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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) |
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| 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): |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| 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 ------------------------------------ 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 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 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 with a Birthing Spa, Laboratory, Rehabilitation, Surgical Services, and Durable Medical Equipment including Home Medical Equipment through Med Source of Stanford. In fiscal year 2016, outpatient registrations, including emergency services were 38,780; there were 920 surgical procedures, 1,181 admissions (including nursery), 454 observation days, and the facility recorded 3,418 total patient days (excluding observation). These numbers reflect an increase in health care access to residents of Lincoln County and the surrounding counties. 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 7 sites in Lincoln and Garrard Counties with a focus on reaching at risk and vulnerable populations. Two hundred and fifteen adults were served. Over fifty two percent had a household income below $35,000; compared to 42 percent in 2015. In clients seen, unemployment increased from thirteen percent in 2015 to 15.1 percent in 2016. Forty-three percent of clients were retired; down 8 percent the prior year. In FY 2016 sixty eight percent reported not having a primary care provider compared to 64 percent in FY 2015. Referral options were provided, including Hope Clinic, reduced fee program, and a primary care provider listing for the region. Seven percent of clients served were African American; 90 percent Caucasian, three 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. Screening test results showed that 50.2 percent were out of normal range, this figure representing a slight increase with the fifty percent reported in FY 2015. Twenty-two percent of participants with abnormal test results were referred to a primary care provider for follow-up care. Forty-three percent of clients were male; fifty-seven percent were female. This represents an increase in female clients seeking preventative care. There was a fourteen percent increase in the number of individuals seen in Lincoln and Garrard Counties in FY 2016 compared to 2015 due to changes in leadership within the school systems, changes in church leadership and engagement in health ministry and preventative care for breast and cervical cancer, as addressed through ACA rather than outreach projects. The increase seen was also due to the inability for individuals to pay for high deductibles/copays, as was deducted from the complaints received. Carry over from the outreach of the HRSA Grant for Healthy People Healthy Communities was also a contributing factor. 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. School-Based Program - The Trauma Bear Fair was sponsored by the EMFLH, EMS, and Air Evac at local schools to provide trauma education to twenty-four 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-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 2014 CHNA, community feedback and implementation plan that was approved by the EMFLH governing board and the Ephraim McDowell Health (EMH) governing board. Services included cardiovascular disease (CVD) risk factors reduction (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 includes skin cancer screening, tobacco use cessation referrals, and distribution of colorectal cancer screening kits. Blood Pressure Screening - Ninety percent of the 230 blood pressure assessments in Lincoln and Garrard Counties exceeded the recommended range as established by the American Heart Association (AHA). This is an increase from 80 percent in FY 2015. 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. The decline in blood pressure screening is a reflection of staffing. Cancer Colorectal Screening - Colorectal cancer screening kits were distributed through screenings, clinics and the hospital with twenty-nine being returned for interpretation. This project was funded by Ephraim McDowell Health Care Foundation (EMHCF). Cancer Skin Screening - In FY 2016 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 2016, thirty-two percent of the 206 total cholesterol tests exceeded the recommended range as established by the American Heart Association (AHA). This is an increase from 24 percent in 2015. Diabetes Screening - In FY 2016, twenty-one and a half percent of the 191 total blood sugar (glucose) tests exceeded the recommended range as established by the American Diabetic Association (ADA). This reflected an increase from 18 percent in 2015 and mirrors the increased incidence of type II diabetes in Kentucky with the aging of the population. In FY 2016 an A1C machine was provided by the Ephraim McDowell Health Care Foundation and A1C testing was implemented at the screening sites for those who met the following high risk criteria: - Known diabetic or pre-diabetic - Fasting Blood Sugar above 111 with unknown diagnosis - Extended family member with diagnosis and not done before - Has not had A1C taken within the last 3 months Nutrition/Obesity Screening - Eighty-seven percent of the adults screened exceed the recommendation related to body mass index, compared to 70 percent in FY 2015. This also reflects the health trend in the Commonwealth of Kentucky. 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, mobility issues, GERD, heart attack and stroke. School Based Screening - TB skin tests were given for the Health Occupations Service Association students from the local high school. Stroke Screening - Stroke screening was provided at the Lincoln County Health Department, and Lancaster Church of Nazarene using The American Stroke Association Scorecard to record the clients 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 most risk factors in the high risk range were referred for PCP follow-up. The service area is the heart of the "stroke belt". Flu shots - Fifty-nine flu shots were administered to COOP students at EMFLH or to cattlemen at the Bluegrass Stockyards in Lincoln County. Health Care Support Services ---------------------------- Blood Drive - EM |
| FORM 990, PART VII, SECTION A | PART-YEAR OFFICERS ------------------ VICKI DARNELL RESIGNED AS CEO ON 1/30/2016 AND WAS REPLACED AS CEO BY SALLY DAVENPORT. |
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