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
JOHN HILL BAILEY CHILDREN'S LEARNING CENTER INC D/B/A A CHILDREN'S PLACE
Employer identification number
61-1186005
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 E(Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service
SchoolsComplete if the organization answered "Yes" to Form 990, Part IV, line 13, or Form 990-EZ, Part VI, line 48. Attach to Form 990 or Form 990-EZ. Information about Schedule E (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
JOHN HILL BAILEY CHILDREN'S LEARNING CENTER INC D/B/A A CHILDREN'S PLACE
Employer identification number
61-1186005
Part I
YES
NO
1
Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body?
......................
1
Yes
2
Does the organization include a statement of its racially nondiscriminatory policy toward students in all its
brochures, catalogues, and other written communications with the public dealing with student admissions,
programs, and scholarships?
......................................
2
Yes
3
Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way
that makes the policy known to all parts of the general community it serves? If "Yes," please describe. If "No,"
please explain. If you need more space use Part II.
.............................
3
Yes
4
Does the organization maintain the following?
a
Records indicating the racial composition of the student body, faculty, and administrative staff?
..........
4a
Yes
b
Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory
Other extracurricular activities?
.....................................
5h
No
If you answered "Yes" to any of the above, please explain. If you need more space, use Part II.
6a
Does the organization receive any financial aid or assistance from a governmental agency?
...........
6a
Yes
b
Has the organization's right to such aid ever been revoked or suspended?
...................
6b
No
If you answered "Yes" to either line 6a or line 6b, explain on Part II.
7
Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05
of Rev. Proc. 75-50, 1975-2 C.B. 587, covering racial nondiscrimination? If "No," explain on Part II.
7
Yes
Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50085D
Schedule E (Form 990 or 990-EZ) 2013
Schedule E (Form 990 or 990EZ) 2013
Page 2
Part II
Supplemental Information. Provide the explanations required by Part I, lines 3, 4d, 5h, 6b, and 7, as applicable. Also complete this part to provide any other additional information (see instructions).
Return Reference
Explanation
SCH E, PART I, LINE 3
RACIALLY NONDISCRIMINATORY POLICY --------------------------------- ON AN ANNUAL BASIS, A NEWS RELEASE IS PUBLISHED WITH THE LOCAL NEWSPAPER AND THE LOCAL HEALTH DEPARTMENT DESCRIBING THE ORGANIZATION'S NONDISCRIMINATORY POLICY.
SCH E, PART I, LINE 6A
GOVERNMENTAL AID OR ASSISTANCE ------------------------------ THE ORGANIZATION RECEIVES ASSISTANCE FROM THE FEDERAL CACSP AND KY CHILD CARE ASSISTANCE PROGRAM.
Schedule E (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
JOHN HILL BAILEY CHILDREN'S LEARNING CENTER INC D/B/A A CHILDREN'S PLACE
Employer identification number
61-1186005
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 ------------------------------------ A CHILDREN'S PLACE IS PART OF AN INTEGRATED 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 AND PROVIDED MARKET DATA 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 JOHN HILL BAILEY CHILDREN'S LEARNING CENTER. ALL SALARIES AND PAYROLL TAXES ARE REPORTED ON A CONSOLIDATED FORM 941. THE EIN ON THE FORM 941 IS 61-0492356.
FORM 990, PART III, LINE 4
PROGRAM SERVICE ACCOMPLISHMENTS -------------------------------- A Children's Place (ACP), a service of Ephraim McDowell Health since 1992, is a handicapped accessible early learning and development center that provides year-round care to a monthly average (FY14) of 155 children, from age 6 weeks through 10 years old; Monday through Friday from 6:00am to 6:00pm. This service has contributed to Ephraim McDowell Health's longstanding programmatic efforts to positively influence childhood obesity and related risk factors. Approximately 117 families from Boyle, Mercer, Lincoln, Anderson, Pulaski and Garrard counties utilize ACP services, including a number of families with children having special needs. Children's programs are organized into three divisional units--Infants and Toddlers, Early Childhood, and School-age Child Care, maximizing age appropriate services throughout the continuum of development. Approximately 29 families using ACP services receive child care assistance and more than half receive free (28) or reduced cost (1) lunches. To ensure the children comprising this at risk age group receive proper nutrition, breakfast, lunch and an afternoon snack are provided to all of the children. Age appropriate activities are part of their daily routine to ensure the children stay active and that the benefits of physical activity are reinforced at all ages. Infant/Toddler Unit ------------------- The Infant/Toddler Unit includes two nurseries and individual, age-based classrooms. The activities in each classroom vary according to the developmental levels of the children. Staff members use activities such as singing, reading, crafts, art and the introduction of colors to focus on the child's physical, intellectual, emotional and social development. Infants in the Nursery I classroom spend most of their day eating and sleeping, according to each child's needs. When the children are awake, staff members interact with them and make them feel comforted and loved. The Nursery II classroom adapts schedules to the children's needs but introduce more activities to stimulate their interest. Toddlers and older children begin a structured schedule that includes creative activities, exercise, singing, reading, identifying colors and numbers, and practicing the letters of the alphabet. Early Childhood Unit -------------------- The Early Childhood Unit has separate classrooms for children ages 3 - 5. In each room the curriculum focuses on preparing each child socially and academically for starting school. Each teacher organizes and follows a monthly lesson plan. Activities include reading a daily calendar that introduces the days of the week and the months of the year. Staff members also review colors, numbers and the letters of the alphabet. Activity centers utilize blocks, puzzles, art and other creative play activities to encourage children to socialize and play with each other at scheduled times as well as during free play time. School-Age Child Care Program ----------------------------- The School-Age Child Care Program is for children age 6 - 10 years old. Services are available both before and after school, and all-day services are available during the summer, school holidays and school cancellation days. After school, the children are allowed a period of time to unwind from the structured school environment. Activities are planned each day as well as time scheduled where students may choose from several centers of learning, including a science center, a dramatic play area or a center of puzzles and games. A homework area is also available, and group projects are planned regularly. Summer programs follow a specific theme each year, and include activities and weekly field trips. Parents are engaged in their child's care and development through direct access to their child's caregiver, special events and activities. Parent/Teacher conferences are readily available in addition to normal daily communications. Activities such as the Mother's Day Brunch, Donuts with Daddy, Grandparent's Day Brunch, the Preschool Graduation Ceremony, Winter Programs, and the Easter Egg Hunt, all encourage active participation and engagement in the child's care and development. More formalized feedback is provided through the Parent Satisfaction Surveys. The center's services are more than day-care services to the community's youth. A Children's Place is a 2 star member of the "STARS for KIDS NOW" program, Kentucky's voluntary quality rating system for licensed Type I and Type II child care centers and certified family child care homes. "STARS for KIDS NOW" represents a collaborative effort to ensure that young children in Kentucky are in early care and education settings that are seeking ever-increasing quality. All STAR programs surpass the minimum licensing requirements that all programs must meet--early care and education programs target quality care that result in positive outcomes for young children. STAR programs are assessed according to staff/child ratios, group size, curriculum, parent involvement, training/education of staff, regulatory compliance, and personnel practices. The 2 STAR designation attained by the ACP program demonstrates the commitment to providing quality care and educational opportunities to the children served. * Staff members are trained and must meet annual competency certification standards. * Children receive personalized attention in an enthusiastic learning environment. * Many staff members are trained as certified Child Development Associates. * Children are provided with age- specific learning environments - an Infant/Toddler Unit, an Early Childhood Unit or a School-Age Child Care program. * Every classroom has appropriate child-size restroom facilities, furniture and indoor and outdoor equipment. * Children enjoy structured activities and free play that encourage imagination, creativity, problem solving and early learning - all designed to foster age-specific development. These standards and protocols exhibit Ephraim McDowell Health's commitment to providing high quality services to the families in our service area. Through the 2 STAR designation, ACP is eligible for technical assistance through the Quality Enhancement Initiative, assistance with staff training and education which is offered through the Early Childhood Development Scholarship Program, and cash STAR Achievement Awards.
FORM 990, PART VI, SECTION A, LINE 6 & 7A
MEMBERS OF THE ORGANIZATION ---------------------------- EPHRAIM MCDOWELL HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF JOHN HILL BAILEY CHILDREN'S LEARNING CENTER, 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 JOHN HILL BAILEY CHILDREN'S LEARNING CENTER, INC. ON AN ANNUAL BASIS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.