2012-11-12T07:55:05-06:00 2012-06-30 610420207 JONES NALE & MATTINGLY PLC 642 SOUTH FOURTH ST STE 300 LOUISVILLE KY 40202 990 2011-07-01 610984463 OWSLEY COUNTY HEALTH CARE CENTER INC OWSL 6065936302 PO BOX 250 BOONEVILLE KY 41314 JUDY TERRY 6065936302 2012-11-09 1 DAVID R PRICE P01272254 5025830248 2011 2016-02-24 21:20:13Z JUDY TERRY PO BOX 250 BOONEVILLE KY 41314 5629403 0 X N/A X 1980 KY HEALTH CARE FACILITY FOR THE PUBLIC. TO MEET THE SPECIFIC INDIVIDUAL NEEDS OF EACH OF OUR RESIDENTS SO THEY WILL RESIDE IN THE CENTER WITH DIGNITY AND AN IMPROVED QUALITY OF LIFE. 8 8 98 0 0 0 0 0 5776152 5588859 6806 4103 19869 36441 5802827 5629403 0 0 0 0 3350828 3224517 0 0 0 2367357 2472963 5718185 5697480 84642 -68077 2758453 2601419 932739 843782 1825714 1757637 X TO MEET THE SPECIFIC INDIVIDUAL NEEDS OF EACH OF OUR RESIDENTS SO THEY WILL RESIDE IN THE CENTER WITH DIGNITY AND AN IMPROVED QUALITY OF LIFE. 0 0 2123163 5275969 NURSING SERVICES 798552 312890 ANCILLARY SERVICES PHARMACY, OCCUPATIONAL, PHYSICAL & SPEECH THERAPIES, LAB, OXYGEN & ENTERAL NUTRITION PROGRAM. 1061447 18728 GENERAL SERVICES DIETARY, HOUSEKEEPING, LAUNDRY, RECREATIONAL ACTIVITIES, SOCIAL SERVICES, MEDICAL RECORDS, AND PLANT OPERATIONS. 864861 17713 ADMINISTRATIVE SERVICES OTHER COSTS INCURRED AS A RESULT OF PROVIDING RESIDENTS WITH CARE. 864861 17713 4848023 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 12 0 98 1 0 0 0 0 0 0 0 0 0 0 X 8 8 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 X X OWSLEY COUNTY HEALTH CARE CENTER INC 6065936302 PO BOX 250 BOONEVILLE KY 41314 DALE ROBERTS 2.00 X X 0 0 0 DALE BISHOP 5.00 X X 2400 0 0 PHYLLIS REFFITT 0.00 X 0 0 0 ROGER ROBERTS 0.00 X 0 0 0 BOBBY SMITH 0.00 X 0 0 0 BERNARD WILSON 0.00 X 0 0 0 ARNOLD WILSON 0.00 X 0 0 0 JASON WILSON 0.00 X 0 0 0 JUDY TERRY 40.00 X 86619 0 0 89019 0 0 0 0 0 0 HERITAGE HEALTHCARE 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY SERVICE 520537 UNITED HEALTHCARE 2424 HARRODSBURG ROAD LEXINGTON KY 40503 HEALTH INSURANCE 311882 HEALTH SYSTEMS OF KENTUCKY 329 TOWNEPARK CIRCLE STE 100 LOUISVILLE KY 40243 MANAGEMENT CONSULTANT 276234 WHAYNE SUPPLY CO 1400 CECIL AVE LOUISVILLE KY 40211 EQUIPMENT SERVICE 214088 OMNICARE OF BEATTYVILLE 1071 BROADWAY STREET BEATTYVILLE KY 41311 PHARMACY 211566 5 PATIENT HEALTH CARE 623000 5275969 5275969 REHABILITATION/SPEECH 623000 296221 296221 MEDICAL SUPP, OXYGEN 623000 16048 16048 PHARMACY 623000 621 621 5588859 4103 4103 MISCELLANEOUS 623000 23016 23016 EMPLOYEE MEALS 623000 13425 13425 36441 5629403 5625300 0 4103 110057 110057 2584454 2444000 140454 23505 20219 3286 299894 257964 41930 206607 177720 28887 197674 197674 70617 70617 48461 48461 6492 6492 37391 37391 19909 19909 105367 105367 77295 11814 65481 ANCILLARY SERVICES 798550 798550 GENERAL SERVICES 564344 564344 OTHER ADMIN 330665 251847 78818 NURSING SERVICES 205646 205646 10552 10552 5697480 4848023 849457 0 1420739 1097644 494671 484941 25767 20262 48997 58534 3300953 2361348 768279 939605 0 433 2758453 2601419 505592 434557 427147 409225 932739 843782 X 1825714 1757637 1825714 1757637 2758453 2601419 -68077 0 X 0 0 0 X 5259090 5152754 5412589 5776151 21600584 5259090 5152754 5412589 5776151 21600584 0 0 0 21600584 3761 6029 9548 6806 26144 3761 6029 9548 6806 26144 11599 7119 27609 19870 66197 5274450 5165902 5449746 5802827 21692925 0.99570 0.99600 0.00120 0.00110 X 1816077 1456023 360054 929701 485803 443898 555175 419522 135653 939605 OBLIGATION UNDER CAPITAL LEASE 409225 409225 5629403 5697480 -68077 -68077 5629403 0 5629403 0 5629403 5697480 0 5697480 0 5697480 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CENTER'S ACCOUNTING POLICY PROVIDES THAT A TAX EXPENSE/BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THE CENTER HAS NO UNCERTAIN TAX POSITIONS RESULTING IN AN ACCRUAL OF TAX EXPENSE OR BENEFIT. SAMMY SEBASTIAN FAMILY MEMBER OF BOARD DIRECTOR (PHYLLIS REFFITT) 43798 EMPLOYEETOTAL COMPENSATION: 43,798 0 KATHY ROBERTS FAMILY MEMBER OF BOARD DIRECTOR (DALE ROBERTS AND ROGER ROBERTS) 33930 EMPLOYEETOTAL COMPENSATION: 33,930 0 MARIE SEBASTIAN FAMILY MEMBER OF BOARD DIRECTOR (PHYLLIS REFFITT) 35606 EMPLOYEETOTAL COMPENSATION: 35,606 0 FORM 990, PART VI, SECTION A, LINE 2 DALE ROBERTS (CHAIRMAN & DIRECTOR) IS THE FATHER OF ROGER ROBERTS (DIRECTOR). ARNOLD WILSON (DIRECTOR) IS THE FATHER OF JASON WILSON (DIRECTOR). FORM 990, PART VI, SECTION B, LINE 11 ADMINISTRATOR JUDY TERRY WILL PROVIDE A COPY OF THE 990 TO ALL BOARD MEMBERS AND WILL REQUIRE THEM TO SIGN A STATEMENT AFFIRMING THAT THEY HAVE REVIEWED THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT AFFIRMING COMPLIANCE. FORM 990, PART VI, SECTION C, LINE 18 THE 990 IS AVAILABLE THROUGH WWW.GUIDESTAR.ORG AND BY REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS WILL BE MADE AVIALABLE TO THE PUBLIC UPON REQUEST. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII DALE ROBERTS - EAST SIDE APTS, #802, BOONEVILLE, KY 41314. DALE BISHOP - PO BOX 256, BOONEVILLE, KY 41314. PHYLLIS REFFITT - 1313 OLD U.S. 25 NORTH, BEREA, KY 40403. ROGER ROBERTS - PO BOX 112, BOONEVILLE, KY 41314. BOBBY SMITH - HC88 BOX 1980, BOONEVILLE, KY 41314. BERNARD WILSON - RT#2 BOX 1082, BOONEVILLE, KY 41314. ARNOLD WILSON - RT#23 BOX 220, BOONEVILLE, KY 41314. JASON WILSON - 110 WHISPERING WOODS STONEWALL ESTATES, RICHMOND, KY 40475.