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
EPHRAIM MCDOWELL HEALTH RESOURCE INC
Employer identification number
31-1545520
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......
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.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
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...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)
13
Total support (Add lines 9, 10c, 11 and 12.).
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
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
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
EPHRAIM MCDOWELL HEALTH RESOURCE INC
Employer identification number
31-1545520
Identifier
Return Reference
Explanation
PROCESS TO REVIEW FORM 990
FORM 990, PART VI, SECTION B, LINE 11
----------------------- COPIES OF THE FORM 990 ARE SUBMITTED TO THE FULL BOARD VIA EMAIL PRIOR TO FILING. THE FINANCE COMMITTEE WILL REVIEW THE FILED RETURNS AT THEIR NEXT COMMITTEE MEETING.
MONITORING THE CONFLICT OF INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12B AND 12C
----------------------- ALL GOVERNING BODY MEMBERS ARE REQUIRED TO FILL OUT CONFLICT OF INTEREST FORMS ANNUALLY.
PROCESS FOR DETERMINING COMPENSATION
FORM 990, PART VI, SECTION B, LINE 15A AND 15B
----------------------- EPHRAIM MCDOWELL HEALTH RESOURCE, INC. IS PART OF AN INTERGRATED HEALTHCARE DELIVERY SYSTEM WHOSE PARENT IS EPHRAIM MCDOWELL HEALTH, INC. COMPENSATION FOR ALL AFFILIATES IS OVERSEeN AND COORDINATED THROUGH EPHRAIM MCDOWELL HEALTH, INC. THE MERCER GROUP, INDEPENDENT CONSULTANTS, CONDUCTED A REVIEW IN 2010 FOR ESTABLISHING REASONABLE COMPENSATION OF OFFICERS AND KEY EMPLOYEES FOR THE SYSTEM. THE ORGANIZATION ALSO UTILIZED COMPENSATION STUDIES. THE COMPENSATION IS APPROVED BY THE COMPENSATION COMMITTEE OF THE EPHRAIM MCDOWELL HEALTH, INC. BOARD OF DIRECTORS. THE DECISION AND PROCESS IS DOCUMENTED BY THE COMMITTEE.
MAKING DOCUMENTS AVAILABLE TO THE PUBLIC
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.
COMMON PAYMASTER
FORM 990, PART V, LINE 2A
----------------------- EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER IS THE COMMON PAYMASTER FOR EPHRIAM MCDOWELL HEALTH RESOURCE, INC. ALL SALARIES AND PAYROLL TAXES ARE REPORTED ON A CONSOLIDATED FORM 941. THE EIN ON THE FORM 941 IS 61-0492356.
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4A
----------------------- Ephraim McDowell Health Resource (EMHR) is responsible for attracting physicians and other medical providers for service delivery to approximately 140,000 individuals in Boyle, Casey, Lincoln, Garrard, Mercer and Washington counties-the primary service area of Ephraim McDowell Health (EMH). Clinical services are as appropriate, available on a reduced fee or sliding scale basis. Ephraim McDowell Health through EMHR, has created a network of clinic facilities designed to service the diverse healthcare needs of the region. Nine family medical and immediate care centers offer clinic services in Boyle and each of the other five surrounding counties in the EMH service area, in FY2011 totaling over 100,000 visits. These facilities provide physical examinations, well-child checkups, and treatment of acute illnesses as well as laboratory and X-ray services on-site, including EKG. The immediate care centers provide more urgent ambulatory care than the standard clinic services, in facilities dedicated to the delivery of medical care outside of a hospital emergency department, and provide these services on an unscheduled, walk-in basis, over extended hours and on the weekends when primary care services are not available and emergency care services are not necessary. Three specialty clinic services, Vascular, Cardiology, and Pulmonology services are offered in coordination with resources provided by EMRMC. In FY 2011, Ephraim McDowell Vascular, Cardiology, and Pulmonary services logged over 7,073 visits. Our Vascular services treats patients with carotid disease, aortic aneurysms, lower extremity vascular disease, hemodialysis complications and venous disease. Ephraim McDowell just opened an additional new Cardiovascular Cath Lab this year. The new Cath Lab uses equipment that provides three-dimensional imaging technology along with X-ray technology to offer exceptional image clarity for diagnosing and treating cardiovascular disease. More invasive procedures are performed in our state of the art vascular operating room at Ephraim McDowell Regional Medical Center. The vascular service program offers a full range of services for diagnosing and treating diseases of the heart and circulatory system as well as the body's entire vascular system with all services provided by a board-certified interventional cardiologist. Ephraim McDowell Pulmonology offers a comprehensive approach to treating and managing lung conditions including interstitial lung diseases, chronic obstructive pulmonary disease (COPD), infectious lung disease, drug-related pulmonary disorders, and carcinoma of the lung. Each of these specialties provide care to individuals experiencing illnesses all consistent with or potential co-morbidities to conditions effecting patients meeting the criteria targeted by objectives 1 and 2 identified in the Community Health Assessment. Finally, Ephraim McDowell Health, through EMHR offers wellness living resources through Ephraim McDowell Wellness Center (EMWC) and McDowell Place of Danville. EMWC, a community wellness center, provides fitness equipment, aquatics, a full spectrum of fitness and conditioning classes, and childcare services to over 2800 members from school aged children to senior citizens. The assisted living center, McDowell Place offers assisted living facilities to approximately 100 assisted living residents and membership to EMWC located next door.
MEMBERS OF THE ORGANIZATION
FORM 990, PART VI, SECTION A, LINE 6 & 7A
----------------------- EPHRAIM MCDOWELL HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF EPHRAIM MCDOWELL HEALTH RESOURCE, INC. EPHRAIM MCDOWELL HEALTH, INC., A RELATED 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. EPHRAIM MCDOWELL HEALTH, INC. ELECTS BOARD MEMBERS OF EPHRAIM MCDOWELL HEALTH RESOURCE, INC. ON AN ANNUAL BASIS.
RECONCILIATION OF NET ASSETS
FORM 990, PART XI, LINE 5
----------------------- OTHER CHANGE IN NET ASSETS: PRIOR PERIOD ADJUSTMENT DUE TO THE RECLASSIFICATION OF MINORITY INTEREST $51,030
COMPENSATION REPORTED FOR FORMER CEO
FORM 990, PART VII
----------------------- L. Clark Taylor, former Chief Executive Officer, resigned from Ephraim McDowell Health on January 4, 2010. Form 990 instructions specify that compensation reported on Form 990, Part VII, must be reported on a calendar year basis using the calendar year that falls within the reporting period. The calendar year which falls with the reporting period for the year ended September 30, 2011 is 1/1/10 to 12/31/10. Mr. Taylor'S compensation reported on Form 990, Part VII includes payment of deferred compensation and accrued paid time off.
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DENA DEMAREE TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DALE KIHLMAN TITLE:SECRETARY HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JUDY HAMMONS TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DAVID HOPPER, MD TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JAMES JACOBUS TITLE:VICE CHAIR HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:MARK MORGAN TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:KIM RAGLAND, PH.D TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JOHN CUNY TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:BOB ROWLAND TITLE:TREASURER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:WILLIAM RUTH III TITLE:CHAIR HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:REV. QUENTIN SCHOLTZ III TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:SHEREE GILLIAM TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JAMES ALEXANDER, MD TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DONALD HAMNER, MD TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:THOMAS SEREY, MD TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:RODNEY BATES, MD TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:WILLIAM SNAPP III TITLE:VP & CFO HOURS:56
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:VICKI DARNELL TITLE:CEO HOURS:56
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.