Emhfl Inc.

“Process to review form 990 -------------------------- copies of the form 990 are submitted to the full board via email prior to filing.”

“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.”

“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.”

“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.”

“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.”

“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.”

“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, and Family-Centered Maternity Care with a Birthing Spa, Swing Beds, Laboratory, Rehabilitation, Surgical Services, and Durable Medical Equipment. In fiscal year 2017, outpatient registrations, including emergency services were 31,920; there were 814 surgical procedures, 1,283 admissions (including nursery), and the facility recorded 5,002 total patient days (including 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 6 sites in Lincoln and Garrard Counties with a focus on reaching at risk and vulnerable populations. One hundred and ninety-one adults were served. Over fifty-five percent had a household income below $35,000; compared to 52% in 2016 and 42 percent in 2015. In clients seen, unemployment increased from thirteen percent in 2015 to 15.1 percent in 2016 and decreased to 8% in 2017. Twenty percent of clients were retired; down 20% from the preceding year and 30 percent for 2015. In FY 2017 only 11.5 percent reported not having a primary care provider compared to FY 2016 sixty-eight percent and 64 percent in FY 2015. Referral options were provided, including Hope Clinic, reduced fee program, and a primary care provider listing for the region. The decrease in those lacking a primary care provider is probably due to the Affordable Care Act. Three percent of clients served were African American; 95 percent Caucasian, 1.8 percent was other and .06% was Hispanic. The African American and Hispanic 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 54 percent were out of normal range, compared to 50.2 percent in FY 2016 and 50% in FY 2015.Twenty-two percent of participants with abnormal test results were referred to a primary care provider for follow-up care for both FY 2017 and 2016. Fifty-three percent of clients were female; forty-seven percent were male. This represents an increase in female clients seeking preventative care. While 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, there was a 11% decrease in the number of individuals seen in FY 2017. The increase seen in FY 2016 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. In FY 2017 the HRSA Grant for Healthy People Healthy Communities had completely concluded resulting in fewer reminders for individuals to participate. Staff and department reductions may have be”

“------------------------------------------ Nutrition/Obesity Screening - Eighty-seven point six percent of 129 adults screened for body mass index compared to eighty-seven percent in FY 2016 and 70 percent in FY 2015 exceeded the national health recommendations. 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 - There were no school based screenings or TB skin tests due to the reduction of staff in the Community Service Department and due to the availability of preventive health care provided by the ACA. Stroke Screening - Stroke screening was provided at Lincoln County Health Department, Lancaster Church of Nazarene, Level Green Christian Church, New Salem Church and Garrard County Cooperative Extension Services using The American Stroke Association Scoreboard 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. The service area is the heart of the "stroke belt". The sites provided a variation in rural versus town communities and varying area of the two counties. Community-Based Clinical Services - Immunizations ----------------------------------------- Flu shots - Thirty-two flu shots were administered to individuals from one congregation and to cattlemen at the Bluegrass Stockyards in Lincoln County. Community Service Department did not have the opportunity or staffing to work with the COOP students this year. 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. Three blood drives were held with thirteen units collected. Financial Donations for the Community Cost of Fund Raising - Projects in this category included the Rotary pancake breakfast fund raiser. EMFLH staff worked the event to assist in meeting identified community needs. Financial Donations for the Community-In-Kind ---------------------------------------------- Medical Support - Area residents were served through medical support services at the Lincoln County Fair. Services included blood pressure checks and first aid services. EMFLH personnel helped plan, set up and provide health services at the event. Personnel/Administrative Support - EMFLH leaders served as team captains for the American Cancer Society Relay for Life in Lincoln County. This is the major fund-raiser for the American Cancer Association with $5,578 raised by the EMFLH team in FY 2017. EMFLH leaders serve on the Lincoln County Cancer Coalition which meets monthly to address health risk and needs related to cancer. The Coalition strives to provide access to care/treatment/screenings, making public policy recommendations, and providing client education. Senior leadership serves as a member of the Lincoln County Health Department Board that meets bi-monthly. The Lincoln County Board of Health is focused on improving the health of the community. A hospital representative on this board improves awareness of population health issues, communication, collaboration, and reduces duplication of services. Senior leadership serves on the chamber of commerce in both Lincoln and Garrard Counties addressing economic and quality of life issues in the community. EMFLH leaders and staff participate in the Day of Caring and Day of Action to improve our community through service proje”