Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
EMHFL INC
Employer identification number
61-1388556
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
EMHFL INC
Employer identification number
61-1388556
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
PROCESS TO REVIEW FORM 990 -------------------------- COPIES OF THE FORM 990 ARE SUBMITTED TO THE FULL BOARD VIA EMAIL PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12B AND 12C
MONITORING THE CONFLICT OF INTEREST POLICY ------------------------------------------ ANNUALLY, BOARD OF DIRECTORS, SENIOR LEADERSHIP AND MEDICAL STAFF LEADERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. COMPLETION OF THE ANNUAL QUESTIONNAIRE IS COORDINATED BY GENERAL COUNSEL AND EPHRAIM MCDOWELL'S CORPORATE COMPLIANCE OFFICER. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE SENIOR LEADERSHIP AND THE CORPORATE COMPLIANCE OFFICER. THE CHAIRMAN OF THE BOARD OF DIRECTORS IS MADE AWARE OF CONFLICTS WHICH HAVE BEEN DISCLOSED ON ANNUAL STATEMENTS. IF CONFLICTS EXIST, THE CONFLICT IS DISCLOSED AND THE INDIVIDUAL WITH THE CONFLICT DOES NOT PARTICIPATE OR VOTE ON ACTIVITIES WHERE A CONFLICT OF INTEREST IS PRESENT.
FORM 990, PART VI, SECTION B, LINE 15A AND 15B
PROCESS FOR DETERMINING COMPENSATION ------------------------------------ EMHFL, INC. IS PART OF AN INTERGRATED HEALTHCARE DELIVERY SYSTEM WHOSE PARENT IS EPHRAIM MCDOWELL HEALTH, INC. COMPENSATION FOR ALL AFFILIATES IS OVERSEeN AND COORDINATED THROUGH EPHRAIM MCDOWELL HEALTH, INC. THE MERCER GROUP, INDEPENDENT CONSULTANTS, CONDUCTED A REVIEW IN 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.
FORM 990, PART VI, SECTION C, LINE 19
MAKING FORMS AVAILABLE TO THE PUBLIC ------------------------------------ THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART V, LINE 2A
COMMON PAYMASTER ---------------- EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER IS THE COMMON PAYMASTER FOR EMHFL, INC. ALL SALARIES AND PAYROLL TAXES ARE REPORTED ON A CONSOLIDATED FORM 941. THE EIN ON THE FORM 941 IS 61-0492356.
FORM 990, PART VI, SECTION A, LINE 6, 7A & 7B
MEMBERS OF THE ORGANIZATION --------------------------- EPHRAIM MCDOWELL HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF EMHFL, INC. EPHRAIM MCDOWELL HEALTH, INC., A RELATED 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. EPHRAIM MCDOWELL HEALTH, INC. ELECTS BOARD MEMBERS OF EMHFL, INC. ON AN ANNUAL BASIS. THE BYLAWS OF EMHFL, INC. REQUIRE APPROVAL OF CERTAIN TRANSACTIONS BY ITS SOLE CORPORATE MEMBER, EPHRAIM MCDOWELL HEALTH, INC.
FORM 990, PART III, LINE 4
PROGRAM SERVICE ACCOMPLISHMENTS ------------------------------- Ephraim McDowell Fort Logan Hospital (EMFLH), located in Stanford, Kentucky, is a 25-bed critical access hospital offering quality health care and Level IV Trauma certified emergency services. The facility is Joint Commission accredited and recognized as a Certified Preferred Employer through The Work Institute. EMFLH represents less than five percent of employers, among more than 200 healthcare organizations that are a part of The Work Institute to receive such a distinction. EMFLH offers a variety of Ephraim McDowell Health system services locally through the facility, including Cardiopulmonary, Diagnostic, Dietary, Family-Centered Maternity Care including a Birthing Spa, Laboratory, Rehabilitation, Surgical Services, and Durable Medical Equipment including Home Medical Equipment through Med Source of Stanford. In fiscal year 2014, Emergency services were provided to over 11,194 people locally, the facility recorded 2,560 total inpatient days, and over 21,388 patients were registered for outpatient services. These numbers reflect an increase in health care access to residents of Lincoln and the surrounding counties. The total salary cost reported for community benefit activities by EMFLH Associates paid by the organization in FY 2014 were $43,094. Community Health Education - General ------------------------------------ Health Fairs - A registered nurse (RN) met with each client to develop a written plan to decrease their life style associated health risk factors. Services were offered at 24 sites (21 percent increase) in Lincoln and Garrard Counties with a focus on reaching at risk and vulnerable populations. Four hundred sixty one adults were served. Over 43 percent had a household income below $35,000. In clients seen, unemployment decreased from 20 percent in FY 2013 to just over seven percent in 2014, and 19 percent of participants were retired. In FY 2014, 36 percent reported not having a primary care provider (PCP) compared to 27 percent in FY 2013. Referral options were provided, including Hope Clinic, reduced fee program, and primary provider listing for the region. Over five percent of clients served were African American; 93 percent Caucasian, less than 2 percent were other. The African American population represents a high risk group due to poverty, diabetes, high blood pressure, high body mass index, and other factors and was a focus for services. The ethnicity percentages are representative of the regional demographics. Forty five percent of screening test results were out of normal range; 64 percent of participants with abnormal test results were referred to a primary care provider for follow-up care. Forty percent of clients were male; 60 percent were female. The number of individuals screened in Lincoln and Garrard Counties was essentially unchanged from FY 2013 to FY 2014. There was a decrease in the number of individuals that were uninsured, unemployed, or retired with 30 percent living in poverty. There was an increase in hospital based outpatient services which reflects increased access to care. The conclusion is that high risk individuals were served by the screening programs. Community Health Education - Self HelP -------------------------------------- Sports Injury Prevention program - In 2014 the Trauma Bear Fair was sponsored by the EMFLH, EMS, and Air Evac at local schools to provide trauma education to sixty second grade students. The focus was on what to expect if involved in an accident requiring a hospital visit. EMS addresses the events at the accident/scene and transport; the nurses address patient care at the hospital. Teddy Bears, bandages to place on the bear and coloring books were provided to the students. This was part of community education related to trauma. Funding for the event was provided by Ft. Logan Hospital and in-kind services from the community partners. Community Health Education - Support Group ------------------------------------------ Cancer - The Lincoln County Cancer Coalition hosted three breast cancer support group meetings with attendance ranging from 5-10 participants. There were fewer meetings in 2014 due to cancellations related to weather, illness, vacations, etc. Community-Based Clinical Services --------------------------------- Health Screenings - Health fairs were conducted in Lincoln and Garrard Counties in collaboration with the school systems, health departments, county extension offices, churches, and stock yards. Services offered were based upon the 2011 health risk assessment, community feedback and work plan. Services included cardiovascular disease (CVD) risk factors (both stroke and heart attack). CVD risk screenings included cholesterol, glucose, body mass index (BMI), blood pressure, tobacco use, family history, pulse regularity, activity intensity, risk score card, and consultation with an RN to develop goal(s) for health risk reduction. Early detection/ prevention of cancer include skin cancer screening, tobacco use cessation referrals, and distribution of colorectal cancer screening kits. Blood Pressure Screening - Seventy-five percent of the 358 blood pressure assessments in Lincoln and Garrard Counties exceeded the recommended range as established by the American Heart Association (AHA); down from 85 percent in FY 2013. Dietary information was provided. Instructions for monitoring and recording blood pressure, and the significance of blood pressure control in the prevention of heart attack and stroke were key elements in client education for those with pre-hypertension and Stage I Hypertension. Stage II Hypertension and above clients were referred for primary care follow-up and evaluation. During Nurses' Week, EMFLH nurses checked blood pressure for visitors and public in the hospital lobby, screening fifty community members. This was a new activity for Nurses' Week. Cancer - Colorectal Screening - Colorectal cancer screening kits were distributed through screenings, clinics and the hospital with ten being returned for interpretation. This project was funded by Ephraim McDowell Health Care Foundation (EMHCF). Cancer - Mammography/Breast - With the close of the Woman to Woman Rural Outreach Program, there is not funding for free mammograms but the preventative care component of the ACA has increased access, as has the expanded Medicaid coverage in the Commonwealth of Kentucky. Cancer Skin Screening - In FY 2014 there was not a skin cancer screening offered in Lincoln County due to the lack of a community partner and limited licensed independent practitioner coverage. This service was offered in Boyle County and open to Lincoln and Garrard County residents. Cholesterol Testing - In FY 2014 , twenty-seven percent of the 346 total cholesterol tests exceeded the recommended range as established by the American Heart Association (AHA). Diabetes Screening - In FY 2014, twelve percent of the 346 total blood sugar (glucose) tests exceeded the recommended range as established by the American Diabetic Association (ADA). Nutrition/Obesity Screening - Sixty-nine percent of the adults screened exceed the recommendation related to body mass index, compared to 83 percent in FY 2013. Education was offered related to portion control and glycemic index for all clients exceeding the recommended range. Referral to a dietitian, county health department nutrition classes or primary care provider was made for those in the high risk group due to the relationship between obesity and some forms of cancer, diabetes, heart attack and stroke. Stroke Screening - Stroke screening was provided at Garrard and Lincoln County Health Departments, Journey Church, Fairview Baptist Church, Boneyville Baptist Church, Forks of Dix River Baptist Church and Wallaceton Baptist Church using The American Stroke Association Scorecard to record the client's risk factors as high (red), medium, (yellow) or low (green) for purposes of education and goal setting to reduce modifiable life style related CVD risk factors. Individuals with three or more risk factors in the high risk range were referred for PCP follow-up. Height and Weight & BMI screenings - Community Service staff assisted the school nurses in Lincoln County with height, weight and BMI measurement for students. Community-Based Clinical Services- Immunizations Flu shots - Eighty-one flu shots were administered at the stockyards and churches in Lincoln and Garrard Counties. Health Care Support Services - Other Health Care Support Services Blood Drive - EMFLH pays on duty Associates for the time necessary to participate in the blood drives conducted at the hospital in collaboration with the Central Kentucky Blood Bank. Four individuals participated in the blood drive at the EMFLH work site in FY 2014 Health Professionals Education ------------------------------ Other Allied Health Professional - Radiology students were provided clinical supervision for their practicum as req
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.