2012-05-15T15:42:53-05:00 2011-06-30 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2010-07-01 610945743 KENTUCKY MEDICAL SERVICES FOUNDATION INC KENT 8592577910 2333 ALUMNI PARK PLAZA NO 200 LEXINGTON KY 40517 DARRELL A GRIFFITH 8592577910 2012-05-15 1 LEIGH MCKEE 8592552341 2010 2016-02-24 21:20:13Z EMERY WILSON MD 2333 ALUMNI PARK PLAZA NO 200 LEXINGTON KY 40517 206261976 0 X N/A X 1980 KY SUPPORTING THE UNIVERSITY OF KY SO IT MAY ACHIEVE ITS GOALS IN HEALTHCARE 23 23 199 0 -14453 -14453 0 0 193855535 203252236 164504 -31545 2564025 592816 196584064 203813507 687697 741046 0 0 10407070 10596036 0 0 0 190057273 194868978 201152040 206206060 -4567976 -2392553 110252347 113994488 90862317 97167297 19390030 16827191 SEE SCHEDULE O 0 0 185842211 741046 203252236 KMSF COLLECTS FEES FROM PROVISION OF PATIENT SERVICES PROVIDED BY THE UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE. BY PERFORMING THESE DUTIES KMSF SUPPORTS THE HOSPITAL AND HELPS THEM TO FULFILL THEIR EXEMPT PURPOSE. COLLECTIONS, AFTER PAYMENT OF DIRECT EXPENSES, ARE REMITTED TO THE COLLEGE WHICH USES THE FUNDS IN THE AREAS OF TEACHING, RESEARCH AND SERVICE. 185842211 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 217 0 1 199 1 1 1 0 0 0 0 0 0 0 0 0 X 23 23 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X DARRELL A GRIFFITH 8592577910 2333 ALUMNI PARK PLAZA SUITE 200 LEXINGTON KY 40517 WENDY HANSEN 1.00 X 0 460698 174 RALEIGH O JONES 1.00 X 0 369316 4227 ROBERT T MEANS 1.00 X 0 268392 110 EDWIN A BOWE 1.00 X 0 498525 110 PHILLIP A TIBBS 1.00 X 0 1039530 74 MICHAEL L CIBULL 1.00 X 0 300687 87 WILLEM DE VILLIERS 1.00 X 0 285890 4235 FREDERICK C DE BEER 1.00 X 0 472282 87 PAUL BACHNER 1.00 X 0 373644 258 CAROL STELTENKAMP 1.00 X 0 221075 8403 REGINA FRAGNETO 1.00 X 0 363661 64 LON R HAYS 1.00 X 0 310050 13079 ROGER L HUMPHRIES 1.00 X 0 201516 0 DARREN L JOHNSON 1.00 X 0 434416 4465 MARCUS RANDALL 1.00 X 0 633025 12946 MARY ELIZABETH OATES 1.00 X 0 566250 4372 JOSEPH ZWISCHENBERGER 1.00 X 0 737178 243 GERALD V KLIM 1.00 X 0 280904 48 PAUL A PEARSON 1.00 X 0 364631 40 KEVIN PEARCE 1.00 X 0 190194 12830 EMERY A WILSON 1.00 X 0 356039 131 CARMEL WALLACE 1.00 X 0 178696 0 J TIMOTHY BRICKER 1.00 X 0 341500 174 DARRELL A GRIFFITH 45.00 X 264809 0 26409 PEGGY S HALCOMB 45.00 X 216679 0 21668 JAMES M TILLETT 45.00 X 104506 0 10451 JUDY B BENSON 45.00 X 106985 0 10699 JOSEPH R BERGER 1.00 X 0 430550 4259 SAMUEL C MATHENY 1.00 X 0 257767 0 692979 9936416 139643 4 1 1 0 PERFUSION CONCEPTS INC 2089 BAHAMA ROAD LEXINGTON KY 40509 MEDICAL SERVICES 627599 HARRODSBURG ANESTHESIA 425 SHAWNEE RUN ROAD HARRODSBURG KY 40330 MEDICAL SERVICES 345559 RIVER CITY ANESTHESIA 20 WEST OWL CREEK ROAD CAMPBELLSVILLE KY 42718 MEDICAL SERVICES 232677 JULIA M GOODMAN BRADLEYCOMMONWEALTH 709 EVEREST CT LEXINGTON KY 40515 TRANSCRIPTION 202486 BAKER & HOSTETLER LLP 1900 E 9TH ST SUITE 3200 CLEVELAND OH 441143482 LEGAL SERVICES 158725 20 CLINIC SERVICE FEES 561000 199902286 199902286 RENT FROM SUPPORTED OR 531120 3287074 3287074 RENTAL REIMBURSEMENT P 531120 62876 62876 203252236 102562 102562 225544 256562 -31018 -31018 -14453 -16565 2057800 2191907 -134107 -134107 -134107 HONORARIUM & OTHER MIS 900099 623834 623834 623834 203813507 203252236 -14453 575724 741046 741046 291217 291217 7471597 7471597 739805 739805 738027 738027 1355390 1355390 117097 117097 148981 148981 173125 173125 1532410 1532410 676364 676364 1434953 1434953 2353941 2353941 39714 39714 UK STAFF SALARIES & FRI 55635958 55635958 UK PHYSICIANS' SALARIES 39201759 39201759 CAPITAL & CURRENT OPERA 26757220 26757220 PROFESSIONAL DEVELOPMEN 25015778 24949761 66017 BAD DEBTS 17385619 17385619 24396059 21170848 3225211 206206060 185842211 20363849 0 27618902 38580797 25555358 19830994 1042867 1643003 50666373 12812795 40522491 37853578 14445227 15370419 510857 340571 556645 375126 110252347 113994488 4867306 3537231 27013060 24313117 58981951 69316949 90862317 97167297 X 19390030 16827191 19390030 16827191 110252347 113994488 X -2392553 -170286 X X 0 1 1 X 0 X X X X 0 0 0 UNIVERSITY OF KENTUCKY 616001218 2 1 1 1 206206060 1 206206060 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: KMSF HAS BEEN ASSIGNED THE RESPONSIBILITY TO BILL, COLLECT AND ADMINISTER ALL CLINICAL INCOME GENERATED BY THE PHYSICIANS OF THE UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE, THUS PROVIDING A SERVICE TO UK. 2066767 2066767 38777834 6996737 31781097 9579587 5798904 3780683 242185 17154 225031 37853578 DUE TO UNIV. OF KENTUCKY 1719996 DUE TO UNIV. OF KENTUCKY MALPRACTICE FUND 15910277 DUE TO COLL. OF MEDICINE DEPARTMENTS 51300306 REFUNDS PAYABLE 386370 69316949 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: KMSF IS A NON-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME. KMSF HAS EVALUATED THE TAX POSITIONS TAKEN ON ALL INCOME TAX RETURNS THAT REMAIN OPEN TO EXAMINATION BY THE RESPECTIVE TAXING AUTHORITIES. KMSF DOES NOT BELIEVE THAT THERE ARE ANY UNCERTAIN POSITIONS ON THOSE RETURNS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 1 UNDERGRADUATE SCHOLARSHIPS FOR DEPENDENTS OF UK FACULTY MEMBERS 97 741046 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: KMSF REQUIRES TRANSCRIPTS AND PROOF OF ENROLLMENT EVERY SEMESTER TO MONITOR APPROPRIATE USE OF SCHOLARSHIP FUNDS. X X 0 0 0 0 0 0 0 0 0 WENDY HANSEN 0 460698 0 0 0 0 0 0 0 174 0 460872 0 0 RALEIGH O JONES 0 369316 0 0 0 0 0 0 0 4227 0 373543 0 0 ROBERT T MEANS 0 268392 0 0 0 0 0 0 0 110 0 268502 0 0 EDWIN A BOWE 0 498525 0 0 0 0 0 0 0 110 0 498635 0 0 PHILLIP A TIBBS 0 1039530 0 0 0 0 0 0 0 74 0 1039604 0 0 MICHAEL L CIBULL 0 300687 0 0 0 0 0 0 0 87 0 300774 0 0 WILLEM DE VILLIERS 0 285890 0 0 0 0 0 0 0 4235 0 290125 0 0 FREDERICK C DE BEER 0 472282 0 0 0 0 0 0 0 87 0 472369 0 0 PAUL BACHNER 0 373644 0 0 0 0 0 0 0 258 0 373902 0 0 CAROL STELTENKAMP 0 221075 0 0 0 0 0 0 0 8403 0 229478 0 0 REGINA FRAGNETO 0 363661 0 0 0 0 0 0 0 64 0 363725 0 0 LON R HAYS 0 310050 0 0 0 0 0 0 0 13079 0 323129 0 0 ROGER L HUMPHRIES 0 201516 0 0 0 0 0 0 0 0 0 201516 0 0 DARREN L JOHNSON 0 434416 0 0 0 0 0 0 0 4465 0 438881 0 0 MARCUS RANDALL 0 633025 0 0 0 0 0 0 0 12946 0 645971 0 0 MARY ELIZABETH OATES 0 566250 0 0 0 0 0 0 0 4372 0 570622 0 0 JOSEPH ZWISCHENBERGER 0 737178 0 0 0 0 0 0 0 243 0 737421 0 0 GERALD V KLIM 0 280904 0 0 0 0 0 0 0 48 0 280952 0 0 PAUL A PEARSON 0 364631 0 0 0 0 0 0 0 40 0 364671 0 0 KEVIN PEARCE 0 190194 0 0 0 0 0 0 0 12830 0 203024 0 0 EMERY A WILSON 0 356039 0 0 0 0 0 0 0 131 0 356170 0 0 CARMEL WALLACE 0 178696 0 0 0 0 0 0 0 0 0 178696 0 0 J TIMOTHY BRICKER 0 341500 0 0 0 0 0 0 0 174 0 341674 0 0 DARRELL A GRIFFITH 264809 0 0 0 0 0 0 0 26409 0 291218 0 0 0 PEGGY S HALCOMB 216679 0 0 0 0 0 0 0 21668 0 238347 0 0 0 JOSEPH R BERGER 0 430550 0 0 0 0 0 0 0 4259 0 434809 0 0 SAMUEL C MATHENY 0 257767 0 0 0 0 0 0 0 0 0 257767 0 0 BRANDON SJOHNSON SON OF BOARD MEMBER 4430 SCHOLARSHIP ERICA GRIFFITH DAUGHTER OF KEY EMPLOYEE 6365 SCHOLARSHIP CHRISTINA PEARCE DAUGHTER OF BOARD MEMBER 8860 SCHOLARSHIP JOHN M JANSEN SON OF BOARD MEMBER 4430 SCHOLARSHIP JORDAN WAGERS SON OF KEY EMPLOYEE 10795 SCHOLARSHIP KAROLYN ELAINE HAYS DAUGHTER OF BOARD MEMBER 8860 SCHOLARSHIP MARYCOBB B RANDALL DAUGHTER OF BOARD MEMBER 8860 SCHOLARSHIP AMELIA BISCOMB HANSEN DAUGHTER OF BOARD MEMBER 4430 SCHOLARSHIP RACHEL BERGER DAUGHTER OF BOARD MEMBER 8860 SCHOLARSHIP LUCAS ROY HANSEN SON OF BOARD MEMBER 4430 SCHOLARSHIP KATHRYN ANN HAYS DAUGHTER OF BOARD MEMBER 13555 SCHOLARSHIP SCHEDULE L, PART III GRANTS LISTED ON SCHEDULE L ARE SCHOLARSHIPS PROVIDED TO CHILDREN OF BOARD MEMBERS WHO ARE FACULTY MEMBERS AT THE UNIVERSITY OF KENTUCKY. THE DEPENDENTS OF ALL FULL-TIME FACULTY ARE ELIGIBLE FOR THESE SCHOLARSHIPS AND ELIGIBILITY AND DISTRIBUTION ARE SUBJECT TO THE REQUIREMENTS OF THE PROGRAM. BOARD MEMBERS DO NOT SPECIFICALLY SELECT RECIPIENTS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 TAX RETURN IS PREPARED BY AN INDEPENDENT CPA FIRM BASED ON THE INFORMATION OBTAINED FROM THE AUDIT AND INQUIRIES FROM MANAGEMENT. BEFORE THE RETURN IS FILED, A DRAFT OF THE INFORMATIONAL RETURN IS REVIEWED BY THE FINANCE COMMITTEE OF KENTUCKY MEDICAL SERVICES FOUNDATION. THE FINANCE COMMITTEE APPROVES THE FORM 990 AND REPORTS THEIR APPROVAL TO THE BOARD OF DIRECTORS. THE RETURN IS THEN FILED. FORM 990, PART VI, SECTION B, LINE 12C EXECUTIVE LEADERSHIP HAS IMPLEMENTED A POLICY THAT OFFICERS, DIRECTORS, AND KEY EMPLOYEES SHOULD ANNUALLY DISCLOSE CONFLICTS AND THE CONFLICT OF INTEREST POLICY IS CONSISTENTLY MONITORED AND ENFORCED. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DELIBERATED BY THE BOARD IN A CLOSED DOOR MEETING. AS PART OF THEIR REVIEW THEY USE AAMC GROUP ON FACULTY PRACTICE BENCHMARKS FOR COMPARISON. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24F MALPRACTICE INSURANCE: PROGRAM SERVICE EXPENSES 6,238,799. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,238,799. UKHMO CAPITATION EXPENSE: PROGRAM SERVICE EXPENSES 5,592,109. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,592,109. ACADEMIC ENRICHMENT: PROGRAM SERVICE EXPENSES 4,023,280. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,023,280. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,221,451. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,221,451. UK PHYSICIANS' FRINGE BENEFITS: PROGRAM SERVICE EXPENSES 2,404,765. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,404,765. KY CLINIC CENTRAL: PROGRAM SERVICE EXPENSES 2,201,654. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,201,654. HOUSESTAFF: PROGRAM SERVICE EXPENSES 421,011. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 421,011. KY CLINIC SOUTH EXPENSES: PROGRAM SERVICE EXPENSES 289,230. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 289,230. CASH COLLECTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,760. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,760. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: IMPARIMENT LOSS -170,286. TOTAL TO FORM 990, PART XI, LINE 5: -170,286. FORM 990, PART XI, LINE 2C: THE AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. DESCRIPTION OF ORGANIZATION MISSION FORM 990, PART III, LINE 1 TO COORDINATE AND DEVELOP SUPERIOR PATIENT CARE IN A GROUP PRACTICE SETTING WITHIN THE ACADEMIC ENVIRONMENT OF THE MEDICAL CENTER OF THE UNIVERSITY OF KENTUCKY IN LEXINGTON, INCLUDING THE PROVISION OF FINANCIAL SUPPORT FOR THE MEDICAL CENTER'S TEACHING, RESEARCH AND SERVICE PROGRAMS AND FOR THE PERSONNEL AND EQUIPMENT NECESSARY FOR SUCH PROGRAMS, AND IN FURTHERANCE OF THIS GENERAL PURPOSE TO EXECUTE AND PERFORM A PUBLIC TRUST IN SUPPORTING, AIDING, AND ADVANCING THE STUDY AND INVESTIGATION OF HUMAN ILLNESSES AND INJURIES, AND THE CAUSES, PREVENTIONS, RELIEF AND CURE THEREOF, AND THE STUDY AND INVESTIGATION OF PROBLEMS OF HYGIENE AND HEALTH; TO ENCOURAGE, PROMOTE AND PERFORM MEDICAL, SURGICAL AND SCIENTIFIC LEARNING, SKILL, EDUCATION AND INVESTIGATION; TO PROMOTE MEDICAL, SURGICAL, AND SCIENTIFIC SERVICES; TO ATTRACT AND RETAIN HIGH QUALITY FACULTY TO TEACH, CONDUCT RESEARCH AND PROVIDE PATIENT CARE; TO PROVIDE SUPPORT TO ENABLE THE COLLEGE OF MEDICINE TO ACCOMPLISH ITS EDUCATIONAL, RESEARCH AND SERVICE GOALS; TO ASSIST PROGRAMS OF MEDICAL, SURGICAL AND SCIENTIFIC EDUCATION AND RESEARCH; TO CARRY ON SUCH PROGRAMS OF PUBLIC CHARITY AS MAY BE RELATED TO THE CARRYING OUT OF THE OTHER STATED PURPOSES OF THE CORPORATION, AND, SPECIFICALLY THE CHARITABLE PROGRAMS UTILIZING THE KNOWLEDGE AND SKILLS ACQUIRED BY THE CORPORATION THROUGH ITS ABOVE-DESCRIBED OPERATIONS FOR THE BENEFIT OF ALL PERSONS WHO MAY BE IN NEED THEREOF, REGARDLESS OF HIS OR HER ABILITY TO PAY. UNIVERSITY OF KENTUCKY 800 ROSE STREET LEXINGTON KY 40536 616001218 EDUCATIONAL DEVELOPMENT, HEALTHCARE KY 115 N/A N/A 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0