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...... | ||||||
| 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| 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 |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
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 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 ------------------------------------ EPHRAIM MCDOWELL HEALTH RESOURCE, INC. IS PART OF AN INTERGRATED HEALTHCARE DELIVERY SYSTEM WHOSE PARENT IS EPHRAIM MCDOWELL HEALTH, INC. COMPENSATION FOR ALL AFFILIATES IS OVERSEEN AND COORDINATED THROUGH EPHRAIM MCDOWELL HEALTH, INC. THE MERCER GROUP, INDEPENDENT CONSULTANTS, CONDUCTED A REVIEW AND PROVIDED MARKET DATA IN 2015 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 DOCUMENTS 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 EPHRIAM MCDOWELL HEALTH RESOURCE, INC. ALL SALARIES AND PAYROLL TAXES ARE REPORTED ON A CONSOLIDATED FORM 941. THE EIN ON THE FORM 941 IS 61-0492356. |
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS ------------------------------- Ephraim McDowell Health Resource (EMHR) is responsible for attracting physicians and other medical providers for service delivery to approximately 155,000 individuals in Boyle, Casey, Lincoln, Garrard, Mercer and Washington counties-the primary service area of Ephraim McDowell Health (EMH). Clinical services are as appropriate, available on a reduced fee or sliding scale basis. Ephraim McDowell Health through EMHR has created a network of clinic facilities designed to service the diverse healthcare needs of the region. Twelve family medical and immediate care centers offer clinic services in Boyle and each of the other five surrounding counties in the EMH service area, in FY 2015 totaling over 125,000 visits. These facilities provide physical examinations, well-child checkups, and treatment of acute illnesses as well as laboratory and X-ray services on-site, including EKG. The immediate care centers provide more urgent ambulatory care than the standard clinic services, in facilities dedicated to the delivery of medical care outside of a hospital emergency department, and provide these services on an unscheduled, walk-in basis, over extended hours and on the weekends when primary care services are not available and emergency care services are not necessary. Along with our vast Primary Care service line, we also offer several specialty clinics: Cardiology, Vascular, Behavioral Health, General Surgery, OBGYN/Women's Health, Neurology, Sleep Medicine, Urology, Physical Medicine and Pulmonology services are offered in coordination with resources provided by EMRMC. In FY 2015, Ephraim McDowell Health Resources Specialty Services provided care for over 30,000 visits. - EMHR Cardiology treats patients with carotid disease, aortic aneurysms, lower extremity vascular disease, hemodialysis complications and venous disease. Ephraim McDowell now operates two fully serviceable cath lab suites. The Cath Lab uses equipment that provides three-dimensional imaging technology along with X-ray technology to offer exceptional image clarity for diagnosing and treating cardiovascular disease. - EMHR Vascular service program offers a full range of services for diagnosing and treating diseases of the heart and circulatory system as well as the body's entire vascular system with all services provided by a board-certified interventional cardiologist. - EMHR Behavioral Health service line provides psychiatry, adolescent psychiatry, geriatric psychiatry, neuropsychiatry to all age groups. - EMHR General Surgery service program offers a broad range of procedures including EGD, and colonoscopy; stereotactic breast biopsy and surgery; laparoscopic abdominal surgeries including gallbladder and appendix; hernia repairs and intestinal surgeries. - EMHR Obstetrics & Gynecology offers a full range of services for women's health, minimally invasive gynecologic procedures including laparoscopy, laparoscopic hysterectomy, endometrial ablation, routine and high-risk pregnancies, infertility and certain gynecologic cancers - EMHR Neurology offers a full range of services for diagnosing and treating diseases of the nervous system, which includes the brain, spinal cord, nerve and muscle. - EMHR Sleep Center diagnose and treat sleep-related problems in children (age 4 and over) and adults, including circadian rhythm disorders, insomnia, narcolepsy, restless legs, shift-work problems and sleep apnea - EMHR Urology offers a full range of services in the treatment of disorders and diseases of the genitourinary system. They treat surgical and medical disorders of the kidney, bladder, and urethra in both men and women, as well as the prostate and genital system in men. - EMHR Physical Medicine treats a variety of ailments covering all aspects of pain management. - EMHR Pulmonology offers a comprehensive approach to treating and managing lung conditions including interstitial lung diseases, chronic obstructive pulmonary disease (COPD), infectious lung disease, drug-related pulmonary disorders, and carcinoma of the lung. Each of these specialties provide care to individuals experiencing illnesses all consistent with or potential co-morbidities to conditions effecting patients meeting the criteria targeted by objectives 1 and 2 identified in the Community Health Assessment. Finally, Ephraim McDowell Health, through EMHR offers wellness living resources through Ephraim McDowell Wellness Center (EMWC) and McDowell Place of Danville. EMWC, a community wellness center, provides fitness equipment, aquatics, a full spectrum of fitness and conditioning classes, and childcare services to over 3,558 members from school aged children to senior citizens. The assisted living center, McDowell Place offers assisted living facilities to approximately 96 assisted living residents and membership to EMWC located next door. |
| FORM 990, PART VI, SECTION A, LINE 6 & 7A | MEMBERS OF THE ORGANIZATION --------------------------- EPHRAIM MCDOWELL HEALTH, INC. IS THE SOLE CORPORATE MEMBER OF EPHRAIM MCDOWELL HEALTH RESOURCE, INC. EPHRAIM MCDOWELL HEALTH, INC., A RELATED 501(C)(3) ENTITY, IS THE PARENT ORGANIZATION OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. EPHRAIM MCDOWELL HEALTH, INC. ELECTS BOARD MEMBERS OF EPHRAIM MCDOWELL HEALTH RESOURCE, INC. ON AN ANNUAL BASIS. |
| FORM 990, PART XI, LINE 9 | RECONCILIATION OF NET ASSETS ---------------------------- OTHER CHANGE IN NET ASSETS: CONTRIBUTIONS FROM NONCONTROLLING INTEREST ($215,000) |
| FORM 990, PART VII, SECTION A | PART-YEAR OFFICERS ------------------ BILL DEMROW SERVED ON THE BOARD AS VICE CHAIRMAN UNTIL MARCH 2015 WITH ALLEN WHITE REPLACING HIM THROUGH THE REST OF THE YEAR. |
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