2011-05-16T15:41:19-05:00 2010-06-30 DEAN DORTON ALLEN FORD PLLC 106 W VINE STREET SUITE 600 LEXINGTON KY 40507 990 2009-07-01 610945743 KENTUCKY MEDICAL SERVICES FOUNDATION INC KENT 8592577910 2333 ALUMNI PARK PLAZA No 200 LEXINGTON KY 40517 Darrell A Griffith 8592577910 2011-05-12 1 LEIGH MCKEE 8592552341 2009 2016-02-24 21:20:13Z EMERY WILSON MD 2333 Alumni Park Plaza Lexington KY 40517 196905976 0 X N/A X 1980 KY SUPPORTING THE UNIVERSITY OF KY SO IT MAY ACHIEVE ITS GOALS IN HEALTHCARE 23 23 210 0 16024 0 0 186914635 193855535 480262 164504 1138351 2564025 188533248 196584064 659208 687697 0 10635920 10407070 0 0 173217379 190057273 184512507 201152040 4020741 -4567976 104166675 110252347 80123327 90862317 24043348 19390030 See Schedule O 0 0 182207581 687697 193855535 KMSF COLLECTS FEES FROM PROVISION OF PATIENT SERVICES PROVIDED BY THE UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE. BY PERFORMING THESE DUTIES KMSF SUPPORTS THE HOSPITAL AND HELPS THEM TO FULFILL THEIR EXEMPT PURPOSE. COLLECTIONS, AFTER PAYMENT OF DIRECT EXPENSES, ARE REMITTED TO THE COLLEGE WHICH USES THE FUNDS IN THE AREAS OF TEACHING, RESEARCH AND SERVICE. 182207581 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 236 0 1 210 1 1 1 0 0 0 0 0 0 0 0 23 23 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X X DARRELL A GRIFFITH 8592577910 2333 Alumni Park Plaza Suite 200 LEXINGTON KY 40517 Wendy Hansen 1.00 X 0 421882 2088 RALEIGH JONES MD 1.00 X 0 287395 8735 Robert Means MD 1.00 X 0 261019 1320 Edwin Bowe MD 1.00 X 0 497402 1320 J Timothy Bricker MD 1.00 X 0 347390 2088 Phillip Tibbs MD 1.00 X 0 1066855 888 Jay Perman MD 1.00 X 0 585664 5428 Joseph Berger MD 1.00 X 0 433065 9119 Michael Cibull MD 1.00 X 0 299376 1044 SAMUEL MATHENY MD 1.00 X 0 257767 0 Willem de Villiers MD 1.00 X 0 257935 8831 FREDerick DE BEER MD 1.00 X 0 475000 1044 Paul Bachner MD 1.00 X 0 365081 3096 carol steltenkamp md 1.00 X 0 228050 540 Regina Fragneto MD 1.00 X 0 362297 768 Lon Hays MD 1.00 X 0 309121 8440 Roger Humphries MD 1.00 X 0 440738 504 Darren Johnson MD 1.00 X 0 494694 1259 Marcus Randall MD 1.00 X 0 661303 10254 Elizabeth Oates MD 1.00 X 0 565750 11776 Joseph Zwischenberger MD 1.00 X 0 669500 2916 Gerald Klim 1.00 X 0 210946 576 Paul Pearson 1.00 X 0 370923 480 Darrell A Griffith 45.00 X 268885 0 27181 PEGGY HALCOMB 45.00 X 217426 0 22167 james tillett 45.00 X 101515 0 10274 JUDY BENSON 45.00 X 123573 0 12714 711399 9869153 154850 4 0 1 0 Perfusion Concepts Inc 2089 Bahama Road Lexington KY 40509 Medical Services 646737 medical doctor associates llc PO Box 277185 atlanta GA 30384 medical Services 586958 Harrodsburg Anesthesia 425 Shawnee Run Road Harrodsburg KY 40330 Medical Services 317328 River City Anesthesia 20 West OWl Creek Road Campbellsville KY 42718 Medical Services 211253 STITES & HARBISON PLLC 250 W MAIN ST SUITE 2300 lexington KY 40507 legal services 187055 8 CLINIC SERVICE FEES 561000 190216357 190216357 Rent from Supported or 531120 3639178 3639178 193855535 164504 164504 349978 321912 28066 28066 16024 12042 Honorarium & other mis 900099 2535959 2535959 2535959 196584064 193855535 16024 2712505 687697 687697 296065 296065 7286019 7286019 705499 705499 845601 845601 1273886 1273886 257795 257795 161509 161509 162931 162931 1506227 1506227 594744 594744 1218133 1218133 2122075 2122075 uk staff salaries & fri 52097347 52097347 uk physicians' salaries 51339919 51339919 PROFESSIONAL DEVELOPMEN 21587530 21559300 28230 BAD DEBTS 17937758 17937758 capital & current opera 17016234 17016234 24055071 21569326 2485745 201152040 182207581 18944459 0 25062500 27618902 18672378 25555358 944714 1042867 50946380 10423889 44269541 40522491 12799952 14445227 596000 510857 1821590 556645 104166675 110252347 4440660 4867306 28251653 27013060 47431014 58981951 80123327 90862317 X 24043348 19390030 24043348 19390030 104166675 110252347 X 0 1 1 X 0 X X X X 0 0 0 UNIVERSITY OF KENTUCKY 616001218 2 1 1 1 201152040 1 201152040 Schedule A, Part IV, Supplemental Information: KMSF has been assigned the responsibility to bill, collect and administer all clinical income generated by the physicians of the University of Kentucky College of Medicine, thus providing a service to UK. 4215808 4215808 38086017 5951162 32134855 8481325 4464063 4017262 163230 8664 154566 40522491 DUE TO UNIV. OF KENTUCKY 7147633 DUE TO UNIV. OF KENTUCKY MALPRACtice Fund 15081650 DUE TO COLL. OF MEDICINE DEPARTMENTS 36195310 REFUNDS PAYABLE 557358 58981951 Part X: Description of Uncertain Tax Positions Under FIN 48: KMSF adopted the provisions of FASB ASC 740-10 relating to uncertainty in income taxes on July 1, 2009. The implementation included evaluating the tax positions taken on all income tax returns that remain open to examination by the respective taxing authorities. KMSF does not believe that there are any uncertain tax positions on those returns that meet the requirements of FASB ASC 740-10 and therefore should be reflected in the financial statements. 1 MEDICAL STUDENT SCHOLARSHIPS 99 712572 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: KMSF requires transcripts and proof of enrollment every semester to monitor appropriate use of scholarship funds. Other Information: Part IV: DIFFERENCE BETWEEN GRANTS LISTED IN SCHEDULE I AND THOSE EXPENSED IN PART IX OF FORM 990 IS $24,875, WHICH REPRESENTs SCHOLARSHIPS ACCRUED AND EXPENSED IN THE PRIOR YEAR FOR FINANCIAL STATEMENT PURPOSES BUT NOT AWARDED TO SPECIFIC INDIVIDUALS UNTIL THE CURRENT YEAR. X X 0 0 0 0 0 0 0 0 0 Wendy Hansen 0 421882 0 0 0 0 0 0 0 2088 0 423970 0 0 RALEIGH JONES MD 0 287395 0 0 0 0 0 0 0 8735 0 296130 0 0 Robert Means MD 0 261019 0 0 0 0 0 0 0 1320 0 262339 0 0 Edwin Bowe MD 0 497402 0 0 0 0 0 0 0 1320 0 498722 0 0 J Timothy Bricker MD 0 347390 0 0 0 0 0 0 0 2088 0 349478 0 0 Phillip Tibbs MD 0 1066855 0 0 0 0 0 0 0 888 0 1067743 0 0 Jay Perman MD 0 585664 0 0 0 0 0 0 0 5428 0 591092 0 0 Joseph Berger MD 0 433065 0 0 0 0 0 0 0 9119 0 442184 0 0 Michael Cibull MD 0 299376 0 0 0 0 0 0 0 1044 0 300420 0 0 SAMUEL MATHENY MD 0 257767 0 0 0 0 0 0 0 0 0 257767 0 0 Willem de Villiers MD 0 257935 0 0 0 0 0 0 0 8831 0 266766 0 0 FREDerick DE BEER MD 0 475000 0 0 0 0 0 0 0 1044 0 476044 0 0 Paul Bachner MD 0 365081 0 0 0 0 0 0 0 3096 0 368177 0 0 carol steltenkamp md 0 228050 0 0 0 0 0 0 0 540 0 228590 0 0 Regina Fragneto MD 0 362297 0 0 0 0 0 0 0 768 0 363065 0 0 Lon Hays MD 0 309121 0 0 0 0 0 0 0 8440 0 317561 0 0 Roger Humphries MD 0 440738 0 0 0 0 0 0 0 504 0 441242 0 0 Darren Johnson MD 0 494694 0 0 0 0 0 0 0 1259 0 495953 0 0 Marcus Randall MD 0 661303 0 0 0 0 0 0 0 10254 0 671557 0 0 Elizabeth Oates MD 0 565750 0 0 0 0 0 0 0 11776 0 577526 0 0 Joseph Zwischenberger MD 0 669500 0 0 0 0 0 0 0 2916 0 672416 0 0 Gerald Klim 0 210946 0 0 0 0 0 0 0 576 0 211522 0 0 Paul Pearson 0 370923 0 0 0 0 0 0 0 480 0 371403 0 0 Darrell A Griffith 268885 0 0 0 0 0 0 0 27181 0 296066 0 0 0 PEGGY HALCOMB 217426 0 0 0 0 0 0 0 22167 0 239593 0 0 0 ANDREW JONES SON OF BOARD MEMBER SCHOLARSHIP ERICA GRIFFITH DAUGHTER OF key employee SCHOLARSHIP GERA M DE VILLIERS DAUGHTER OF BOARD MEMBER SCHOLARSHIP JOHN M JANSEN SON OF BOARD MEMBER SCHOLARSHIP JORDAN WAGERS STEPSON OF key employee SCHOLARSHIP KAROLYN ELAINE HAYS DAUGHTER OF BOARD MEMBER SCHOLARSHIP MARYCOBB B RANDALL DAUGHTER OF BOARD MEMBER SCHOLARSHIP MORGAN H RANDALL SON OF BOARD MEMBER SCHOLARSHIP RACHEL BERGER DAUGHTER OF BOARD MEMBER SCHOLARSHIP VICTORIA J WINFREY DAUGHTER OF BOARD MEMBER SCHOLARSHIP Form 990, Part VI, Section B, line 11 The 990 tax return is prepared by an independent CPA firm based on the information obtained from the audit and inquiries from Management. Before the return is filed, a draft of the informational return is reviewed by management. the board will review the 990 at a meeting shortly after filing and any necessary changes will be made at that time. Form 990, Part VI, Section B, line 12c executive leadership has implemented a policy that officers, directors, and key employees should annually disclose conflicts and the conflict of interest policy is consistently monitored and enforced. Form 990, Part VI, Section B, line 15 Compensation is deliberated by the Board in a closed door meeting. As part of their review they use AAMC Group on Faculty Practice Benchmarks for comparison. Form 990, Part VI, Section C, line 19 Available upon request FORM 990, PART XI, LINE 2C: The audit Committee assumes responsibility for the oversight of the audit and selection of the independent accountant. In the prior year, this was done by the finance committee, which has now been split into two groups: the finance committee and the audit committee. schedule l, part iii grants listed on schedule l are scholarships provided to children of board members who are faculty members at the university of kentucky. the dependents of all full-time faculty are eligible for these scholarships and eligibility and distribution are subject to the requirements of the program. board members do not specifically select recipients. form 990, prior year revenues, expenses, and balance sheet items The beginning balance sheet and prior year revenues and expenses have been restated to reflect corrections in the accounting for an entity included in the consolidated financial statements, but that files a separate 990. Form 990, Part III, Line 1 Description of Organization Mission TO COORDINATE AND DEVELOP SUPERIOR PATIENT CARE IN A GROUP PRACTICE SETTING WITHIN THE ACADEMIC ENVIRONMENT OF THE MEDICAL CENTER OF THE UNIVERSITY OF KENTUCKY IN LEXINGTON, INCLUDING THE PROVISION OF FINANCIAL SUPPORT FOR THE MEDICAL CENTER'S TEACHING, RESEARCH AND SERVICE PROGRAMS AND FOR THE PERSONNEL AND EQUIPMENT NECESSARY FOR SUCH PROGRAMS, AND IN FURTHERANCE OF THIS GENERAL PURPOSE TO EXECUTE AND PERFORM A PUBLIC TRUST IN SUPPORTING, AIDING, AND ADVANCING THE STUDY AND INVESTIGATION OF HUMAN ILLNESSES AND INJURIES, AND THE CAUSES, PREVENTIONS, RELIEF AND CURE THEREOF, AND THE STUDY AND INVESTIGATION OF PROBLEMS OF HYGIENE AND HEALTH; TO ENCOURAGE, PROMOTE AND PERFORM MEDICAL, SURGICAL AND SCIENTIFIC LEARNING, SKILL, EDUCATION AND INVESTIGATION; TO PROMOTE MEDICAL, SURGICAL, AND SCIENTIFIC SERVICES; TO ATTRACT AND RETAIN HIGH QUALITY FACULTY TO TEACH, CONDUCT RESEARCH AND PROVIDE PATIENT CARE; TO PROVIDE SUPPORT TO ENABLE THE COLLEGE OF MEDICINE TO ACCOMPLISH ITS EDUCATIONAL, RESEARCH AND SERVICE GOALS; TO ASSIST PROGRAMS OF MEDICAL, SURGICAL AND SCIENTIFIC EDUCATION AND RESEARCH; TO CARRY ON SUCH PROGRAMS OF PUBLIC CHARITY AS MAY BE RELATED TO THE CARRYING OUT OF THE OTHER STATED PURPOSES OF THE CORPORATION, AND, SPECIFICALLY THE CHARITABLE PROGRAMS UTILIZING THE KNOWLEDGE AND SKILLS ACQUIRED BY THE CORPORATION THROUGH ITS ABOVE-DESCRIBED OPERATIONS FOR THE BENEFIT OF ALL PERSONS WHO MAY BE IN NEED THEREOF, REGARDLESS OF HIS OR HER ABILITY TO PAY. University of Kentucky 800 Rose Street Lexington KY 40536 616001218 Educational development, healthcare KY 115 N/A N/A 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0