4A (Expenses $ 33558964 including grants of $ 0) (Revenue $ 40471631)
Ephraim McDowell James B. Haggin Hospital (EMJBHH), located in Harrodsburg, Kentucky, is a 25-bed critical access hospital. The hospital offers a full array of health care services ranging from surgery to diagnostic imaging. The hospital's Emergency Department is also recognized as a Level IV Trauma Center and the hospital now has Pediatric Ready Designation and Acute Stroke Ready Designation. The facility is Joint Commission accredited. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.

SCHEDULE H, PART V, SECTION B, LINE 5
COMMUNITY INPUT ---------------- THROUGH THE FOCUS GROUP AND ONLINE SURVEY, PARTICIPATION AND INPUT WAS GATHERED FROM REPRESENTATIVES OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY (INCLUDING HISPANIC, AFRICAN AMERICAN), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (SPECIFICALLY, THE ELDERLY, DISABLED, YOUNG ADULTS, LGBT COMMUNITY, THE MENTALLY ILL, INMATES, HEARING IMPAIRED, MEDICAID RECIPIENTS, AND THE UNINSURED). HISPANIC, AFRICAN AMERICAN), OR OTHER MEDICALLY UNDERSERVED POPULATIONS (SPECIFICALLY, THE ELDERLY, DISABLED, YOUNG ADULTS, LGBT COMMUNITY, THE MENTALLY ILL, INMATES, HEARING IMPAIRED, MEDICAID RECIPIENTS, AND THE UNINSURED).

SCHEDULE H, PART V, SECTION B, LINE 7 AND 10
CHNA REPORT & IMPLEMENTATION STRATEGY -------------------------------------- THE HOSPITAL'S CHNA REPORT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.EMHEALTH.ORG/SERVICES/COMMUNITY-HEALTH

SCHEDULE H, PART V, SECTION B, LINE 11
ASSESSING THE NEEDS OF THE COMMUNITY ------------------------------------- THE INTERNAL STAKEHOLDERS OF JAMES B. HAGGIN MEMORIAL HOSPITAL DETERMINED THE FOLLOWING TO BE THE TOP HEALTH PRIORITIES FOR THE HOSPITAL TO ADDRESS IN THE COMMUNITY FOR THE COMING YEARS: - DIABETES - ACCESS TO THE HEALTHCARE SERVICES - CANCER - EARLY DETECTION AND PREVENTION - CARDIOVASCULAR DISEASE & RELATED RISK FACTORS - NUTRITION, PHYSICIAL ACTIVITY, & WEIGHT - INJURY & VIOLENCE - SUBSTANCE ABUSE THESE PRIORITY AREAS, AND PLANS TO ADDRESS THESE, WILL BE INTEGRATED INTO THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE RATIONALE FOR SELECTING THESE AREAS IN AN UNDERSTANDING THAT IMPACTING THESE WOULD ALSO IMPACT MANY OTHER AREAS OF NEED IDENTIFIED IN THE ASSESSMENT, SUCH AS DEMENTIA, MENTAL HEALTH, SEXUALLY TRANSMITTED DISEASES, & HIV/AIDS, ORAL HEALTH, INFANT HEALTH & FAMILY PLANNING, RESPIRATORY DISEASES, TOBACCO USE, AND CHRONIC KIDNEY DISEASE. THESE AREAS ALSO REPRESENT A CONTINUATION OF EXISTING WORK AND ALLOW THE HOSPITAL TO BUILD ON PAST SUCCESSES. NEEDS NOT ADDRESSED --------------------- THERE ARE ADDITIONAL NEEDS IDENTIFIED WITHIN THE CHNA REPORT THAT ARE NOT SPECIFICALLY ADDRESSED BY THE HOSPITAL, DUE TO NO EXPERTISE OR LIMITED RESOURCES, BUT ARE BEING ADDRESSED BY OTHER AGENCIES WITHIN THE COMMUNITY. SOME OF THESE INCLUDE: ** 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. 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 IS DEFERRED AS PART OF THE WORK PLAN. ** CHRONIC KIDNEY DISEASE AND END STAGE RENAL FAILURE LINKS TO DIABETES. FREE SCREENINGS WILL PROVIDE EARLY DETECTION AND POSSIBLY PREVENTION WHEN ADDRESSING NUTRITION, BODY MASS INDEX, AND EXERCISE. SOME FAITH COMMUNITY NURSES IN CONGREGRATIONS 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 POPULATIONS IN THE REGION. THERE IS AN ALZHEIMER'S SUPPORTS 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 ALZHEIMER'S LONG TERM CARE UNIT. THE SANDERS BROWN CENTER AT THE UNIVERSITY OF KENTUCKY HAS ON-GOING ALZHEIMER'S 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 COALITIONS. ** 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. ** IN THE AREAS OF INFECTIOUS DISEASE, THE COUNTY HEALTH DEPARTMENTS WILL CONTINUE TO ADDRESS HIV EDUCATION AND TESTING. HEPATITIS C VACCINE IS AVAILABLE AT THE HEALTH DEPARTMENTS. EPHRAIM WILL DEFER DUE TO RESOURCE ALLOCATIONS - BOTH PERSONNEL AND TIME. ** INJURY AND VIOLENCE EDUCATION IS IN THE HEALTH DEPARTMENTS, COUNTY EXTENSION OFFICES, SCHOOL RESOURCE CENTERS, FAMILY COURT, AND LAW ENFORCEMENT IN ALL COUNTIES. EPHRAIM WILL DEFER FOCUS ON INJURY AND VIOLENCE AT THIS TIME DUE TO OTHER AGENCIES COVERING ALL ASPECTS, HAVING GREATER EXPERTISE AND DEPARTMENTAL RESOURCE LIMITATIONS. ** ORAL HEALTH, INCLUDING REGULAR DENTAL CARE AND DENTAL INSURANCE, IS A REGIONAL ISSUE. EPHRAIM BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION.

SCHEDULE H, PART V, SECTION B, LINE 16A, 16B, AND 16C
FINANCIAL ASSISTANCE POLICY WEBSITE ------------------------------------ THE HOSPITAL'S FAP, FAP APPLICATION FORM, AND PLAIN LANGAUGE SUMMARY ARE AVAILABLE AT: HTTP://WWW.EMHEALTH.ORG/FOR-PATIENTS/GOING-HOME/BILLING-INSURANCE/

SCHEDULE H, PART I, LINE 7
COSTING METHODOLOGY -------------------- THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEET 1. COST COMPUTED ON IRS WORKSHEET 3 WAS COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT STEP-DOWN PROCESS.

SCHEDULE H, PART I, LINE 7, COLUMN (F)
PERCENT OF TOTAL EXPENSE ------------------------- TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990.

SCHEDULE H, PART II
COMMUNITY BUILDING ACTIVITIES ----------------------------------------- HOSPITAL LEADERS AND STAFF ARE ENGAGED IN LEADERSHIP POSITIONS WITHIN SEVERAL ORGANIZATIONS IN THE LOCAL COMMUNITY. THEY ALSO VOLUNTEER ON LOCAL, REGIONAL AND STATE PROJECTS TO IMPROVE HEALTH, EDUCATION, AND THE GENERAL WELFARE OF THE CITIZENS OF THE REGION. SOME OF THESE ACTIVITIES INCLUDE: ** RINGING THE BELL FOR THE SALVATION ARMY DURING THE CHRISTMAS HOLIDAY SEASON, SUPPORTING SALVATION ARMY'S GOAL OF FEEDING THE HUNGRY AND PROVIDING CHRISTMAS FOR NEEDY FAMILIES. LEADERS AND STAFF ALSO PARTICIPATED IN THE SALVATION ARMY'S KETTLE DRIVE. ** PARTICIPATED IN THE UNITED WAY DAY OF CARING AND DAY OF ACTION TO IMPROVE OUR COMMUNITY THROUGH SERVICE PROJECTS ** PARTICIPATION IN THE SOUTHERN KY AHEC (AREA HEALTH EDUCATION CENTER) FUTURE DOCS PROGRAM. THIS PROGRAM GIVES A BOOST TO PRE-MED STUDENTS IN THE REGION TO LEARN MORE ABOUT THE MEDICAL SCHOOL APPLICATION PROCESS, PRACTICE INTERVIEW SKILLS, & INTERACT WITH MEDICAL STUDENTS AND PHYSICIANS. ** PARTICIPATION AND ATTENDANCE WITH THE HARRODSBURG ROTARY CLUB. ** PARTICIPATION WITH LOCAL EMERGENCY MANAGEMENT AND BLUEGRASS HEALTHCARE COALITION. ** PARTICIPATION IN THE MERCER COUNTY YOUTH LEADERSHIP PROGRAM, PROVIDING HOSPITAL TOURS AND EDUCATION ABOUT DIFFERENT CAREER OPPORTUNITIES IN HEALTHCARE. ** PARTICIPATION WITH THE MERCER COUNTY LEADERSHIP PROGRAM. ** PARTICIPATION IN THE MERCER COUNTY PIONEER DAYS EVENT BY PROVIDING HEALTH SERVICES AT THE EVENT.

SCHEDULE H, PART III, LINE 2
BAD DEBT EXPENSE ----------------- THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED SEPTEMBER 30, 2022. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. THIS AMOUNT IS DIRECTLY FROM THE FINANCIAL STATEMENTS AND INCLUDES ESTIMATES AND ACCRUALS OF BAD DEBT EXPENSE AND DOES NOT NECESSARILY REFLECT ACTUAL WRITE-OFFS DURING THE PERIOD.

SCHEDULE H, PART III, LINE 3
BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE ----------------------------------------------- BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS REPORTED PER THE MEDICARE COST REPORT WORKSHEET S-10.

SCHEDULE H, PART III, LINE 4
BAD DEBT EXPENSE FOOTNOTE ------------------------- THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THE HOSPITAL ELECTED TO EARLY ADOPT ASU 2011-07. ACCORDINGLY, BAD DEBT EXPENSE IS REFLECTED AS A DEDUCTION FROM REVENUE RATHER THAN AN OPERATING EXPENSE FOR FINANCIAL REPORTING PURPOSES.

SCHEDULE H, PART III, LINE 8
MEDICARE SURPLUS / SHORTFALL ----------------------------- AMOUNTS REPORTED ON LINES 5 AND 6 WERE BASED ON THE CORPORATION'S MEDICARE COST REPORT.

SCHEDULE H, PART III, LINE 9B
WRITTEN DEBT COLLECTION POLICY AND FINANCIAL ASSISTANCE -------------------------------------------------------- IF IT IS DETERMINED THAT A PATIENT OR RESPONSIBLE PARTY IS ELIGIBLE FOR FINANCIAL ASSISTANCE, EMH WILL: - SEND WRITTEN NOTIFICATION TO THE RESPONSIBLE INDIVIDUAL OF THE ASSISTANCE DETERMINATION AND - IF THE DISCOUNT IS LESS THAN 100%, EMH WILL: * PROVIDE THE RESPONSIBLE INDIVIDUAL WITH A BILLING STATEMENT SHOWING THE AMOUNT OWED, HOW THE AMOUNT WAS DETERMINED, AND DESCRIBE HOW THE INDIVIDUAL CAN LEARN MORE ABOUT HOW THE HOSPITAL CALCULATES AGB; * ISSUE REFUNDS TO THE RESPONSIBLE INDIVIDUAL IF HE OR SHE PREVIOUSLY PAID AN AMOUNT TO EMH EXCEEDING WHAT HE OR SHE IS PERSONALLY RESPONSIBLE TO PAY; AND * TAKE ALL REASONABLE MEASURES TO REVERSE ANY ECAS (WITH THE EXCEPTION OF A SALE OF A DEBT OR DEFERRING OR DENYING CARE FOR NON-PAYMENT OF AMOUNTS FOR PREVIOUS CARE) TAKEN AGAINST THE RESPONSIBLE INDIVIDUAL TO THE EXTENT POSSIBLE.

SCHEDULE H, PART VI, LINE 2
NEEDS ASSESSMENT ------------------ IN 2020, PROFESSIONAL RESEARCH CONSULTANTS (PRC) WAS ENGAGED TO CONDUCT A NEEDS ASSESSMENT OF EMJBH'S COMMUNITY, WHICH IS DEFINED AS THE PRINCIPAL RESIDENTIAL ZIP CODES IN BOYLE, GARRARD, MERCER, AND WASHINGTON COUNTIES IN KENTUCKY. A SURVEY AND A COMMUNITY FOCUS GROUP WERE COMPLETED TO OBTAIN PRIMARY DATA FROM INDIVIDUALS WITHIN THE COMMUNITY. THE FOCUS GROUP WAS COMPRISED OF REPRESENTATIVES FROM PUBLIC HEALTH, SOCIAL SERVICES PROVIDERS, EMPLOYERS, AND OTHER COMMUNITY LEADERS, SELF REPORT DATA, MORTALITY, MORBIDITY, LIFESTYLE, INCIDENCE OF CHRONIC DISEASE, INJURY DATA AND DISABILITY DATA ARE PART OF THE ASSESSMENT PROCESS. THE BENCH MARK IS ESTABLISHED USING HEALTHY PEOPLE 2020 DATA.

SCHEDULE H, PART VI, LINE 3
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ------------------------------------------------- THE HOSPITAL'S CHARITY CARE POLICY IS POSTED ON THE WWW.EMHEALTH.ORG WEBSITE. AT REGISTRATION OF SELF-PAY CLIENTS, INFORMATION IS GIVEN ON A REDUCED FEE, CHARITY APPLICATION, AND A REFERRAL TO A FINANCIAL COUNSELOR. THE FREE COMMUNITY SCREENINGS ARE POSTED ON THE WEBSITE AND IN AREA NEWSPAPERS IF THE HOSTING ORGANIZATION INVITES COMMUNITY PARTICIPATION. SOME EVENTS ARE DISCUSSED ON LOCAL RADIO. INFORMATION REGARDING THE FREE CLINIC IS ALSO GIVEN BY HEALTHCARE PROVIDERS, FAITH COMMUNITY NURSES, CASE WORKERS, AND OTHER MEDICAL PROFESSIONALS.

SCHEDULE H, PART VI, LINE 4
COMMUNITY INFORMATION ----------------------- THE COMMUNITY DEFINED FOR THE CHNA REPORT INCLUDES THE PRINCIPAL RESIDENTIAL ZIP CODES IN BOYLE, GARRARD, MERCER, AND WASHINGTON COUNTIES IN KENTUCKY, COMPRISING THE HOSPITAL'S SERVICE AREA. THE HEALTH SYSTEM SERVES BOYLE, MERCER, CASEY, LINCOLN, GARRARD, AND WASHINGTON COUNTIES, WHICH HAVE A RURAL POPULATION OF APPROXIMATELY 124,000. ACCESS IS AN ISSUE, DUE TO TRAVEL BARRIERS SUCH AS AN OUT-OF-DATE HIGHWAYS AND LACK OF PUBLIC TRANSPORTATION. THESE ACCESS ISSUES INFLUENCED THE DECISION TO SERVE WITH FREE SCREENINGS AT KEY GATHERING PLACES SUCH AS CHURCHES AND SCHOOLS, ETC. INSURANCE COVERAGE IS ANOTHER ISSUE. THE NUMBERS OF UNINSURED CONTINUES TO EXCEED THE NATIONAL AVERAGE AND THE UNDERINSURED IN THIS SERVICE AREA CONTINUES TO EXCEED POST ACA.

SCHEDULE H, PART VI, LINE 5
PROMOTION OF COMMUNITY HEALTH --------------------------------- OFFICERS AND STAFF OF THE HOSPITAL ARE ENGAGED IN LEADERSHIP POSITIONS WITHIN SEVERAL ORGANIZATIONS IN THE LOCAL COMMUNITY. THE HOSPITAL IS THE ONLY ACUTE CARE HOSPITAL OPERATING IN MERCER COUNTY AND PROVIDES EMERGENCY TREATMENT TO LOCAL RESIDENTS WHO WOULD OTHERWISE HAVE TO TRAVEL OUT OF THE COUNTY TO RECEIVE EMERGENCY MEDICAL TREATMENT. THE HOSPITAL ALSO PROVIDES A WEEKEND AND AFTER HOURS WALK-IN CLINIC TO PROVIDE A BETTER (MORE APPROPRIATE) OPTION THAN THE ER TO OUR RESIDENTS WHO REQUIRE BASIC HEALTHCARE NEEDS AFTER HOURS AND ON THE WEEKEND. THE HOSPITAL, ALONG WITH THE LOCAL HEALTH DEPARTMENT, IS RESPONSIBLE FOR EDUCATION AND PROVIDING THE MEDICAL CARE TO ITS LOCAL AND SURROUNDING RESIDENTS. THE HOSPITAL PROVIDES FREE COMMUNITY HEALTH FORUMS MONTHLY TO THE COMMUNITY AT THE PUBLIC LIBRARY EDUCATING THEM ON HEALTH RELATED ISSUES (HOW TO IMPROVE THEIR MENTAL HEALTH, HOW TO KEEP UP WITH THEIR MEDICATIONS, BIKE SAFETY, HOW TO MAINTAIN A WALKING PROGRAM, HEALTHY EATING, BREAST SCREENING AND EARLY DETECTION EDUCATION). WE ALSO PROVIDE NUMEROUS HEALTH FAIRS TO LOCAL COMPANIES FOR A NOMINAL CHARGE. STAFF HAS ALSO GIVEN TESTIMONY AT LOCAL, STATE, AND FEDERAL LEVELS RELATED TO OUR SERVICE AREA'S HEALTH, EDUCATION AND ECONOMIC ISSUES. THE HOSPITAL'S BOARD AND EPHRAIM MCDOWELL HEALTH'S BOARD IS COMPRISED OF COMMUNITY MEMBERS WITH REPRESENTATION FROM MEDICAL STAFF AND SENIOR LEADERSHIP. THE GOVERNING BOARD APPROVED THE ESTABLISHMENT AND FUNDING OF THE COMMUNITY SERVICE DEPARTMENT AND THE FUNDING OF THE HEALTH RISK BEHAVIOR ASSESSMENT OF BOYLE COUNTY. THEY ALSO APPROVED THE CHARITY CARE POLICY. THERE IS NEVER A FEE FOR SERVICES PROVIDED BY THE COMMUNITY SERVICE DEPARTMENT. WE ALSO APPROACHED CHURCHES IN THE SIX-COUNTY AREA WITH HEALTH SCREENINGS. PREVENTATIVE CARE, SUCH AS FLU SHOTS, ARE TAKEN TO THE COMMUNITY. SO, TOO, ARE ANNUAL SKIN CANCER CHECKS, MONTHLY BLOOD PRESSURE CHECKS, SEMIANNUAL GLUCOSE AND CHOLESTEROL CHECKS, ALONG WITH NURSE CONSULTS. SUCH SERVICES ARE OFFERED IN SCHOOLS, CHURCHES, AND OTHER PUBLIC ENTITIES IN THE REGION.

SCHEDULE H, PART VI, LINE 6
AFFILIATED HEALTH CARE SYSTEM -------------------------------- JAMES B. HAGGIN MEMORIAL HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN MERCER COUNTY. ON DECEMBER 1, 2017, THE HOSPITAL WAS ACQUIRED BY EPHRAIM MCDOWELL HEALTH (EMH). EMH IS A COMPREHENSIVE, INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES 124,000 RESIDENTS FROM SIX COUNTIES IN SOUTH CENTRAL KENTUCKY. THE EMH BOARD IS COMPRISED OF COMMUNITY MEMBERS AND REPRESENTATION FROM FT LOGAN HOSPITAL, JAMES B. HAGGIN MEMORIAL HOSPITAL, MEDICAL STAFF, AND EMRMC LEADERSHIP. FT LOGAN HOSPITAL IS A CRITICAL ACCESS HOSPITAL LOCATED IN LINCOLN COUNTY. HEALTH RESOURCE IS COMPRISED OF CLINICS, A WELLNESS CENTER, ASSISTED LIVING FACULTY, AND DURABLE MEDICAL EQUIPMENT OUTLETS. THERE ARE REPRESENTATIVES FROM OUR SIX COUNTIES, MEDICAL STAFF, AND LEADERSHIP ON THE COMMUNITY BOARD THAT OVERSEES AND COORDINATES THE SERVICES OF EPHRAIM MCDOWELL HEALTH.