2011-03-15T14:12:32-05:00 2010-04-30 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2009-05-01 611124401 MARY BRECKINRIDGE HEALTHCARE INC MARY 8592816783 170 PROSPEROUS PLACE LEXINGTON KY 40509 michael steinmetz 8592816783 2011-03-15 1 LEIGH MCKEE 8592552341 2009 2016-02-24 21:20:13Z MICHAEL STEINMETZ 170 PROSPEROUS PLACE LEXINGTON KY 40509 16205193 0 X WWW.FRONTIERNURSING.ORG X 1986 KY TO PROVIDE MEDICAL CARE TO THE PEOPLE OF LESLIE AND SURROUNDING COUNTIES 11 11 217 11 0 0 19735 9396 14079493 16026751 963 1572 1163126 167474 15263317 16205193 0 0 7677916 6264525 0 0 11671997 11559068 19349913 17823593 -4086596 -1618400 2984164 2716174 15483855 17220958 -12499691 -14504784 TO PROVIDE MEDICAL CARE TO THE PEOPLE OF LESLIE AND SURROUNDING COUNTIES. 0 0 14616999 16026751 HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO LOCAL RESIDENTS. 14616999 1 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 17 0 1 217 1 0 0 0 0 0 0 0 0 0 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 KY X X The Organization 8592816783 170 PROSPEROUS PLACE LEXINGTON KY 40509 X NANCY HINES 1.00 X 0 0 0 KEN TUGGLE 1.00 X 0 0 0 JOHN FOLEY 1.00 X 0 0 0 JANE LEIGH POWELL 1.00 X 0 0 0 DR CHARLIE MAHAN 1.00 X 0 0 0 DR MICHAEL CARTER 1.00 X 0 0 0 MARY ETHEL WOOTON 1.00 X 0 0 0 RHONDA BRASHEAR 1.00 X 0 0 0 EFFIE STIDHAM 1.00 X 0 0 0 ANTHONY LITTLE 1.00 X 0 0 0 MIKE RUST 1.00 X 0 0 0 NATHAN LEE 40.00 X 0 208935 14785 ROBERT BESTEN 40.00 X 0 98929 8226 ENRICO ASCANI 40.00 X 201020 0 8513 LONNIE HUBBARD 40.00 X 102874 0 9602 ANDREW KRASUSKI 40.00 X 223595 0 15225 GABOR LAUFER 40.00 X 109374 0 6133 636863 307864 62484 4 0 1 0 FNS INC 170 PROSPEROUS PLACE LEXINGTON KY 40509 CORPORATE COSTS 1161294 DEFINITIVE MEDICAL SOLUTIONS P O BOX 418 EAST BERNSTADT KY 40729 ANESTHESIA DOCTORS 713800 SOUTHERN MEDICAL PARTNERS 3107 STIRLING RD STE 300 FT LAUDERDALE FL 33312 EMERGENCY ROOM DOCTORS 646545 GE HEALTHCARE P O BOX 96483 CHICAGO IL 606936483 MAINTENANCE 190995 4 1300 8096 9396 net patient service re 621400 16026751 16026751 16026751 1572 1572 cafeteria sales 900099 69778 69778 medicare receipts 621400 60227 60227 other revenue 900099 28528 28528 8941 8941 167474 16205193 16026751 0 169046 5060261 4861759 198502 217566 162129 55437 641232 575384 65848 345466 326936 18530 1161294 1161294 114778 114778 25316 25316 2908967 2885404 23563 7297 3665 3632 70375 1886 68489 1605504 1605504 6140 2892 3248 39990 12209 27781 49000 4106 44894 1293675 1293675 BAD DEBTS 1719219 1719219 SUPPLIES 1530649 1518557 12092 EQUIPMENT RENTAL 712373 648076 64297 TAXES 251356 251356 SMALL EQUIPMENT/TOOLS 28711 24101 4610 34424 13816 20608 17823593 14616999 3206594 0 15935 12651 2227780 2207250 314728 418142 20874 425721 57257 2984164 2716174 3038919 2790734 142068 137895 6776768 6776768 5526100 7515561 15483855 17220958 X -12925412 -14543812 342513 -44180 83208 83208 -12499691 -14504784 2984164 2716174 X 0 1 1 X 0 X 425721 1300 -50783 337210 39028 514232 19735 -108246 425721 1.00000 1 0 0 dues to affiliates 6778234 NOTES PAYABLE 737327 7515561 Part V, Line 4: Description of Intended Use of Endowment Funds: TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE HOSPITAL HAS BEEN LIMITED BY DONORS TO A SPECIFIC TIME PERIOD OR PURPOSE. PERMANENTLY RESTRICTED NET ASSETS HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY THE HOSPITAL IN PERPETUITY. THESE FUNDS HAVE BEEN SET ASIDE TO PROVIDE SUPPORT FOR THE CONTINUED OPERATIONS OF THE HOSPITAL. Part X: Description of Uncertain Tax Positions Under FIN 48: The Service adopted the provisions of FASB ASC 740-10 relating to uncertainty in income taxes on May 1, 2009. The implementation includes evaluating the tax positions taken on all income tax returns that remain open to examination by the respective taxing authorities. The Service does not believe that there are any uncertain positions on those returns that require recognition or disclosure in the consolidated financial statements. 1 1 1 X 0 0 1 1 0 0 1220290 1220290 0.06850 5606811 4690084 916727 0.05140 6827101 4690084 2137017 0.11990 2286 2286 0.00010 2286 2286 0.00010 6829387 4690084 2139303 0.12000 791 791 0.00000 791 791 1 665907 0 4259301 4221152 38149 X 1 0 mary breckinridge healthcare inc

130 kate ireland drive HYDEN KY 41749

X X X X Part I, Line 3c: THE HOSPITAL DOES NOT NORMALLY PROVIDE DISCOUNTED CARE, BUT THE HOSPITAL LOOKS AT ELIGIBILITY FOR FREE OR DISCOUNTED CARE ON A CASE BY CASE BASIS. THE HOSPITAL FOLLOWS THE APPLICATION FOR DSH IN DETERMINING FREE CARE. IF ELIGIBILITY IS NOT MET USING THE DSH APPLICATION, THE HOSPITAL WORKS WITH THE PATIENT TO MAKE A PAYMENT PLAN BY LOOKING AT BOTH INCOME AND NET ASSETS WHICH INCLUDE CASH AND INVESTMENTS LESS OTHER MEDICAL BILLS. Part III, Line 4: COST OF BAD DEBT EXPENSE WAS DETERMINED BY MULTIPLYING THE BAD DEBT EXPENSE AS REPORTED ON THE HOSPITAL'S FINANCIAL STATEMENT BY THE COST TO CHARGE RATIO CACLULATED ON WORKSHEET 2 OF SCHEDULE H INSTRUCTIONS. Part III, Line 8: THE HOSPITAL IS A CRITICAL ACCESS HOSPITAL. MEDICARE COSTS WERE DETERMINED ON THE MEDICARE COST REPORT ON WORKSHEETS D-1, D PART V AND D-4. Part VI, Line 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY BY REVIEWING THE PATIENT SURVEYS IN THE ER AND MED/SURG UNITS. Part VI, Line 3: When a patient presents at registration and does not have insurance, they are routed to the Financial Counselor to complete DSH application. If the patient meets the guidelines, then the registration is keyed to the DSH financial class. If the patient does not qualify for DSH, they are placed in the Self Pay financial class. Part VI, Line 4: MBH is located in Hyden, Leslie Co., Ky. Leslie Co. is a small, rural community in southeastern KY. Other than healthcare and education, the major employers in the area are coal mining and logging. Part VI, Line 5: By participating in local health fairs, our organization provides free blood pressure screenings, as well as other health-related screenings free of charge. Part VI, Line 6: THE HOSPITAL PROVIDES A WIDE ARRAY OF COMMUNITY HELP INCLUDING THE PROMOTION OF BREAST CANCER AWARENESS DURING OCTOBER WHEN IT PROVIDES DISCOUNTED MAMOGRAMS, DRUG AWARENESS PROGRAMS, CAR SEAT EDUCATION FOR NEWBORNS, SPONSORING COMMUNITY WIDE PICNICS AND BABY SHOWERS FOR NEWBORNS, PROVIDING TOURS OF THE HEALTHCARE FACILITIES FOR LOCAL 5TH AND 6TH GRADE STUDENTS, PROVIDING STAFF FOR THE INVOLVEMENT OF CAREER DAYS AND SENIOR DAY AT THE LOCAL HIGH SCHOOL, AND VOLUNTEERING FOR LOCAL CHAMBER OF COMMERCE COMMUNITY EVENTS THROUGHOUT THE YEAR. X X 0 0 0 0 0 0 0 0 0 NATHAN LEE 0 201451 0 0 0 7484 0 6268 0 8517 0 223720 0 0 ENRICO ASCANI 201020 0 0 0 0 0 0 0 8513 0 209533 0 0 0 ANDREW KRASUSKI 223595 0 0 0 0 0 0 0 15225 0 238820 0 0 0 Form 990, Part VI, Section B, line 11 THE HOSPITAL'S MANAGEMENT REVIEWS THE FORM 990 FOR ACCURACY, THEN DISTRIBUTES A COPY TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION TO THE IRS. Form 990, Part VI, Section B, line 12c EACH BOARD MEMBER IS REQUIRED TO READ AND SIGN A CONFLICT OF INTEREST POLICY ANNUALLY. Form 990, Part VI, Section B, line 15 The Board of Directors revIEws CEO and President's compensation annually. The CEO, President, or respective managers reviews employees salary annually. Form 990, Part VI, Section C, line 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C: A COMMITTEE OF THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FNS INC 170 prosperous place lexington KY 40509 611124268 provide nursing care and health education to the community KY 501(c)(3) 11b N/A FRONTIER NURSING SERVICE INCORPORATED 170 prosperous place lexington KY 40509 611124266 promotion of education, public health and social welfare in rural areas KY 501(c)(3) 07 FNS INC frontier school of midwifery and family nursing inc 170 prosperous place lexington KY 40509 611124267 education promoting public health and social welfare KY 501(c)(3) 02 FNS INC frontier nursing healthcare inc 170 prosperous place lexington KY 40509 010700085 provide health care for economically disadvantaged rural citizens KY 501(c)(3) 03 FNS INC fns real estate inc 170 prosperous place lexington KY 40509 611124991 title holding company KY 501(c)(2) n/a FNS INC mary breckinridge home health inc 170 prosperous place lexington KY 40509 611485691 provide in-home medical care KY 501(c)(3) 09 FNS INC 0 0 1 1 1 0 0 0 0 1 0 1 0 0 1 0 0 0 fns real estate inc J 1351308