Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
EMA HEALTH SERVICES INC
Employer identification number
52-1234495
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
531,697
603,424
516,258
582,945
813,252
3,047,576
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
531,697
603,424
516,258
582,945
813,252
3,047,576
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
3,047,576
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
531,697
603,424
516,258
582,945
813,252
3,047,576
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
156
156
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
156
156
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
10,007
3,354
13,361
13
Total support (Add lines 9, 10c, 11 and 12.).
541,704
606,778
516,414
582,945
813,252
3,061,093
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
99.560 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.130 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.010 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.010 %
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
EMA HEALTH SERVICES INC
Employer identification number
52-1234495
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
EMA HEALTH SERVICES IS GOVERNED BY THE BOARD OF DIRECTORS FOR EPISCOPAL MINISTRIES TO THE AGING, INC (EIN: 52-1710891).
FORM 990, PART VI, SECTION A, LINE 6
EPISCOPAL MINISTRIES TO THE AGING, INC IS THE SOLE MEMBER OF EMA HEALTH SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7A
EPISCOPAL MINISTRIES TO THE AGING, INC, THE SOLE MEMBER OF EMA HEALTH SERVICES, INC, APPOINTS ALL DIRECTORS, EXCEPT FOR THE PRESIDENT, WHO SHALL BE AN EX OFFICIO MEMBER OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 7B
THE FOLLOWING MUST BE APPROVED BY THE SOLE MEMBER: 1) CHANGING OF THE PHILOSOPHY, OBJECTIVES, OR PURPOSE OF THE CORPORATION. 2) AMENDING OF THE BY-LAWS OR ARTICLES OF INCORPORATION OF THE CORPORATION. 3) DISSOLUTION OR LIQUIDATION OF THE CORPORATION. 4) ELECTION OR REMOVAL OF ANY MEMBER OF THE BOARD OF DIRECTORS. 5) MERGING OR CONSOLIDATION OF THE CORPORATION. 6) APPOINTMENT OR REMOVAL OF THE PRESIDENT. 7) CREATION OF ANY SUBSIDIARY ORGANIZATION OR AFFILIATE OF THE CORPORATION WITH ANY OTHER ENTITY FOR THE PURPOSE OF THE JOINT CONDUCT OF BUSINESS OR OTHER PROGRAMS. 8) CONVEYANCE OF GRANT MORTGAGES, TRUST DEEDS OR CREATION OF OTHER LIENS ON ANY REAL PROPERTY ASSETS, OTHER THAN CONVEYANCES OR LIENS IN FAVOR OF ANY PUBLIC OR QUASI-PUBLIC AUTHORITY FOR ACCESS, UTILITIES, ROAD WIDENING AND SIMILAR FUNCTIONS WHICH DO NOT MATERIALLY IMPAIR THE USE OR VALUE OF THE BALANCE OF THE PROPERTY. 9) CONVEYANCE OF ANY OTHER ASSETS OF THE CORPORATION WHOSE FAIR MARKET VALUE EXCEEDS $25,000. 10) INCURRING ANY INDEBTEDNESS OR SERIES OF INDEBTEDNESS, EITHER OF WHICH EXCEEDS $25,000 OR TO GUARANTEE ANY INDEBTEDNESS OR SERIES OF INDEBTEDNESS, EITHER OF WHICH EXCEEDS $25,000. 11) TO APPROVE THE ANNUAL OPERATING BUDGET AND ANNUAL CAPITAL BUDGET AND ANY CHANGE IN EXCESS OF $50,000 THERETO. 12) APPROVAL OF THE STRATEGIC PLAN OF THE CORPORATION AND ANY AMENDMENT THERETO. 13) EXERCISING OF ANY POWERS MENTIONED ABOVE, OTHER THAN #10, THE CORPORATION MAY HAVE AS A MEMBER OR STOCKHOLDER OF ANOTHER CORPORATION OR PARTICIPANT IN ANY LLC, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY.
FORM 990, PART VI, SECTION B, LINE 11
THE PROCESS TO REVIEW THE FORM 990 IS AS FOLLOWS: 1) THE FINANCE STAFF REVIEWS THE RETURN FOR ACCURACY AND COMPLETENESS. 2) THE RETURN IS PRESENTED TO THE FINANCE COMMITTEE OF THE EMA BOARD OF TRUSTEES FOR THEIR REVIEW AND APPROVAL. 3) ONCE APPROVED BY THE FINANCE COMMITTEE, THE 990 IS RELEASED TO THE ENTIRE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO THE RETURN BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12C
CONFLICT OF INTEREST DISCLOSURES ARE DISTRIBUTED TO TRUSTEES AND MANAGEMENT STAFF ANNUALLY IN EARLY JUNE. THE COMPLETED FORMS ARE RETURNED TO HUMAN RESOURCES. A REPORT IS PREPARED SHOWING ALL CONFLICT OF INTEREST DISCLOSURES. THIS REPORT IS PRESENTED AT THE JULY MEETING OF THE AUDIT COMMITTEE. IF A CONFLICT OF INTEREST IS DETERMINED TO EXIST, THOSE WITH WHOM THERE IS A CONFLICT ABSTAIN FROM BEING INVOLVED IN DISCUSSIONS AND/OR DECISIONS REGARDING THE CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15
THE PRESIDENT/CEO'S PERFORMANCE IS REVIEWED ANNUALLY BY A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, THE HUMAN RESOURCES AND TRUSTEESHIP COMMITTEE. THE PRESIDENT/CEO PREPARES A COMPREHENSIVE REPORT SHOWING THE RESULTS OF HIS/HER WORK DURING THE PAST YEAR, AN ESTIMATE OF HOURS SPENT IN VARIOUS CATEGORIES OF HIS/HER JOB DESCRIPTION, AND GOALS FOR THE COMING YEAR. THIS REPORT IS REVIEWED BY THE HUMAN RESOURCES AND TRUSTEESHIP COMMITTEE, MANY MEMBERS OF WHICH ARE HUMAN RESOURCE PROFESSIONALS. THEY DETERMINE THE ONGOING COMPENSATION FOR THE PRESIDENT/CEO. THEY GIVE THIS INFORMATION TO THE VICE PRESIDENT FOR HUMAN RESOURCES, WHO THEN PROCESSES IT FOR PAYROLL. IN THE CASE OF A NEW CEO, A SEARCH FIRM IS USED TO NEGOTIATE SALARY AND BENEFITS DIRECTLY WITH THE CANDIDATE. THE SALARY IS NEGOTIATED TAKING INTO CONSIDERATION COMPARABLE SALARIES IN THE INDUSTRY TO DETERMINE A COMPENSATION PACKAGE WITHIN FAIR MARKET RANGE. A WRITTEN EMPLOYMENT CONTRACT IS USED TO DOCUMENT THE COMPENSATION PACKAGE AND THE PROCESS IS ALSO DOCUMENTED IN MINUTES DURING AN EXECUTIVE SESSION. COMPENSATION FOR THE EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES IS DETERMINED BY THE CEO USING SIMILAR METHODS. SENIOR MANAGEMENT POSITIONS ARE PAID ACCORDING TO RESPONSIBILITY IN THE COMPANY, EXPERIENCE, CREDENTIALS, AND MANAGEMENT AND LEADERSHIP SKILLS.
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.
HOURS PER WEEK FOR RELATED ORGANIZATIONS:
FORM 990, PAGE 7,PART VII, COLUMN B
WITHIN THEIR RESPECTIVE ROLES, JACLYN HARRIS AND WILLIAM A FISHER, III ALSO DEVOTE TIME TO RELATED ORGANIZATIONS. IT IS ESTIMATED THAT EACH WEEK, THESE EMPLOYEES DEVOTE THEIR TIME TO RELATED ORGANIZATIONS AS FOLLOWS: 8 HOURS TO FAIRHAVEN, INC 8 HOURS TO COPPER RIDGE, INC 8 HOURS TO WILLIAM HILL MANOR, INC 8 HOURS TO BUCKINGHAM'S CHOICE, INC 4 HOURS TO EPISCOPAL MINISTRIES TO THE AGING, INC 2 HOURS TO THE COPPER RIDGE INSTITUTE, INC 2 HOURS TO EMA HEALTH SERVICES, INC CHRISTINE HUGHES IS A BOARD MEMBER AND FULL-TIME EMPLOYEE OF THE CONSOLIDATED GROUP OF ORGANIZATIONS THAT COMPRISE EMA, OF WHICH EMA HEALTH SERVICES IS A SUBSIDIARY. IT IS ESTIMATED THAT EACH WEEK SHE DEVOTES 38 HOURS TO RELATED ORGANIZATIONS AND 2 HOURS TO EMA HEALTH SERVICES. DR. WILLIAM TAN IS A BOARD MEMBER AND DEVOTES A PORTION OF HIS PROFESSIONAL TIME TO THE CONSOLIDATED GROUP OF ORGANIZATIONS THAT COMPRISE EMA, OF WHICH EMA HEALTH SERVICES IS A SUBSIDIARY. IN HIS PROFESSIONAL ACTIVITIES WITH THE EMA CONSOLIDATED GROUP, HE IS TREATED AS A SUBCONTRACTOR. IT IS ESTIMATED THAT EACH WEEK WITHIN THE EMA CONSOLIDATED GROUP HE DEVOTES 20 HOURS TO RELATED ORGANIZATIONS AND 2 HOURS TO EMA HEALTH SERVICES.
AUDIT OVERSIGHT:
FORM 990, PAGE 12, PART XI, LINE 2C
THE EMA AUDIT COMMITTEE REVIEWS THE DRAFTS OF THE CONSOLIDATED AUDIT AND MANAGEMENT LETTER AND RECOMMENDS ACCEPTANCE TO THE FULL EMA BOARD. IN ADDITION, THE COMMITTEE REVIEWS THE MANAGEMENT RESPONSE TO THE MANAGEMENT LETTER AND ALSO REVIEWS RESPONSES TO CONFLICT OF INTEREST QUESTIONNAIRES. THE AUDIT COMMITTEE CONSISTS OF BOARD MEMBERS. THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.