Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2011 and ending 09-30-2012
BCheck if applicable:
CName of organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
217 SOUTH THIRD STREET
 
Room/suite
City or town, state or country, and ZIP + 4
DANVILLE, KY40422
D Employer identification number

61-0492356
E Telephone number

G Gross receipts $ 153,582,751
F Name and address of principal officer:
VICKI A DARNELL
217 SOUTH THIRD STREET
DANVILLE,KY40422
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.EMHEALTH.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1972
M State of legal domicile: KY
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE ORGANIZATION'S PRIMARY MISSION IS TO PROVIDE HEALTH CARE AND RELATED SERVICES TO THE 140,000 INDIVIDUALS RESIDING WITHIN ITS SERVICE REGION IN SOUTH CENTRAL KENTUCKY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 15
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 1,229
6 Total number of volunteers (estimate if necessary) .... 6 243
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 3,208,258
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 314,682
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 408,898 303,408
9 Program service revenue (Part VIII, line 2g) ......... 140,782,861 149,925,684
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 30,740 1,514
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 1,615,876 3,351,698
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 142,838,375 153,582,304
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,000 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 57,901,595 61,586,322
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 73,599,063 78,521,375
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 131,502,658 140,107,697
19 Revenue less expenses. Subtract line 18 from line 12....... 11,335,717 13,474,607
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 175,439,921 187,847,906
21 Total liabilities (Part X, line 26)............. 10,523,697 9,457,075
22 Net assets or fund balances. Subtract line 21 from line 20..... 164,916,224 178,390,831
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: THE ORGANIZATION'S PRIMARY MISSION IS TO PROVIDE HEALTH CARE AND RELATED SERVICES TO THE 140,000 INDIVIDUALS RESIDING WITHIN ITS SERVICE REGION IN SOUTH CENTRAL KENTUCKY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 125,594,256 including grants of $   ) (Revenue $ 146,717,426 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 125,594,256
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
87
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,229
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
16
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
KY
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
EPHRAIM MCDOWELL HEALTH
217 SOUTH THIRD STREET
DANVILLE,KY40422
(859) 239-2424
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) DENA DEMAREE
BOARD MEMBER
 3.0 X           0 3,450 0
(2) JUDY HAMMONS
BOARD MEMBER
 3.0 X           0 3,150 0
(3) DAVID HOPPER MD
BOARD MEMBER
 3.0 X           0 3,000 0
(4) JAMES JACOBUS
VICE CHAIR
 3.0 X   X       0 3,600 0
(5) MARK MORGAN
BOARD MEMBER
 3.0 X           0 3,600 0
(6) KIM RAGLAND PH D
BOARD MEMBER
 3.0 X           0 3,150 0
(7) JOHN CUNY
BOARD MEMBER
 3.0 X           0 3,450 0
(8) BOB ROWLAND
TREASURER
 3.0 X   X       0 3,600 0
(9) WILLIAM RUTH III
CHAIR
 3.0 X   X       0 3,600 0
(10) REV QUENTIN SCHOLTZ III
BOARD MEMBER
 3.0 X           0 3,600 0
(11) SHEREE GILLIAM
BOARD MEMBER
 3.0 X           0 4,950 0
(12) DALE KIHLMAN
SECRETARY
 3.0 X   X       0 3,150 0
(13) DONALD HAMNER MD
BOARD MEMBER
 3.0 X           7,825 3,450 0
(14) ERIC GUERRANT MD
BOARD MEMBER
 3.0 X           2,000 900 0
(15) RODNEY BATES MD
BOARD MEMBER
 3.0 X           0 3,450 0
(16) GARY AHNQUIST MD
BOARD MEMBER
 3.0 X           3,334 2,550 0
(17) WILLIAM SNAPP
VP & CFO
 30.0     X       0 274,413 92,837
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) VICKI DARNELL
CEO
 30.0     X       0 458,504 144,173
(19) SALLY DAVENPORT
VP & CNO
 40.0       X     196,767 0 91,976
(20) CARL METZ
VP HUMAN RESOURCES
 40.0       X     193,797 0 56,471
(21) MICHELLE FRALEY
PHARMACIST
 40.0         X   125,483 0 35,948
(22) JOAN HALTOM
PHARMACY DIRECTOR
 40.0         X   162,038 0 38,482
(23) RONALD BARBATO
REHAB DIRECTOR
 40.0         X   140,718 0 37,030
(24) ANDREW LOSCH
PHARMACIST
 40.0         X   142,982 0 17,657
(25) TINA COOLEY
PHARMACIST
 40.0         X   139,424 0 12,116










1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,114,368 785,567 526,690
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet34
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MARSHALL MEDICAL MANAGEMENT LLC
1792 ALYSHEBA WAY STE 150
LEXINGTON,KY40509 		PHYSICIAN SERVICES 1,013,890
KENTUCKY BLOOD CENTER
3121 BEAUMONT CENTER CIRCLE
LEXINGTON,KY40512 		BLOOD SERVICES 739,665
LOGAN HEALTHCARE LINEN DIVISION
PO BOX 643958
CINCINNATI,OH45264 		LINEN SERVICES 484,073
MARSHALL EMERGENCY SERVICES
4104 TATES CREEK CTR STE 194
LEXINGTON,KY40517 		PHYSICIAN SERVICES 811,776
EMPIRE CONSTRUCTION
3611 GENTRY LANE
DANVILLE,KY40422 		CONSTRUCTION SERVICE 399,431
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet19
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 297,756
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		5,652
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 303,408
Program Service Revenue Business Code
2a PATIENT REVENUE 621,110 144,690,936 141,853,329 2,837,607  
b PHARMACY REVENUE 446,110 2,392,524 2,369,031 23,493  
c JOINT VENTURE INCOME 621,110 2,199,637 2,199,637    
d OTHER OPERATING 621,110 295,429 295,429    
e REFERENCE LAB 621,400 347,158   347,158  
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 149,925,684
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 14     14
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 68,212  
b Less: rental expenses    
c Rental income or (loss) 68,212  
d Net rental income or (loss).......MediumBullet 68,212     68,212
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   1,947
b Less: cost or other basis and sales expenses   447
c Gain or (loss)   1,500
d Net gain or (loss)..........MediumBullet 1,500     1,500
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a EHR INCENTIVE 900,099 2,200,000     2,200,000
b VENDING COMMISSION 722,210 15,335     15,335
c CAFETERIA 722,210 668,301     668,301
d All other revenue .... 399,850     399,850
e Total. Add lines 11a–11d ......MediumBullet 3,283,486
12 Total revenue. See Instructions....MediumBullet 153,582,304 146,717,426 3,208,258 3,353,212
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 582,429   582,429  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 45,752,674 40,653,979 5,098,695  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,474,981 2,173,141 301,840  
9 Other employee benefits ....... 9,085,285 7,977,275 1,108,010  
10 Payroll taxes ........... 3,690,953 3,240,817 450,136  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
c Accounting ........... 59,656   59,656  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 17,682,015 15,419,627 2,262,388  
12 Advertising and promotion .... 11,179 7,705 3,474  
13 Office expenses ....... 5,316,937 4,314,224 1,002,713  
14 Information technology ...... 1,424,745 301,226 1,123,519  
15 Royalties .. 0      
16 Occupancy ........... 2,057,276 1,922,927 134,349  
17 Travel ............ 116,714 78,068 38,646  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 97,407 43,816 53,591  
20 Interest ........... 1,375,612 1,363,944 11,668  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 7,648,636 7,648,636    
23 Insurance .............. 683,053 3,896 679,157  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 21,863,497 21,863,497    
b BAD DEBTS 13,742,891 13,742,891    
c TAXES & LICENSES 2,358,603 2,303,533 55,070  
d REPAIRS & MAINTENANCE 3,058,966 2,460,665 598,301  
e
f All other expenses 1,024,188 74,389 949,799  
25 Total functional expenses. Add lines 1 through 24f 140,107,697 125,594,256 14,513,441 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 2,240 1 2,515
2 Savings and temporary cash investments ....... 105,535 2 102,180
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 12,528,065 4 13,656,051
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 3,192,815 8 3,521,506
9 Prepaid expenses and deferred charges ............ 1,190,808 9 1,185,148
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 161,189,393
b Less: accumulated depreciation. ..... 10b 98,577,400 65,517,075 10c 62,611,993
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 1,431,712 13 1,036,350
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 91,471,671 15 105,732,163
16 Total assets. Add lines 1 through 15 (must equal line 34)... 175,439,921 16 187,847,906
Liabilities 17 Accounts payable and accrued expenses . 9,784,580 17 9,457,075
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 739,117 25 0
26 Total liabilities. Add lines 17 through 25..... 10,523,697 26 9,457,075
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 164,897,934 27 178,373,041
28 Temporarily restricted net assets ..... 18,290 28 17,790
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 164,916,224 33 178,390,831
34 Total liabilities and net assets/fund balances ..... 175,439,921 34 187,847,906
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
153,582,304
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
140,107,697
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
13,474,607
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
164,916,224
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
 
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
178,390,831
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
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
f
g
(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
(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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
  		Employer identification number

61-0492356
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
  		Employer identification number

61-0492356
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
  		Employer identification number

61-0492356
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
13,189
j
Total. Add lines 1c through 1i ...............................
13,189
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING EXPENDITURES SCH. C, PART III-B, LINE 1I A PORTION OF DUES PAID TO THE KENTUCKY HOSPITAL ASSOCIATION (KHA) AND THE AMERICAN HOSPITAL ASSOCIATION (AHA) ARE USED FOR LOBBYING.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   2,353,765 2,353,765
b Buildings ................   69,070,973 30,727,832 38,343,141
c Leasehold improvements ............   2,829,252 1,698,983 1,130,269
d Equipment ................   82,113,950 64,778,023 17,335,927
e Other .................   4,821,453 1,372,562 3,448,891
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 62,611,993
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Scholarship Account 18,501
(2) Physician Income Guarantee 312,885
(3) Due from Related Parties 105,341,517
(4) DUE FROM THIRD PARTY PAYERS 59,260





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 105,732,163
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 0
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 153,582,304
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 140,107,697
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 13,474,607
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 13,474,607
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 139,534,505
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d -13,742,891
e Add lines 2a through 2d ..................... 2e -13,742,891
3 Subtract line 2e from line 1..................... 3 153,277,396
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b 304,908
c Add lines 4a and 4b....................... 4c 304,908
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 153,582,304
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 126,059,898
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d -304,908
e Add lines 2a through 2d...................... 2e -304,908
3 Subtract line 2e from line 1..................... 3 126,364,806
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b 13,742,891
c Add lines 4a and 4b....................... 4c 13,742,891
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 140,107,697
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
RECONCILIATION TO AUDIT REPORT SCH D, PART XII & XIII --------------------------- PART XII LINE 2D OTHER ITEMS INCLUDED ON LINE 1 BUT NOT ON 990 PART VIII: ---------------- BAD DEBT EXPENSE NETTED AGAINST REVENUE PER AUDIT (13,742,891) PART XII LINE 4B AMOUNTS INCLUDED IN 990 PART VIII BUT NOT ON LINE 1: ---------------- CONTRIBUTION REV INCLUDED IN EXPENSE PER AUDIT 303,408 GAIN ON SALE OF ASSETS INCLUDED IN EXPENSE PER AUDIT 1,500 --------- 304,908 PART XIII LINE 2D AMOUNTS INCLUDED ON LINE 1 BUT NOT ON 990 PART IX: ---------------- CONTRIBUTION REV INCLUDED IN EXPENSE PER AUDIT 303,408 GAIN ON SALE OF ASSETS INCLUDED IN EXPENSE PER AUDIT 1,500 -------- 304,908 PART XIII LINE 4B AMOUNTS INCLUDED ON 990 PART IX BUT NOT ON LINE 1: ---------------- BAD DEBT EXPENSE NETTED AGAINST REVENUE PER AUDIT 13,742,891
INCOME TAXES SCH D, PART X, LINE 2 --------------------------- THE CORPORATION AND CERTAIN AFFILIATES (MEDICAL CENTER, RESOURCE, FOUNDATION, FORT LOGAN AND ACP) HAVE BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE CORPORATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. CONSOLIDATED SUBSIDIARIES THAT ARE NOT EXEMPT FROM INCOME TAXES HAD NO MATERIAL TAX LIABILITY. THE CORPORATION FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. WITH A FEW EXCEPTIONS, THE CORPORATION IS NO LONGER SUBECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		1   5,024,450   5,024,450 4.000 %
b Medicaid (from Worksheet 3, column a) ..... 1   15,305,851 12,581,991 2,723,860 2.170 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		2   20,330,301 12,581,991 7,748,310 6.170 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		447 18,770 1,059,007   1,059,007 0.840 %
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		2 576 4,751,925 4,323,820 428,105 0.340 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) .... 1 10 132   132  
jTotal Other Benefits ... 504 30,038 5,811,064 4,323,820 1,487,244 1.180 %
kTotal. Add lines 7d and 7j. .. 506 30,038 26,141,365 16,905,811 9,235,554 7.350 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
13,742,891
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
12,060,149
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
46,504,279
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
52,232,514
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-5,728,235
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1CNTL KY SURGERY CTR
  		ASC 60.000 %   40.000 %
2BLUEGRASS IMM CARE
  		URGENT TREATMENT CLINIC 73.000 %   27.000 %
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
217 SOUTH THIRD STREET
DANVILLE,KY40422 		X X         X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1 Yes  
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20 11
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3 Yes  
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4 Yes  
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5 Yes  
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7   No
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 125.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address Type of Facility (describe)
1 CENTRAL KY SURGERY CENTER
230 WEST MAIN STREET
DANVILLE,KY40422 		OUTPATIENT SURGERY CENTER
2 EPHRAIM MCDOWELL DIAGNOSTIC CENTER
101 DANIEL DRIVE
DANVILLE,KY40422 		DIAGNOSTIC IMAGING & TEST/LAB
3 MEDSOURCE HOME MEDICAL
150 SOUTH THIRD STREET
DANVILLE,KY40422 		DUREABLE MEDICAL EQUIPMENT
4 EPHRAIM MCDOWELL SLEEP DISORDERS
440 WHIRL-A-WAY DR
DANVILLE,KY40422 		SLEEP DISORDER CENTER
5 EPHRAIM MCDOWELL SPINE PHYSICAL THERAPY
236 WEST MAIN ST
DANVILLE,KY40422 		OUTPATIENT REHAB FACILITY
6 EPHRAIM MCDOWELL CANCER SUPPORT CENTER
520 TECHWOOD DR
DANVILLE,KY40422 		OUTPATIENT SERVICES
7 EM DIABETES & ENDOCRINOLOGY CENTER
440 WHIRL-A-WAY DR
DANVILLE,KY40422 		DIABETES CENTER
8 CASEY COUNTY REHABILITATION
513 MIDDLEBURG ST
LIBERTY,KY42539 		OUTPATIENT REHAB FACILITY
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
BAD DEBT EXPENSE SCHEDULE H, PART III, LINE 4 ------------------- THE CORPORATION REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE CORPORATION PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE CORPORATION BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.
COSTING METHODOLOGY SCHEDULE H, PART III, LINE 8 ------------------- Amounts reported on Lines 5 and 6 were based on the corporation's Medicare Cost Report.
NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 ------------------- In 2008, Professional Research Consultants (PRC) was engaged to conduct a needs assessment of Boyle County. The scope of the assessment was only Boyle County due to financial limitations and similarities of the other counties. Three years later, PRC was again engaged to re-assess the service area that includes Boyle and the surrounding counties. The 2011 survey consisted of a telephone interview process and a community focus group. Telephone interviews were stratified by ethnicity, age, gender and economic status proportionate to the population base. The focus group were comprised of invitees from all six counties, including representation from the medical staff leadership of Ephraim McDowell Health (EMH), health department directors, county judge executives, educators, the Salvation Army, Heart of Kentucky United Way and other social agencies. Self report data, mortality, moridity, lifestyle, incidence of chronic disease, injury data and disability data are part of the assessment process. The bench mark is established using Healthy People 2020 data.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 ------------------- EMRMC's charity care policy is posted on the www.emhealth.org website. At registration of self-pay clients, information is given on reduced fee, charity application, and a referral to a financial counselor. The free community screenings are posted on the website and in area newspapers if the hosting organization invites community participation. Some events are discussed on local radio. Information regarding the free clinic is also given by healthcare providers, faith community nurses, case workers and other medical professionals.
COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 ------------------- The health system serves Boyle, Mercer, Casey, Lincoln, Garrard and Washington counties, which have a rural population of approximately 113,000. Access is an issue, due to travel barriers such as out-of-date highways and lack of public transportation. These access issues influenced the decision to serve with free screenings at key gathering places such as churches and schools, etc. Insurance coverage is another issue. There are large numbers of uninsured or underinsured in this service area, and their numbers have increased as some industries have moved out. There is also literacy issues linked to high drop-out rates within the school systems. Literacy issues translate to poverty and poor health. The 2011 community health risk behavior assessment of need exceeded the resources of Ephraim McDowell Health system. The entire report was made available to anyone upon request, shared, discussed and prioritized with input from the Boyle County Health Department, The Salvation Army, Heart of Kentucky United Way and EMH leaders. The focus of resources has been on cardiovascular disease since this is the number-one killer in the world, the US, our state and our region. In fact, the local incidence exceeds state levels. Second priority has been education, early detection and prevention related to skin, colorectal and prostate cancer - again due to local incidence exceeding the state rate. Because of a federal grant, there has been funding for personnel as well as for free mammograms and cervical cancer screening for all six counties. This was done in collaboration with the county health departments. The third priority has been obesity. Again Kentucky is the least active state, and rates of obesity are rising faster here than in the nation generally. Priority groups to reach are low income, uninsured, minority populations, elderly, school age children, and rural populations. We take our screening services to the communities served rather than being hospital or clinic based in an effort to increase access. Schools, county extension offices, health departments, churches and stockyards are the most common venues for services. Much work has been done in collaboration with the school systems to measure body mass index (BMI) starting in middle school and track through to graduation. Course materials to address how to alter BMI have been addressed within the school systems. EMH's Community Service staff collaborated with the Coordinated School Health Committees that were formed in Lincoln and Boyle counties to address the health needs of students and staff. The Basic Faith Community Nursing Course is taught by EMH's Community Service staff to assist churches with establishing health ministries, which help monitor the health of their congregation and act as health advocates for their members. An Alzheimer's Support Group is led by an adult psychiatric and mental nurse practitioner at McDowell Place on a monthly basis to support our dementia patients and their families. Given that Kentucky has an older-than-normal population, the incidence is higher and growing. Reduced-fee clinics are available for those meeting the federal guidelines. We also work with the local health departments for assistance for those that meet guidelines. The Hope Clinic & Pharmacy was founded to provide free care for uninsured clients with diagnoses that most frequently use emergency departments for management of their chronic disease(s) type II diabetes, hypertension, hyperlipidemia, GERDs and obesity. Those that are at 150% or less of the federal poverty guidelines are provided free primary care services and medications as the result of a collaboration among EMH, The Salvation Army, Heart of Kentucky United Way, The Presbyterian Church of Danville, the Boyle County Health Department and the Ephraim McDowell Health Care Foundation. Other needs are often impacted and improved by addressing the top priorities. The advisory group has met annually to assess progress and discuss the next year's work plan. Priorities have not changed since the establishment of the community service department due to the region's vast need. Case finding and early intervention have increased. For those needs identified within the survey that are not directly addressed by our plan due to resource limitations (both financial and human), referrals are made on a case-by-case basis in collaboration with social agencies and other health systems. Also, many of the needs are met through the charity care program.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 ------------------- Officers and staff of EMRMC are engaged in leadership positions with the following: Boyle County Relay for Life; Boyle County Health Department; Mercer County Health Department; Chamber of Commerce and Economic Development agencies in Boyle, Lincoln and Garrard counties; Boyle County School System; 4-H Council; Danville Rotary Club; Heart of Danville; McDowell House; Christian Care Communities; Foundation for Healthy Kentucky; Kentucky Hospital Association and Danville Kiwanis. Staff has also given testimony at local, state, and federal levels related to our service area's health, education and economic issues. EMRMC has an open medical staff comprised of primary care, specialists and subspecialists. Physician recruitment is based upon community need with approval from the governing board. The EMRMC and EMH system boards are comprised of community members with representation from the medical staff and senior leadership and the Fort Logan Hospital Board. The governing board approved the establishment and funding of the Community Service department and the funding of the health risk behavior assessment of Boyle County. They also approved the charity care policy. There is never a fee for services provided by the Community Service department. With H1N1 outbreak, the Community Service department approached churches in the six-county area with hand-washing signs, "Cover your Cough" posters and floor-stand hand sanitizers to help reduce the risk of the spread of flu within congregations and communities. Preventative care, such as flu shots, are taken to the community. So, too, are annual skin cancer checks, monthly blood pressure checks, semi-annual glucose and cholesterol checks, along with nurse consults. Such services are offered in schools, churches, and other public entities in the region, including the stockyards in Lincoln County.
AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 ------------------- EMRMC is a 222 licensed bed acute care hospital serving the community for nearly a century as part of Ephraim McDowell Health (EMH). EMH is a comprehensive, integrated healthcare delivery system that serves 113,000 residents from six counties in south central Kentucky. The EMH Board is comprised of community members and representation from Ft Logan Hospital, medical staff, and EMRMC leadership. Ft Logan Hospital is a critical access hospital located in Lincoln County. Health Resource is comprised of clinics, an early childhood development center, assisted living faculty, and durable medical equipment outlets. There are representatives from our six counties, medical staff, and leadership on the community board that oversees and coordinates the services of Ephraim McDowell Health.
% OF TOTAL EXPENSE CALCULATION Schedule H, Part I, Line 7, column (f) ------------------- The amount of bad debt expense included on Form 990, Part IX, Line 25, column(A), but subtracted for purposes of calculating the percentage of total expense is $13,742,891.
Written Debt Collection Policy and Financial Assistance Schedule H, Part III, Line 9b ------------------- If a patient cannot satisfy standard payment expectations, a financial assistance screening process for alternative sources of balance resolution is completed. Those resolutions may include a discount on charges, Medicaid enrollment or application for charity care.
COMMUNITY HEALTH NEEDS ASSESSMENT SCHEDULE H, PART V, SECTION B ------------------- LINE 1J: THE COMMUNITY HEALTH NEEDS ASSESSMENT ALSO DESCRIBES THE ASSESSMENT OF MODIFIABLE HEALTH RISKS, ASSESSMENT OF HEALTH EDUCATION AND OUTREACH AND PERCEPTIONS OF HEALTHCARE. LINE 3: THE HOSPITAL CONSULTED WITH EMS DIRECTORS, JUDGE EXECUTIVES, HEALTH DEPARTMENT DIRECTORS, SCHOOL NURSES, SCHOOL SUPERINTENDENTS, FAITH COMMUNITY NURSES, SALVATION ARMY COMMANDER, HEART OF KY UNITED WAY, COUNTY EXTENSION OFFICES, SOCIAL WORKERS, LEGISLATORS, CLERGY, PHYSICIANS AND FREE CLINIC STAFF. LINE 4: THE NEEDS ASSESSMENT WAS CONDUCTED WITH EPHRAIM MCDOWELL FORT LOGAN HOSPITAL DUE TO OVERLAP OF POPULATION SERVED. LINE 5: THE NEEDS ASSESSMENT WAS ALSO PROVIDED TO VARIOUS EDUCATION FACILITIES - CENTRE COLLEGE, EASTERN KENTUCKY UNIVERSITY SCHOOL OF NURSING, UNIVERSITY OF KENTUCKY SCHOOL OF NURSING AND SCHOOL OF PUBLIC HEALTH. LINE 7: Deferred needs from the Health Risk Assessment of Boyle and the surrounding Counties based upon resources and/or expertise included the following: Arthritis/rheumatism is an issue. This links to the high obesity rate and the lack of a built environment that facilities mobility. This issue is deferred by EMRMC due to resources but the factors to decrease cardiovascular (CV) risks will assist with mobility, i.e. weight reduction, improved nutrition, decreased inflammatory markers, etc. Both Lincoln and Garrard County Health Departments offer a self-help program for managing arthritis. Lincoln County has plans to expand the offering. The McDowell Wellness Center offers pool exercises for those with arthritis and silver snickers as options to assist in managing both mobility and pain. There is a rheumatologist at the specialty clinic in Boyle County. The closest arthritis support group is in Lexington, Kentucky. Osteoporosis is addressed as a nutritional issue. This links with the high consumption of carbonated beverages and poor nutrition in the region. This is being deferred due to resources but is part of the farm to school dialogue in the school coalitions. Migraine headaches are treated by primary care physicians and referred as needed. A neurologist is on the physician recruitment plan to make access for evaluation and specialty care easier to access and closer to home. Twenty-five percent of the population suffers from chronic back pain or sciatica. There are pain centers in Boyle County. Chiropractic and physical therapy services are available in all six counties. Obesity, inactivity, and a diet high in fat and calories compound the issues related to arthritis, back and sciatica pain. Addiction to pain-killers and other drugs is an issue in the state and region. Addiction services are offered by private providers, Comprehensive Care, and Self-Refined in the region. EMRMC behavioral medicine unit does treat dual diagnosis patients and the psychiatrists and counselors treat out patients. There is an active Alcoholics Anonymous chapter. Due to lack of expertise and resources, addiction will be deferred as part of the work plan by EMRMC. Chronic kidney disease and end stage renal failure links to diabetes. Moderate exercise, a healthier diet, and weigh reduction can prevent the development of type 2 diabetes in persons at risk (Diabetes Prevention Program funded by NIH). The free screenings will provide early detection and possibly prevention when addressing nutrition, body mass index and exercise. The health departments collaborate with the kidney foundation to conduct screening and education related to kidney health. Disabilities and activity limitations correlates with the poverty of resources. Those with a disability report not getting preventative care, i.e., annual dental visit, mammogram, pap smear, additional findings include lifestyle issues, such as use of tobacco and inactive; health issues such as obesity, high blood pressure, high stress and poor mental health, lower employment rates, lower income, and less social support. This area will be deferred, but the work with school age children related to diet, activity, and self-esteem has preventative value (DPP). The screening for obesity, diabetes, high blood pressure, tobacco use, high cholesterol and the risk factor reduction education for adults provides early detection and can be preventative. For those individuals with one of the chronic diseases the RN consult can improve self-care health management. Dementia links to CV health and stroke incidence and vascular issues. It also links to the aging of the population in the region. There is an Alzheimer's support group in Danville. Also there is mental evaluation and medication management available by a psychiatrist at the medical center. James B. Haggin Hospital offers adult day care that serves some clients. Danville Health & Rehabilitation Center has an Alzheimer long term care unit. The Sanders Brown Center at the University of Kentucky has on-going Alzheimer's related research and serves as a referral center for the region. Births to teenagers and unwed mothers, and low birth-weight births are being addressed by the health departments and the school health collations. The Lincoln County Health Department has a 5-year grant to address self-esteem and character building in 6th grade through middle school. The Lincoln and Boyle County school nurses and Community Service staff conduct the Perkins Assessment in middle school through high school as part of the effort to help youth make fewer high risk behavior choices. Both school systems have contracts with the University of Kentucky for the services of an adolescent medicine specialist for on-site services. The Pregnancy Resource Center supports all six counties. Fair/poor mental health and major depression was cited by the county residents as a major issue. The health system does have mental health providers on their recruitment plan. Community Service does conduct depression screening for adults and refer if needed. For children in middle school and high school the Community Service department works with the school nurses to conduct the Perkins Assessment. High school students have the option to participate in the High School Artist project annually. No leisure time physical activity, not meeting physical activity guidelines, links to the lack of built environment - bike & walking paths/trails in a large rural environment. Boyle County has ongoing dialogue about the need for a biking/walking path to connect the county both for health and economic reasons. There is no public transportation system to make it easy to access a central gym/wellness faculty for families living in the counties. The Stanford Rotary Club talked about the need for a Wellness Center in Stanford for access by the community and the youth after school. The Lincoln County Fiscal Court is funding a walking track in Lincoln County. One of the Lincoln County elementary schools uses jump ropes from Community Service as an opportunity for brief activity breaks for students. Boyle County School System will be implementing the SPARK curriculum. Camp Dick Robinson Elementary has created an exercise room for students that is highly utilized. Chronic lung/respiratory disease is being addressed with tobacco education, stop smoking classes at the health departments, pulmonary rehab at the Wellness Center in Danville and public policy. The Community Service department screens for tobacco use in all venues and refers to the health departments. The health departments offer Cooper Clayton classes to help residents stop smoking. The health departments also conduct tobacco education in the school systems. Respiratory disease has a genetic, environmental and a cultural component in the six county region. The exposure to tobacco smoke, agrichemicals, dust, pollen all contribute to asthma and chronic lower respiratory disease. The health departments address smoking cessation. The extension offices address safe handling of agrichemicals. The school health nurses are addressing childhood asthma. Community Service provided the peek flow meters for the Lincoln County School System given the School Health Index priority. Community Service also provided the competency education for the Lincoln County School Nurses related to childhood asthma. Community Service screens for tobacco use and refers at all screening events. Community Service screens for obesity using a calculated BMI for both children and adults. Starting in middle school, Community Services staff and volunteers help map student BMI and chart against the norms. Upon request education is provided for the class regarding how to impact BMI by nutrition, exercise and sleep. Screening for lung capacity occurs in high risk populations given the link between respiratory disease and CV disease. Community Services has given testimony related to smoking in public places at the local and state level. Model legislation was drafted and sent to the legislator in Frankfort by AHEC with EMRMC staff serving on that board and input from the c
Individuals Eligible for Financial Assistance Schedule H,Part V, Line 19d The maximum amount that can be charged to FAP-Eligible individuals for emergency or other medically necessary care is based upon income guidelines stated in the Hospital's Financial Assistance Policy.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) WILLIAM SNAPP (i)
(ii)		 0
232,219 		0
29,959 		0
12,235 		0
66,979 		0
25,858 		0
367,250 		0
29,959
(2) VICKI DARNELL (i)
(ii)		 0
386,204 		0
45,486 		0
26,814 		0
112,386 		0
31,787 		0
602,677 		0
45,486
(3) SALLY DAVENPORT (i)
(ii)		 176,624
0 		14,959
0 		5,184
0 		74,321
0 		17,655
0 		288,743
0 		14,959
0
(4) CARL METZ (i)
(ii)		 163,938
0 		13,509
0 		16,350
0 		38,007
0 		18,464
0 		250,268
0 		13,509
0
(5) MICHELLE FRALEY (i)
(ii)		 125,386
0 		0
0 		97
0 		10,562
0 		25,386
0 		161,431
0 		0
0
(6) JOAN HALTOM (i)
(ii)		 151,899
0 		8,221
0 		1,918
0 		23,228
0 		15,254
0 		200,520
0 		8,221
0
(7) RONALD BARBATO (i)
(ii)		 126,209
0 		7,361
0 		7,148
0 		21,620
0 		15,410
0 		177,748
0 		7,361
0
(8) ANDREW LOSCH (i)
(ii)		 136,747
0 		0
0 		6,235
0 		11,116
0 		6,541
0 		160,639
0 		0
0
(9) TINA COOLEY (i)
(ii)		 139,143
0 		0
0 		281
0 		11,194
0 		922
0 		151,540
0 		0
0







Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
MANAGEMENT INCENTIVE PLANS Schedule J, Part I, Question 6a ------------------------- Ephraim McDowell Health, Inc. and its affiliates have management incentive plans for corporate officers, senior vice-presidents, vice-presidents and directors. Annual payouts related to these incentive plans have two components. 30% of the annual payout is based on net operating income goals compared to budget. The other 70% is based on quality measures, patient satisfaction goals, associate satisfaction goals, and safety measures.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
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.
MONITORING THE CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12B AND 12C --------------------------- THE GOVERNING BOARD MEMBERS FILL OUT CONFLICT OF INTEREST FORMS ANNUALLY.
PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINE 15A AND 15B --------------------------- EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER 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 2012 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 FORMS 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 THE FOLLOWING RELATED ORGANIZATIONS: EPHRAIM MCDOWELL HEALTH, INC. EPHRAIM MCDOWELL HEALTH RESOURCE, INC. EPHRAIM MCDOWELL HEALTH CARE FOUNDATION, INC. JOHN HILL BAILEY CHILDREN'S LEARNING CENTER, INC. EMHFL, INC. COOPERATIVECARE, INC. ALL SALARIES AND PAYROLL TAXES ARE REPORTED ON A CONSOLIDATED FORM 941. THE EIN ON THE FORM 941 IS 61-0492356.
MEMBERS OF THE ORGANIZATION FORM 990, PART VI, SECTION A, LINE 6, 7A & 7B --------------------------- EPHRAIM MCDOWELL HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER. 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 REGIONAL MEDICAL CENTER ON AN ANNUAL BASIS. THE BYLAWS OF EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER REQUIRE APPROVAL OF CERTAIN TRANSACTIONS BY EPHRAIM MCDOWELL HEALTH, INC.
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A --------------------------- Ephraim McDowell Regional Medical Center (EMRMC) is a not-for-profit, 222-bed licensed level III trauma center dedicated to serving the health and wellness needs of the populations of Boyle, Lincoln, Mercer, Garrard, Casey and Washington Counties. EMRMC scope of services include: behavioral health, cancer care center, outpatient cancer care, cardiac care services, critical care, diabetes and endocrinology, diagnostic services, level III trauma/emergency care center, Kids Can Do pediatric therapy center, laboratory services, medical-surgical services, orthopedic/spine care, pastoral care, pain management center, pulmonology, rehabilitation, respiratory therapy, surgical services, vascular services, volunteer/auxiliary, women's health services and wound healing center. Ephraim McDowell Regional Medical Center for Fiscal Year 2012 experienced 7,512 admissions and 35,040 patient days or a .29% increase in admissions and a 3.03% decrease in patient days as compared to 2011. Observation patient days for 2012 totaled 2,429 vs. 2,225, a 9.17% increase over 2011 volume. Outpatient registrations (including ER visits) increased 2.14% to 122,536 as compared to 119,966 in 2011. Surgical procedures at EMRMC fell 19% to 5,155 as compared to 2011 volume of 6,359. The ambulatory surgical center volume increased 3.6% to 6,614 procedures vs. 6,387 in 2011. Community Health Education --------------------------- Cancer Education - One thousand five hundred individuals participated in skin cancer awareness events at Millinum Park and Garrard County Party on the Square. EPA sun safety literature, sun screen and lip balm with sun screen was distributed to re-enforce the message of sun safety. Funding was provided by Ephraim McDowell Health Care Foundation (EMHCF). CPR/First Aid - Ephraim McDowell Health Care Foundation (EMHCF) funded CPR/AED/First Aid education for seventy-one 9th Grade Academy students in Mercer County. Education Website/Community Publication - Eleven editions of the Health Ministry/Faith Community Nursing newsletter were produced, and distributed in Kentucky, Indiana, Ohio, Virginia, and North Carolina. The intent is to provide relevant and current information to the congregations. All information can be reproduced and used for congregation information/education. Exercise/Fitness - In collaboration with the regional 4-H chapter, Wilderness Trace YMCA, and McDowell Wellness Center 637 children school age through teens were served. Venues included Mercer County horse camp, Healthy Kids Day and Feltner 4H camp. The focus was developing leadership skills, promoting physical activity, and encouraging healthy life style habits. Health Fairs - Services were offered at 148 events at 58 sites in Boyle, Lincoln, Garrard, Mercer, Casey, and Washington Counties with focus on reaching at risk and vulnerable populations. Including all programs 36,459 community contacts occurred (screenings, education, support groups, awareness events, etc.). Forty-five percent of participants were male; 55 percent were female. Ninety-three percent of clients served were Caucasian, seven percent were African America and less than one percent were other; this reflects the population of the region. Over seventy percent of participants served within our health ministries programs had a household income below $35,000; total population 56% had a household income less than $35, 000. Twenty-six percent were unemployed that were served within the health ministries program; 20 percent of the total population served was unemployed. Five percent of the participants within the health ministries program were retired, compared to 25 percent in the total population served. Fifteen percent of those served were uninsured. Twenty-seven percent of those served through the health ministries program did not have a primary care provider compared to 15 percent of all participants served. A registered nurse (RN) met with each client to develop a written plan to decrease their life style associated risk factors. At each screening, referral options were provided including Hope Clinic, reduced fee program and primary provider listing for the region for the uninsured. Forty-six percent of screening tests were abnormal with 25 percent requiring a referral to primary care. Parish Nursing Program - Grant funding from Ephraim McDowell Health Care Foundation, O'Donnell Scholars, Northwestern Mutual Insurance and Margaret T. Stoeckinger Foundation made possible the Faith Community Nursing educational programs. The Faith Community Nursing Foundation Course in the spring of 2012 with 19 graduates and an Advanced Faith Community Nursing Module: Mental Health First Aid in the fall of 2012. This was the first time Mental Health First Aid has been offered in the service area. Twenty-four participants completed the 12 hour course. A partnership with Eastern Kentucky University (EKU) made possible both KBN and ANCC credits for the course participants. Faith Community Nursing (FCN) faculty provided consultation to the Central Baptist Hospital Magnet committee regarding a hospital based faith community nursing service. There were 16 participants representing multiple disciplines including volunteers, chaplain, nursing, senior leadership and others. FCN faculty also served as faculty for the Tri-State Foundations Course in Southern Indiana. Nineteen participants completed the program. FCN faculty met with members of Trinity Episcopal Church in Danville regarding decisions related to aging in place, such as, home safety, living will, management of chronic disease, etc. Continuing education was provided for 8 area FCNs with CEUs related to the revised scope and standards of practice. Seventy-two participants have completed the faith community nursing foundations course since its inception at EMRMC in 2009 and serve as volunteers within their congregations. These community partners serve in 23 counties within the Commonwealth of Kentucky and support persons of all denominations. Eleven health ministry newsletters were created and disseated to health ministry partners in Kentucky, Ohio, Illinois, Indiana, Virginia and North Carolina. School-Based Programs - High school aged students were involved in the building of a canvas, selection of a famous painting, reproducing a painting, and an opening night at the Community Art Center culminating in the auction of their painting. This is both a skill building project and a self-esteem enhancing project (Rosenbum). Students from Boyle County, Danville, and Bruce Hall Day Treatment Center participated in the program, producing 74 paintings. There were 150 community patrons on opening night, an additional 650 community visitors viewed the showing at the Community Art Center during the month of May. In collaboration with the Boyle County School District nurses, height/weight/body mass index was completed for 716 middle school students. The Perkins risk assessment was completed for 850 high school students. Nine hundred Boyle County High School students participated in the spring safety fair. The focus was the role of alcohol and driving impaired using the breathalyzer to demonstrate. Seventy area teens participated in the District 4-H Teen Summit. Community Service staff collaborated with Boyle County 4-H on this project. A total of 3,450 youth from Mercer, Boyle, Casey, Garrard, Lincoln, Powell, Estill, Jessamine counties were served through these venues. Speakers Bureau (Health Topics) - The speakers' bureau reached 2,360 individuals, through venues including service clubs, churches, professional groups, teen programs, governing boards and colleges. Topics included heart health, stroke risk, leadership, health ministry, care for the care giver, end of life decisions, and skin cancer prevention and warning signs. There were eighteen sites across the commonwealth. Community Health Education -Self Help -------------------------------------- Fitness/Exercise Nutrition/Weight Management - Twenty-one teens participated in pilot program sponsored by 4-H and Community Service. The focus was to help teens make healthy choices, control portions, food handling principles, and prep. The group celebrated by eating what they prepared. Tobacco/Smoking Cessation - Two hundred thirty nine individuals were referred to the area health departments for smoking cessation assistance. This is a sixteen percent referral rate. The decline in adults reporting tobacco use is believed to be attributed to the passage of no smoking ordinance in some of the communities served. A statewide ordinance has been drafted by some of the agencies (FHK, SoAHEC, etc) for consideration by the legislature during the 2013 session.
PROGRAM SERVICE ACCOMPLISHMENTS (CONT)   Community Health Education - Support Groups ------------------------------------------ Alzheimer's - Twelve Alzheimer's Support Group meetings were facilitated by an advanced practice mental health practitioner. The average attendance was eight participants. The group serves both patients and care-givers/family. Community-Based Clinical Services-Health Screenings --------------------------------------------------- Asthma Screening - Lung capacity was used to screen for lung function at five sites. Two hundred-ninety individuals were screened. Thirty-three percent were referred for further evaluation. Blood Pressure Screening - Blood pressure screenings were offered at 47 sites, serving 1,269 individuals. Eighty-one percent of clients had a blood pressure reading that exceeded the recommended range by the American Heart Association (AHA). Those classified as pre-hypertension received instructions for monitoring and recording as well as dietary instructions related to low sodium diet. Those that were on medications but exceed the recommend range were instructed to share the finding with their primary care provider. Those at stroke level were transported for immediate follow-up by a physician. Cancer -Colorectal Screening - The Ephraim McDowell Health Care Foundation (EMHCF) funded colorectal screening at 25 sites for a total distribution of 369 kits with a 42 percent return rate. Kits were distributed in six counties. Sites included churches, senior citizen centers, wellness center, assisted living facilities, health departments, clinics, hospital lobbies, and the county extension service offices. There was a two percent referral rate. Cancer -Mammography/Breast - A HRSA Outreach grant funded a fourth year for screening and early detection of breast cancer through the Woman to Woman program in the six county service area. There were seventy-seven mammograms provided through the outreach service in partnership with the six county health departments. Cancer- Skin Screening - The Ephraim McDowell Health Care Foundation (EMHCF) funded skin cancer screening by a licensed independent practitioner during May and June. One hundred thirteen individuals were seen. Seventy percent were female; 30 percent male. Sixty-two percent stated on an exit survey that they would not have seen their doctor for a skin cancer screen even though 89 percent had a primary care provider. Forty-two percent were referred to a specialist for follow-up care. Cholesterol Testing - Total cholesterol was measured for 1,020 clients in six counties at 36 sites within health ministries and community settings (excludes grant projects) with 32 percent of participants exceeding the recommend range as set by AHA. Within the lipid panel 60 percent of participants had one or more measure outside the recommended range. Derma Scan for Sun Damage - EMHCF funded the purchase of the DermaView equipment for screening for sun damage in the region due to the increase in skin cancer and the agrarian lifestyle in the region. .Two hundred ninety-six individuals were screened at 7 sites with 36 percent of participants were referred to their primary care provider for follow-up care. Diabetes Screening - Participants were screened at 36 sites in six counties (excluding grant projects) for diabetes. Twenty-eight percent of the 1,006 individuals screened had a glucose level that exceeded the recommend level by the American Diabetes Association (ADA). No one was below the recommended level. This is one of three screening measures that has resulted in immediate referral and transport to emergency care. Mental Health/Depression Screening - The Beck Depression Scale was used to screen for depression in at risk groups at six sites involving 95 individuals. Eight individuals (8%) were referred for follow-up by a mental health provider. Nutrition/Obesity Screening - Height, weight, percent body fat, calculated body mass index (BMI) was offered at 43 sites in six counties with 1,053 adult participants. Seventy-five percent of the participants exceeded the recommend range. Stroke Screening - The American Stroke Association Stroke Risk Scorecard became the standard tool for screening for stroke risk within the department in fiscal year 2012. Stroke risk screening was conducted at 33 sites in six counties involving 913 participants with a 23 percent referral rate. This is one of three screening tests that has resulted in direct referral and transport to emergency care Two hundred seventy-five clients were screened for signs and symptoms of sleep apnea or sleepiness using the Kentucky Sleep Society assessment tool. Fifteen percent reported sleepiness in the moderate or above category; 31percent reported three or more symptoms of obstructive sleep apnea and were provide information for further evaluation. Women's Health Screening - Funding by HRSA Outreach grant contributed $94,931 for women's health screenings for the purpose of prevention and early detection. Services offered included: - Mammograms - Pap smears - Lipid panel - Glucose - Dexa scan for osteoporosis - Lung function - Body Mass Index - DermaView for sun damage - Blood pressure - Stress vulnerability scale - Patient education material - RN consult Other providers were present to offer services such as Heritage Hospice and Coventry Medicaid brokers. Community-Based Clinical Services-Immunizations -------------------------------------------------- Flu Shots - Flu shots were administered at 15 sites in Mercer, Lincoln, Boyle, Garrard, and Washington Counties to 327 individuals age 12 and above. Primary sites were churches and the stockyards. Community-Based Clinical Services-Nonbilled/Reduced -fee Clinic (Hospital Based) -------------------------------------- Hope Clinic & Pharmacy - served 255 patients and provided 888 clients visits for chronic disease management, a record. Eighty-one individuals were screened by The Salvation Army for Hope Clinic; 77 were seen. To qualify for Hope Clinic & Pharmacy an individual must have one or more of the following diagnoses: hypertension, diabetes, obesity, hyperlipidemia, and/or gastro esophageal reflux disease, be uninsured and with a household income below 150% of the federal poverty level. All staff members are volunteers except the part-time LIP and part-time office manager. The clinic is managed by a community advisory board with members from the Boyle County Health Department, Danville Presbyterian Church, Ephraim McDowell Health Care Foundation, Ephraim McDowell Regional Medical Center, Heart of Kentucky United Way, and the Salvation Army. The clinic was started due to community need by a collaboration of the key board members and is a department of EMRMC.
PROGRAM SERVICE ACCOMPLISHMENTS (CONT)   Health Professions Education ----------------------------- Continuing Health Professions Education Interns, Residents and Fellows - EMRMC did not have medical school interns or residents in FY 2012. Medical Students - Twenty seven medical students rotated through emergency services, anesthesia or surgical services with EMRMC medical staff mentors. Nursing - Two hundred ninety six nursing students completed their clinical or practicum at EMRMC in FY 2012. Educational partners included Campbellsville University, University of Kentucky, Eastern Kentucky University, Midway College, Kentucky State University, and Bluegrass Community & Technical College,. Other Allied Health Professions - Forty-three individuals enrolled and 41 completed the Medicare CNA course with a pass rate of 92 percent. Clinical instruction hours totaled. EMRMC served as a clinical site for students from multiple disciplines from the following institutions: Eastern Kentucky University, University of Kentucky, St. Catherine's College, Midway College, Central Kentucky Technical College, Lindsay Wilson College, Kentucky State University, Indiana Wesleyan, Campbellsville University and University of Louisville health sciences. Research ------------- Community Health Research - HRSA Outreach Grant: Healthy People: Healthy Communities targeted cardiovascular disease (CVD) risk factor reduction in a rural population. Lincoln, Garrard, Mercer and Boyle County Health Departments and Boyle County Extension Office collaborate with EMRMC on this grant. Four hundred and nine individuals were screened by this project in FY 2012. Screening included cholesterol (either total or lipid panel) glucose (either fasting or non-fasting), body mass index, blood pressure, pulse check for atrial fibrillation, family history of stroke, tobacco use, activity level. Results of testing are recorded on the Stroke Risk Scorecard. The Healthy People: Healthy Communities study has institutional review board approval. Enrollment for the study opened in September 1, 2012 with 568 tests completed, with 47% of test results exceeding the recommended range and 17 referrals for follow by primary care providers. Forty-eight individuals consented to participate in the study with follow-up by an RN. These services were funded by HRSA at a cost of $26,915. Good Samaritan Foundation- Group Visits for Management of Chronic Disease in a Rural Free Clinic - This grant funding cycle begin in August of 2012, therefore there were only two groups formed - one for hypertension and one for diabetes. A total of fifteen clients were enrolled in the study. HeartHealth Study Phase II - This grant was funded through a sub-award from University of Kentucky. Biometric testing with the grant included: cholesterol, ratio HDL/LDL, HDL, LDL, triglycerides, dental assessment, A1C, heart sensitive C-reactive protein, height, weight, body mass index, waist circumference, obesity (European caliper measurement). An additional option was to participate in the gene typing for those whose risk did not respond to standard interventions. Another option was to participate in the lycopene study if C-reactive protein was elevated. A total of 10,682 biometric tests were completed. Self-reported measures include family history, medication history, diet history, behavioral questionnaire, symptom inventory, health views, MOS-SAS, perceived social support scale, patient health questionnaire, SF-12 v2 questionnaire, Crandell Cognition Inventory, family caregiver questionnaire, and ice cream label reading test. Funding was provided through a HRSA grant sub-award from UK. The total cost of services in 2012 was $101,208. Financial Donations for the Community - In Kind ---------------------------------------------- Personnel/Administrative Support - Information Systems Specialist provided SKYPE setup to assist the Heart of Danville in their search for a Director at no charge to the community for labor or materials. The result was an expedited search at a lower cost to the community and less time for the 10 volunteer community board members. Community Building Activities ----------------------------- Coalition Building - Community Service staff served in two statewide planning sessions with District 4-H leaders related to the annual Kentucky youth leadership conference. A total of 75 individuals were involved in the conference planning process. Community Health Improvement Advocacy - Community Service Staff served on the boards of Foundation for Healthy Kentucky and served on the finance and ambassador committees in addition to their board membership advocating for improve access to care, better built environment and improved nutrition. FHK endowed chairs at the University of Kentucky to focus on public health issues in rural Kentucky. Community Service Staff served on the executive, governance, and workforce committees for Christian Care Communities advocating for safe housing and care for the elderly. Community Service Staff supported the education of health care professionals by serving on the board of the Southern Area Health Education Council. Community Service Staff served as community faculty for University of Kentucky with participation in community research, education and performance improvement. Community Service Staff served on the board of the Mercer County Health Department. Leadership Development/Training for Community Members - Community Service staff collaborated with 4-H staff related to three events to provide leadership and skill development for a total of 40 students within the district. Workforce Development - The Southern Area Health Education Council is involved in the education of health professionals in rural South-Central Kentucky and health policy. . Staff participated in three regional board meetings and the screening and selection for the Youth Health Careers Camp (an on campus emergence in health science experience for high school age students) at the University of Kentucky Community Benefit Operations ----------------------------- Dedicated Staff - There was a dedicated staff of 4 full time staff plus flex RNs and Technicians that work as needed within the community service department and funded by the health system. The staff was comprised of a grant writer, children's programs coordinator, faith community nursing coordinator and the executive director. Total salary expense for dedicated community benefit staff was $280,916 for FY 2012. There was a part-time RN project director dedicated to the to the HeartHealth Phase II Program funded through a UK grant sub-award plus one full time RN and two part time RNs The HeartHealth Phase II program expenses were $101,208 in FY 2012.There was a part-time RN project director dedicated to the to the. Healthy People: Health Community research and outreach program funded by the HRSA outreach grant.$26,915. There is a full time project director for the Woman to Woman HRSA Outreach grant. Granted funded expenses for FY 2012 were$111,891. There was a full time program director for the University of Kentucky Center for Rural Health - Danville that worked on outreach and access issues and funded by a UK grant. UK Rural Health Center - Danville had expenses of $94,931 for FY 2012. All report to community services and share space and office and resources. The SANE grant funded the purchase of equipment and supplies to expand sexual assault services to Ephraim McDowell Fort Logan at a cost of $36,732. This expands services in the region for victims of sexual assault.
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: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:DALE KIHLMAN TITLE:SECRETARY 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:ERIC GUERRANT 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:GARY AHNQUIST MD TITLE:BOARD MEMBER HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM SNAPP TITLE:VP & CFO HOURS:29
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VICKI DARNELL TITLE:CEO HOURS:29
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER
 
Employer identification number

61-0492356
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) JOHN HILL BAILEY CHILDREN'S LEARNING CTR

217 SOUTH THIRD STREET

DANVILLE,KY40422
61-1186005 		DAYCARE CTR KY 501(C)(3) 2 EM HEALTH
 
 
No
(2) EMHFL INC

217 SOUTH THIRD STREET

DANVILLE,KY40422
61-1388556 		CRITICAL HOSP KY 501(C)(3) 3 EM HEALTH
 
 
No
(3) EPHRAIM MCDOWELL HEALTH RESOURCE INC

217 SOUTH THIRD STREET

DANVILLE,KY40422
31-1545520 		HEALTHCARE KY 501(C)(3) 3 EM HEALTH
 
 
No
(4) EPHRAIM MCDOWELL HEALTH CARE FOUNDATION

217 SOUTH THIRD STREET

DANVILLE,KY40422
61-1229333 		FUNDRAISING KY 501(C)(3) 11-II EM HEALTH
 
 
No
(5) EPHRAIM MCDOWELL HEALTH INC

217 SOUTH THIRD STREET

DANVILLE,KY40422
61-1324736 		MGT SERVICES KY 501(C)(3) 11-II NA
 
 
No




For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) CKSC

217 S 3RD
DANVILLE,KY40422
37-1509373 		MEDICAL SERVICES KY NA
  		RELATED 2,069,303 2,904,660   No 0   No 60.000 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) COOPERATIVECARE INC
217 SOUTH THIRD STREET
DANVILLE,KY40422
61-1265715 		CONTRACTING SERV KY NA
  		C 0 0 0 %
(2) EPHRAIM MCDOWELL SERVICES INC
217 SOUTH THIRD STREET
DANVILLE,KY40422
61-1339437 		MGT SERVICES KY NA
  		C 0 0 0 %










Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CENTRAL KENTUCKY SURGERY CENTER LLC

 O 11,032,097 fmv
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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