2013-05-15T13:25:37-05:00 2012-06-30 273858252 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2011-07-01 311139276 CONSOLIDATED HEALTH SYSTEMS INC CONS 6068869558 PO BOX 0787 PRESTONSBURG KY 41653 JACK BLACKWELL 6068869558 2013-05-14 1 LEIGH MCKEE P00169845 8592552341 2011 2016-02-25 16:41:14Z HIGHLANDS HEALTH SYSTEM JACK BLACKWELL PO BOX 0787 PRESTONSBURG KY 41653 16225534 0 X WWW.HIGHLANDSHEALTHSYSTEM.COM X 1984 KY THE ORGANIZATION SERVES TO FOSTER AND DEVELOP HEALTH CARE ACTIVITIES 8 7 61 7 -85807 -108557 0 0 9635219 13485466 358322 614002 1213298 993778 11206839 15093246 6696 3450 0 0 4516485 7245111 0 0 29436 5893665 7611144 10416846 14859705 789993 233541 55465359 56664626 39411391 41276068 16053968 15388558 THE ORGANIZATION SERVES TO FOSTER AND DEVELOP HEALTH CARE ACTIVITIES IN THE SERVICE AREA OF HIGHLANDS REGIONAL MEDICAL CENTER, AN AFFILIATED HOSPITAL. 0 0 10946997 3450 15122668 THE ORGANIZATION SERVES TO FOSTER AND DEVELOP HEALTH CARE ACTIVITIES IN THE SERVICE AREA OF HIGHLANDS REGIONAL MEDICAL CENTER, AN AFFILIATED HOSPITAL. 10946997 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 46 0 1 61 1 1 1 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X THE ORGANIZATION 6068869558 PO BOX 0787 PRESTONSBURG KY 41653 HAROLD C WARMAN 40.00 X X 324438 0 11904 BURL WELLS SPURLOCK 2.00 X 0 0 0 DEWEY L BOCOOK JR 1.00 X 0 0 0 EDWARD R NAIRN 1.00 X 0 0 0 PAUL D NUNN 1.00 X 0 0 0 ROBERT M DUNCAN 1.00 X 0 0 0 GREGORY A WILSON 1.00 X 0 0 0 DENNIS DORTON 1.00 X 0 0 0 JACK BLACKWELL 40.00 X 203713 0 9935 SUSAN ELLIS 40.00 X 142470 0 7124 JAMES D JACKSON 40.00 X 131225 0 6561 DEBRA HALL 40.00 X 232330 0 11616 DARYL LARKE 40.00 X 379445 0 12250 JEREMY PARSONS 40.00 X 153389 0 7669 TERRY D HALL 40.00 X 207883 0 6236 BRETT AKERS 40.00 X 588458 0 7350 2363351 0 80645 11 0 1 0 PROGRESSIVE HEALTHCARE INC 109 WESTPARK DRIVE STE 150 BRENTWOOD TN 37027 CONSULTING 691555 AUTOMATIC DATA PROCESSING 225 2ND AVENUE BOSTON MA 02129 PAYROLL PROCESSING 151654 STAFF CARE INC 5001 STATESMAN DR IRVING TX 75063 STAFFING 110499 3 MANAGEMENT/CONSULTING 541610 7852818 7852818 PHYSICIAN SERVICES 621300 6685127 6685127 REFUNDS/CONTRACT 900099 -1052479 -1052479 13485466 591252 591252 488864 1132288 -643424 -643424 -108557 -534867 22750 0 22750 22750 22750 MEANINGFUL USE FUNDS 900099 1614815 1614815 INTERDEPARTMENT BENEFI 900099 22387 22387 1637202 15093246 15122668 -85807 56385 3450 3450 916381 916381 5018300 4989274 29026 155782 155782 793712 758912 34800 360936 360936 2388 2388 90000 90000 4688230 4249963 438267 676149 675739 410 148894 148894 450418 450418 61733 61733 54072 54072 534 534 418265 418265 11459 11459 SUPPLIES 385142 371351 13791 BAD DEBTS 363851 363851 DUES & SUBSCRIPTIONS 88758 88758 LICENSES & TAXES 65245 65245 106006 106006 14859705 10946997 3883272 29436 322148 1219700 22866457 24472499 1341313 2960744 7329306 7028707 16250 110177 167900 24068272 6590447 8102238 17477825 984927 15393720 2336074 55465359 56664626 1099116 1317118 303056 229856 2141397 889484 35867822 38839610 39411391 41276068 X 16053968 15388558 16053968 15388558 55465359 56664626 X 233541 -898951 X X 0 1 1 X 0 X X X X 0 0 0 HIGHLANDS HOSPITAL CORPORATION 610658773 3 1 1 1 0 1 0 10748641 627218 11375859 8800172 1948469 10748641 8365650 434522 8800172 10839794 -2474144 8365650 1.00000 0 0 2584885 2584885 17767867 4109309 13658558 577896 332170 245726 2896999 2066959 830040 240625 82009 158616 17477825 INTERCOMPANY LIABILITIES 38206010 PHYSICIAN RECRUITING 633600 38839610 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE BOARD RESTRICTED NET ASSETS CONSIST OF ASSETS DESIGNATED BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL IMPROVEMENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PARENT COMPANY, HHHC, THE HOSPITAL AND HCFA ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC), EXCEPT FOR ANY UNRELATED BUSINESS INCOME ACTIVITIES. NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE COMBINED FINANCIAL STATEMENTS FOR ANY OF THESE ENTITIES. CHE IS A FOR-PROFIT CORPORATION ON WHICH APPLICABLE CORPORATE INCOME TAXES APPLY. HMP I, HMP II, HS, HIGHLANDS PRESTONSBURG, HIGHLANDS PAINTSVILLE AND HOMETOWN ARE LIMITED LIABILITY ENTITIES. IN LIEU OF INCOME TAXES, THE OWNERS OF THE ENTITIES ARE REQUIRED TO REPORT THEIR RESPECTIVE SHARES OF THE ENTITIES' TAXABLE INCOME OR LOSS ON THEIR RESPECTIVE INCOME TAX RETURNS. THE HOSPITAL HAS UNRELATED BUSINESS INCOME FROM CERTAIN ACTIVITIES. THESE ACTIVITIES ARE GENERALLY CONDUCTED AT A LOSS AND HELP TO COVER OVERHEAD COSTS. BOTH THE HOSPITAL AND CHE HAVE SMALL NET OPERATING LOSS CARRYFORWARDS. MANAGEMENT HAS EVALUATED THE COMPANY'S TAX POSITIONS AND CONCLUDED THAT THE COMPANY TOOK NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE COMBINED FINANCIAL STATEMENTS TO COMPLY WITH GAAP. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2009. 1 X PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION MAINTAINS RECORDS TO SUBSTANTIATE THE GRANTS PAID AND DOCUMENTATION RECEIVED FROM THE RECIPIENT ORGANIZATION REQUESTING THE GRANT. HOWEVER, THE ORGANIZATION DOES NOT MONITOR THE USE OF THE FUNDS BY THE RECIPIENT ORGANIZATION AT THIS TIME. X X X X 0 0 0 0 0 0 0 0 0 HAROLD C WARMAN 324438 0 0 0 0 0 0 0 11904 0 336342 0 0 0 JACK BLACKWELL 203713 0 0 0 0 0 0 0 9935 0 213648 0 0 0 DEBRA HALL 232330 0 0 0 0 0 0 0 11616 0 243946 0 0 0 DARYL LARKE 379445 0 0 0 0 0 0 0 12250 0 391695 0 0 0 JEREMY PARSONS 153389 0 0 0 0 0 0 0 7669 0 161058 0 0 0 TERRY D HALL 207883 0 0 0 0 0 0 0 6236 0 214119 0 0 0 BRETT AKERS 588458 0 0 0 0 0 0 0 7350 0 595808 0 0 0 BURL WELLS SPURLOCK CHAIRMAN OF THE BOARD 130661 CHS RENTED PROPERTY FROM RIVERSIDE INVESTMENTS INC. WHICH IS OWNED BY MR. SPURLOCK. 0 FORM 990, PART VI, SECTION B, LINE 11 THE DIRECTOR OF ACCOUNTING, CFO AND BOARD OF DIRECTORS WILL REVIEW FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO EACH BOARD MEMBER ANNUALLY. THE POLICY IS DISTRIBUTED BY THE BOARD SECRETARY ALONG WITH A DISCLOSURE FORM. RESPONSES ARE REVIEWED BY THE CEO. IF THERE IS A PARTICULAR ISSUE THAT NEEDS TO BE BROUGHT TO THE ATTENTION OF THE BOARD, THE CEO WILL CONTACT THE BOARD CHAIR TO DISCUSS, AND IF NECESSARY, IT WILL BE PLACED ON THE BOARD AGENDA FOR REVIEW. ADDITIONALLY, IF A BOARD MEMBER OR THE CEO BECOME AWARE OF POTENTIAL CONFLICTS THEY CAN REPORT THIS TO THE BOARD CHAIR DURING THE YEAR. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE CEO AND OFFICERS IS DETERMINED BY A COMMITTEE OF THE BOARD OF DIRECTORS THAT REVIEWS PERFORMANCE ANNUALLY. THE BOARD CONSULTS WITH VARIOUS SOURCES TO DETERMINE MARKET RATES OF COMPENSATION AGAINST COMPARABLE ORGANIZATIONS. THE BOARD USES ACHE COMPENSATION SURVEYS, MODERN HEALTHCARE COMPENSATION SURVEYS, AND VERBALLY CONSULTS WITH THE KY HOSPITAL ASSOCIATION TO DETERMINE KY COMPENSATION. FROM TIME TO TIME, THE BOARD MAY USE OTHER SOURCES THAT ARE AVAILABLE. COMPENSATION IS BASED ON MARKET RATES AND PERFORMANCE AGAINST GOALS, WHICH ARE ESTABLISHED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -106,608. ADJ FOR SMLLCS -792,343. TOTAL TO FORM 990, PART XI, LINE 5: -898,951. FORM 990, PART XI, LINE 2C THERE IS A COMMITTEE OF THE BOARD OF DIRECTORS THAT ASSUMES RESPONSIBILITY FOR THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HHS DEVELOPMENT COMPANY PRESTONSBURG LLC 5000 KY RT 321 PRESTONSBURG KY 41653 271260438 HOLD MEDICAL OFFICE BUILDING KY -225473 7344965 CONSOLIDATED HEALTH SYSTEMS INC HHS DEVELOPMENT COMPANY PAINTSVILEE LLC 5000 KY RT 321 PRESTONSBURG KY 41653 271259520 HOLD MEDICAL OFFICE BUILDING KY -167986 3911278 CONSOLIDATED HEALTH SYSTEMS INC HOMETOWN FAMILY CARE LLC 5000 KY RT 321 PRESTONSBURG KY 41653 202470645 FAMILY CARE CLINIC KY 53675 615472 CONSOLIDATED HEALTH SYSTEMS INC HIGHLANDS HOME CARE INC 5032 KENTUCKY ROUTE 321 PRESTONSBURG KY 41653 611349726 HOME HEALTH SERVICES KY 501(C)(3) 9 CONSOLIDATED HEALTH SYSTEMS INC 1 HIGHLANDS HOSPITAL CORPORATION BOX 668 5032 KENTUCKY ROUTE 321 PRESTONSBURG KY 41653 610658773 HEALTH CARE SERVICES KY 501(C)(3) 3 CONSOLIDATED HEALTH SYSTEMS INC 1 HIGHLANDS FOUNDATION INC 5000 KY HIGHWAY 321 PRESTONSBURG KY 41653 208036784 PROMOTE HEALTH AND COMMUNITY EDUCATION AND INVOLVEMENT KY 501(C)(3) 7 CONSOLIDATED HEALTH SYSTEMS INC 1 HIGHLANDS CENTER FOR AUTISM INC 5000 KY HIGHWAY 321 PRESTONSBURG KY 41653 264541964 SCHOOL FOR AUTISM SPECTRUM DISORDER KY 501(C)(3) 9 CONSOLIDATED HEALTH SYSTEMS INC 1 HIGHLANDS MEDICAL PARTNERS I LLC 5000 KENTUCKY ROUTE 321 PRESTONSBURG KY 41653 262242914 MEDICAL SERIVCES - IMAGING CENTER KY CONSOLIDATED HEALTH SYSTEMS INC RELATED -238423 0 1 HIGHLANDS MEDICAL PARTNERS II LLC 5000 KENTUCKY ROUTE 321 PRESTONSBURG KY 41653 311139276 MEDICAL SERIVCES - SLEEP LAB KY CONSOLIDATED HEALTH SYSTEMS INC RELATED -26033 157835 0 1 CONSOLIDATED HEALTH ENTERPRISES BOX 668 5032 KY ROUTE 321 PRESTONSBURG KY 41653 611261592 PHARMACY KY CONSOLIDATED HEALTH SYSTEMS INC C -157105 752628 1.00000 HIGHLANDS STAFFING INC 5000 KY RT 321 PRESTONSBURG KY 41653 270835324 STAFFING KY CONSOLIDATED HEALTH SYSTEMS INC C 22519 383963 1.00000 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 HIGHLANDS HOSPITAL CORPORATION E 4675069 HIGHLANDS HOME CARE INC E 96719 HIGHLANDS FOUNDATION INC D 106172 HIGHLANDS CENTER FOR AUTISM D 100334 CONSOLIDATED HEALTH ENTERPRISES D 76268 HIGHLANDS STAFFING INC D 69273