Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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...... | 813,252 | 1,091,370 | 1,058,152 | 1,046,834 | 1,402,899 | 5,412,507 |
| 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. | 813,252 | 1,091,370 | 1,058,152 | 1,046,834 | 1,402,899 | 5,412,507 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 5,412,507 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 813,252 | 1,091,370 | 1,058,152 | 1,046,834 | 1,402,899 | 5,412,507 |
| 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 VI.) .. | 101 | 18,351 | 455 | 18,907 | ||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 813,252 | 1,091,370 | 1,058,253 | 1,065,185 | 1,403,354 | 5,431,414 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | OTHER - 2012 AMOUNT: $ 101. 2013 AMOUNT: $ 18,351. 2014 AMOUNT: $ 455. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | EMA HEALTH SERVICES IS GOVERNED BY THE BOARD OF DIRECTORS FOR INTEGRACE, INC. (EIN: 52-1710891). |
| FORM 990, PART VI, SECTION A, LINE 6 | INTEGRACE, INC. IS THE SOLE MEMBER OF EMA HEALTH SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | INTEGRACE, INC., THE SOLE MEMBER OF EMA HEALTH SERVICES, INC., APPOINTS ALL DIRECTORS, EXCEPT FOR THE PRESIDENT, WHO SHALL BE AN EX-OFFICIO MEMBER OF THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING MUST BE APPROVED BY THE SOLE MEMBER: 1) CHANGING OF THE PHILOSOPHY, OBJECTIVES, OR PURPOSE OF THE CORPORATION. 2) AMENDING OF THE BY-LAWS OR ARTICLES OF INCORPORATION OF THE CORPORATION. 3) DISSOLUTION OR LIQUIDATION OF THE CORPORATION. 4) ELECTION OR REMOVAL OF ANY MEMBER OF THE BOARD OF DIRECTORS. 5) MERGING OR CONSOLIDATION OF THE CORPORATION. 6) APPOINTMENT OR REMOVAL OF THE PRESIDENT. 7) CREATION OF ANY SUBSIDIARY ORGANIZATION OR AFFILIATE OF THE CORPORATION WITH ANY OTHER ENTITY FOR THE PURPOSE OF THE JOINT CONDUCT OF BUSINESS OR OTHER PROGRAMS. 8) CONVEYANCE OF GRANT MORTGAGES, TRUST DEEDS OR CREATION OF OTHER LIENS ON ANY REAL PROPERTY ASSETS, OTHER THAN CONVEYANCES OR LIENS IN FAVOR OF ANY PUBLIC OR QUASI-PUBLIC AUTHORITY FOR ACCESS, UTILITIES, ROAD WIDENING AND SIMILAR FUNCTIONS WHICH DO NOT MATERIALLY IMPAIR THE USE OR VALUE OF THE BALANCE OF THE PROPERTY. 9) CONVEYANCE OF ANY OTHER ASSETS OF THE CORPORATION WHOSE FAIR MARKET VALUE EXCEEDS $25,000. 10) INCURRING ANY INDEBTEDNESS OR SERIES OF INDEBTEDNESS, EITHER OF WHICH EXCEEDS $25,000 OR TO GUARANTEE ANY INDEBTEDNESS OR SERIES OF INDEBTEDNESS, EITHER OF WHICH EXCEEDS $25,000. 11) TO APPROVE THE ANNUAL OPERATING BUDGET AND ANNUAL CAPITAL BUDGET AND ANY CHANGE IN EXCESS OF $50,000 THERETO. 12) APPROVAL OF THE STRATEGIC PLAN OF THE CORPORATION AND ANY AMENDMENT THERETO. 13) EXERCISING OF ANY POWERS MENTIONED ABOVE, OTHER THAN #10, THE CORPORATION MAY HAVE AS A MEMBER OR STOCKHOLDER OF ANOTHER CORPORATION OR PARTICIPANT IN ANY LLC, PARTNERSHIP, JOINT VENTURE OR OTHER ENTITY. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE PROCESS TO REVIEW THE FORM 990 IS AS FOLLOWS: 1) THE FINANCE STAFF REVIEWS THE RETURN FOR ACCURACY AND COMPLETENESS. 2) THE RETURN IS PRESENTED TO THE FINANCE COMMITTEE OF THE INTEGRACE BOARD OF TRUSTEES FOR THEIR REVIEW AND APPROVAL. 3) ONCE APPROVED BY THE FINANCE COMMITTEE, THE 990 IS RELEASED TO THE ENTIRE BOARD OF TRUSTEES FOR APPROVAL PRIOR TO THE RETURN BEING FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST DISCLOSURES ARE DISTRIBUTED TO MEMBERS OF THE SENIOR LEADERSHIP TEAM IN JANUARY EACH YEAR. THE REMAINING MANAGEMENT STAFF AND TRUSTEE MEMBERS RECEIVE FORMS IN EARLY JUNE. THE COMPLETED FORMS ARE RETURNED TO HUMAN RESOURCES. A REPORT IS PREPARED SHOWING ALL CONFLICT OF INTEREST DISCLOSURES. THIS REPORT IS PRESENTED AT THE JULY MEETING OF THE AUDIT COMMITTEE. IF A CONFLICT OF INTEREST IS DETERMINED TO EXIST, THOSE WITH WHOM THERE IS A CONFLICT ABSTAIN FROM BEING INVOLVED IN DISCUSSIONS AND/OR DECISIONS REGARDING THE CONFLICT. FAMILY AND BUSINESS RELATIONSHIPS ARE TO BE REPORTED ON DISCLOSURE FORMS TO DETERMINE IF A REPORTABLE RELATIONSHP EXISTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE PRESIDENT/CEO'S PERFORMANCE IS REVIEWED ANNUALLY BY THE EXECUTIVE COMMITTEE. THE PRESIDENT/CEO PREPARES A COMPREHENSIVE REPORT SHOWING THE RESULTS OF HIS/HER WORK DURING THE PAST YEAR AND GOALS FOR THE COMING YEAR. THIS REPORT IS REVIEWED BY THE EXECUTIVE COMMITTEE WHICH THEN DETERMINES THE ONGOING COMPENSATION FOR THE PRESIDENT/CEO. THE COMMITTEE GIVES THIS INFORMATION TO THE CFO WHO THEN SENDS IT TO VP OF HUMAN RESOURCES FOR PROCESSING. IN THE CASE OF A NEW CEO, A SEARCH FIRM IS USED TO NEGOTIATE SALARY AND BENEFITS DIRECTLY WITH THE CANDIDATE. THE SALARY IS NEGOTIATED TAKING INTO CONSIDERATION COMPARABLE SALARIES IN THE INDUSTRY TO DETERMINE A COMPENSATION PACKAGE WITHIN FAIR MARKET RANGE. THE PROCESS IS ALSO DOCUMENTED IN MINUTES DURING AN EXECUTIVE SESSION. COMPENSATION FOR THE EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES IS DETERMINED BY THE CEO USING SIMILAR METHODS. SENIOR MANAGEMENT POSITIONS ARE PAID ACCORDING TO RESPONSIBILITY IN THE COMPANY, EXPERIENCE, CREDENTIALS, AND MANAGEMENT AND LEADERSHIP SKILLS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONSULTING FEES: PROGRAM SERVICE EXPENSES 559,900. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 559,900. X-RAY FEES: PROGRAM SERVICE EXPENSES 2,521. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,521. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 7,703. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,703. PURCHASED SPECIAL SERVICES: PROGRAM SERVICE EXPENSES 156. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156. |
| FORM 990, PAGE 5, PART VI, LINE 1A | EMA HEALTH SERVICES, INC. IS AN AFFILIATE IN A GROUP OF WHICH INTEGRACE, INC. (EIN 52-1710891) IS CONSIDERED THE PARENT. INTEGRACE, INC., AS PART OF ITS MANAGEMENT FUNCTIONS FOR THE GROUP, ISSUES ALL 1099 INFORMATION FORMS UNDER ITS EIN. EMA HEALTH SERVICES, INC. IS THEN ALLOCATED APPROPRIATE AMOUNTS FOR PROFESSIONAL SERVICES WHICH ARE THEN REPORTED ON PART IX OF THE FORM 990. |
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