2013-05-13T14:18:01-05:00 2012-06-30 351178661 BLUE & CO LLC ONE AMERICAN SQUARE 2200 INDIANAPOLIS IN 46282 990 2011-07-01 610605336 ST CLAIRE REGIONAL MEDICAL CENTER STCL 6067836500 222 MEDICAL CIRCLE MOREHEAD KY 40351 GR JONES JR 6067836500 2013-05-01 1 CARRIE A MERRILL CPA P00832283 3176334705 2011 2016-02-24 21:20:13Z STCLAIRE REGIONAL MEDICAL CENTER MARK J NEFF 222 MEDICAL CIRCLE MOREHEAD KY 40351 130349858 0 X WWW.ST-CLAIRE.ORG X 1963 KY THE MISSION IS TO PROCLAIM GOD'S GOODNESS THROUGH A HEALING MINISTRY TO THE PEOPLE OF EASTERN KY. 15 14 1614 15 0 0 1387266 3221780 133822171 115452780 682002 639482 2655892 5061559 138547331 124375601 27376 32257 0 0 72769139 79794382 0 0 0 64322255 46881560 137118770 126708199 1428561 -2332598 87852726 82813781 43628149 41967203 44224577 40846578 X THE MISSION OF ST. CLAIRE REGIONAL MEDICAL CENTER IS TO PROCLAIM GOD'S GOODNESS THROUGH A HEALING MINISTRY TO THE PEOPLE OF EASTERN KENTUCKY. 0 0 78536578 25886 84028585 ST. CLAIRE REGIONAL MEDICAL CENTER SERVES AS A 159-BED REGIONAL REFERRAL CENTER AND IS THE LARGEST RURAL HOSPITAL IN NORTHEASTERN KENTUCKY. SPONSORED BY THE SISTERS OF NOTRE DAME IN COVINGTON, KENTUCKY, ST. CLAIRE REGIONAL SERVES AS A NOT-FOR-PROFIT HOSPITAL. WITH NEARLY 1,500 EMPLOYEES, ST. CLAIRE REGIONAL IS THE SECOND-LARGEST EMPLOYER IN THE REGION. THE MEDICAL CENTER IS AN ESTABLISHED TRAINING SITE FOR THE UNIVERSITY OF KENTUCKY SCHOOL OF MEDICINES PHYSICIAN RESIDENCY PROGRAMS. ST. CLAIRE REGIONAL'S MEDICAL STAFF IS COMPRISED OF OVER 100 PHYSICIANS AND SURGEONS, REPRESENTING 31 MEDICAL AND SURGICAL SPECIALTIES.CONTINUE ON SCHEDULE O.IN ADDITION TO PROVIDING SERVICES AT THE MEDICAL CENTER'S MAIN CAMPUS IN MOREHEAD, ST. CLAIRE REGIONAL'S OPERATIONS CONSIST OF A ST. CLAIRE REGIONAL OUTPATIENT CENTER, CAVE RUN SURGICAL SPECIALISTS, MOREHEAD MEDICAL SPECIALISTS, FIVE COMPREHENSIVE FAMILY MEDICINE CLINICS AS WELL AS A FAMILY MEDICINE EXPRESS, A REGIONAL TELEMEDICINE SYSTEM, AND AN EIGHT-COUNTY HOME CARE SERVICE REGION COMPRISED OF HOME HEALTH, HOSPICE & PALLIATIVE CARE, AND HOME MEDICAL EQUIPMENT. ADDITIONALLY, ST. CLAIRE REGIONAL PARTNERS WITH THE UNIVERSITY OF KENTUCKY MEDICAL CENTER TO OFFER SERVICES THROUGH THE KENTUCKY CLINIC MOREHEAD CANCER TREATMENT CENTERST. CLAIRE REGIONAL MEDICAL CENTER'S SERVICE REGION SERVES A POPULATION OF OVER 160,000 IN BATH, CARTER, ELLIOTT, FLEMING, LEWIS, MAGOFFIN, MENIFEE, MONTGOMERY, MORGAN, ROWAN AND WOLFE COUNTIES. ST. CLAIRE REGIONAL'S FIVE FAMILY MEDICINE CLINICS ARE LOCATED IN FRENCHBURG, MOREHEAD, OLIVE HILL, OWINGSVILLE, AND SANDY HOOK. 10056772 0 11050221 HOME CAREST. CLAIRE HOMECARE IS A SERVICE PROVIDED BY ST. CLAIRE REGIONAL MEDICAL CENTER OFFERING A FULL RANGE OF HOME CARE SERVICES FOR PATIENTS TO RECOVER IN THEIR OWN HOMES. AS ONE OF THE LARGEST PROGRAMS IN THE STATE, ST. CLAIRE HOMECARE IS A COMPREHENSIVE IN-HOME SERVICE SYSTEM COMPRISED OF HOME HEALTH, HOSPICE, AND HOME MEDICAL EQUIPMENT. OUR COMMITTED STAFF INCLUDES NURSES, THERAPISTS AND AIDES WORKING AS A TEAM TO HELP MEET VIRTUALLY EVERY HOME CARE NEED. CONTINUE ON SCHEDULE O.THE JOINT COMMISSION ON THE ACCREDITATION OF HEALTHCARE ORGANIZATIONS (JCAHO) ACCREDITS BOTH ST. CLAIRE REGIONAL MEDICAL CENTER AND ST. CLAIRE HOMECARE. ST. CLAIRE HOMECARE IS MEDICARE-CERTIFIED AND LICENSED IN THE STATE OF KENTUCKY. 6390613 0 6234538 FAMILY MEDICINEST. CLAIRE REGIONAL FAMILY MEDICINE IS A SYSTEM OF FIVE FAMILY MEDICINE CLINICS THAT PROVIDE A FULL RANGE OF PREVENTIVE AND THERAPEUTIC HEALTHCARE SERVICES, FROM NEWBORN TO GERIATRICS, INCLUDING OBSTETRICAL SERVICES. THE ST. CLAIRE REGIONAL FAMILY MEDICINE MEDICAL STAFF INCLUDES BOARD CERTIFIED FAMILY AND INTERNAL MEDICINE PHYSICIANS AS WELL AS ADVANCED REGISTERED NURSE PRACTITIONERS, CERTIFIED PHYSICIAN ASSISTANTS, CERTIFIED NURSE MIDWIVES, AND FAMILY MEDICINE RESIDENTS AFFILIATED WITH THE UNIVERSITY OF KENTUCKY. 16664586 0 14469014 PHYSICIAN SERVICESST. CLAIRE REGIONAL OFFERS A COMPREHENSIVE ARRAY OF PHYSICIAN SERVICES. SPECIALTIES EMPLOYED BY ST. CLAIRE INCLUDE RADIOLOGY, EMERGENCY MEDICINE, ONCOLOGY, NEPHROLOGY, GENERAL SURGERY, ORTHOPEDIC SURGERY, AND CARDIOLOGY. 16664586 14469014 111648549 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 78 0 1 1614 1 0 0 0 0 0 0 0 0 0 0 X 15 14 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X WILLIAM BARTON DIRECTOR OF FINANCIAL SERVICES 6067836587 222 MEDICAL CIRCLE MOREHEAD KY 40351 ROBERT G STEVENS 2.00 X 0 0 0 SISTER MARY LUANN BENDER 2.00 X 0 0 0 GARREN COLVIN 2.00 X 0 0 0 JOHN NORTHCUT 2.00 X 0 0 0 SISTER MARY MARGARET DROEGE 2.00 X 0 0 0 DAN MARKWELL 2.00 X 0 0 0 SAMUEL MATHENY MD 2.00 X 0 0 0 SISTER MARLA MONAHAN 2.00 X 0 0 0 O THOMAS NEWCOMB MD 2.00 X 0 0 0 GLEN TEAGER 2.00 X 0 0 0 BETH PATRICK 2.00 X 0 0 0 EWELL SCOTT MD 2.00 X 0 0 0 RICHARD TAPKE JR 2.00 X 0 0 0 AMY J CONLEY-SALLAZ MD 2.00 X 0 0 0 MARK NEFF 50.00 X X 322215 0 64214 SONNY JONES 50.00 X 167550 0 31807 GREG BAUSCH 50.00 X 154491 0 16900 DR KIM WILLIAMS 50.00 X 227961 0 60975 DR WILL MELAHN 50.00 X 196131 0 39960 DR WILLIAM LEWIS 40.00 X 650875 0 60631 DR CRAIG BUTLER 40.00 X 587053 0 67631 DR STEPHEN WILLIAMS 40.00 X 646515 0 52766 DR CHARLES CROUSE 40.00 X 639004 0 62958 DR MOHAMMAD ANWAR 40.00 X 351389 0 68124 3943184 0 525966 94 0 1 0 ARAMARK ONE SERVICE MASTER WAY DOWNERS GROVE IL 60515 CONTRACT SERVICE 1885653 PROFESSIONAL MEDICAL BILLING 7619 W JEFFERSON BLVD FORT WAYNE IN 46804 BILLING SERVICE 612160 KMSF-PATH FAC SERVICES 138 LEADER AVENUE LEXINGTON KY 40506 PHYSICIAN SERVICES 593178 PRECYSE SOLUTIONS PO BOX 11407 BIRMINGHAM AL 352461736 TRANSCRIPTION SERVICE 524849 MEDICAL DOCTORS ASSOCIATES PO BOX 277185 ATLANTA GA 303847185 CONTRACT PHYSICIAN STAFFING 407592 15 966185 2255595 81000 3221780 NET PATIENT SERVICE RE 621110 102748667 102748667 HOME CARE REVENUE 621610 12704113 12704113 115452780 395259 395259 329578 0 329578 329578 329578 5943322 17628 5716727 0 226595 17628 244223 244223 150598 24275 126323 126323 146397 233255 -86858 -86858 EHR INCENTIVE REVENUE 900099 1120431 1120431 CAFETERIA INCOME 900099 744061 744061 CATERING 900099 228219 228219 2599805 2599805 4692516 124375601 115782358 0 5371463 32257 32257 1992578 1811441 181137 62660372 57145308 5515064 2599353 2370446 228907 8563106 7799021 764085 3978973 3706753 272220 551127 119471 431656 80775 80775 9380491 7720538 1659953 300911 297568 3343 19266362 18906031 360331 6005269 3729498 2275771 171801 133819 37982 324180 301379 22801 657006 1918 655088 5665980 5665980 792991 719543 73448 PROVIDER TAX 1512507 135073 1377434 RECRUITMENT 610815 159780 451035 LICENSES & FEES 501272 37462 463810 DUES & SUBSCRIPTIONS 262082 68531 193551 797991 786732 11259 126708199 111648549 15059650 0 7913154 10224317 19587397 14626702 6667 6668 603264 2124524 2540791 2029437 624710 630316 90984415 56136296 35718084 34848119 18119390 15736459 2739269 2587239 87852726 82813781 16216339 17349581 18678290 17103292 717145 841805 8016375 6672525 43628149 41967203 X 44224577 40184680 661898 44224577 40846578 87852726 82813781 X -2332598 -1045401 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13155 13155 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PAY MEMBERSHIP DUES TO TRADE ORGANIZATIONS OF WHICH A PORTION OF THE DUES ARE USED FOR LOBBY EXPENSES BY THE TRADE ORGANIZATIONS. 0 661898 661898 1.00000 0 0 977373 977373 46724764 28416152 18308612 548481 548481 0 42284550 27171663 15112887 449247 449247 34848119 ESTIMATED SETTLEMENTS PAYABLE 1450000 PROF. LIAB CLAIMS RESERVE 2723599 DEFERRED COMPENSATION 1630041 SWAP AGREEMENT 868885 6672525 124375601 126708199 -2332598 -1045401 -1045401 -3377999 123587657 -1045401 -1045401 124633058 -257457 -257457 124375601 126965656 257457 257457 126708199 0 126708199 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE DONOR-RESTRICTED FOR A SPECIFIC USE OR BY THE PASSAGE OF TIME. INCOME EARNED FROM THE PRINCIPLE AMOUNT IS UNRESTRICTED. THE DONOR-RESTRICTED NET ASSETS ARE TO BE USED FOR CURATIVE TREATMENT AND REHABILITATIVE THERAPY OF PEDIATRIC ILLNESS, DISEASE, OR DEFORMITY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE MEDICAL CENTER AND RECOGNIZE A TAX LIABILITY IF THE MEDICAL CENTER HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE MEDICAL CENTER, AND HAS CONCLUDED THAT AS OF JUNE 30, 2012 AND 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE MEDICAL CENTER IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: COST OF GOOD SOLD -233,182. SPECIAL EVENT EXPENSE -24,275. PART XIII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 233,182. SPECIAL EVENT EXPENSES 24,275. CHARITY GOLF OUTING 129903 129903 6666 3600 1521 3695 MYSTERY DINNER THEATER 20695 20695 7167 1626 150598 150598 6666 3600 8688 5321 24275 126323 1 1 1 X 125.000000000000 1 X 1 1 0 1 1 7083045 0 7083045 0.05590 15938659 13800530 2138129 0.01690 23021704 13800530 9221174 0.07280 3910600 3910600 0.03090 3910600 3910600 0.03090 26932304 13800530 13131774 0.10370 1 6159703 0 32707381 34352086 -1644705 X 1 1 1 1 ST CLAIRE REGIONAL MEDICAL CENTER

222 MEDICAL CIRCLE DRIVE MOREHEAD KY 40391

X X ST CLAIRE REGIONAL MEDICAL CENTER 1 0 1 1 125.000000000000 1 200.000000000000 1 X X X X X X X 1 1 X 1 0 1 X 0 0 PART I, L7 COL(F): TOTAL BAD DEBT EXPENSE HAS BEEN EXCLUDED FROM THE DENOMINATOR FOR THE PERCENTAGE CALCULATION PER IRS INSTRUCTIONS. HOWEVER, THE BAD DEBT EXPENSE OF $19,433,310 WAS NOT INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), DUE TO NEW ACCOUNTING PRONOUNCEMENT, ACCOUNTING STANDARD UPDATE 2011-07, HEALTHCARE ENTITIES (TOPIC 954), "PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTHCARE ENTITIES," WHICH REQUIRES CERTAIN HEALTHCARE ENTITIES TO PRESENT THE PROVISIONS FOR BAD DEBTS RELATING TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE STATEMENT OF OPERATIONS RATHER THAN AS AN OPERATING EXPENSE. PART II: THE ORGANIZATION DOES NOT PROVIDE ANY COMMUNITY BUILDING ACTIVITIES. PART III, LINE 4: SECTION A. BAD DEBT EXPENSE. LINE 2 FOOTNOTE TO ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE MEDICAL CENTER'S EVALUATION OF ITS MAJOR PAYOR SOURCES OF REVENUE, THE AGING OF THE ACCOUNTS, HISTORICAL LOSSES, CURRENT ECONOMIC CONDITIONS, AND OTHER FACTORS UNIQUE TO THEIR SERVICE AREA AND THE HEALTHCARE INDUSTRY. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE,FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTY THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PAYMENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.FOR THE YEAR ENDED JUNE 30, 2012, THE MEDICAL CENTER INCREASED THE ESTIMATE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS TO INCLUDE 90 PERCENT OF ALL SELF-PAY ACCOUNTS LESS THAN 150 DAYS, AND INCLUDE ALL ACCOUNTS, 150 DAYS AND OLDER, NET OF CONTRACTUAL ALLOWANCES ALREADY TAKEN. THE PREVIOUS ESTIMATE RESERVED A LOWER PERCENTAGE OF SELF-PAY ACCOUNTS AND ALL ACCOUNTS 150 DAYS AND OLDER. THE EFFECT OF THIS CHANGE WAS A DECREASE IN INCOME (LOSS) FROM OPERATIONS OF APPROXIMATELY $3,200,000 FOR 2012. THE JUNE 30, 2012 ALLOWANCE FOR DOUBTFUL ACCOUNTS OF $15,190,851 WAS COMPRISED OF $10,600,070 RESERVED FOR SELF-PAY BALANCES AND $4,590,781 RESERVED FOR THIRD-PARTY PAYOR BALANCES.SECTION A. BAD DEBT EXPENSE. LINE 3 EXPLANATION FOR RATIONAL FOR INCLUDING OTHER BAD DEBT AMOUNT IN COMMUNITY BENEFIT: BAD DEBT EXPENSE IS RECORDED AS A GROSS AMOUNT ON THE FINANACIAL STATEMENTS. COSTS ASSOCIATED WITH THIS EXPENSE ARE CALCULATED BY USING THE COST TO CHARGE RATIO WITHIN EACH RESPECTIVE DIVISION OF THE MEDICAL CENTER. THE MEDICAL CENTER HAS A FINANCIAL ASSISTANCE POLICY THAT STATES PARTICIPATION IN CHARITY PROGRAM REQUIRES THAT CANDIDATES FULLY COOPERATE. THE MEDICAL CENTER EDUCATES PATIENTS WILL LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE AND PROVIDES ACCESS TO DEDICATED FINANCIAL COUNSELORS DAILY. FOR THIS REASON THE MEDICAL CENTER BELIEVES THAT IT IS ACCURATELY CAPTURING ALL CHARITY CARE DEDUCTIONS ACCORDING TO THE FINANCIAL ASSISTANCE POLICY AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE UNDER THE ORGANIZATION CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 8: THE SOURCE USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS REPORTED FOR PART III, SECTION B, MEDICARE HAS BEEN PROVIDED FROM THE YEAR ENDED JUNE 30, 2012 REPORT: HOSPITAL STATEMENT OF REIMBURSABLE COST. PART III, LINE 9B: THE MEDICAL CENTER WILL ASSIST ALL PATIENTS AND THEIR RESPONSIBLE PARTY WITH METHODS OF PAYING ACCOUNTS GENERATED AS A RESULT OF NO THIRD PARTY COVERAGE OR BALANCES AFTER INSURANCE PAYMENTS. ACCEPTABLE PAYMENT ARRANGEMENTS ARE REQUESTED IF FULL PAYMENT CANNOT BE MADE. COMPUTER GENERATED STATEMENTS ARE MAILED TO THE RESPONSIBLE PARTY ON A REGULAR SCHEDULE. LETTERS ARE ALSO SENT AS SUPPLEMENT TO THE DATA STATEMENTS TO KEEP THE PATIENT/GUARANTOR INFORMED OF THE STATUS OF THE ACCOUNT. HEALTHCARE FINANCIAL ASSISTANCE WILL BE GRANTED IF THERE ARE NO OTHER RESOURCES AVAILABLE TO THE PATIENT AND THEY HAVE MET THE GUIDELINES AND FURNISHED REQUESTED VERIFICATION. PART VI, LINE 2: THE ORGANIZATION ASSESS COMMUNITY NEEDS THROUGH VOLUNTEER BOARDS, COMMUNITY INVOLVEMENT, VOLUNTEERING, AND BOARD SERVICE. PART VI, LINE 3: PATIENT FINANCIAL SERVICES' PATIENT ACCESS/REGISTRATION STAFF AND CASHIER ASSIST PATIENTS WITH INFORMING AND EDUCATING PATIENTS ABOUT THEIR ACCOUNTS AND CHARGES. PART VI, LINE 4: ST. CLAIRE REGIONAL MEDICAL CENTER'S SERVICE REGION SERVES A POPULATION OF OVER 160,000 IN BATH, CARTER, ELLIOTT, FLEMING, LEWIS, MAGOFFIN, MENIFEE, MONTGOMERY, MORGAN, ROWAN AND WOLFE COUNTIES. ST. CLAIRE REGIONAL'S FIVE FAMILY MEDICINE CLINICS ARE LOCATED IN FRENCHBURG, MOREHEAD, OLIVE HILL, OWINGSVILLE, AND SANDY HOOK. PART VI, LINE 5: THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE BY PROMOTING HEALTH OF THE COMMUNITY THROUGH THE FOLLOWING: THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. THESE VOLUNTEERS ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. ANY SURPLUS FUNDS ARE APPLIED DIRECTLY OR INDIRECTLY TO IMPROVE SERVICES. PART VI, LINE 6: NOT APPLICABLE. THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 KY 1 SCHOLARSHIPS 5 32257 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: HOSPITAL MAKES SCHOLARSHIPS AVAILABLE TO ELIGIBLE PERSONS TO FURTHER HEALTHCARE IN THE COMMUNITY. X X X X X 0 0 0 0 0 0 0 0 0 MARK NEFF 322215 0 0 0 0 0 50750 0 13464 0 386429 0 0 0 SONNY JONES 167550 0 0 0 0 0 24982 0 6825 0 199357 0 0 0 GREG BAUSCH 154491 0 0 0 0 0 7814 0 9086 0 171391 0 0 0 DR KIM WILLIAMS 227961 0 0 0 0 0 50009 0 10966 0 288936 0 0 0 DR WILL MELAHN 196131 0 0 0 0 0 23996 0 15964 0 236091 0 0 0 DR WILLIAM LEWIS 650875 0 0 0 0 0 45250 0 15381 0 711506 0 0 0 DR CRAIG BUTLER 587053 0 0 0 0 0 45250 0 22381 0 654684 0 0 0 DR STEPHEN WILLIAMS 646515 0 0 0 0 0 45250 0 7516 0 699281 0 0 0 DR CHARLES CROUSE 639004 0 0 0 0 0 45250 0 17708 0 701962 0 0 0 DR MOHAMMAD ANWAR 351389 0 0 0 0 0 50750 0 17374 0 419513 0 0 0 ROWAN COUNTY KENTUCKY 616000882 2010-03-22 6000000 PURCHASE AND INSTALL MEDICAL EQUIPMENT 0 0 0 ROWAN COUNTY KENTUCKY 616000882 2010-12-22 14000000 AQUIRE, CONSTRUCT, EQUIP FACILITIES/ RETIRE 1994 ISSUANCE 0 0 0 6000000 6000000 2010 0 0 1 1 14000000 115000 2334385 11550615 2011 1 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 DR CHARLES CROUSE SIGNING/EDUCATIONAL LOAN BONUS X 200000 6668 0 1 1 6668 X 8 81000 FMV 0 1 1 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS RECEIVED BY THE HOSPITAL. THIRD PARTY USE: PART I, LINE 32B: THE ST. CLAIRE FOUNDATION SHALL RESERVE THE RIGHT TO ACCEPT OR REJECT ALL GIFT OFFERS. THE FINAL DECISION SHALL BE MADE BY THE EXECUTIVE DIRECTOR FOR DEVELOPMENT IN CONSULTATION WITH THE PRESIDENT OF THE ST. CLAIRE REGIONAL MEDICAL CENTER, WHEN APPROPRIATE. HE MAY ALSO REFER A PROPOSED GIFT TO THE FOUNDATION'S EXECUTIVE COMMITTEE FOR THEIR RECOMMENDATION. FORM 990, PART VI, SECTION A, LINE 7A THE PRESIDENT OF THE SISTERS OF NOTRE DAME OF COVINGTON, KY IS THE PERSON WHO APPOINTS ALL THE DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE CFO AND BY THE ACCOUNTING DEPARTMENT. THE GOVERNING BODY REVIEWS AND APPROVES THE FORM 990 AND THE FINAL FORM 990 INCLUDING REQUESTED SCHEDULES, AS ULTIMATELY FILED WITH THE IRS, ARE PROVIDED TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD OF DIRECTORS, BOARD COMMITTEES, AND MEDICAL CENTER LEADERSHIP SIGN A CONFLICT OF INTEREST STATEMENT ON INITIAL APPOINTMENT OR EMPLOYMENT AND ANNUALLY THEREAFTER. THE WRITTEN CONFLICT OF INTEREST POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND COMPLIANCE ENFORCED BY THE DEPARTMENT HEAD OF BOARD/ADMINISTRATION. THE SCOPE OF THIS POLICY INCLUDES BOARD OF DIRECTORS, BOARD COMMITTEES, ADMINISTRATIVE STAFF, EMPLOYEES, AND MEDICAL STAFF. THE POLICY IS IN PLACE TO AVOID CONFLICTS OF INTEREST OR THE APPEARANCE OF CONFLICTS BETWEEN PERSONAL INTERESTS AND ONE'S OFFICIAL RESPONSIBILITIES AND PERFORMANCE OF DUTIES ON BEHALF OF THE MEDICAL CENTER. THE COVERED PERSONS ARE TO AVOID BEING PLACED IN A POSITION FOR PERSONAL PROFIT, EITHER THROUGH MONEY, GOODS, OR INFLUENCE FROM THE CONDUCTING OF MEDICAL CENTER RESPONSIBILITIES. A SELF DISCLOSURE FROM COVERED PERSONS TO THE INTEGRITY OFFICER IS REQUIRED ON ANY POTENTIAL CONFLICTS OF INTEREST. THE COVERED PERSONS ARE TO REFUSE FROM PARTICIPATING IN ANY DELIBERATION OR DECISIONS ON SUCH TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS ESTABLISHED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS AND IS BASED ON PERFORMANCE CRITERIA AND ON PUBLISHED MARKET SURVEY COMPARISONS FOR HEALTHCARE INSTITUTIONS SIMILAR IN SIZE AND SCOPE OF OPERATIONS. COMPENSATION FOR OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE CEO, BASED ON PERFORMANCE CRITERIA, AND PUBLISHED MARKET SURVEY COMPARISONS, AND IS REVIEWED AND BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,045,401. OVERSIGHT OF AUDIT FORM 990, PART XI, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. SISTERS OF NOTRE DAME OF COVINGTON KENTUCKY INC 1601 DIXIE HIGHWAY COVINGTON KY 41011 RELIGIOUS ORDER KY 501(C)(3) LINE 1 N/A 0 CLAIRE-FRANCIS HEALTH SERVICES PLLC DBA INFUSION SOLUTIONS 200 MALL ROAD STE 3 ASHLAND KY 41101 311517507 HOME INFUSION SERVICES KY 0 0 0.33000 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0