. SERVICES PROVIDED INCLUDE MORE THAN 75 SCREENING AND EDUCATIONAL EVENTS EACH MONTH, MOBILE HEALTH SERVICES, COORDINATION OF A REGIONAL CPR TRAINING CENTER AND A MEALS ON WHEELS PROGRAM. PATIENTS WITH ABNORMAL RESULTS FROM OUR HEALTH SCREENINGS RECEIVE A FOLLOW-UP LETTER REMINDING THEM OF THE IMPORTANCE OF SHARING THE RESULTS WITH THEIR HEALTHCARE PROVIDER.IDENTIFYING THOSE AT RISK FOR HEART AND VASCULAR DISEASE, EDUCATING THE PUBLIC ABOUT HEART ATTACK AND STROKE SIGNS AND SYMPTOMS, AND REDUCING TOBACCO USE THROUGHOUT THE REGION ARE THREE IMPORTANT AREAS OF FOCUS. OUR REGION HAS A HIGH INCIDENCE OF UNDIAGNOSED OR UNTREATED HEART AND VASCULAR DISEASE. OUR "HEALTH CONNECTIONS" PROGRAM CONTINUES TO EXPAND SERVICES BY OFFERING FREE COMPREHENSIVE HEALTHY HEART AND VASCULAR SCREENINGS TO HIGH RISK POPULATIONS. THIS SCREENING MAY INCLUDE A FASTING LIPID PANEL, TOTAL CHOLESTEROL, AN ANKLE BRACHIAL INDEX, BLOOD PRESSURE, BLOOD SUGAR, OR AN EKG. WE ARE RAISING AWARENESS ABOUT THE CARDIOVASCULAR RISKS AND IDENTIFYING DISEASE THAT HAD NOT BEEN DIAGNOSED SO IT CAN BE TREATED. WE ARE MAKING SURE THE PARTICIPANTS KNOW THEIR HEART RISK NUMBERS. OUR HEART SCREENINGS PROVIDED 6,769 BLOOD PRESSURE (41% ABNORMAL), 6,304 BLOOD SUGAR (10% ABNORMAL) AND 6,275 TOTAL CHOLESTEROL (44% ABNORMAL) SCREENINGS IN 2012. THESE SCREENINGS HAD MORE THAN 3,500 PARTICIPANTS. PART III, LINE 4: MANAGEMENT MAINTAINS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS TO RESERVE FOR ESTIMATED LOSSES BASED ON THE LENGTH OF TIME THE ACCOUNT HAS BEEN PAST DUE, THIRD PARTY PAYER CLASSIFICATION, AND HISTORICAL EXPERIENCE. BAD DEBT IS CLASSIFIED AS A DEDUCTION FROM REVENUE WHICH IS CONSISTENT WITH THE HFMA PRINCIPLES AND PRACTICES BOARD STATEMENT NO. 15.KDMC USED WORKSHEET 2 PROVIDED IN THE 2012 SCHEDULE H INSTRUCTIONS (FORM 990) TO CALCULATE A COST TO CHARGE RATIO. THIS RATIO WAS USED TO CALCULATE BAD DEBT EXPENSE AT COST. BAD DEBT EXPENSE IS RECORDED AFTER ANY DISCOUNTS AND PAYMENTS ARE MADE ONPATIENT ACCOUNTS. HOWEVER, SINCE THE RECENT CHANGE IN THE FINANCIALASSISTANCE POLICY, THE BUSINESS OFFICE NO LONGER KEEPS TRACK OF"NO-RESPONSE" APPLICATIONS ANNUALLY AND DOES NOT FEEL THAT THE PORTIONCONSIDERED TO BE A COMMUNITY BENEFIT IS MATERIAL. PART III, LINE 8: THE HOSPITAL CONTINUES TO PROVIDE CARE TO ALL PRESENTING AND ADMITTED PATIENTS, REGARDLESS OF ABILITY TO PAY. NOTWITHSTANDING THE COSTS TO PROVIDE CARE, RECEIVING "LESS" THAN WHAT IT COSTS TO PROVIDE ADEQUATE CARE TO MEDICARE COVERED LIVES DOES THE HOSPITAL A DISSERVICE. THIS SHORTFALL SHOULD COUNT AS A COMMUNITY BENEFIT. THE HOSPITAL USES THE ALLOWABLE COSTS PER THE MEDICARE COST REPORT. THE 2013 COST REPORT DATA AND PROVIDER SUMMARY REPORT (PSR) WAS USED TO COMPUTE THE INFORMATION. PART III, LINE 9B: THE HOSPITAL DOES HAVE A WRITTEN POLICY FOR BAD DEBT. IT IS A SYSTEM PROGRESSION WITH THREE PATIENT STATEMENTS, THREE LETTERS FROM CREDIT COLLECTIONS, INC., AND IF NO PAYMENT ARRANGEMENTS ARE MADE DURING THIS TIME, THERE IS AUTOMATION TO THE COLLECTION AGENCY. EACH BILL THAT A PATIENT RECEIVES HAS A STATEMENT STATING IF THEY ARE UNABLE TO PAY THEIR BILL TO CONTACT THE HOSPITAL'S FINANCIAL ASSISTANCE TEAM WITH A DIRECT LINE NUMBER. ALSO, EACH SELF-PAY PATIENT IS CONTACTED BY THE HOSPITAL'S MEDICAID ELIGIBILITY VENDOR AS WELL AS RECEIVING A FINANCIAL ASSISTANCE APPLICATION. ASHLAND HOSPITAL CORPORATION PART V, SECTION B, LINE 3: A WIDE RANGE OF COMMUNITY PARTNERS ACTIVELY PARTICIPATED IN THE CHNA THROUGH EIGHT FOCUS GROUPS CONDUCTED TO BETTER ASSESS THE HEALTH NEEDS OF THE REGION. A TOTAL OF 39 SCHOOLS, SOCIAL SERVICE AGENCIES AND/OR BUSINESSES WERE REPRESENTED. PARTICIPANTS INCLUDED LIBRARIES, LOCAL HEALTH DEPARTMENTS, SENIOR CITIZENS CENTERS, YOUTH SERVICES, MENTAL HEALTH AGENCIES, CITY ADMINISTRATORS, MEDIA, HOSPICE, AMERICAN RED CROSS, STATE GOVERNMENT REPRESENTATIVES AND A VARIETY OF BUSINESSES. ASHLAND HOSPITAL CORPORATION PART V, SECTION B, LINE 4: PORTSMOUTH HOSPITAL CORPORATION ASHLAND HOSPITAL CORPORATION PART V, SECTION B, LINE 5C: WWW.KDMC.COM/NEEDS ASHLAND HOSPITAL CORPORATION PART V, SECTION B, LINE 7: SOME NEEDS IDENTIFIED BY KING'S DAUGHTERS' COMMUNITY HEALTH NEEDS ASSESSMENT ARE NOT ADDRESSED IN THIS PLAN. THESE INCLUDE: MENTAL HEALTH, SUBSTANCE ABUSE, ENVIRONMENTAL CONCERNS, LOW BIRTH WEIGHTS, UNEMPLOYMENT, POOR PARENTING, ETC. THESE NEEDS EITHER A) ARE BEING ADDRESSED THROUGH OTHER AGENCIES/SERVICES, OR B) EXCEED THE SCOPE OF RESOURCES OR EXPERTISE FOR KING'S DAUGHTERS FEASIBLY TO ADDRESS. ASHLAND HOSPITAL CORPORATION PART V, SECTION B, LINE 20D: EVERY PATIENT IS CHARGED THE SAME AMOUNT WHETHER OR NOT THEY HAVE INSURANCE. THE DIFFERENCE IS THE ADJUSTMENT THAT IS MADE TO THOSE CHARGES FOR THESE TYPES OF PATIENTS. OUR SELF-PAY PATIENTS ARE AUTOMATICALLY ADJUSTED BY 50% WHICH IS IN LINE WITH OUR LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE. PART VI, LINE 2: WE USE A VARIETY OF RESOURCES TO HELP MAKE DECISIONS ON HOW TO BEST TARGET OUR ACTIVITIES, INCLUDING INFORMATION FROM OUR COMMUNITY HEALTH NEEDS ASSESSMENT, STATE AND COUNTY MORTALITY DATA. WE ARE ACTIVELY INVOLVED IN THE COMMUNITY PARTICIPATING ON NON-PROFITS BOARDS, ATTENDING COMMUNITY PROGRAMS/MEETINGS AND OTHER ACTIVITIES TO HELP KEEP US INFORMED OF NEEDS, CONCERNS AND ISSUES. ONCE WE KNOW WHAT ISSUES WE WANT TO TARGET, OUR COMMUNITY HEALTH INITIATIVES ARE BUILT INTO THE MEDICAL CENTER'S STRATEGIC PLAN. IN FY 2013, THE HIGH INCIDENCE OF HEART DISEASE AND DIABETES WAS A TARGETED HEALTH CONCERN. OVER THE COURSE OF THE YEAR, 181 COMMUNITY HEART HEALTH AND DIABETES SCREENINGS WERE HELD REACHING MORE THAN 15,000 ADULTS. WE ALSO OFFERED A VARIETY OF SCREENINGS AND EDUCATIONAL PROGRAMS ON DOZENS OF TOPICS INCLUDING PHYSICAL ACTIVITY, FIRE SAFETY, FIRST AID, HAND WASHING AND CAR SEAT SAFETY REACHING MORE THAN 83,400 INDIVIDUALS. IN FY 13, A TOTAL OF 2,762 TEAM MEMBERS, PHYSICIANS AND ALLIED HEALTH PROFESSIONALS VOLUNTEERED THEIR TIME TO SUPPORT THESE ACTIVITIES GIVING MORE THAN 33,600 VOLUNTEER HOURS. PART VI, LINE 3: THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY PROVIDES DIRECTION FOR FREE OR DISCOUNTED SERVICES TO RESIDENTS OF THE COMMUNITY WHO HAVE INADEQUATE FINANCIAL RESOURCES TO PAY FOR NECESSARY HEALTHCARE SERVICES PROVIDED BY KDMC. THE POLICY STATES THAT THE MEDICAL CENTER WILL NOT DENY CARE TO ANY PATIENT REQUIRING CARE DUE TO THEIR INABILITY TO PAY. THE FINANCIAL ASSISTANCE POLICY PROVIDES GUIDANCE TO PROVIDING ASSISTANCE BASED ON SLIDING SCALE METHODOLOGY AND THE FEDERAL POVERTY GUIDELINES ESTABLISHED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE FINANCIAL ASSISTANCE PROGRAM IS ON THE KDMC WEBSITE AND THE PHONE NUMBER TO ACCESS INFORMATION IS PROVIDED TO PATIENTS THROUGH THE PATIENT INFORMATION GUIDE AT ADMITTANCE TO THE HOSPITAL. KDMC WORKS TO IDENTIFY PATIENTS THAT MAY HAVE LIMITED RESOURCES AND OFFERS FINANCIAL ASSISTANCE WHEN APPROPRIATE. THERE ARE SIGNS POSTED IN VARIOUS REGISTRATION AREAS INFORMING PATIENTS OF THE PHONE NUMBER TO CALL IF THEY NEED FINANCIAL ASSISTANCE. ON EACH PATIENT STATEMENT THE INFORMATION IS ALSO PRINTED WITH THE PHONE NUMBER. WE ALSO HAVE STAFF IN THE OUTPATIENT IMAGING CENTER, HEART AND VASCULAR CENTER, ADMITTING AND PRE-ADMISSION TESTING AREAS. ALL SELF-PAY PATIENTS RECEIVE CORRESPONDENCE AND PHONES CALLS AND INPATIENTS RECEIVE VISITS FROM OUR MEDICAID ELIGIBILITY VENDOR IN REFERENCE TO GOVERNMENT PROGRAMS. PART VI, LINE 4: KING'S DAUGHTERS MEDICAL CENTER IS LOCATED IN EASTERN KENTUCKY, WHERE THE KENTUCKY, OHIO AND WEST VIRGINIA STATE LINES MEET. KDMC'S PRIMARY SERVICE AREA ENCOMPASSES SIX COUNTIES IN TWO STATES: BOYD, CARTER, LAWRENCE AND GREENUP COUNTIES IN KENTUCKY AND LAWRENCE AND SCIOTO COUNTIES IN OHIO. MORE THAN 269,000 PEOPLE (U.S. CENSUS BUREAU) LIVE IN THE FIVE-COUNTY PRIMARY SERVICE AREA. WITH THE EXCEPTION OF TWO CITIES WITH POPULATIONS AROUND 20,000 THE AREA IS VERY RURAL, COVERING NEARLY 2,400 SQUARE MILES WITH A POPULATION DENSITY OF 112 PEOPLE PER SQUARE MILE. NEARLY 20.3% OF THE POPULATION LIVES IN POVERTY, COMPARED WITH 18.6% FOR KENTUCKY, 15.4% FOR OHIO AND 14.9% FOR THE NATION. MORE THAN 25% OF CHILDREN LIVE IN POVERTY. THE POPULATION IS 97% WHITE, 2% BLACK AND ALL OTHER RACES 1%. THE AVERAGE PER CAPITA INCOME IS $19,795, WELL BELOW THE LEVELS FOR KENTUCKY ($23,051), OHIO ($25,857) AND THE NATION ($28,051). IN KDMC'S PRIMARY MARKET AREA, 17% OF THOSE AGED 19-64 YEARS LACKED ANY FORM OF HEALTHCARE COVERAGE, COMPARED TO KENTUCKY-18%, OHIO-14% AND THE NATION-11%. PART VI, LINE 5: TO REACH OUR COMMUNITIES AND TO PROVIDE THE BEST OUTREACH SERVICES POSSIBLE, WE PARTNER WITH A DIVERSE GROUP OF BOTH PUBLIC AND PRIVATE ENTITIES. WE HAVE ESTABLISHED PARTNERSHIPS WITH AREA RETAILERS, HEALTH DEPARTMENTS, FACTORIES, CITY OF ASHLAND, LOCAL EMS SERVICES, AMERICAN RED CROSS, SUSAN G. KOMEN FOR THE CURE, CARES, COMMUNITY KITCHEN, SAFE HARBOR, 16 SCHOOL DISTRICTS AND NEARBY COLLEGES AND UNIVERSITIES, SHELTER OF HOPE, ASHLAND AREA YMCA, AREA SENIOR CITIZENS CENTERS AND MORE THAN 150 CHURCHES. WE SEND OUR OUTREACH TEAMS OUT INTO THE COMMUNITY TO MEET PEOPLE ON THEIR TIME AND IN THE PLACES THAT ARE COMFORTABLE FOR THEM - SCHOOLS, MALLS, CHURCHES, LIBRARIES, WORKSITES, GROCERY STORES AND MORE. SERVICES PROVIDED INCLUDE MORE THAN 50 SCREENING AND EDUCATIONAL EVENTS EACH MONTH, MOBILE HEALTH SERVICES, COORDINATION OF A REGIONAL CPR TRAINING CENTER AND A MEALS ON WHEELS PROGRAM. PATIENTS WITH ABNORMAL RESULTS FROM OUR HEALTH SCREENINGS RECEIVE A FOLLOW-UP LETTER REMINDING THEM OF THE IMPORTANCE OF SHARING THE RESULTS WITH THEIR HEALTHCARE PROVIDER.THE BOARD OF DIRECTORS IS MADE UP OF UNCOMPENSATED COMMUNITY MEMBERS WHO ARE VOLUNTARILY PROVIDING GUIDANCE TO THE HOSPITAL. ANY SURPLUS FUNDS ARE REINVESTED IN THE CAPITAL AND OPERATIONS OF THE HOSPITAL. PART VI, LINE 6: KING'S DAUGHTERS MEDICAL CENTER IS PART OF AN AFFILIATED HEALTH CARE DELIVERY SYSTEM.THE SYSTEM OPERATES ANOTHER HOSPITAL, KING'S DAUGHTERS MEDICAL CENTER OHIO ("KDOH") IN PORTSMOUTH, OH. KDOH HAS BEEN SPECIFICALLY DESIGNED TO MEET THE HEALTHCARE NEEDS OF PORTSMOUTH AND ITS SURROUNDING AREAS. KDOH OFFERS SERVICES RANGING FROM SURGERY, CARDIAC CARE AND URGENT CARE. KDOH PROVIDES CHARITY CARE AND PARTICIPATES IN GOVERNMENT PROGRAMS.THE SYSTEM PROVIDES PHYSICIAN SERVICES THROUGH TWO AFFILIATES, KENTUCKY HEART INSTITUTE AND KING'S DAUGHTERS MEDICAL SPECIALTIES, INC. BOTH AFFILIATES PROVIDE CHARITY CARE AND PARTICIPATE IN GOVERNMENT PROGRAMS. KING'S DAUGHTERS ALSO INCLUDES TWO OTHER AFFILIATES - KING'S DAUGHTERS MEDICAL TRANSPORT, WHICH SEEKS TO CONTINUOUSLY IMPROVE THE PRE- AND POST-HOSPITAL HEALTHCARE PROVIDED IN ALL OF ITS SERVICE AREAS WHILE ENSURING THAT EMERGENCY AND NON-EMERGENCY AMBULANCE SERVICE WILL BE AVAILABLE TO ALL THOSE IN NEED; AND KINGSBROOK NURSING HOME, WHICH PROVIDES QUALITY CARE TO PATIENTS, MEETING THE NEEDS AND DESIRES OF RESIDENTS AT VARIOUS LEVELS OF CARE, INCLUDING SHORT-TERM AND LONG-TERM CARE.PART VI LINE 7: THE COMMUNITY BENEFIT REPORT IS NOT REPORTED WITH ANY STATE BUT IT IS AVAILABLE TO THE PUBLIC. 1 UNITED WAY OF NORTHEAST KENTUCKY 1236 WINCHESTER AVENUE ASHLAND KY 41101 616000060 501(C)(3) 140000 ANNUAL SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ANY REQUEST FOR A GRANT MUST BE SUBMITTED IN WRITING TO THE COMMUNITY SERVICES DEPARTMENT AT KDMC. THIS REQUEST MUST BE SPECIFIC AS TO THE USE OF THE GRANT BY THE REQUESTING ORGANIZATION. ONCE THE GRANT CHECK IS ISSUED, A REPRESENTATIVE FROM THE GRANTEE ORGANIZATION MUST SIGN FOR THE CHECK AND SUBMIT A REPORT ON THE USE OF THE FUNDS AS WELL AS THE NUMBER OF PEOPLE SERVED BY THE GRANT. SINCE THIS IS A SMALL COMMUNITY, KDMC ALSO USUALLY KNOWS SOMEONE WITH CLOSE ASSOCIATION TO THE ORGANIZATION OR WHO REPRESENTS THE MEDICAL CENTER ON THEIR BOARD SO THAT USE OF THE GRANT CAN BE INDIRECTLY MONITORED. X 0 1 X X X X 0 1 0 0 0 0 0 0 0 JACKSON FRED 831137 0 216673 0 4190315 0 14000 0 18860 0 5270985 0 3355889 0 MCDOWELL PAUL 285691 0 170293 0 88210 0 11250 0 21107 0 576551 0 69899 0 MAHANEY SHERYL 219538 0 136622 0 63650 0 110337 0 24977 0 555124 0 48202 0 FIORET PHILIP MD 451682 0 187905 0 124897 0 116679 0 23859 0 905022 0 86441 0 HIGGINS LARRY 244767 0 143097 0 84294 0 108947 0 15744 0 596849 0 53515 0 WHITLATCH KRISTIE 350327 0 154240 0 59290 0 149850 0 20977 0 734684 0 45374 0 BOYKIN MAYOLA MD 751664 0 0 0 0 0 14000 0 20119 0 785783 0 0 0 FRALEY ERIK MD 652344 0 0 0 0 0 11250 0 5991 0 669585 0 0 0 HOWARD-CLAUDIO CANDACE MD 828819 0 0 0 0 0 11250 0 24977 0 865046 0 0 0 MOTIMAYA ASH MD 701467 0 0 0 0 0 14000 0 22121 0 737588 0 0 0 POWELL STELLA MD 659659 0 0 0 0 0 11250 0 20119 0 691028 0 0 0 PART I, LINE 1A THE HOSPITAL PAID GROSS UP PAYMENTS TO PAUL MCDOWELL ($3,084 - 100% TAXABLE)AND SHERYL MAHANEY ($6,434 - 100% TAXABLE). PART I, LINE 1B THE GROSS UPS ARE APPROVED BY THE CEO FOR THE VICE PRESIDENTS. PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: PAUL MCDOWELL $69,899, SHERYL MAHANEY $48,202, PHILIP FIORET $86,441, LARRY HIGGINS $53,515, KRISTIE WHITLATCH $45,374, FRED JACKSON $4,117,216 THE CEO AND 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. IN ADDITION, FRED JACKSON WAS PROVIDED WITH A LUMP SUM SUPPLEMENTAL RETIREMENT BENEFIT SINCE HE WAS STILL EMPLOYED AT AGE 62. THE LUMP SUM PAYMENT, WHEN COMBINED WITH ALL OTHER RETIREMENT BENEFITS, WAS ESTIMATED TO PRODUCE A TARGET RETIREMENT INCOME REPLACEMENT EQUAL TO A PERCENTAGE OF FRED JACKSON'S FINAL AVERAGE PAY COMMENCING AT AGE 62. A KENTUCKY ECONOMIC DEVELOPMENT AUTHORITY (KEDFA) 610600439 491269CG9 2008-09-24 146580000 REFUND PRIOR BOND ISSUES 0 0 0 B KENTUCKY ECONOMIC DEVELOPMENT AUTHORITY (KEDFA) 610600439 491269CY0 2010-04-01 75000000 HEALTHCARE FACILITIES, BUILDING AND EQUIPMENT 0 0 0 C CITY OF ASHLAND KENTUCKY 616001775 044293AA6 2010-04-01 32615000 REFUND SERIES 1998 BONDS 0 0 0 A 2780000 145708338 1423351 12574982 131710005 2010 1 0 1 1 B 6930000 73888381 1170837 62344160 10373384 0 0 0 1 C 4440000 33986558 507546 33479012 2010 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 1 JP MORGAN 22.500000000000 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 0 1 0 0 0 0 0 0 A 0 B 0 C 0 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: KENTUCKY ECONOMIC DEVELOPMENT AUTHORITY (KEDFA) DATE THE REBATE COMPUTATION WAS PERFORMED: 11/06/2013 PART II, LINE 3, ISSUE A TOTAL PROCEEDS LISTED ON LINE 3 ARE NOT THE SAME AS THE ISSUE PRICE. SERIES 2008C BOND DISCOUNT $871,662. ALSO, THE BOND ISSUES LISTED ON SCHEDULE K, PART I, LINE A CONSISTED OF THREE SERIES: SERIES 2008A, CUSIP 49126CG9, ISSUE PRICE 50,000,000 VARIABLE RATE ISSUE; SERIES 2008B, CUSIP 401269CH7, ISSUE PRICE 50,000,000, VARIABLE RATE ISSUE; SERIES 2008C, CUSIP 491269CJ3, ISSUE PRICE $46,580,000, FIXED RATE ISSUE. PART II, LINE 3, ISSUE B TOTAL PROCEEDS LISTED ON LINE 3 ARE NOT THE SAME AS THE ISSUE PRICE. SERIES 2010A BOND DISCOUNT $1,318,161.05, OFFSET BY $206,541 INTEREST EARNED THROUGH SEPTEMBER 30, 2013. PART II, LINE 3, ISSUE C TOTAL PROCEEDS LISTED ON LINE 3 ARE NOT THE SAME AS THE ISSUE PRICE. SERIES 2010B BOND PREMIUM $1,371,558.05 PART III LINE 9, PART IV LINE 7, AND PART V WRITTEN PROCEDURES TO MONITOR COMPLIANCE WITH BOND REQUIREMENTS HAVE BEEN DRAFTED, BUT HAVE NOT BEEN FINALIZED AS OF 9/30/13. ANNE SLOAN SISTER IN LAW OF JOHN STEWART, BOARD DIRECTOR 44631 EMPLOYEE PAYROLL COMPENSATION FOR ANNE SLOAN 0 ASHLAND AREA YMCA TOM BURNETTE & KIM MCCANN,BOARD DIRECTORS, ON BOARD OF ASHLAND AREA YMCA 361433 TOM BURNETTE AND KIM MCCANN ARE ON THE ASHLAND AREA YMCA BOARD. ASHLAND HOSPITAL CORPORATION PAID THE YMCA VIA PAYROLL DEDUCTIONS FOR DUES FOR EMPLOYEES. 0 ASHLAND OFFICE SUPPLY TOM BURNETTE, BOARD DIRECTOR, IS THE OWNER OF ASHLAND OFFICE SUPPLY 1448246 TOM BURNETTE IS OWNER OF ASHLAND OFFICE SUPPLY. THE HOSPITAL PURCHASES OFFICE SUPPLIES & EQUIPMENT FROM ASHLAND OFFICE SUPPLY. 0 FRESENIUS MEDICAL CARE DON HAMMONDS IS MEDICAL DIRECTOR 1305390 FRESENIUS MEDICAL PROVIDES INPATIENT DIALYSIS TREATMENT FOR THE HOSPITAL 0 VAN ART PROPERTIES SON OF JOHN STEWART, BOARD DIRECTOR, IS THE OWNER OF VAN ART PROPERTIES 510256 THE SON OF JOHN STEWART IS THE OWNER OF VAN ART PROPERTIES. THE HOSPITAL RENTS OFFICE SPACE FROM VAN ART PROPERTIES. 0 VANANTWERP MONGE JONES EDWARDS & MCCANN KIM MCCANN IS A PARTNER IN THE LAW FIRM 1498974 PAYMENTS FOR LEGAL SERVICES 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 KDMC CLOSED TWO UNITS DURING FISCAL YEAR 2013 - THE SKILLED NURSING AND INPATIENT REHABILITATION UNITS. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE OF THE AHC BOARD IS MADE UP OF THE FOLLOWING MEMBERS: DAVID JONES, CHAIR; STEPHEN ADDINGTON, VICE CHAIR; FRED JACKSON, CHIEF EXECUTIVE OFFICER; JOHN STEWART, TRUSTEE; TOM BURNETTE, TRUSTEE; DR. RAYMOND MECCA, TRUSTEE AND JIM CANTRELL, TRUSTEE. ELECTION AND COMPOSITION: THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE TRUSTEES CHAIR, ANY VICE-CHAIRS, THE CHIEF EXECUTIVE OFFICER, AND ANY OTHER TRUSTEE RECOMMENDED BY THE CHAIR AND APPROVED BY THE TRUSTEES. THE TRUSTEES CHAIR SHALL SERVE AS CHAIR OF THE EXECUTIVE COMMITTEE. THE CHIEF EXECUTIVE OFFICER SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE. POWERS AND FUNCTIONS: THE EXECUTIVE COMMITTEE SHALL HAVE ALL POWERS AND AUTHORITY OF THE TRUSTEES TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY LIMITATIONS IMPOSED BY THE TRUSTEES, THE BYLAWS OR BY APPLICABLE LAW. MEETINGS OF THE EXECUTIVE COMMITTEE SHALL BE HELD AS NEEDED. THE EXECUTIVE COMMITTEE SHALL FROM TIME TO TIME AS IT DETERMINES APPROPRIATE REVIEW AND RECOMMEND REVISIONS TO THE BYLAWS FOR CONSIDERATION AND APPROVAL BY THE TRUSTEES. THE EXECUTIVE COMMITTEE SHALL ALSO RECEIVE SUCH REPORTS AS THE COMMITTEE MAY DIRECT FROM THE EXECUTIVE OR ANY SIMILAR COMMITTEE OF THE BOARD OF DIRECTORS OF EACH AFFILIATED ORGANIZATION CONCERNING THE ACTIVITIES OF SUCH COMMITTEE AND PROVIDE PERIODIC REPORTS ON SUCH ACTIVITIES TO THE TRUSTEES FORM 990, PART VI, SECTION A, LINE 6 KING'S DAUGHTERS HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF ASHLAND HOSPITAL CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B AS THE PARENT ORGANIZATION OF THE HEALTH CARE SYSTEM, KDHS HAS CERTAIN GOVERNANCE RIGHTS WITH RESPECT TO AHC. THOSE RIGHTS REQUIRE CERTAIN SIGNIFICANT AHC ACTIONS TO NOW ALSO BE APPROVED BY KDHS, INCLUDING, AMONG OTHERS, A CHANGE OF MEMBERSHIP OR SALE OF AHC, ELECTING OR REMOVING AHC'S DIRECTORS AND OFFICERS, AMENDING AHC'S ARTICLES AND BYLAWS, OR ANY BANKRUPTCY, LIQUIDATION OR DISSOLUTION OF AHC, INCLUDING THE TAX-EXEMPT ORGANIZATION TO WHOM AHC'S ASSETS ARE DISTRIBUTED UPON ITS DISSOLUTION. KDHS' BOARD OF TRUSTEES MAY IDENTIFY ADDITIONAL AHC ACTIONS THAT MUST BE APPROVED BY KDHS IN ADDITION TO THOSE SPECIFICALLY LISTED IN AHC'S ARTICLES AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WILL BE REVIEWED IN DETAIL BY THE CFO AND CONTROLLER. 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 KING'S DAUGHTERS MEDICAL CENTER REQUIRES ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES TO COMPLY WITH ITS CONFLICTS OF INTEREST POLICY, WHICH TRACKS THE IRS'S RECOMMENDED POLICY WITH RESPECT TO SUCH OFFICERS AND DIRECTORS. MEMBERS OF THE MEDICAL CENTER'S BOARD OF DIRECTORS MUST ANNUALLY IDENTIFY, IN WRITING, ANY INTEREST THAT COULD GIVE RISE TO A CONFLICT, SUCH AS A LEADERSHIP POSITION IN A CONFLICTING ORGANIZATION; DISCLOSURE IS NOT LIMITED TO FINANCIAL CONFLICTS. LEADERSHIP EMPLOYEES MUST ANNUALLY CERTIFY, IN WRITING, THAT NO CONFLICTS OF INTEREST EXIST. IN ADDITION, EMPLOYEES OF THE MEDICAL CENTER MUST CERTIFY THAT NO CONFLICTS OF INTEREST EXIST OR OBTAIN AN ADVANCE WAIVER OF ANY CONFLICTS. THE MEDICAL CENTER'S GENERAL COUNSEL OBTAINS ALL RELEVANT DISCLOSURES AND SIGNATURES. IF A CONFLICT OF INTEREST IS REPORTED, THE VICE PRESIDENT TO WHOM THE REPORTING EMPLOYEE DIRECTLY OR INDIRECTLY REPORTS, TOGETHER WITH THE CEO, DETERMINES IF A CONFLICT EXISTS. IF THE REPORTING EMPLOYEE IS A VICE PRESIDENT, THE CEO, IN CONSULTATION WITH THE GENERAL COUNSEL, DETERMINES IF A CONFLICT EXISTS. A MEMBER OF THE MEDICAL CENTER'S BOARD OF DIRECTORS REPORTS ANY CONFLICT OR POTENTIAL CONFLICT TO THE CHAIRMAN OF THE BOARD, THE CEO AND/OR THE GENERAL COUNSEL OF THE MEDICAL CENTER, AS APPROPRIATE. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE EMPLOYEE OR BOARD MEMBER IS REMOVED FROM ANY PART OF THE DECISION-MAKING PROCESS, AND HAS NO ROLE IN THE INSTANCE IN WHICH THE CONFLICT EXISTS. A BOARD MEMBER WHO REPORTS A POTENTIAL OR ACTUAL CONFLICT OF INTEREST MUST ABSTAIN FROM ANY RELEVANT DISCUSSION OR VOTE. IF A CONFLICT OF INTEREST IS DISCOVERED AFTER THE FACT, THE CEO AND VICE PRESIDENT, TOGETHER WITH THE GENERAL COUNSEL, IF APPROPRIATE, REVIEWS THE INSTANCE IN WHICH THE CONFLICT OCCURRED. THOSE LEADERS ENSURE THAT THE CONFLICTED INDIVIDUAL DID NOT INFLUENCE DECISION-MAKING OR PROFIT FROM THE CONFLICT. THE CONFLICTED INDIVIDUAL IS REMOVED FROM ANY FURTHER INVOLVEMENT. IN ADDITION, ANY FAILURE TO REPORT CONFLICTS OF INTEREST VIOLATES THE MEDICAL CENTER'S POLICY AND COULD RESULT IN DISCIPLINARY ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT OR REMOVAL FROM THE MEDICAL CENTER'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 AT THE DIRECTION OF THE HUMAN RESOURCES & COMPENSATION COMMITTEE OF THE BOARD, KDMC ENGAGES AON HEWITT, A LEADING INDEPENDENT GLOBAL HUMAN CAPITAL AND COMPENSATION CONSULTING COMPANY TO ASSIST IN DETERMINING COMPENSATION OF THE CEO AND VICE PRESIDENTS. THIS IS AN ANNUAL PROCESS AND AON HEWITT'S MOST RECENT EXECUTIVE COMPENSATION REVIEW WAS PERFORMED IN 2013. THE CEO COMPENSATION ONLY WAS REVIEWED AGAIN IN 2014. AON HEWITT IS NOT ENGAGED IN ANY OTHER WORK WITH KDMC. 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 KDMC 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 AON HEWITT DATA COUPLED WITH THE PERFORMANCE OF THE ORGANIZATION AS WELL AS THE PERSONAL PERFORMANCE OF EACH EXECUTIVE IS THE BASIS FOR KDMC'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 ADMINISTRATIVE OFFICER VP, CHIEF LEGAL & REGULATORY OFFICER/GENERAL COUNSEL VP, CHIEF OPERATING OFFICER VP, CHIEF FINANCIAL OFFICER VP, CHIEF MEDICAL OFFICER VP, CHIEF INFORMATION OFFICER/INFORMATION SERVICES & TECHNOLOGY VP, EXECUTIVE DIRECTOR KING'S DAUGHTERS INTEGRATED PHYSICIANS VP, FACILITIES VP, PATIENT SERVICES/CHIEF NURSING OFFICER VP, QUALITY FORM 990, PART VI, SECTION C, LINE 19 ON A QUARTERLY BASIS, THE FINANCIAL STATEMENTS ARE REPORTED TO EMMA (ELECTRONIC MUNICIPAL MARKET ACCESS) AND MADE AVAILABLE ON THEIR WEBSITE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN MARKET VALUE INTEREST RATE SWAP 9,259,482. CHANGE IN MARKET VALUE SELF INSURANCE FUNDS -998,566. PENSION LIABILITY ADJUSTMENT 12,094,731. OTHER ADJUSTMENTS 79,556. GOVERNMENT SETTLEMENT ADJUSTMENT -48,900,000. ASHLAND NURSING HOME CORP 2500 STATE ROUTE 5 ASHLAND KY 41102 611386016 NURSING HOME KY 501(C)(3) 11-I ASHLAND HOSPITAL CORPORATION 1 CHILD DEVELOPMENT CENTER CORP 2201 LEXINGTON AVENUE ASHLAND KY 41101 010560598 CHILD CARE KY 501(C)(3) 11-I ASHLAND HOSPITAL CORPORATION 1 KENTUCKY HEART INSTITUTE 2201 LEXINGTON AVENUE ASHLAND KY 41101 611255904 PHYSICIANS KY 501(C)(3) 9 ASHLAND HOSPITAL CORPORATION 1 KENTUCKY HEART FOUNDATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 260791997 MEDICAL RESEARCH KY 501(C)(3) 7 ASHLAND HOSPITAL CORPORATION 1 KENTUCKY MEDICAL LOGISTICS INC 425 22ND STREET ASHLAND KY 41101 264736971 MEDICAL TRANSPORT KY 501(C)(3) 9 ASHLAND HOSPITAL CORPORATION 1 KING'S DAUGHTERS HEALTH FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611035701 FUNDRAISING KY 501(C)(3) 11-III-FI ASHLAND HOSPITAL CORPORATION 1 KING'S DAUGHTERS HEALTH SYSTEM INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) 11-II N/A 1 KING'S DAUGHTERS MEDICAL SPECIALTIES INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 264183569 PHYSICIANS KY 501(C)(3) 9 ASHLAND HOSPITAL CORPORATION 1 PORTSMOUTH HOSPITAL CORP 2201 LEXINGTON AVENUE ASHLAND KY 41101 453215312 HEALTHCARE KY 501(C)(3) 3 ASHLAND HOSPITAL CORPORATION 1 ASHLAND MEDICAL PROPERTIES INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611079090 RENTALS KY ASHLAND HOSPITAL CORPORATION C 54400 1.00000 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 1 ASHLAND NURSING HOME CORP R 886385 ALL TRANSACTIONS ASHLAND NURSING HOME CORP S 914624 BETWEEN COMPANIES CHILD DEVELOPMEN CENTER CORP R 53447 ARE CAPTURED KENTUCKY HEART FOUNDATION INC A 28764 IN THE DUE TO/FROM KENTUCKY HEART FOUNDATION INC R 90531 ACCOUNTS. THE TYPES OF KENTUCKY HEART INSTITUTE INC A 186635 TRANSACTIONS THAT HIT THIS KENTUCKY HEART INSTITUTE INC O 230261 ACCOUNT ARE TRACKED MONTHLY. KENTUCKY HEART INSTITUTE INC R 8286800 KENTUCKY MEDICAL LOGISTICS INC R 747639 KENTUCKY MEDICAL LOGISTICS INC S 1500000 KING'S DAUGHTERS MEDICAL SPECIALTIES INC A 245884 KING'S DAUGHTERS MEDICAL SPECIALTIES INC B 586052 KING'S DAUGHTERS MEDICAL SPECIALTIES INC O 2634726 KING'S DAUGHTERS MEDICAL SPECIALTIES INC R 11881517 KING'S DAUGHTERS MEDICAL SPECIALTIES INC S 4000000 PORTSMOUTH HOSPITAL CORPORATION B 30362234 PORTSMOUTH HOSPITAL CORPORATION R 13772248 PORTSMOUTH HOSPITAL CORPORATION S 516242 KENTUCKY HEART FOUNDATION INC O 407061