2013-07-03T13:07:36-05:00 2012-08-31 273858252 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2011-09-01 800639940 KENTUCKY EASTER SEAL SOCIETY INC GROUP RETURN KENT 8592545701 2050 VERSAILLES ROAD LEXINGTON KY 40504 OFFICER 8592545701 2013-07-02 1 LEIGH MCKEE P00169845 8592552341 2011 2016-02-24 21:20:13Z GARY PAYNE 2050 VERSAILLES ROAD LEXINGTON KY 40504 90784408 1 1 5231 X WWW.CARDINALHILL.ORG X DEFINING EXCELLENCE IN PHYSICAL REHABILITATION-GIVING HOPE AND ENHANCING OUTCOMES FOR PATIENTS AND FAMILIES. 11 11 965 414 928422 0 1704130 1995450 62552658 60194862 3746174 943653 385223 48484 68388185 63182449 0 0 0 0 45494528 44720039 0 0 652165 21598511 22634115 67093039 67354154 1295146 -4171705 101729287 98602110 44376956 44184863 57352331 54417247 X THE KENTUCKY EASTER SEAL SOCIETY WAS FOUNDED IN 1923 WITH THE MISSION OF HELPING PEOPLE WITH DISABILITIES ACHIEVE MAXIMUM INDEPENDENCE. IN ACCORDANCE WITH THIS GOAL, THE SOCIETY PROVIDES PROGRAMS AND SERVICES AT SITES THROUGHOUT THE STATE. PROGRAMS INCLUDE PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, REHABILITATION, VOCATIONAL EDUCATION AND TRAINING, RECREATION, CHILDCARE AND ADULT DAY CARE PROGRAMS, AUDIOLOGY AND A VARIETY OF OTHER PROGRAMS. TO THE EXTENT FINANCIALLY FEASIBLE, THE SOCIETY ACCEPTS PATIENTS WHO ARE UNABLE TO PAY. FOR THE FISCAL YEAR ENDED 8/31/12, CHARITY CARE WAS $3,286,177. 0 0 54359297 57842591 CARDINAL HILL REHABILITATION HOSPITALLEXINGTON, KYCARDINAL 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 INPATIENT 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 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. THE HEALTHCARE SYSTEM PROVIDES SERVICES AT TWO LOCATIONS THROUGHOUT KENTUCKY. SERVICES INCLUDE INPATIENT HOSPITAL CARE FOR PHYSICAL REHABILITATION NEEDS AND MEDICALLY COMPLEX CLIENTS. IN ADDITION TO THE THREE INPATIENT PROGRAMS, OUTPATIENT THERAPY, 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. 2064833 1424748 CARDINAL HILL REHABILITATION CENTERLOUISVILLE, KYCARDINAL HILL REHABILITATION CENTER (CHRC) WAS FOUNDED IN 1958. CLIENTS COME FROM A 20 COUNTY AREA SURROUNDING GREATER LOUISVILLE, INCLUDING SOUTHERN INDIANA. THE CENTER PROVIDES OCCUPATIONAL AND SPEECH THERAPIES, AUDIOLOGY SERVICES FOR CHILDREN AND ADULTS AND CREATIVE BEGINNINGS, ONE OF THE REGION'S ONLY INTEGRATED EARLY CHILDHOOD DEVELOPMENT PROGRAMS FOR CHILDREN WITH DISABILITIES AND THEIR TYPICAL PEERS. CARDINAL HILL HOME CARELEXINGTON, KY CARDINAL HILL HOME CARE BEGAN OFFERING A FULL ARRAY OF QUALITY HOME HEALTH SERVICES IN 2004 WITH AN EMPHASIS ON THE INTENSE THERAPY FOR WHICH CARDINAL HILL HOSPITAL IS KNOWN. CARDINAL HILL HOME CARE SERVES PATIENTS IN THE FOLLOWING CENTRAL KENTUCKY COUNTIES: FAYETTE, FRANKLIN, JESSAMINE, MADISON AND WOODFORD. 56424130 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 108 0 1 965 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 1 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 KY X MARTY LAUTNER 8592545701 2050 VERSAILLES ROAD LEXINGTON KY 40504 MIKE KANAREK 1.00 X 0 0 0 CHARLOTTE LUNDERGAN 1.00 X 0 0 0 GLENN NORVELL 1.00 X 0 0 0 RICHARD STURGILL 1.00 X 0 0 0 TED RENAKER 1.00 X 0 0 0 GREGG THORNTON 1.00 X 0 0 0 JEFF RATANAPOOL 1.00 X 0 0 0 J HAGAN CODELL 1.00 X 0 0 0 ROGER DALTON 1.00 X 0 0 0 KEN HILER 1.00 X 0 0 0 JIMMY NASH 1.00 X 0 0 0 ELIZABETH MONARCH 40.00 X 226881 0 22913 KATHLEEN FITZGERALD 40.00 X 157608 0 12436 MARTIN LAUTNER 40.00 X 215249 0 21003 GARY PAYNE 40.00 X 82522 0 1422 JANICE BAUER 40.00 X 118735 0 7515 WILLIAM DUTTON 40.00 X 107882 0 17567 SCOTT FERGUSON 40.00 X 109365 0 12317 PAMELA HEISSENBUTTEL 40.00 X 103735 0 17486 STEVEN KINKAID 40.00 X 111614 0 17104 KERRY G GILLIHAN 40.00 X 333958 0 1942 CYNTHIA WILLIAMS 40.00 X 112481 0 7484 LABAN MILLER 40.00 X 120426 0 11389 1800456 0 150578 11 1 1 0 BURCHFIELD & THOMAS PO BOX 11748 LEXINGTON KY 40577 GENERAL CONTRACTOR 11136350 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING 1215685 THE COMPETITIVE EDGE II 3716 WILLOW RIDGE ROAD LEXINGTON KY 40514 TEMP HELP 529338 SDGBLUE LLC 501 DARBY CREEK ROAD SUITE 9 LEXINGTON KY 40509 COMPUTER TECH SERVICES 377041 UNIVERSITY OF KENTUCKY GRADUATE MEDICAL 800 ROSE STREET LEXINGTON KY 40536 RESIDENTS STAFFING 293183 8 301927 1693523 195837 1995450 PROGRAM SERVICE FEES 623000 58993685 58993685 CHILDCARE FACILITY REV 624410 1201177 273654 927523 60194862 442288 899 441389 158930 224178 -65248 -65248 -65248 26498293 25960057 36871 538236 -36871 501365 501365 108044 301927 338241 -230197 -230197 1058959 1010680 48279 48279 29873 31932 -2059 -2059 CAFETERIA 722210 247942 247942 RECORD TRANSCRIPTION 561000 44670 44670 MISCELLANEOUS 900099 5097 5097 297709 63182449 59267339 928422 991238 1170938 1170938 35853572 32083110 3477191 293271 909720 802539 97629 9552 4160231 3608212 509075 42944 2625578 2279143 325805 20630 164832 164832 8426 8426 6362653 4776283 1515372 70998 6939297 5086481 1705524 147292 1098089 1026231 59228 12630 190961 170894 18551 1516 1565850 1321862 225713 18275 3791848 3200754 556900 34194 PROVIDER TAX 1049090 1048982 0 108 CORPORATE EXP ALLOCATED 396605 0 396605 0 BAD DEBT EXPENSE 364657 364657 RESIDENCY PROGRAM 267147 267147 0 0 434660 387835 46070 755 67354154 56424130 10277859 652165 4370126 -1250170 4088905 869837 580086 450524 484718 703654 100448972 32943825 58814104 67505147 28569610 24499994 4821738 5823124 101729287 98602110 6087697 -4767195 155630 481777 34938878 41598657 1769576 3633514 1425175 3238110 44376956 44184863 X 48083796 44420621 4504778 5232869 4763757 4763757 57352331 54417247 101729287 98602110 X -4171705 1236621 X X 0 1 1 X 0 X 1708277 2091874 1574574 1704130 1995450 9074305 1708277 2091874 1574574 1704130 1995450 9074305 739201 8335104 1438142 1085298 727519 583667 601218 4435844 13510149 317615531 0.61700 0.55410 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 8426 0 8426 67345730 67354156 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 44080 43552 19105 8426 115163 250000 250000 250000 250000 1000000 1500000 8080 7552 8262 8426 32320 29158036 100121 1743226 6043999 24957384 31888635 102968 4735861 7569428 29158036 37115198 195951 1493002 6915516 31888635 44937704 496107 -4803481 3515132 37115198 0.73070 0.26930 1 0 1015453 1015453 75169903 19581467 55588436 24263616 13362358 10901258 67505147 OTHER ASSETS 1301370 ASSETS HELD IN TRUST BY OTHERS 2776754 LICENSING FEES 1745000 5823124 ESTIMATED MEDICARE-MEDICAID COST REPORT SETTLEMENT 3076697 ACCRUED BENEFIT PLAN LIABILITY 151413 BUILDING PLEDGE 10000 3238110 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE SOCIETY HAS ADOPTED THE PROVISIONS OF GAAP RELATING TO UNCERTAINTY IN INCOME TAXES. THE ASSESSMENT INCLUDES EVALUATING THE TAX POSITIONS TAKEN ON ALL INCOME TAX RETURNS THAT REMAIN OPEN TO EXAMINATION BY THE RESPECTIVE TAXING AUTHORITIES (RETURNS FILED AFTER 2008). THE SOCIETY DOES NOT BELIEVE THAT THERE ARE ANY UNCERTAIN TAX POSITIONS ON THOSE RETURNS THAT SHOULD BE REFLECTED IN THE FINANCIAL STATEMENTS. KENTUCKY BASH 106342 60517 45825 2111 57903 46092 5000 10444 TASTE OF THE OAKS BOURBON TASTING 162749 130024 32725 37190 30794 59730 4 140880 111386 29494 12004 12184 4349 60440 409971 301927 108044 51305 100881 50441 5000 130614 338241 -230197 283590 314679 100 27750 79514 1 1.00000 767405 587867 1 1.00000 7964 770 1 1.00000 1058959 903316 100 27750 79514 1010680 48279 KY 1 0 0 0 0.00000 1.00000 SHARON DELLECHIAIE 2050 VERSAILLES ROAD LEXINGTON KY 40504 0 GAMING IS MANAGED BY VOLUNTEERS ALL GAMING IS MANAGED BY VOLUNTEERS. 1 51326 1 1 X 1 X 1 X 1 1 0 0 2191659 145294 2046365 0.03050 7232860 4387105 2845755 0.04250 9424519 4532399 4892120 0.07300 98209 4122 94087 0.00140 1606039 119283 1486756 0.02220 74578 49783 24795 0.00040 24877 24877 0.00040 1803703 173188 1630515 0.02440 11228222 4705587 6522635 0.09740 24050 24050 0.00040 32822 32822 0.00050 14918 14918 0.00020 71790 71790 0.00110 1 161556 0 25839775 18681040 7158735 X 1 1 1 2 CARDINAL HILL REHABILITATION CENTER

2050 VERSAILLES ROAD LEXINGTON KY 40504

X X X INPATIENT REHAB FACILITY CARDINAL HILL REHABILITATION CENTER 1 1 1 100.000000000000 1 200.000000000000 1 X X X 1 1 X 1 X 1 X X X X 0 X X 0 0 1 CARDINAL HILL REHABILITATION CENTER

9810 BLUEGRASS PARKWAY LOUISVILLE KY 40299

OUTPATIENT PHYSICAL REHABILITATION PART I, LINE 7, COLUMN (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 $ 364657. PART II: ALL OF KESS' 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. THE HIGHEST POPULATION OF PATIENTS ARE 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. ALONG WITH THE FOURTH STATEMENT, A FINANCIAL WORKSHEET IS SENT, WITH WORDING THAT FUNDS MAY BE AVAILABLE IF THE PATIENT NEEDS ASSISTANCE. IF NO RESPONSE IS RECEIVED, THEN AFTER THE FIFTH STATEMENT, THERE ARE TWO SUBSEQUENT COLLECTION LETTERS SENT, ALSO REQUESTING THE PATIENT CONTACT THE HOSPITAL IF THEY HAVE FINANCIAL HARDSHIP. THE SECOND COLLECTION LETTER STATES THAT THE ACCOUNT WILL BE SENT TO COLLECTION IF THE PATIENT TAKES NO ACTION. THE MINIMUM ACCOUNT BALANCE SENT TO COLLECTIONS IS $50. IF NO RESPONSE, AND THE ACCOUNT EXCEEDS THIS THRESHOLD, THE ACCOUNT IS SENT TO A COLLECTION AGENCY. AMOUNTS UNDER $50 ARE WRITTEN OFF TO BAD DEBTS, SINCE THE PATIENT HAS NOT DEMONSTRATED AN INABILITY TO PAY. IF 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. CARDINAL HILL REHABILITATION CENTER PART V, SECTION B, LINE 11H: OTHER FACTORS USED TO DETERMINE THE AMOUNTS CHARGED TO PATIENTS ARE THE NUMBER OF HOUSEHOLD MEMBERS. CARDINAL HILL REHABILITATION CENTER PART V, SECTION B, LINE 15E: THE HOSPITAL FACILITY SENDS THE UNCOLLECTED AMOUNTS TO A COLLECTION AGENCY. CARDINAL HILL REHABILITATION CENTER PART V, SECTION B, LINE 16E: THE HOSPITAL FACILITY SENDS THE UNCOLLECTED AMOUNTS TO A COLLECTION AGENCY. CARDINAL HILL REHABILITATION CENTER PART V, SECTION B, LINE 17E: THE HOSPITAL SENDS A SERIES OF COLLECTION LETTERS PRIOR TO COLLECTION ACTIONS BY THE THIRD PARTY. CARDINAL HILL REHABILITATION CENTER PART V, SECTION B, LINE 19D: THE HOSPITAL DETERMINED THE AMOUNTS BILLED TO INDIVIDUALS, WHO DID NOT HAVE INSURANCE, BASED ON THE MEDICAID RATE. 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: KESS HAS ONE HOSPITAL - CHRH LOCATED IN KENTUCKY. CHRH IS IN A SUBURBAN AREA, BUT SERVES A MIX OF RURAL AND SUBURBAN 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 24% 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: KESS 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. KESS 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. X X X 0 0 0 0 0 0 0 0 0 ELIZABETH MONARCH 226881 0 0 0 0 0 9553 0 13360 0 249794 0 0 0 KATHLEEN FITZGERALD 157608 0 0 0 0 0 7318 0 5118 0 170044 0 0 0 MARTIN LAUTNER 215249 0 0 0 0 0 9880 0 11123 0 236252 0 0 0 KERRY G GILLIHAN 333958 0 0 0 0 0 984 0 958 0 335900 0 0 0 CYNTHIA WILLIAMS 112481 0 0 0 0 0 4760 0 2724 0 119965 0 0 0 LABAN MILLER 120426 0 0 0 0 0 4961 0 6428 0 131815 0 0 0 KENTUCKY ECONOMIC DEVELOPMENT FINANCE AUTHORITY 610600439 2010-02-12 13000000 HOSPITAL CONSTRUCTION 0 0 0 KENTUCKY ECONOMIC DEVELOPMENT FINANCE AUTHORITY 610600439 2009-12-30 30000000 REFINANCING AND HOSPITAL CONSTRUCTION 0 0 0 13000000 54456 10515736 2011 0 0 0 1 30000000 208983 25024935 2011 0 1 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 X 1202 FAIR MARKET VALUE X 6745 FAIR MARKET VALUE X 12 1935 FAIR MARKET VALUE X 21 9150 FAIR MARKET VALUE X WHEELCHAIRS, WALKERS, SCOOTERS, HOSPITAL BEDS, CRU 33 31723 FAIR MARKET VALUE X PLANTS AND TREES 11 6555 FAIR MARKET VALUE X BOX SEATS 24 4890 FAIR MARKET VALUE X TOYS 9 905 FAIR MARKET VALUE X FURNITURE 14 2618 FAIR MARKET VALUE X ELECTRONICS 4 2485 FAIR MARKET VALUE X QUILTS AND BLANKETS 4 1570 FAIR MARKET VALUE X TELECOMMUNICATION 1 81000 FAIR MARKET VALUE X ADVERTISEMENTS 4 24100 FAIR MARKET VALUE X MEDICAL SERVICE 1 250 FAIR MARKET VALUE X TOURS AND MEMBERSHIPS 5 465 FAIR MARKET VALUE X RENTAL EXPENSE WAIVED 1 500 FAIR MARKET VALUE X CARDS AND AUTOGRAPHS 9 1070 FAIR MARKET VALUE X GENERAL SERVICES 7 1387 FAIR MARKET VALUE X GETAWAYS AND SPA TREATMENTS 11 6086 FAIR MARKET VALUE X GIFT CERTIFICATES 57 11201 FAIR MARKET VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BY-LAWS WERE REVISED TO REMOVE INFORMATION REGARDING CARDINAL HILL REHAB UNIT SAMARITAN, WHICH TERMINATED IN NOVEMBER 2011 AND CARDINAL HILL SPECIALTY HOSPITAL, WHICH TERMINATED IN JANUARY 2012. REQUIREMENTS FOR BOARD MEETINGS AND FOR VARIOUS COMMITTEES WERE ALSO REVISED. 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 CFO. 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. IN 2010 AND 2011, THE CEO DID NOT RECEIVE AN INCREASE IN COMPENSATION, BUT IN THOSE YEARS WAS PROVIDED WITH THE SAME COMPENSATION RATE THAT WAS APPROVED BY THE OVERSIGHT COMMITTEE OF THE BOARD OF DIRECTORS IN 2008. A NEW CEO, GARY PAYNE, BEGAN EMPLOYMENT IN OCTOBER 2011, AND HIS COMPENSATION WAS DETERMINED BY THE COMPENSATION COMMITTEE. HIS COMPENSATION WAS EVALUATED AFTER 12 MONTHS. THE CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER REVIEW COMPENSATION OF OFFICERS OF THE COMPANY. IN ADDITION, FORMAL, WRITTEN PERFORMANCE EVALUATIONS ARE COMPLETED ANNUALLY ON THE OFFICERS BY THE CEO AND COO. 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. QUESTION 15B THE CHIEF EXECUTIVE OFFICER AND CHIEF OPERATING OFFICER REVIEW 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 AND COO. 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 COMPANY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST, AT THE DISCRETION OF THE BOARD OF DIRECTORS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,308,956. LOSS ON DISCONTINUANCE OF BUSINESS UNIT -1,815,307. EFFECT OF FASB 158 -1,100,347. TRANSFER OF NET ASSETS TO KESS 2,925,837. CARDINAL HILL REHAB UNIT AT SAMARITAN REPORTED ON SEPARATE RETURN -82,518. TOTAL TO FORM 990, PART XI, LINE 5: 1,236,621. 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. NUMBER OF EMPLOYEES FORM 990, PART I, LINE 5 AND PART V, LINE 2A. THE NUMBER OF W-2S ISSUED AS REPORTED ON FORM W-3, 1,863, 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 965. YEAR OF SUBSTANTIAL COMPLETION SCHEDULE K, PART II, LINE 13 THE FACILITY WAS COMPLETED IN OCTOBER 2011, WHICH IS IN FISCAL YEAR 2012.