2024-05-15T10:06:38-05:00 2023-06-30 390859910 BAKER TILLY US LLP 1570 FRUITVILLE PIKE SUITE 400 LANCASTER PA 17601 990 2022-10-01 611386016 ASHLAND NURSING HOME CORP ASHL 6063241414 2500 STATE ROUTE 5 ASHLAND KY 41102 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 6063241414 2024-05-13 1 AUTUMN MCFANN 999009999 1 KERRI N BOGDA CPA P00760402 7177404863 2024-05-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KINGSBROOK LIFECARE CENTER SARA MARKS 2201 LEXINGTON AVENUE ASHLAND KY 41101 10853862 0 X WWW.KINGSBROOK-LIFECARE.COM X 2002 KY TO PROVIDE QUALITY CARE TO PATIENTS NEEDING SHORT-TERM REHAB AND/OR LONG-TERM HEALTHCARE. 10 10 300 13 0 0 328765 129485 12688630 10635332 2569 12497 89902 76548 13109866 10853862 0 0 0 0 8401404 6397801 0 0 0 6016357 4468471 14417761 10866272 -1307895 -12410 10815927 13770690 1761100 1102799 9054827 12667891 OUR MISSION IS TO MEET THE NEEDS OF RESIDENTS AT VARIOUS LEVELS OF CARE INCLUDING SHORT-TERM REHAB AND LONG-TERM HEALTHCARE. 0 0 9254644 0 10635332 KINGSBROOK PROVIDES QUALITY CARE TO PATIENTS, MEETING THE NEEDS AND DESIRES OF RESIDENTS AT VARIOUS LEVELS OF CARE, INCLUDING SHORT-TERM AND LONG-TERM CARE. KINGSBROOK IS A 137-BED NURSING FACILITY WHICH PROVIDES SKILLED NURSING SERVICES AND REHABILITATION THERAPY TO RESIDENTS DESIRING TO RETURN HOME FROM AN ACUTE CARE HOSPITAL STAY. KINGSBROOK ALSO PROVIDES NURSING SERVICES AND CARE FOR RESIDENTS ON A LONG-TERM BASIS. 9254644 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 300 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KY X LAURIE STEWART CONTROLLER 6064089640 2201 LEXINGTON AVENUE ASHLAND KY 41101 DAVID JONES BOARD CHAIRMAN 0.25 6.25 X X 0 0 0 DR MARK NEWMAN BOARD VICE-CHAIRMAN (UNTIL 12/31/22) 0.25 5.75 X X 0 0 0 PENNY COX DIRECTOR 0.25 2.25 X 0 0 0 GINA DUGAS DIRECTOR 0.25 2.25 X 0 0 0 ROBERT DIPAOLA DIRECTOR 0.25 2.25 X 0 0 0 JOHN STEWART DIRECTOR 0.25 2.75 X 0 0 0 TOM BURNETTE DIRECTOR 0.25 2.75 X 0 0 0 STEPHEN ADDINGTON DIRECTOR 0.25 2.50 X 0 0 0 ERIC MONDAY DIRECTOR 0.25 2.25 X 0 0 0 CRAIG COLLINS DIRECTOR 0.25 2.25 X 0 0 0 MARK BIRDWHISTELL DIRECTOR 0.25 2.25 X 0 0 0 KRISTIE WHITLATCH PRESIDENT/CEO (10/1/22-12/31/22) 1.25 60.75 X 0 0 0 SARA MARKS PRESIDENT/CEO (BEG. 1/1/23) 1.25 60.25 X 0 1844834 142949 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 1.25 60.25 X 0 1897128 131808 SHERYL MAHANEY UNTIL 113022 SECRETARY, VP/CHIEF LEGAL OFFICER 1.25 60.75 X 0 1518132 8395 STEVEN CLIFTON SECRETARY (BEG. 12/1/22) 0.25 5.75 X 0 0 0 AMY SAUNDERS ASSISTANT SECRETARY (BEG. 12/1/22) 0.25 45.75 X 0 227968 12371 JANE STRADER MD ANHC MEDICAL DIRECTOR 20.00 40.00 X 0 403333 45660 JANE BLANKENSHIP EXECUTIVE DIRECTOR 40.00 10.00 X 0 180362 26299 LISA QUEEN ANHC DIRECTOR OF PATIENT CARE SERVICES 40.00 0.00 X 74196 32025 10201 ARLENE MASSIE ANHC DIRECTOR OF NURSING 40.00 0.00 X 72069 31542 10013 146265 6135324 387696 0 0 1 0 0 100000 29485 129485 NET PATIENT SERVICE REVENUE 623000 10635332 10635332 10635332 12497 12497 MEALS ON WHEELS 722513 31563 31563 CAFETERIA/LAUNDRY SERVICES 722513 28670 28670 BEAUTY/BARBER SHOP 812900 8860 8860 7455 7455 76548 10853862 10635332 0 89045 5527610 4809021 718589 260307 226467 33840 609884 530599 79285 128827 128827 29500 29500 869262 756258 113004 60 52 8 55362 48165 7197 332179 288996 43183 398724 346890 51834 284531 284531 MEDICAL SUPPLIES 935671 814034 121637 PHARMACY 479459 479459 BAD DEBT EXPENSE 390620 390620 PROVIDER TAX 335873 335873 228403 198710 29693 10866272 9254644 1611628 0 818259 674859 1978333 1414105 108269 111621 11292 37955 11799291 325141 6078176 11474150 1821598 58000 10815927 13770690 587580 381987 1173520 720812 1761100 1102799 X 9054827 12667891 9054827 12667891 10815927 13770690 X -12410 3625474 X 0 1 X 1 1 1 X 866812 222184 328765 29485 1447246 12718593 12161069 12951594 12688630 10735332 61255218 12718593 13027881 13173778 13017395 10764817 62702464 0 0 0 62702464 13036 5954 988 2569 12497 35044 13036 5954 988 2569 12497 35044 62977 99260 55329 89902 76548 384016 12794606 13133095 13230095 13109866 10853862 63121524 0.99340 0.99390 0.00060 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CAFETERIA/LAUNDRY - 2018 AMOUNT: $ 41,817. 2019 AMOUNT: $ 53,667. 2020 AMOUNT: $ 44,246. 2021 AMOUNT: $ 26,322. 2022 AMOUNT: $ 28,670. BEAUTY/BARBER - 2018 AMOUNT: $ 17,100. 2019 AMOUNT: $ 7,575. 2020 AMOUNT: $ 6,515. 2021 AMOUNT: $ 7,511. 2022 AMOUNT: $ 8,860. VENDING COMMISSION/REBATE - 2018 AMOUNT: $ 3,856. 2019 AMOUNT: $ 4,237. 2020 AMOUNT: $ 3,393. OTHER INCOME - 2018 AMOUNT: $ 204. 2019 AMOUNT: $ 57. 2020 AMOUNT: $ 1,175. 2021 AMOUNT: $ 15,818. 2022 AMOUNT: $ 7,455. EMPLOYEE RETENTION CREDIT - 2019 AMOUNT: $ 33,724. MEALS ON WHEELS - 2021 AMOUNT: $ 40,251. 2022 AMOUNT: $ 31,563. SCHEDULE A, PAGE 3, PART III ASHLAND NURSING HOME CORP FILED A SHORT YEAR RETURN FOR FISCAL YEAR END JUNE 30, 2023. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1725000 1725000 9049982 266535 8783447 774309 34405 739904 250000 24201 225799 11474150 DUE TO AFFILIATES 720812 720812 1 1 0 0 0 0 0 1 0 AUTUMN MCFANN TREASURER, SR VP/CFO/CAO 0 480101 0 138000 0 1279027 0 113725 0 18083 0 2028936 0 50000 SARA MARKS PRESIDENT/CEO (BEG. 1/1/23) 0 464919 0 133500 0 1246415 0 113725 0 29224 0 1987783 0 50000 SHERYL MAHANEY UNTIL 113022 SECRETARY, VP/CHIEF LEGAL OFFICER 0 307303 0 0 0 1210829 0 0 0 8395 0 1526527 0 0 JANE STRADER MD ANHC MEDICAL DIRECTOR 0 402600 0 0 0 733 0 13725 0 31935 0 448993 0 0 AMY SAUNDERS ASSISTANT SECRETARY (BEG. 12/1/22) 0 190304 0 37219 0 445 0 10268 0 2103 0 240339 0 0 JANE BLANKENSHIP EXECUTIVE DIRECTOR 0 163237 0 16358 0 767 0 8191 0 18108 0 206661 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS DETERMINED BY ASHLAND HOSPITAL CORPORATION (RELATED ORGANIZATION) USING THE FOLLOWING METHODS: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. PART I, LINES 4A-B THE FOLLOWING EMPLOYEES RECEIVED CHANGE IN CONTROL PAYMENTS: - SHERYL MAHANEY: $1,209,162 - SARA MARKS: $1,175,614 - AUTUMN MCFANN: $1,208,771 THESE WERE PAID AS A RESULT OF THE 12/1/22 MEMBER SUBSTITUTION WITH THE UNIVERSITY OF KENTUCKY. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: - AUTUMN MCFANN: $18,996 - SARA MARKS: $19,541 THE CEO AND CERTAIN VICE PRESIDENTS, WHOSE BENEFIT IN THE QUALIFIED TAX SHELTERED ANNUITY PLAN IS LIMITED DUE TO THE IRS COMPENSATION AND BENEFIT LIMITS, RECEIVE A BENEFIT RESTORATION CONTRIBUTION UNDER THE DEFERRED ANNUITY PLAN THAT IS PAID AS A TAXABLE DISTRIBUTION TO THE PARTICIPANT ANNUALLY. THE FOLLOWING EMPLOYEES RECEIVED 457(F) EXECUTIVE RETENTION PLAN PAYOUTS: - AUTUMN MCFANN: $50,000 - SARA MARKS: $50,000 ALL OF THESE PAYMENTS WERE MADE BY AHC. PART I, LINE 7 NONFIXED PAYMENTS ARE MADE AS A PART OF THE MEDICAL CENTER'S TEAM INCENTIVE AWARD (TIA) PLAN. ALL TEAM MEMBERS ARE ELIGIBLE FOR THE TIA. THE TIA IS PAID OUT BASED UPON SUCCESSFUL COMPLETION OF BOTH QUANTITATIVE AND QUALITATIVE STRATEGIC GOALS, SET ANNUALLY BY THE MEDICAL CENTER LEADERSHIP TEAM AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 ASHLAND HOSPITAL CORPORATION (AHC) IS THE SOLE CORPORATE MEMBER OF ASHLAND NURSING HOME CORPORATION (ANHC). AHC, A 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A THE ANHC BOARD IS FOLDED INTO THE MAIN BOARD OF TRUSTEES OF AHC'S PARENT CORPORATION. THE BUSINESS OF ANHC IS IS MANAGED AS AND AGENDA ITEM BY THE FULL BOARD INDEPENDENTLY OR THROUGH ITS COMMITTEE STRUCTURE. FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED BY THE CFO AND CONTROLLER BEFORE IT IS FILED WITH THE IRS. THE 990 WILL BE KEPT ON FILE AND AVAILABLE FOR REVIEW BY BOARD MEMBERS UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C ANY EMPLOYEE, MANAGER, OR OFFICER WHO REGULARLY INFLUENCES OR MAKES DECISIONS INVOLVING THE EXPENDITURE OF FACILITY FUNDS SHALL SIGN A CONFLICT OF INTEREST STATEMENT. THE FORM SHALL BE REVIEWED YEARLY AND SHALL BE FILED IN THE HUMAN RESOURCES OFFICE. WHEN AN EMPLOYEE HAS REPORTED A POTENTIAL OR ACTUAL CONFLICT OF INTEREST TO THE IMMEDIATE SUPERVISOR, THE RESPONSIBLE MANAGER AND THE ADMINISTRATOR SHALL BE NOTIFIED OF ALL FACTS PERTAINING TO ANY POTENTIAL TRANSACTIONS. IF IT IS DETERMINED THAT A CONFLICT DOES EXIST, THEN THE EMPLOYEES SHALL BE REMOVED FROM ANY PART OF THE DECISION-MAKING PROCESS, AND SHALL HAVE NO ROLE IN THE INSTANCE WHERE THE CONFLICT OF INTEREST EXISTS. THE EMPLOYEE'S IMMEDIATE SUPERVISOR SHALL ASSUME OR ASSIGN THE AUTHORITY TO ACT ON BEHALF OF THE EMPLOYEE IN ALL ACTIONS INVOLVING THE AREA OF CONFLICT. FAILURE TO REPORT CONFLICTS OF INTEREST IS A DIRECT VIOLATION OF ANHC'S POLICY AND WILL RESULT IN DISCIPLINARY ACTION. WHEN A MANAGER OF THE FACILITY REPORTS A POTENTIAL CONFLICT, THE MANAGER SHALL REMOVE HIMSELF/HERSELF FROM ANY DISCUSSION OR VOTING REGARDING THE POTENTIAL CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AT THE DIRECTION OF THE BOARD OF DIRECTORS, KDMC SET COMPENSATION FOR THE TEAM MEMBERS AND LEADERS USING LOCAL, REGIONAL AND NATIONAL SALARY INFORMATION PROVIDED THROUGH SURVEY DATA. THE PRIMARY OBJECTIVE OF KING'S DAUGHTERS COMPENSATION PHILOSOPHY IS TO HAVE COMPENSATION AND BENEFITS SET THAT REFLECT OTHER SIMILAR INDEPENDENT NOT FOR PROFIT HEALTHCARE SERVICES AS WELL AS THE WORK PERFORMANCE OF THE ORGANIZATION. MERCER, AN INDEPENDENT COMPENSATION EXPERT, PERIODICALLY PERFORMS A REVIEW OF EXECUTIVE COMPENSATION AND BENEFITS. SULLIVAN COTTER, AN INDEPENDENT COMPENSATION EXPERT, PROVIDES ANNUAL MARKET SURVEY DATA FOR PHYSICIAN COMPENSATION AND BENEFITS WHICH IS USED FOR DETERMINATION OF FAIR MARKET VALUE. FORM 990, PART VI, SECTION C, LINE 19 ON A QUARTERLY BASIS, THE FINANCIAL STATEMENTS ARE REPORTED TO THE MUNICIPAL SECURITIES RULEMAKING BOARD AND MADE AVAILABLE ON THEIR WEBSITE. GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: FASB TO GASB CONVERSION 3,625,474. ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 610444716 HEALTHCARE KY 501(C)(3) LINE 3 ROYAL BLUE HEALTH LLC 0 KENTUCKY MEDICAL LOGISTICS INC 425 22ND STREET ASHLAND KY 41101 264736971 MEDICAL TRANSPORT KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 KING'S DAUGHTERS HEALTH SYSTEM 2201 LEXINGTON AVENUE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 0 PORTSMOUTH HOSPITAL CORPORATION 1901 ARGONNE AVENUE PORTSMOUTH OH 45662 453215312 HEALTHCARE OH 501(C)(3) LINE 3 ROYAL BLUE HEALTH LLC 0 KENTUCKY HEART FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 260791997 MEDICAL RESEARCH KY 501(C)(3) LINE 7 ASHLAND HOSPITAL CORPORATION 0 CHILD DEVELOPMENT CENTER CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 010560598 DAYCARE KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 KING'S DAUGHTERS MEDICAL SPECIALTIES INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 264183569 PHYSICIANS KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 KENTUCKY HEART INSTITUTE INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611255904 PHYSICIANS KY 501(C)(3) LINE 10 ASHLAND HOSPITAL CORPORATION 0 ROYAL BLUE HEALTH LLC 2201 LEXINGTON AVENUE ASHLAND KY 41101 862993817 HEALTHCARE KY 501(C)(3) LINE 12B, II N/A 0 KING'S DAUGHTERS HEALTH FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611035701 FUNDRAISING KY 501(C)(3) LINE 12B, II N/A 0 ASHLAND MEDICAL PROPERTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 611079090 RENTALS KY N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1