2018-08-14T15:03:57-05:00 2017-09-30 390859910 Baker Tilly Virchow Krause LLP 1650 Market Street Suite 4500 Philadelphia PA 191037341 990 2016-10-01 453215312 Portsmouth Hospital Corporation PORT 7409914000 1901 Argonne Avenue Portsmouth OH 45662 AUTUMN MCFANN TREASURER 7409914000 2018-08-14 1 Julius C Green CPA P00350393 2159720701 2016 2022-09-23 18:48:47Z King's Daughters Medical Center Ohio Kristie Whitlatch 2201 LEXINGTON AVENUE ASHLAND KY 41101 24482651 0 X www.kingsdaughtershealth.com/locations X 2010 OH To Care. To Serve. To Heal. 5 3 192 3 0 0 0 0 24924070 24478972 0 -35722 14308 3679 24938378 24446929 12595 4250 0 0 8226232 8848066 0 0 0 14341332 15668088 22580159 24520404 2358219 -73475 31441482 28797313 39427418 36856724 -7985936 -8059411 X King's Daughters Medical Center Ohio is located in the historic town of Portsmouth, OH at the confluence of the Ohio, Scioto, and Little Scioto Rivers. We have been specifically designed to meet the healthcare needs of the community. Our primary service area is the county of Scioto. Additional counties we serve are Lawrence, Adams and Jackson in Ohio and Greenup and Lewis in Kentucky. 0 0 21762740 4250 24478972 PORTSMOUTH HOSPITAL CORPORATION DBA KING'S DAUGHTERS MEDICAL CENTER OHIO (KDOH) OPENED FOR BUSINESS IN FEBRUARY 2013. KDOH IS LOCATED IN THE HISTORIC RIVER TOWN, PORTSMOUTH, OHIO. PORTSMOUTH SITS AT THE CONFLUENCE OF THE OHIO, SCIOTO AND LITTLE SCIOTO RIVERS. KDOH HAS BEEN SPECIALLY DESIGNED TO MEET THE HEALTHCARE NEEDS OF the community. WITH SERVICES RANGING FROM PHYSICIAN VISITS TO SURGERY, URGENT CARE, CARDIAC CATHETERIZATION AND INPATIENT STAYS, KING'S DAUGHTERS MEDICAL CENTER OHIO OFFERS RESIDENTS A CHOICE FOR WORLD-CLASS HEALTHCARE IN PORTSMOUTH AND SCIOTO COUNTY. KDOH SERVICES INCLUDE: -24/7/365 URGENT CARE CENTER -SURGICAL CARE IN ORTHOPEDICS, EAR, NOSE AND THROAT, UROLOGY AND OPHTHALMOLOGY -DIAGNOSTIC CARDIAC CATHETERIZATION-HYBRID OPERATING ROOM-INPATIENT SERVICES-DIAGNOSIS AND TREATMENT OF DIGESTIVE DISEASES / ENDOSCOPIC PROCEDURES -SPECIALLY DESIGNED AND DEDICATED UROLOGY PROCEDURE ROOM -PRIMARY CARE SERVICES -ADVANCED IMAGING TECHNOLOGY, INCLUDING MRI, CT, NUCLEAR MEDICINE, DIGITAL MAMMOGRAPHY AND X-RAY -FULL-SERVICE LAB -FAMILY PHARMACY SCIOTO COUNTY IS THE PRIMARY MARKET SERVED BY KDOH. ADDITIONAL COUNTIES WHERE KDOH SERVES PATIENTS ARE LAWRENCE, ADAMS AND JACKSON COUNTIES IN OHIO, AND GREENUP AND LEWIS COUNTIES IN KENTUCKY. 21762740 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 192 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 1 1 1 0 0 1 1 0 1 1 1 1 1 0 OH X Laurie Stewart Controller 6064089640 2201 Lexington Avenue Ashland KY 41101 Dan Cassidy Board Chairman 2.00 X X 0 0 0 Kristie Whitlatch President 1.25 61.25 X X 0 688020 11186 Chris Schmidt DO Director 10.25 40.00 X 75795 61019 2838 Neal Hatcher Director 0.25 X 0 0 0 David Jones Director 0.25 5.75 X 0 0 0 Autumn McFann treasurer 1.25 61.25 X 0 283114 14709 SHERYL MAHANEY Secretary 1.25 61.25 X 0 422753 9111 Kimberly Grooms Administrator 45.00 X 151125 0 9996 anne baker pharmacist 40.00 X 144413 0 9558 LISA REYNOLDS DIRECTOR OF PATIENT ACCESS 15.00 25.00 X 41050 59855 6957 412383 1514761 64355 2 0 1 0 Emergency Professional Services Inc 332 Congress Park Drive Dayton OH 45459 Emergency Medicine Physicians 698685 MAYO COLLABORATIVE SERVICES INC PO BOX 4100 ROCHESTER MN 559034100 REFERENCE LAB 433918 Ohio Valley Physicians Inc PO Box 390 Huntington WV 25708 Emergency Medicine Physicians 281006 Ironton Physical Therapy Inc 2700 Greenup Avenue Ashland KY 41101 Physical Therapy Services 143700 4 Net Patient Revenue 622310 23768374 23768374 MEANINGFUL USE REVENUE 622310 710598 710598 24478972 35722 -35722 -35722 -35722 interest on claims 900099 3679 3679 3679 24446929 24478972 0 -32043 X 4250 4250 268599 268599 6516090 5794586 721504 81387 73573 7814 1473728 1277385 196343 508262 428973 79289 241740 241740 839 839 3539631 3245505 294126 672 672 211608 159409 52199 717078 717078 46889 31675 15214 7098 7077 21 20156 20156 2857585 2857585 Medical Supplies 4927844 4829755 98089 Bad Debt Expense 1927414 1927414 Repairs and Maintenance 844259 819827 24432 Rental Fees 118072 118072 207203 187654 19549 24520404 21762740 2757664 0 3302349 3081626 3537422 3930434 1325378 1097433 88698 64758 36014380 15391318 23187635 20623062 31441482 28797313 676088 1390781 38751330 35465943 39427418 36856724 X -7985936 -8059411 -7985936 -8059411 31441482 28797313 -73475 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 839 839 0 Part II-B, Line 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ($748) AND THE COLLEGE OF AMERICAN PATHOLOGISTS ($91) IS ATTRIBUTABLE TO LOBBYING. 17216065 3128081 14087984 16956188 11880599 5075589 1842127 382638 1459489 20623062 Due to Affiliates 35465943 35465943 X Part X, Line 2: The Medical Center, KHF, KBNH, CDC, KHI, KDMT, KDMS, KDHF, AND KDOH 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; therefore, no tax is recorded. 1 1 X 1 X 1 X 1 1 0 1 1 52525 52525 0.00230 6616840 3900643 2716197 0.12020 6669365 3900643 2768722 0.12250 167198 167198 0.00740 25468 25468 0.00110 192666 192666 0.00850 6862031 3900643 2961388 0.13100 1 627810 6921483 9715611 -2794128 X 1 1 1 1 Portsmouth Hospital Corporation 1901 Argonne Rd Portsmouth OH 45662 www.kdmcohio.com X X X Urgent Care - 24 Hours Portsmouth Hospital Corp dba KDMC Ohio 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.kdmcohio.com/aboutus/communityoutreach X 1 15 1 www.kdmcohio.com/aboutus/communityoutreach 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X www.kingsdaughtershealth.com/Patients-Visitors/Patients X www.kingsdaughtershealth.com/Patients-Visitors/Patients X www.kingsdaughtershealth.com/Patients-Visitors/Patients X X X X X X 1 X 0 X X X X 1 X 0 1 Portsmouth Hospital Corp dba KDMC Ohio Part V, Section B, Line 5: KDOH used two types of data collection. Primary (qualitative) data was collected using focus groups, data collected from a community health survey by the Portsmouth City and Scioto County Health Departments and a key informant survey conducted by KDOH with community leaders. Secondary (quantitative) data was collected by using Community Commons website's tool to create the community health need assessment. KDOH will work in partnership with the Scioto County Health Coalition and its members; other healthcare providers; educational institutions; government agencies and business to help provide services and resources to improve the health of Scioto County. Portsmouth Hospital Corp dba KDMC Ohio Part V, Section B, Line 11: In spring/summer 2016, KDOH conducted a community health needs assessment. The assessment was conducted for KDOH's primary market of Scioto County. The top concerns were developed using primary data collected from focus groups, a community questionnaire, key informant survey and behavioral risk factor surveillance system results. The primary data was compared to secondary data collected using local, state and national statistics for Scioto County. From these multiple data sources, the KDOH leadership team adopted the needs to be met.Identified needs not being addressed: All primary needs identified are being addressed.Health needs to be met: KDOH evaluated 11 priority health needs identified within the service area and concluded that key issues could be reduced to the following priorities which could have overlapping strategies and are within KDOH's ability to address.- Obesity- Tobacco use/smoking- Heart disease- Cancer- DiabetesObesity KDOH is providing nutrition education in Scioto County through community events and patient education. In addition, KDOH is hosting or participating in events that encourage physical activity. During FY17, the following impacts were made:- Nutrition education - 2,919 individuals reached- Physical activity - 5 events, 251 individuals reachedWorking with physicians and other healthcare providers, KDOH is establishing the means to educate and track patient weight (BMI) and nutrition/physical activity counseling through the EPIC electronic medical record. - BMI assessments - 38,957 patients screened for BMI, 78% increase over FY16- KDOH is currently building the capacity through EPIC for nutrition/physical activity counseling/tracking of patients with BMI in the overweight/obese range.Tobacco Use/Smoking Cessation KDOH is working with partners to place tobacco users in successful tobacco cessation programs until this service can be provided by KDOH staff. Patients and others interested in tobacco cessation were referred to programs at King's Daughters Medical Center, Ashland, KY and Southern Ohio Medical Center, Portsmouth, Ohio. Quit tobacco materials were also provided at fairs, festivals and other events during the year.- Community members identified through community events referred to tobacco quit programs - 10 tobacco users referred- KDOH is working on capacity building to conduct tobacco cessation referrals from ambulatory care and hospital settings. The capability to do this through the electronic medical record should be complete in 2018.Heart Disease To reduce the mortality/morbidity from cardiovascular disease, KDOH is providing education about the signs and symptoms of a heart attack, with appropriate response in the community. In addition, free healthy heart screenings are being provided at fairs, festivals and other community events. More comprehensive testing is being provided low-cost as blood profiles and vascular screenings for individuals that want more information.- Heart attack signs and symptoms education - 1,649 provided educational materials- Healthy Heart screenings - 178 individuals screened- Low-cost blood profiles - 185 screened- Low-cost vascular screenings - 62 screenedHealth messages on social media were also used to promote heart healthy living.Cancer KDOH has focused on three types of cancer identified through the need assessment: skin, prostate and lung. By providing free or reduced cost screening, KDOH is working to identify cancer early and reduce morbidity and mortality.- Skin cancer screening - 43 individuals screened- Lung cancer screening - 51 individuals screened- Prostate cancer screening - 8 individuals screenedIn addition, KDOH provided the following activities:- Breast cancer education - 737 individuals- Skin cancer education - 46 individuals- Mobile mammography - 647 servedDiabetes Mellitus KDOH has a full time diabetic educator that works with patients and the community to raise awareness for diabetes mellitus and help educate individuals on preventive tactics. As part of this goal, KDOH offers education for newly diagnosed diabetic patients, reduced cost blood profiles, free non-fasting blood sugar tests in the community, nutrition education and diabetes support groups.- Diabetic patient education - 120 served- Diabetes education in the community - 298 served- Reduced cost blood profiles - 185 served- Free non-fasting blood sugar testing - 284 served- Support groups (Type 1) - 97 served- Healthy eating education - 2,919Other screening and health education activities:Screenings, immunizations and physicals:- sports physicals - 57 adults (college), 336 children- flu shots - 372 - low cost vascular screenings - 62 served- General health screenings (includes blood pressure, oxygen, total cholesterol, blood sugar screenings) - 1,181 screenedHealth education:- First aid - 60 adults, 201 children served- Stroke - 307 adults, 150 children served- Depression Education - 11 educated- Pregnancy education - 130 educated- Tobacco education - 108 educated- Maternal and lactating nutrition education - 51 educated- Heat stroke education - 450 educated- Stretching and taping (for sports) education - 48 educatedOther Community Activities:- Blood Drives: KDOH partnered with the American Red Cross to increase blood donations by encouraging team members to participate in local blood drives during work hours. - Coat drive: KDOH team members, in partnership with the community and Life Point Church, donated coats, hats and gloves to the Salvation Army for those in need. 63 coats were collected.- Backpack Program: team members made backpacks for 40 elementary aged children to ensure students start the year with the necessary school supplies and at least one new outfit.- Adopt-a-family: team members adopted 2 families with a total of 10 family members at Christmas time where they provided gifts and food to those in need.- Veteran food drive: team members donated food to help replenish the empty food closet at the local Portsmouth American Legion. - Salvation Army: team members donated time to help facilitate Christmas gifts to families in need in Scioto County along with the Salvation Army. A food drive was also held by team members to help provide meals for these families not only at Christmas time but throughout the year and serving meals in March in the soup kitchen. - Komen Cook Off: team members cook food to raise money to be matched by KDOH to donate to the Susan G. Komen Columbus - $200 raised.- PMHA back pack drive: National Night Out backpacks/school supplies drive - 21 backpacks donated.- Burg Football Mom's Clinic: sports nutrition to moms and athletes - 20 participants Portsmouth Hospital Corp dba KDMC Ohio Part V, Section B, Line 13b: Does not cover services deemed not medically necessary Portsmouth Hospital Corp dba KDMC Ohio Part V, Section B, Line 23: Only for services excluded from eligibility as defined within the FAP, which are defined as elective services and therefore not medically necessary. Portsmouth Hospital Corp dba KDMC Ohio Part V, Section B, Line 24: FAP eligible patients are charged the gross charge for any services excluded from eligibility as defined within the FAP, which are defined as elective services and therefore not medically necessary. Part I, Line 7: KDOH used worksheet 2 provided in the Schedule H Instructions (Form 990) to calculate a cost to charge ratio. This ratio was used to calculate charity care at cost (a. above). To calculate the unpaid costs of Medicaid (b), the hospital's cost accounting system was used. Remaining items were reported at net expense. Part I, Ln 7 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 $1,927,414. Part III, Line 2: Bad debt expense is recorded after any discounts and payments are made on patient accounts. KDOH used worksheet 2 provided in the Schedule H Instructions (Form 990) to calculate a cost of charge ratio. This ratio was used to calculate bad debt expense at cost. Part III, Line 3: BAD DEBT EXPENSE IS RECORDED AFTER ANY DISCOUNTS AND PAYMENTS ARE MADE ON PATIENT ACCOUNTS. HOWEVER, SINCE THE RECENT CHANGE IN THE FINANCIAL ASSISTANCE POLICY, THE BUSINESS OFFICE NO LONGER KEEPS TRACK OF "NO-RESPONSE" APPLICATIONS ANNUALLY AND DOES NOT FEEL THAT THE PORTION CONSIDERED TO BE A COMMUNITY BENEFIT IS MATERIAL. Part III, Line 4: Patient accounts receivable are reported at net realizable value. Accounts are written off when they are determined to be uncollectible based upon management's assessment of individual accounts. In evaluating the collectability of patient accounts receivable, KDOH analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts.KDOH 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 billed rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. 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. The shortfall should count as a community benefit. The hospital uses allowable costs per the Medicare Cost Report. The 2017 cost report data and Provider Summary Report (PSR) was used to compute the information. Part III, Line 9b: The hospital has a written policy for bad debt. Uninsured patients are screened for eligibility for Medicare, Medicaid and other such programs by a contracted vendor. All patients, insured and uninsured, with valid mailing addresses receive post-discharge billing statements over the course of a 120 day period. If there are no active disputes or other payment sources available, and the balance is unpaid at the end of the statement period, the account will be placed with a collection agency to report as a bad debt. Each statement includes information regarding the availability of the hospital's financial assistance program along with a number where representatives can be reached for assistance.According to our F/A Policy KDOH will forego extraordinary collection actions against an individual including, without limitation, lawsuits, liens on residences, arrests, bodily attachments or similar processes, until a reasonable effort has been made to determine whether the individual is eligible for assistance under this financial assistance policy. 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 and hospital data. We are actively involved in the community participating on the Scioto Co. Health Coalition, 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 spring/summer 2016, KDOH conducted a community health needs assessment. The assessment was conducted for KDOH's primary market of Scioto County. The top concerns were developed using primary data collected from focus groups, a community questionnaire, key informant survey and behavioral risk factor surveillance system results. The primary data was compared to secondary data collected using local, state and national statistics for Scioto County. From these multiple data sources, the KDOH leadership team adopted the needs to be met. 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 King's Daughters. 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. Patients requiring care with income below 300% of the Federal Poverty Level qualify for free or reduced cost services. King's Daughters also contracts with Cardon Outreach to assist patients in government enrollment programs. 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. 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 Ohio (KDOH) is located in the historic river town Portsmouth, OH. Portsmouth sits at the confluence of the Ohio, Scioto and Little Scioto Rivers. According to the U.S. Census Bureau, Scioto County has more than 78,000 residents with 20,226 people residing in Portsmouth, Scioto County's largest city. The Scioto County population is predominantly white - 94.4%; with 2.6% black and all other races making up 3%. The per capita income for the county is $19,769 and more than 25% of the population is in poverty. 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 officials, schools, Scioto County Health coalition, Salvation Army, plus more. 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. We work with King's Daughters in Ashland to provide include more than 50 screening and educational events each month and mobile health services. Part VI, Line 6: King's Daughters Medical Center OHIO (KDOH) is part of an affiliated health care delivery system. The system operates another hospital, King's Daughters Medical Center (KDMC) in ASHLAND, KY. KDMC's primary service area encompasses six counties in two states: Boyd, Carter, Greenup and Lawrence in Kentucky and Lawrence and Scioto in Ohio. KDMC offers services ranging from surgery, cardiac care and EMERGENCY care. KDMC provides charity care and participates in Government programs.The system provides physician services through King's Daughters Medical Specialties, Inc. (KDMS). KDMS provides charity care and participates 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. 0 1 0 0 0 0 0 0 0 Kristie Whitlatch President 0 500034 0 68054 0 119932 0 3975 0 7211 0 699206 0 117310 Autumn McFann treasurer 0 226377 0 48871 0 7866 0 3975 0 10734 0 297823 0 0 SHERYL MAHANEY Secretary 0 289847 0 42345 0 90561 0 3975 0 5136 0 431864 0 88629 Kimberly Grooms Administrator 130398 0 14158 0 6569 0 2305 0 7691 0 161121 0 0 0 anne baker pharmacist 142545 0 1808 0 60 0 2178 0 7380 0 153971 0 0 0 Part I, Line 3 COMPENSATION FOR THE CEO IS DETERMINED BY ASHLAND HOSPITAL CORPORATION (RELATED ORGANIZATION) USING THE FOLLOWING METHODS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY/STUDY AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE. Part I, Line 4b SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: SHERYL MAHANEY - $88,629 KRISTIE WHITLATCH - $117,310 THERE WERE NO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS/DEFERRALS IN 2016. THE CEO AND VICE PRESIDENTS ARE ELIGIBLE TO RECEIVE DISCRETIONARY INCENTIVES BASED ON CERTAIN METRICS (QUALITY MEASURES, INDIVIDUAL GOALS, ETC.). THESE AWARDS ARE DETERMINED BY THE BOARD AND VESTED OVER A 5-10 YEAR PERIOD IF THE INDIVIDUAL REMAINS WITH THE ORGANIZATION. 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. Form 990, Part VI, Section A, line 6 King's Daughters Health Sytem, Inc. is the sole corporate member of Portsmouth Hospital Corporation. Form 990, Part VI, Section A, line 7a King's Daughters Health System, Inc. elects the board members of Portsmouth Hospital Corporation on an annual basis or until a successor is named. Form 990, Part VI, Section A, line 7b As the parent organization of the health care system, King's Daughters Health System, Inc. (KDHS) has certain governance rights with respect to PHC. Those rights require certain significant PHC actions to now also be approved by KDHS, including, among others, a change of membership or sale of PHC, electing or removing PHC's directors and officers, amending PHC's articles and bylaws, or any bankruptcy, liquidation or dissolution of PHC, including the tax-exempt organization to whom PHC's assets are distributed upon its dissolution. KDHS' board of trustees may identify additional PHC actions that must be approved by KDHS in addition to those specifically listed in PHC's articles and bylaws. Form 990, Part VI, Section B, line 11b THE 990 WILL BE REVIEWED BY THE CFO/TREASURER AND CONTROLLER OF ASHLAND HOSPITAL CORPORATION. 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 Ohio (KDOH) requires all directors and officers 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 KDOH'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. IN ADDITION, EMPLOYEES OF KDOH CERTIFY THAT NO CONFLICTS OF INTEREST EXIST OR OBTAIN AN ADVANCE WAIVER OF ANY CONFLICTS. KDOH'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 KDOH's Board of Directors reports any conflict or potential conflict to the Chairman of the Board, the CEO and/or the General Counsel, 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 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 of King's Daughters Health System (KDHS), KDHS engaged sullivan cotter and associates, inc., a leading independent compensation consulting company specializing in executive, employee and physician compensation and benefits for the health care and not-for-profit industry, to assist in determining compensation of the CEO,vice presidents, and chief medical officers. This is an annual process and sullivan cotter's most recent executive compensation review was performed in 2016. 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 KDHS 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 sullivan cotter data coupled with the performance of the organization as well as the personal performance of each executive is the basis for KDHS's Human Resource & Compensation Committee's review and recommendations, and the Board's review and approval of 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 Compliance Officer VP, Chief Financial Officer VP, Chief Legal & Regulatory Officer/General Counsel Chief Medical Officers VP, People Services VP, Executive Director King's Daughters Integrated Physicians VP, Patient Services/Chief Nursing Officer 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. Form 990, Part IX, line 11g PHYSICIAN SERVICES: Program service expenses 2,357,507. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,357,507. other fees: Program service expenses 887,998. Management and general expenses 294,126. Fundraising expenses 0. Total expenses 1,182,124. ASHLAND NURSING HOME CORPORATION 2500 STATE ROUTE 5 ASHLAND KY 41102 611386016 Nursing Home KY 501(c)(3) Line 10 Ashland Hospital Coporation 0 CHILD DEVELOPMENT CENTER CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 010560598 Child Care KY 501(c)(3) Line 10 Ashland Hospital Coporation 0 KENTUCKY HEART INSTITUTE INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611255904 Physicians KY 501(c)(3) Line 10 ashland Hospital Coporation 0 KENTUCKY HEART FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 260791997 Medical Research KY 501(c)(3) Line 7 Ashland Hospital Coporation 0 KENTUCKY MEDICAL LOGISTICS INC 425 22ND STREET ASHLAND KY 41101 264736971 Medical Transport KY 501(c)(3) Line 10 ashland Hospital Coporation 0 KING'S DAUGHTERS HEALTH FOUNDATION INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 611035701 Fundraising KY 501(c)(3) Line 12c, III-FI ashland Hospital Coporation 0 KING'S DAUGHTERS HEALTH SYSTEM 2201 LEXINGTON AVENUE ASHLAND KY 41101 274553836 Healthcare KY 501(c)(3) Line 12b, II N/A 0 KING'S DAUGHTERS MEDICAL SPECIALTIES INC 2201 LEXINGTON AVENUE ASHLAND KY 41101 264183569 physicians KY 501(c)(3) Line 10 ashland Hospital Coporation 0 ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVENUE ASHLAND KY 41101 610444716 Healthcare KY 501(c)(3) Line 3 King's Daughters Health System 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 0 0 0 1 1