Emhfl Inc.

“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.”

“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.”

“Part-year officers -------------------- sally davenport retired in july 2018, at which time daniel mckay became the ceo. Mckay did not receive any compensation during calendar year 2017, therefore no compensation is reported in part vii.”

“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. 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, 24-hour emergency care, and durable medical equipment. In fiscal year 2018, outpatient registrations, including emergency services were 33,480; there were 822 surgical procedures, 1,290 admissions (including nursery and swing), and the facility recorded 4,549 total patient days (including observation and swing). 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 lifestyle associated health risk factors. Services were offered at 7 sites (10 events) in lincoln and garrard counties with a focus on reaching at risk and vulnerable populations. One hundred and fifty-two adults were served. Fifty-four percent had a household income below $35,000; compared to 55% in fiscal year 2017, 52 percent in 2016 and 42 percent in 2015. In clients seen, unemployment was at 13% compared to 8% in 2017, and 15.1% in 2016. Forty-one percent (48 of 117) of clients were retired; up from 20% in fy 2017, 43% in 2016 and 30% in 2015. In fy 2018 only 3% (3 of 104) reported not having a primary care provider compared 11.5 percent in fy 2017 and sixty-eight percent in fy 2016. Referral options were provided, including hope clinic, reduced fee program, and a primary care provider listing for the region. During fy 2018, six percent of clients served were african american, 76 percent were caucasian, and 4% were hispanic compared to fy 2017 where three percent of clients served were african american; 95 percent caucasian, 1.8 percent other and .06% 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. Out of 833 screening procedures done, 299 were abnormal or 35%, compared to 54% out of range for fy 2017 and 50% for fy 2016. Fourteen percent (21) of participants with abnormal test results out of 152 screened were referred to a primary care provider for follow-up care for fy 2018 compared to 22% in both fy 2017 and 2016. Sixty-one percent of clients were female compared to 53% in fy 2017; forty-two percent were male compared to 47% in fy 2017. This represents an increase in female clients seeking preventative care. There was a decrease in the number of persons screened in the ephraim mcdowell health system due to a decrease in the number of screenings provided; a result of budget constraints instituted during the spring of fy 2018. High risk individuals continued to be served by the screening programs on a scaled back version. 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 been a contributing factor to the reduction of individuals seen. The conclusion is that high risk individuals continued to be served by the screening programs in spite of the decline in numbers. School based programs - the school based program was terminated due to a significant personnel reduction within the community service department. Community health education support group ------------------------------------------- clients at screenin”

“Using this criteria, thirty individuals were screened in fy 2018 compared to thirty-nine individuals in fy 2017. Forty percent of those screened in fy 2018 (12 of 30) had abnormal results compared to and 17, or 43.5% of those individuals screened in fy 2017. Diet and lifestyle changes were a significant part of the education provided to try to reduce these numbers, which reflect the growing trend nationally. Nutrition/obesity screening - ninety-three percent of 101 adults screened in fy 2018 compared to eighty-seven point six percent of 129 adults screened for body mass index in 2017 and eighty-seven percent in fy 2016 exceeded the national health recommendations. This also reflects the health trend in the commonwealth of kentucky. Diet and lifestyle changes were a significant part of the education provided. 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. Stroke screening - stroke screening was provided at the lincoln county health department, level green christian church, new salem church and garrard county cooperative extension services, and camp dick elementary school. One heart risk screening was done at level green christian church 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 lifestyle 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 areas of the two counties. Community-based clinical services immunizations -------------------------------------------------- flu shots - fifty-five flu shots were administered in fy 2018 to individuals from 2 congregations, one community agency, and cattleman at the bluegrass stockyards in lincoln and garrard counties. This is compared to seventy-six flu shots administered to individuals from two congregations in lincoln and garrard counties and to cattlemen at the bluegrass stockyards in lincoln county in fy 2017. Health care support services 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. One blood drive was held with six units collected. Financial donations for the community cost of fund raising -------------------------------------------------------------- cost of fundraising - 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 $8,000 raised by the emflh team in fy 2018. 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 l”

“Unassigned program -------------------- additional community involvement that enhanced the lives of the citizens of lincoln county and the surrounding counties included involvement in lay health/faith community nursing ministries within the congregations. Full congregational impact was generated by leadership positions within the various church committees. Services provided included, but were not limited to, serving on boards/committees, teaching, meal preparation, music and worship leadership, choir participation and home visits/calls. The journal of christian nursing reports that christian faith and practice supports better mental, physical and spiritual health (march, 2013). Community involvement in childrens programs through the area churches resulted in over 1,000 children being served. Deferred needs from the chna of boyle and the surrounding counties based upon resources and/or expertise included the following: substance abuse is an issue in the state and region. Addiction services are offered by private providers, comprehensive care, and self-refined in the region. Emrmc behavioral medicine unit does treat dual diagnosis patients and the psychiatrists and counselors treat out patients. There is an active alcoholics anonymous chapter. Celebrate recovery is offered at various sites in the service area. Substance abuse task force resources and committees are in the surrounding service area, and collaboration occurs as needed. Due to lack of expertise and resources, addiction will be deferred as part of the work plan by emrmc. Chronic kidney disease and end stage renal failure links to diabetes. Moderate exercise, a healthier diet, and weight reduction can prevent the development of type 2 diabetes in persons at risk (diabetes prevention program funded by nih). The free screenings will provide early detection and possibly prevention when addressing nutrition, body mass index and exercise. Some faith community nurses in congregations assess blood pressures and medication adherence as well as provide education. Renal specialists and dialysis centers serve this population as well. Dementia links to cv health and stroke incidence and vascular issues. It also links to the aging of the population in the region. There is an alzheimers support group in boyle and mercer counties. Also, mental evaluation and medication management is available by a psychiatrist at the medical center. Danville health & rehabilitation center as well as morning point has an alzheimers long term care unit. The sanders brown center at the university of kentucky has on-going alzheimers related research and serves as a referral center for the region. Births to teenagers and unwed mothers, and low birth-weight births are being addressed by the health departments and the school health collations. The lincoln county health department has a 5-year grant to address self-esteem and character building in 6th grade through middle school. The lincoln and boyle county school nurses conduct the perkins assessment in middle school through high school as part of the effort to help youth make fewer high risk behavior choices. Both school systems have contracts with the university of kentucky for the services of an adolescent medicine specialist for on-site services. The haven care center provides pregnancy resources and supports all six counties. Chronic lung/respiratory disease is being addressed with tobacco education, stop smoking classes at the health departments, pulmonary rehab at ephraim mcdowell specialty center and through public policy. The community service department screens for tobacco use at all venues and refers clients to the health departments. The health department offers freedom from smoking classes to help residents stop smoking. The health departments also conduct tobacco education in the school systems. In the areas of infectious disease the county health departments will continue to address hiv education and testing. Hepatitis c vaccine is availabl”

“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.”

“Reconciliation of net assets - other changes --------------------------------------------- transfer of net assets from ephraim mcdowell health resource due to clinic restructuring: $(13,114,840)”