2017-08-15T11:42:45-05:00 2016-09-30 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 1650 MARKET STREET SUITE 4500 PHILADELPHIA PA 19103 990 2015-10-01 453215312 PORTSMOUTH HOSPITAL CORPORATION PORT 7409914000 1901 ARGONNE AVENUE PORTSMOUTH OH 45662 AUTUMN MCFANN TREASURER 7409914000 2017-08-11 1 JULIUS C GREEN CPA P00350393 2159720701 2015 2021-01-29 14:40:06Z KING'S DAUGHTERS MEDICAL CENTER OHIO KRISTIE WHITLATCH 2201 LEXINGTON AVENUE ASHLAND KY 41101 24938378 0 X WWW.KDMCOHIO.COM X 2010 OH TO CARE. TO SERVE. TO HEAL. 5 3 188 3 0 0 0 0 21458473 24924070 -34468 0 100125 14308 21524130 24938378 3832 12595 0 0 8324704 8226232 0 0 0 15174505 14341332 23503041 22580159 -1978911 2358219 31708025 31441482 42052180 39427418 -10344155 -7985936 X KINGS 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 WITH A POPULATION OF 78,000. ADDITIONAL COUNTIES WE SERVE ARE LAWRENCE, ADAMS AND JACKSON IN OHIO AND GREENUP AND LEWIS IN KENTUCKY. MORE THAN 25% OF OUR SERVICE MARKET IS BELOW THE POVERTY LEVEL INCLUDING 37% OF THOSE UNDER AGE 18 AND 14.5% OF RESIDENTS 65 OR OVER. SCIOTO COUNTY IS RANKED 83 OUT OF 88 IN OHIO FOR HEALTH OUTCOMES AND QUALITY OF LIFE AND 87 OUT OF 88 FOR HEALTH FACTORS LIKE SOCIOECONOMIC STATUS AND PHYSICAL ENVIRONMENT. 0 0 19812652 12595 24924070 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 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.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. ACCORDING TO THE COUNTY HEALTH RANKINGS AND ROADMAPS, SPONSORED BY THE ROBERT WOOD JOHNSON FOUNDATION, SCIOTO COUNTY IS RANKED 83/88 IN THE STATE OF OHIO FOR HEALTH OUTCOMES AND QUALITY OF LIFE AND 87/88 FOR HEALTH FACTORS LIKE SOCIOECONOMIC STATUS AND PHYSICAL ENVIRONMENT. 19812652 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 0 188 1 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 0 1 1 0 0 1 1 0 1 1 1 1 1 0 OH X GREG WHITLOCK CONTROLLER 6064080160 2201 LEXINGTON AVENUE ASHLAND KY 41101 CASSIDY DAN BOARD CHAIRMAN 2.00 X X 0 0 0 HATCHER NEAL DIRECTOR 0.25 X 0 0 0 JONES DAVID DIRECTOR 0.50 6.00 X 0 0 0 SCHMIDT CHRIS DO DIRECTOR 10.25 X 0 86975 0 WHITLATCH KRISTIE PRESIDENT 1.25 61.25 X X 0 623142 13721 MCFANN AUTUMN TREASURER 1.25 61.25 X 0 257682 13660 MAHANEY SHERYL SECRETARY 1.25 61.25 X 0 404207 14223 GROOMS KIMBERLY ADMINSTRATOR 50.00 X 139627 0 23496 BAKER ANNE PHARMACIST 40.00 X 141500 0 13086 JACKSON FRED FORMER PRESIDENT 0.00 X 0 855151 0 281127 2227157 78186 2 1 1 0 OHIO VALLEY PHYSICIANS INC PO BOX 390 HUNTINGTON WV 25708 EMERGENCY DEPARTMENT PHYSICIANS 1436962 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 554809146 REFERENCE LAB 278702 ABUL-KHOUDOUD HASSAN MD 108 WINDEMERE DRIVE RUSSELL KY 41169 PHYSICIAN SERVICES 213070 3 NET PATIENT REVENUE 622310 24394968 24394968 MEANINGFUL USE REVENUE 622310 529102 529102 24924070 INTEREST ON CLAIMS 900099 14308 14308 14308 24938378 24924070 0 14308 X 12595 12595 186750 186750 6111525 5417473 694052 1468875 1327436 141439 459082 399034 60048 241740 241740 5802 5802 3096766 2600698 496068 210840 157490 53350 711345 711345 91946 91017 929 17683 17651 32 1924 1924 2949277 2949277 MEDICAL SUPPLIES 4089865 3994323 95542 BAD DEBT EXPENSE 1566474 1566474 REPAIRS AND MAINTENANCE 874491 832377 42114 RENTAL FEES 248432 248432 234747 198375 36372 22580159 19812652 2767507 0 1822153 3302349 3228567 3537422 930839 1325378 62734 88698 35763758 12576123 25663732 23187635 31708025 31441482 1434467 676088 40617713 38751330 42052180 39427418 X -10344155 -7985936 -10344155 -7985936 31708025 31441482 2358219 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 5802 5802 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO THE OHIO HOSPITAL ASSOCIATION ($994) AND THE COLLEGE OF AMER PAT ($4,808) IS ATTRIBUTABLE TO LOBBYING. 17094962 2745517 14349445 16826669 9529869 7296800 1842127 300737 1541390 23187635 DUE TO AFFILIATES 38751330 38751330 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 177850 177850 0.00850 6314393 3608606 2705787 0.12880 6492243 3608606 2883637 0.13730 174628 174628 0.00830 26555 26555 0.00130 201183 201183 0.00960 6693426 3608606 3084820 0.14690 1 511922 4281143 5576245 -1295102 X 1 1 1 1 PORTSMOUTH HOSPITAL HOSPITAL 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 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X X 1 X WWW.KDMCOHIO.COM/FINANCIALRESOURCECENTER X WWW.KDMCOHIO.COM/FINANCIALRESOURCECENTER X X X X 1 X 0 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: WE OFFER A VARIETY OF SCREENINGS AND EDUCATIONAL PROGRAMS ON DOZENS OF TOPICS THROUGHOUT THE YEAR. WE MAKE SURE TO ALIGN SCREENING AND EDUCATION EFFORTS WITH THE RESULTS OF OUR HEALTH NEEDS ASSESSMENT. WE ALSO MAKE SURE THAT OUR SPONSORSHIPS AND DONATIONS ALIGN WITH OUR MOST RECENT HEALTH NEEDS. IN ADDITION, WE KNOW THAT COLLABORATION WITH COMMUNITY PARTNERS IS VERY IMPORTANT AND PLAN TO UTILIZE PARTNERSHIPS FOR IMPLEMENTATION. SUBSTANCE ABUSE DID SURFACE AS A NEED BUT KING'S DAUGHTERS OHIO NEITHER HAS THE EXPERTISE OR RESOURCES TO SIGNIFICANTLY IMPACT THIS ISSUES. KING'S DAUGHTERS OHIO WILL, HOWEVER, SUPPORT OTHER ORGANIZATIONS IN THE COMMUNITY WORKING ON THESE ISSUES. PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 20E: SIGNAGE POSTED AT REGISTRATION LOCATIONS INDICATING FAP AVAILABILITY AND CONTACT INFO. PORTSMOUTH HOSPITAL CORP DBA KDMC OHIO PART V, SECTION B, LINE 22D: THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS IS BASED ON THE AVERAGE OVERALL COMMERCIAL RATE WITH A 50% SELF PAY DISCOUNT. 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 $1,566,474. PART III, LINE 2: 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 2016 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. 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. PART VI, LINE 7, REPORTS FILED WITH STATES KY,OH 1 1 0 0 0 0 0 0 0 WHITLATCH KRISTIE PRESIDENT 0 452763 0 0 0 170379 0 0 0 13721 0 636863 0 89713 MCFANN AUTUMN TREASURER 0 212480 0 0 0 45202 0 0 0 13660 0 271342 0 0 MAHANEY SHERYL SECRETARY 0 281136 0 0 0 123071 0 0 0 14223 0 418430 0 75383 GROOMS KIMBERLY ADMINSTRATOR 126580 0 0 0 13047 0 0 0 23496 0 163123 0 0 0 BAKER ANNE PHARMACIST 139684 0 0 0 1816 0 0 0 13086 0 154586 0 0 0 JACKSON FRED FORMER PRESIDENT 0 0 0 0 0 855151 0 0 0 0 0 855151 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, LINES 4A-B FRED JACKSON RECEIVED A SEVERANCE PAYMENT OF $854,833. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: SHERYL MAHANEY - $75,383 KRISTIE WHITLATCH - $89,713 THERE WERE NO SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN CONTRIBUTIONS/DEFERRALS IN 2015. 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 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 III, LINE 4A NEEDS ASSESSMENT: IN SPRING 2013, IN PARTNERSHIP WITH ASHLAND HOSPITAL CORPORATION, KDOH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT. THE ASSESSMENT WAS CONDUCTED FOR KDOH'S PRIMARY MARKET OF SCIOTO COUNTY. THE ASSESSMENT SHOWED: - LEADING CAUSES OF DEATH (AGE ADJUSTED) ARE HEART DISEASE, CANCER, COPD AND UNINTENTIONAL INJURY. THESE RATES ARE HIGHER IN SCIOTO COUNTY THAN THE NATION. - PEOPLE LIVING IN SCIOTO COUNTY LIVE UNHEALTHY LIFESTYLES WITH 33% OF ADULTS SMOKING, 34% OBESE AND 31% PHYSICALLY INACTIVE. THESE RATES ARE ALL WELL ABOVE THE NATIONAL AVERAGE. - SCIOTO COUNTY HAS A HIGH NUMBER OF VULNERABLE POPULATIONS, WITH A HIGH LOW BIRTH WEIGHT RATE OF 9.4% (8.6% NATIONALLY), 17% OF THE POPULATION UNINSURED AND 37% OF CHILDREN LIVING IN POVERTY. - ENVIRONMENTAL FACTORS OFTEN CONTRIBUTE TO THE HEALTH OF THE COMMUNITY. IN SCIOTO COUNTY THERE ARE BARRIERS TO LIVING HEALTHY, INCLUDING LOW ACCESS TO RECREATIONAL FACILITIES, LIMITED ACCESS TO HEALTHY FOODS AND A HIGHER THAN AVERAGE NUMBER OF FAST FOOD RESTAURANTS. COMMUNITY INPUT WAS SOUGHT THROUGH FOCUS GROUPS AND SURVEYS, WITH THE FOLLOWING FINDINGS: - FOCUS GROUP PARTICIPANTS CITED, AS BARRIERS TO GOOD HEALTH, IN SCIOTO COUNTY THE FOLLOWING: POOR PARENTING CONTRIBUTING TO CHILDREN HAVING BAD EATING AND SLEEP HABITS UNHEALTHY LIFESTYLES DRUGS AND CRIME RELATED TO DRUGS LACK OF JOBS - RESPONDENTS TO THE HEALTH SURVEY CITED THE FOLLOWING TOP ISSUES IN THE COUNTY: SUBSTANCE ABUSE OBESITY CHRONIC DISEASES - CANCER, HEART DISEASE AND DIABETES IN PARTNERSHIP WITH THE ASHLAND HOSPITAL CORPORATION, AN IMPLEMENTATION PLAN WAS DEVELOPED AND APPROVED BY THE BOARD OF DIRECTORS, AND IMPLEMENTATION BEGAN IN 2014-2016. THE FOLLOWING COMMUNITY ACTIVITIES WERE PLANNED AND EXECUTED WHILE KEEPING IN MIND THE ASSESSMENT'S TOP PRIORITIES. KING'S DAUGHTERS OHIO DID RECENTLY COMPLETE THEIR COMMUNITY HEALTH NEEDS ASSESSMENT FOR FISCAL YEAR 2016 AND THE BOARD OF DIRECTORS APPROVED THE NEW IMPLEMENTATION PLAN FOR FISCAL YEARS 2017-2019. THE NEW IMPLEMENTATION PLAN WILL BE REPORTED ON NEXT FISCAL YEAR. COMMUNITY BUILDING ACTIVITIES: AS PART OF OUR COMMUNITY BENEFIT, KDOH OFFERS FREE HEALTH SCREENINGS AND EDUCATIONAL OPPORTUNITIES IN THE COMMUNITY. DURING FISCAL YEAR 2016, KDOH PROVIDED THE FOLLOWING HEALTH SCREENINGS IN SCIOTO COUNTY: - CARPAL TUNNEL- 15 ADULTS SERVED - PROSTATE CANCER - 18 ADULTS SERVED - GENERAL HEALTH (TOTAL CHOLESTEROL, BLOOD PRESSURE, BLOOD SUGAR) - 1,442 ADULTS SERVED - HEART - (TOTAL CHOLESTEROL, BLOOD PRESSURE, BLOOD SUGAR AND EKG) - 550 ADULTS SERVED - MOBILE MAMMOGRAPHY- 934 ADULTS - DERMA SCAN- 45 ADULTS; 16 CHILDREN - SKIN CANCER- 54 ADULTS - SPORTS PHYSICALS- 0 ADULTS, 565 CHILDREN - FIRST AID STATION- 42 CHILDREN HELPING PEOPLE LEARN THEIR RISK FOR DISEASE AND HOW TO TAKE PREVENTIVE MEASURES TO MINIMIZE RISK IS ALSO IMPORTANT. KDOH PROVIDED HEALTH EDUCATION TO THE FOLLOWING: - BONE HEALTH- 48 ADULTS; 40 CHILDREN - BREAST CANCER - 148 ADULTS; 40 CHILDREN - COLON CANCER- 130 ADULTS - HEART- 962 ADULTS, 50 CHILDREN - CHF-CONGESTIVE HEART FAILURE- 134 ADULTS SERVED - HAND WASHING- 15 ADULTS, 100 CHILDREN - NUTRITION- 3,257 ADULTS, 507 CHILDREN - SKIN CANCER - 138 ADULTS SERVED - DIABETES - 954 ADULTS, 74 CHILDREN - EXERCISE- 539 ADULTS, 229 CHILDREN - FIRST AID- 12 ADULTS, 50 CHILDREN - FLU- 643 ADULTS, 5 CHILDREN - POISON- 120 ADULTS; 75 CHILDREN - PREGNANCY- 22 ADULTS; 10 CHILDREN - SAFETY, OTHER- 36 ADULTS - STROKE - 214 ADULTS - SUMMER SAFETY- 295 ADULTS, 60 CHILDREN - TOBACCO - 219 ADULTS, 194 CHILDREN - WHEEL OF HEALTH- 10 ADULTS - MOSQUITO/ZIKA VIRUS- 3,000 ADULTS - MISCELLANEOUS HEALTH- 78 ADULTS; 28 CHILDREN - A VARIETY OF HEALTH TOPICS MAY BE OFFERED ONLY ONCE OR TWICE A YEAR. THOSE TOPICS ARE CONSIDERED MISCELLANEOUS IN NATURE AND ARE INCLUDED AS SUCH. IN ADDITION, KDOH, IN PARTNERSHIP WITH ASHLAND HOSPITAL CORPORATION, SENT OUT HEALTH TEAMS INTO THE COMMUNITY TO MEET PEOPLE ON THEIR TIME AND IN THE PLACES THAT ARE COMFORTABLE FOR THEM- SCHOOLS, LIBRARIES, WORKSITES, HOUSING COMPLEXES, GROCERY STORES AND MORE. INDIVIDUALS ATTENDING HEALTH SCREENINGS ARE PROVIDED COUNSELING ON THEIR PERSONAL RESULTS AT THE TIME OF THE EVENT. IDENTIFYING THOSE AT RISK FOR HEART AND VASCULAR DISEASE, EDUCATING THE PUBLIC ABOUT HEART ATTACK AND STROKE SIGNS AND SYMPTOMS AND REDUCING TOBACCO USE ARE THREE OF OUR FOCUS AREAS. SCIOTO COUNTY HEALTH COALITION: KING'S DAUGHTERS MEDICAL CENTER OHIO IS AN ACTIVE PARTNER WITH THE SCIOTO COUNTY HEALTH COALITION. THIS COALITION WAS CALLED TOGETHER IN THE SPRING OF 2012 BY STATE REPRESENTATIVE, TERRY JOHNSON, MD. KING'S DAUGHTERS MEDICAL CENTER OHIO HAS PARTICIPATED IN THEIR MONTHLY MEETINGS, PROVIDED MOBILE UNITS FOR COALITION SCREENING EVENTS AND TAKEN A LEADERSHIP ROLE ON THE SUBCOMMITTEES FOR HEALTH AND WELLNESS. THE SCIOTO COUNTY HEALTH COALITION HAS HELPED STRENGTHEN KDOH'S RELATIONSHIP WITH OTHER HEALTH ORGANIZATIONS AND COMMUNITY LEADERS, INCLUDING: SOUTHERN OHIO MEDICAL CENTER, PORTSMOUTH CITY HEALTH DEPARTMENT, COMPASS COMMUNITY HEALTH, THE CITY OF PORTSMOUTH, YOST ENGINEERING, SHAWNEE STATE UNIVERSITY, COUNTY COMMISSIONERS, LOCAL SCHOOL BOARDS, SHAWNEE MENTAL HEALTH, THE CENTER FOR APPALACHIAN DEVELOPMENT, THE PORT AUTHORITY, ETC. OTHER KDOH PARTNERSHIPS: KDOH KNOWS THE POWER OF PARTNERSHIPS. IN 2016, KDOH PARTNERED WITH THE FOLLOWING: -CITY OF PORTSMOUTH AND OTHER LOCAL GOVERNMENTS -LOCAL CHAMBER OF COMMERCE -LOCAL EMS SERVICES -NON-PROFITS- AMERICAN RED CROSS, AMERICAN HEART ASSOCIATION, SUSAN G. KOMEN COLUMBUS, UNITED WAY, SALVATION ARMY, PORTSMOUTH METROPOLITAN HOUSING AUTHORITY, SCIOTO COUNTY HEALTH COALITION, THE COUNSELING CENTER, PLUS MORE -CIVIC ORGANIZATIONS - I.E. ROTARY CLUB -SEVERAL SCHOOL DISTRICTS AND NEARBY COLLEGES AND UNIVERSITIES, -OHIO LAW ENFORCEMENT -AREA SENIOR CENTERS -GIRL SCOUTS -NUMEROUS CHURCHES TO DELIVER HEALTH SERVICES AND EDUCATION TO RESIDENTS. OTHER SERVICES: FLU SHOTS: DURING THE FISCAL YEAR, KDOH PROVIDED 648 FREE FLU SHOTS THROUGHOUT THE COMMUNITY. FLU SHOTS ARE DELIVERED THROUGH A VARIETY OF SETTINGS AND IN MULTIPLE COUNTIES SERVED BY THE MEDICAL CENTER. GO RED FOR GIRL SCOUTS OHIO: GO RED FOR GIRL SCOUTS IS A PROGRAM THAT TOOK PLACE IN FEBRUARY 2016 IN HONOR OF AMERICAN HEART MONTH. FUNDED BY KING'S DAUGHTERS, GIRLS HAD THE OPPORTUNITY TO EXPLORE EXERCISE TECHNIQUES SUCH AS ZUMBA, MAKE THEIR OWN HEALTHY BANANA SPLITS WITH YOGURT AND VARIETIES OF COLORFUL FRUITS, HOW TO PROPERLY WASH THEIR HANDS TO PREVENT SPREADING GERMS WITH THE HELP OF GLO-GERM AND A BLACK LIGHT, A LEARN HOW EVERYDAY ACTIVITIES SUCH AS BRUSHING THEIR TEETH CAN HELP THEIR HEARTS. KING'S DAUGHTERS, ITS COMMUNITY RELATIONS TEAM AND THE GIRL SCOUTS ALL AIM TO TEACH GIRLS HEALTHY CHOICES AT AN EARLIER AGE. GIRLS WHO PARTICIPATED IN THE PROGRAM RECEIVED MATERIALS TO SHARE WHAT THEY HAD LEARNED WITH THEIR FAMILIES. THERE WERE APPROXIMATELY 50 GIRLS IN ATTENDANCE. MY CHART: KDOH PROVIDES A FREE TOOL TO PATIENTS TO HELP THEM MANAGE THEIR OWN HEALTH. MY CHART GIVES PATIENTS PERSONALIZED ACCESS TO PARTS OF THEIR MEDICAL RECORD. PATIENTS CAN VIEW THEIR HEALTH SUMMARY, TRACK HEALTH OVER TIME AND SCHEDULE APPOINTMENTS AS NEEDED. HEALTHY BUCKS PROGRAM- A PROGRAM SPONSORED BY KDOH AT THE PORTSMOUTH FARMER'S MARKET. AN EMPLOYEE OF KDOH SETS UP A FEATURED TABLE AND INVITES COMMUNITY MEMBERS TO TASTE TEST DIFFERENT HEALTHY FOODS EACH WEEK, EACH RECIPE IS FEATURED ON THE KDOH FACEBOOK PAGE. IN RETURN, PARTICIPANTS ARE GIVEN HEALTH BUCKS TO PURCHASE FRESH FRUITS AND VEGETABLES. APPROXIMATELY 300 CHILDREN AND ADULTS WERE SERVED THROUGH THIS PROGRAM. SHAWNEE LODGE CHRISTMAS OPEN HOUSE- TIPS FOR HEALTHY EATING DURING THE HOLIDAYS WAS PROVIDED BY THE KDOH REGISTERED DIETITIAN. FUEL UP TO PLAY 60- KDOH PARTNERED WITH WHEELERSBURG TO BRING IN FUEL UP TO PLAY 60 FUNDS FOR BETTER NUTRITION AND PHYSICAL ACTIVITY. POSITIVELY PORTSMOUTH SHOW- A KDOH REGISTERED DIETITIAN APPEARED ON THE SHOW TO DISCUSS HEALTH EATING AND LIVING. NATIONAL NUTRITION MONTH- THE KDOH TEAM HOSTED A HEALTHY RECIPE COOK-OFF TO RAISE MONEY FOR THE STEVEN HUNTER POWER PACK PROGRAM WHICH PROVIDES FOOD TO UNDER NOURISHED CHILDREN IN SCIOTO COUNTY. SUPPORT GROUPS- KDOH ESTABLISHED A TYPE 1 DIABETES SUPPORT GROUP DURING FY15 AND CONTINUED IN FY16. THE GROUP IS LED BY A KDOH DIETITIAN AND THE MEETINGS ARE HELD BI-MONTHLY AT KDOH. THE SUPPORT GROUP SERVED 71 ADULTS AND 20 CHILDREN IN FY16. CELEBRITY CHEF- AN EVENT IN PARTNERSHIP WITH THE COUNSELING CENTER. FUNDS RAISED SUPPORT THEIR SUMMER OUTREACH PROGRAM FOR CHILDREN IN SCIOTO COUNTY. DANCING WITH OUR STARS- A KDOH EMPLOYEE PARTICIPATED IN DANCING WITH OUR STARS TO BENEFIT AND SUPPORT THE OHIO RIVER VALLEY CHAPTER OF THE RED CROSS. CHILI COOK-OFF FOR A CURE- HELD IN PARTNERSHIP WITH THE SUSAN G. KOMEN FOUNDATION. FORM 990, PART III, LINE 4A PORTSMOUTH RIVER DAYS- PARTICIPATED IN A COMMUNITY FESTIVAL AND PARADE WITH BATMAN AND HIS BAT MOBILE WITH SUPER HERO FRIENDS AND KDOH HEROES OF HEALTHCARE. PORTSMOUTH AREA JAYCEES- PARTICIPATED IN COMMUNITY PARADE AND DONATION OF TOYS FOR THE JAYCEES AREA TOY DRIVE. DONATIONS - DONATED MORE THAN 30 BUSINESS DRESS BLAZERS TO THE COUNSELING CENTER'S DRESS FOR SUCCESS PROGRAM THAT HELPS RECOVERING ADDICTS GET BACK INTO THE WORKFORCE, BY PROVIDING RESOURCES FOR INTERVIEWS. KDOH ALSO DONATED OVER 150 USED TONERS TO A LOCAL CATHOLIC SCHOOL. KING'S DAUGHTERS OHIO PARTNERS WITH KING'S DAUGHTERS IN KENTUCKY ON THE FOLLOWING ACTIVITIES: BUILD-A-BED: EACH YEAR KDOH TEAM MEMBERS PARTNER WITH KDMC TEAM MEMBERS ON MAKING GENEROUS DONATIONS OF BLANKETS, COMFORTERS, PILLOWS, BOOKS, HYGIENE ITEMS AND STUFFED ANIMALS FOR BUILD-A-BED MOREHEAD, AN AGENCY THAT MAKES A DIFFERENCE IN CHILDREN'S LIVES. MANY KENTUCKY CHILDREN GO TO BED EACH NIGHT IN MAKESHIFT CIRCUMSTANCES - SLEEPING ON THE FLOOR, COUCH, WITH PARENTS OR SIBLINGS. BACKPACK PROGRAM: TEAM MEMBERS MADE BACKPACKS FOR ELEMENTARY AGED CHILDREN TO ENSURE STUDENTS START THE YEAR WITH THE NECESSARY SCHOOL SUPPLIES AND AT LEAST ONE NEW OUTFIT. KDOH FILLED 25 FOR SCIOTO COUNTY IN CONJUNCTION WITH THE PORTSMOUTH METROPOLITAN HOUSING AUTHORITY. ADOPT-A-FAMILY: TEAM MEMBERS ADOPTED FAMILIES AT CHRISTMAS TIME WHERE THEY PROVIDED GIFTS AND FOOD TO THOSE IN NEED. SPORTS PHYSICALS- MORE THAN 1,521 SPORTS PHYSICALS WERE COMPLETED FOR HIGH SCHOOLS IN KY, OH AND FOR KENTUCKY CHRISTIAN UNIVERSITY. FORM 990, PART VI, SECTION A, LINE 6 ASHLAND HOSPITAL CORPORATION IS THE SOLE CORPORATE MEMBER OF PORTSMOUTH HOSPITAL CORPORATION. ASHLAND HOSPITAL CORPORATION, A 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTERGRATED HEALTHCARE DELIVERY SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A ASHLAND HOSPITAL CORPORATION ELECTS THE BOARD MEMBERS OF PORTSMOUTH HOSPITAL CORPORATION ON AN ANNUAL BASIS OR UNTIL A SUCCESSOR IS NAMED. FORM 990, PART VI, SECTION B, LINE 11 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 DECISIONMAKING 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 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 2015 AND REMAINS IN PROCESS. 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 ANNUAL 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, CHIEF STRATEGY/INFORMATION SERVICES & TECHNOLOGY OFFICER 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 2,106,041. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,106,041. OTHER FEES: PROGRAM SERVICE EXPENSES 494,657. MANAGEMENT AND GENERAL EXPENSES 496,068. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 990,725. ASHLAND NURSING HOME CORP 2500 STATE ROUTE 5 ASHLAND KY 41102 611386016 HEALTHCARE KY 501(C)(3) 9 ASHLAND HOSPITAL COPORATION 0 CHILD DEVELOPMENT CENTER CORP 2201 LEXINGTON AVE ASHLAND KY 41101 010560598 DAYCARE KY 501(C)(3) 9 ASHLAND HOSPITAL COPORATION 0 KENTUCKY HEART INSTITUTE 2201 LEXINGTON AVE ASHLAND KY 41101 611255904 PHYSICIANS KY 501(C)(3) 9 ASHLAND HOSPITAL COPORATION 0 KENTUCKY HEART FOUNDATION 2201 LEXINGTON AVE ASHLAND KY 41101 260791997 MEDICAL RESEARCH KY 501(C)(3) 7 ASHLAND HOSPITAL COPORATION 0 KENTUCKY MEDICAL LOGISTICS INC 425 22ND STREET ASHLAND KY 41101 264736971 MEDICAL TRANSPORT KY 501(C)(3) 9 ASHLAND HOSPITAL COPORATION 0 KING'S DAUGHTERS HEALTH FOUNDATION INC 2201 LEXINGTON AVE ASHLAND KY 41101 611035701 FUNDRAISING KY 501(C)(3) 11-III-FI ASHLAND HOSPITAL COPORATION 0 KING'S DAUGHTERS HEALTH SYSTEM INC 2201 LEXINGTON AVE ASHLAND KY 41101 274553836 HEALTHCARE KY 501(C)(3) 11-II N/A 0 KING'S DAUGHTERS MEDICAL SPECIALTIES INC 2201 LEXINGTON AVE ASHLAND KY 41101 264183569 PHYSICIANS KY 501(C)(3) 9 ASHLAND HOSPITAL COPORATION 0 ASHLAND HOSPITAL CORPORATION 2201 LEXINGTON AVE ASHLAND KY 41101 610444716 HEALTHCARE KY 501(C)(3) 3 KING'S DAUGHTERS HEALTH SYSTEM INC 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