2023-08-11T14:25:58-05:00 2022-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2021-10-01 560538020 COLUMBUS REGIONAL HEALTHCARE SYSTEM COLU 9106421703 500 JEFFERSON STREET WHITEVILLE NC 28472 M JEFFERY ARMSTRONG CFO 9106421703 2023-08-11 1 M JEFFERY ARMSTRONG 999009999 JOHN NORMAN P01506766 7049985200 2023-08-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z W JASON BECK 500 JEFFERSON STREET WHITEVILLE NC 28472 130507853 0 X WWW.CRHEALTHCARE.ORG X 1937 NC SERVING THE CITIZENS BY PROVIDING COMMUNITY SERVICES, HEALTH EDUCATION, AND CHARITY CARE. 8 7 784 34 0 0 10252185 4116517 123194125 123715262 631441 528049 446917 999002 134524668 129358830 11911 9939 0 0 40788770 40172114 0 0 0 82266637 76994492 123067318 117176545 11457350 12182285 197969739 198324168 51494205 44708684 146475534 153615484 TO PROVIDE COMPASSIONATE CARE, ADVANCE HEALING AND INSPIRE HOPE FOR OUR PATIENTS AND THEIR LOVED ONES. 0 0 106474845 9939 123715262 WE WILL BE THE PRIMARY HEALTHCARE HOME FOR THE CITIZENS OF COLUMBUS COUNTY AND SURROUNDING COMMUNITIES. CRHS WILL ESTABLISH ITSELF AS THE HEALTH SYSTEM OF CHOICE IN COLUMBUS COUNTY BY DEVELOPING LONG-TERM RELATIONSHIPS WITH PATIENTS AND PROVIDERS AND LEVERAGING PARTNERSHIPS AND TECHNOLOGY TO ENSURE EASY, TIMELY ACCESS TO A FULL BREADTH OF CLINICAL SERVICES. CRHS WILL FACILITATE THE COORDINATION OF CARE THAT RESULTS IN EXCELLENT OUTCOMES, HIGH LEVELS OF SATISFACTION AND VALUE FOR THE PATIENT, AND MEASURABLE IMPROVEMENTS IN OUR POPULATION'S HEALTH. OUR VALUES START WITH THE RECOGNITION OF OUR PRIMARY ROLE AS A CARE GIVING HEALTH SYSTEM: THE NEEDS OF OUR PATIENTS COME FIRST. 106474845 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 1 125 0 784 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 X X M JEFFERY ARMSTRONG 9106421703 500 JEFFERSON ST WHITEVILLE NC 28463 FREDA GORE BOARD MEMBER 1.00 3.00 X 0 0 0 TERRAY SUGGS BOARD MEMBER/CHAIRMAN 12.00 4.00 X X 0 0 0 DR SAM WHEATLEY BOARD MEMBER/SEC & TREAS. 1.00 3.00 X X 0 0 0 CARL MEARES JR BOARD MEMBER 1.00 3.00 X 0 0 0 ANDY MARTIN BOARD MEMBER 1.00 3.00 X 0 0 0 DR DAVID GRECO BOARD MEMBER 1.00 3.00 X 0 0 0 BRENT WATTS BOARD MEMBER 1.00 3.00 X 0 0 0 JEROME MCMILLIAN BOARD MEMBER 3.00 1.00 X 0 0 0 M JEFFERY ARMSTRONG CFO 60.00 4.00 X 0 0 0 TERESA VENEZIANO CNO 40.00 0.00 X 214567 0 18697 WARREN BECK CEO/FORMER COO 40.00 0.00 X 238205 0 22943 RACHEL DUNBAR COO/FORMER ADMIN CHIEF OF STAFF 40.00 0.00 X 170866 0 27467 GLORIA MILLER CRNA 40.00 0.00 X 247940 0 20545 JEFFREY SAVAGE CRNA 40.00 0.00 X 320016 0 17052 HEATHER HINSON CRNA 40.00 0.00 X 210501 0 225 JOHN SCACHERI CRNA 40.00 0.00 X 205280 0 28430 SHANNON MORGAN-BAEHR CRNA 40.00 0.00 X 300231 0 9363 1907606 0 144722 51 0 1 0 ATRIUM HEALTH PO BOX 32861 CHARLOTTE NC 28232 MANAGEMENT SERVICES 2712321 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 1763590 CROTHALL HEALTHCARE 13028 COLLECTION CIRCLE CHICAGO IL 60693 ENGINEERING AND EVS SERVICES 1552330 TOTAL HEALTH & REHAB 109 E WYCHE ST WHITEVILLE NC 28472 PHYSICAL THERAPY SERVICES 1504437 GRAKA BUILDERS 113 E WALTER ST WHITEVILLE NC 28472 CONSTRUCTION SERVICES 704744 23 3840110 276407 216500 4116517 PATIENT SERVICE REVENUE 621990 120924356 120924356 ANCILLARY REVENUE 621990 2790906 2790906 123715262 1481345 1481345 877516 195727 681789 681789 681789 953536 -240 -953536 240 -953296 -953296 MISCELLANEOUS 621990 317213 317213 317213 129358830 123715262 0 1527051 X 9939 9939 623638 623638 32717405 31560085 1157320 4352672 4120168 232504 2478399 2346012 132387 93090 93090 89537 89537 24506448 22274989 2231459 828687 5713 822974 5487713 2439011 3048702 45492 45492 2097507 2062037 35470 111961 40347 71614 824037 824037 7109266 7038149 71117 1145906 1145906 MEDICAL SUPPLIES 19993362 19993362 BAD DEBT 13953906 13953906 FOOD 678822 585635 93187 MISCELLANEOUS 28758 28758 117176545 106474845 10701700 0 2392935 1618466 2876299 2433311 13988946 14949507 2672651 2498148 5660698 9365834 148693480 98261072 48490072 50432408 58329071 40907771 60239916 72447138 2133515 2062398 1185636 1609187 197969739 198324168 13369206 12683214 12251708 1055370 20348532 20428065 5524759 10542035 51494205 44708684 X 143732798 150500396 2742736 3115088 146475534 153615484 197969739 198324168 X 12182285 -4878780 -163555 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7853 7853 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE MEMBERSHIP DUES PAID TO THAT ORGANIZATION IS ALLOCATED TO LOBBYING EXPENDITURES ON BEHALF OF ITS MEMBERSHIP BODY. THE AMOUNT OF DUES ALLOCATED TO LOBBYING EXPENDITURES WAS APPROXIMATELY $2,255 THE ORGANIZATION IS A MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION. A PORTION OF THE MEMBERSHIP DUES PAID TO THAT ORGANIZATION IS ALLOCATED TO LOBBYING EXPENDITURES ON BEHALF OF ITS MEMBERSHIP BODY. THE AMOUNT OF DUES ALLOCATED TO LOBBYING EXPENDITURES WAS APPROXIMATELY $5,598. 1563423 1563423 49675684 30279812 19395872 92015020 65319098 26695922 5439353 2662162 2777191 50432408 INVESTMENT IN CHRN 65547861 F INVESTMENT IN CRHO 740388 F INVESTMENT IN DIAGNOSTICS 3575111 F INVESTMENT IN CR PROPOERTIES II 2583778 F 72447138 EST 3RD PARTY PAYOR SETTLEMENTS 5457396 DEFERRED PENSION COST 3374329 LEASE LIABILITIES 1710310 10542035 X PART X, LINE 2: INCOME TAXES- THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2022. 1 1 X 1 X 1 X 1 1 0 1 1 2462559 2462559 0.02100 14866293 13769600 1096693 0.00940 17328852 13769600 3559252 0.03040 9939 9939 0.00010 9939 9939 0.00010 17338791 13769600 3569191 0.03050 9150 9150 0.00010 2100 2100 0.00000 661 661 0.00000 11911 11911 0.00010 0 13953906 3318195 51115762 42226166 8889596 X 1 0 1 1 COLUMBUS REGIONAL HEALTHCARE SYSTEM 500 JEFFERSON STREET WHITEVILLE NC 28472 X X X COLUMBUS REGIONAL HEALTHCARE SYSTEM 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V 1 19 1 SEE PART V 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X X 1 0 X X X 1 X 0 0 COLUMBUS REGIONAL HEALTHCARE SYSTEM PART V, SECTION B, LINE 5: IN THE SPRING OF 2022, COLUMBUS REGIONAL HEALTHCARE SYSTEM STAFF IN COLLABORATION WITH STAKEHOLDERS IN COLUMBUS COUNTY CONVENED A WELLNESS INITIATIVE TO REVIEW OBSTACLES TO HEALTH AND PHYSICAL NEEDS OF RESIDENTS IN OUR COUNTY. THIS EFFORT FOCUSED ON ASSESSING COMMUNITY HEALTH NEEDS, LOCAL HEALTH RESOURCES, BARRIERS TO CARE, GAPS IN SERVICES, AND TRENDS REGARDING HEALTH AND HEALTHY LIFESTYLES AND TO SEEK FUNDS TO ADDRESS STRATEGIES DEVELOPED DURING THIS PROCESS. THE CHNA WILL BE UTILIZED TO DOCUMENT COMMUNITY NEED AND LINK THOSE NEEDS TO BENEFIT COMMUNITYEFFORTS THROUGH PARTNERSHIPS WITH LOCAL HEALTH RESOURCES. THE NEEDS ASSESSMENT WILL BE UTILIZED TO ASSIST THE HOSPITAL IN PLANNING AND PRIORITIZING ITS COMMUNITY BENEFIT INVESTMENTS. THE ASSEMBLED TASK FORCE MET TO DISCUSS QUESTIONS TO BE INCLUDED ON THE SURVEY AND HOW THE SURVEY SHOULD BE DISSEMINATED ACROSS THE COUNTY. DURING THE FIRST MEETING OF THIS GROUP IT WAS DETERMINED THAT WE NEEDED A THIRD PARTY FACILITATOR TO ENSURE THE PROCESS WAS COMPREHENSIVE AND WAS OPEN TO ALL RESIDENTS. MDC-RURAL FORWARD AGREED TO TAKE ON THIS TASK AND HAS BEEN INVOLVED IN DEVELOPINGAGENDAS, MEETING TIMES AND STAKEHOLDERS. OUR COUNTY HAS COMPLETED TWO NEEDS ASSESSMENTS IN THE PAST NINE MONTHS. A STUDY OF THE RECREATION NEEDS OF THE COUNTY WAS COMMISSIONED BY THE COUNTY AND HAS BEEN COMPLETED. THE SECOND NEEDS ASSESSMENT WAS FUNDED THROUGH KATE B. REYNOLD AND ADDRESSES THE SUBSTANCE ABUSE/MISUSE ISSUES IN OUR COUNTY AND IS TARGETING SOME OF THE SAME AREAS WE ARE ADDRESSING IN OUR HEALTH ASSESSMENT. THE NEEDS ASSESSMENT IS WORKING WITH THE HOSPITAL AND LOCAL AGENCIES TO DETERMINE HOW TO BEST ALLOCATE FUNDS FROM THE PHARMASETTLEMENT WHICH WILL AVERAGE 7 MILLION DOLLARS OVER AN 18 YEAR PERIOD. THERE IS CURRENTLY A COLUMBUS COUNTY OPIOID SUBSTANCE ABUSE/MISUSE COALITION MADE UP OF MEMBERS FROM ACROSS THE COUNTY THAT IS ADDRESSING THESE ISSUES.THE CHNA WAS INCORPORATED INTO A SURVEY MONKEY AND PEN AND PAPER SURVEYS WERE PREPARED IN BOTH ENGLISH AND SPANISH. A LISTING OF POSSIBLE AGENCIES THAT SHOULD BE INCLUDED IN THE DISSEMINATION OF SURVEYS WAS DEVELOPED. THESE SITES INCLUDED, BUT WERE NOT LIMITED TO: - COLUMBUS REGIONAL HEALTHCARE STAFF- COLUMBUS COUNTY AND WHITEVILLE CITY SCHOOLS- SOUTHEASTERN COMMUNITY COLLEGE FACULTY, STAFF AND STUDENTS- LOCAL PUBLIC LIBRARIES- PHYSICIAN OFFICES- BEHAVIORAL HEALTH CENTERS- DEPARTMENT OF AGING SITES- CIVIC GROUPS SUCH AS ROTARY AND COLUMBUS CHILDREN, YOUTH AND FAMILIES- HISPANIC OUTREACH PROGRAMS- WACCAMAW SIOUAN DEVELOPMENT OFFICE- ALL LAW ENFORCEMENT AGENCIES- COLUMBUS COUNTY GOVERNMENT- LOCAL TOWN AND CITY GOVERNMENTS- FAITH BASED ORGANIZATIONS- COLUMBUS COUNTY CHAMBER AND TOURISM- INTERNATIONAL PAPER- COLUMBUS COUNTY JOBS FOUNDATION- PRIVATE MEDICAL PRACTICES AND CLINICS- LOCAL CHAMBERS OF COMMERCE (CHADBOURN, TABOR CITY AND FAIR BLUFF.- MINORITY OWNED BARBER SHOPS AND SALONSOUR INTENT WAS TO DISTRIBUTE SURVEYS THROUGHOUT THE COUNTY AND UTILIZE THOSE LISTED ABOVE TO OBTAIN RESPONSES THAT REFLECT THE ENTIRE COMMUNITY. WHITEVILLE, BEING THE LARGEST TOWNSHIP IN THE COUNTY, WAS EXPECTED TO HAVE THE GREATEST RETURN AND THAT WAS REFLECTED IN OUR RESPONSE RATE. AN EFFORT WAS MADE TO REACH UNDERSERVED AREAS OF THE COUNTY AND MEMBERS OF THE COMMITTEE WERE ASKED TO REACH OUT TO IDENTIFY INDIVIDUALS IN THESE AREAS. THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) SURVEY DEVELOPED FOR THIS ASSESSMENT CYCLE WAS UTILIZED IN ADDITION TO A SURVEY COMPLETED IN THE SUMMER OF 2022 TO ASSESS OPIOID, SUBSTANCE ABUSE AND MISUSE IN COLUMBUS COUNTY. THE OPIOID/SUBSTANCE ABUSE SURVEY WAS IMPLEMENTED THROUGH A JOINT EFFORT BY THE COLUMBUS COUNTY REGIONAL HOSPITAL AND COLUMBUS COUNTY GOVERNMENT. A TASK FORCE APPOINTED BY ADDICTION CONSULTANT TRAINING, LLC FROM CHAPEL HILLAND APPROVED BY THE COLUMBUS COUNTY BOARD OF COMMISSIONERS WILL OVERSEE THE SETTLEMENT FUNDING DESIGNATED FOR OUR COUNTY THROUGH THE BIG PHARMA SETTLEMENT. THIS SURVEY, INCLUDED AS A LINK IN THIS DOCUMENT, AND QUESTIONS/COMMENTS GATHERED DURING THIS PROCESS TEND TO VALIDATE ISSUES IDENTIFIED WITH THE CHNA. ALSO INCLUDED AS A LINK IN THIS DOCUMENT IS THE COMMUNITY RECREATION NEEDS ASSESSMENT, A STUDY CONDUCTED BY THE COLUMBUS COUNTY PARKS AND RECREATION TO RESEARCH STATUS OF ACCESS TO HEALTH AND RECREATION FACILITIES FOR RESIDENTS IN OUR COUNTY. THESEDOCUMENTS VALIDATE MANY OF THE FINDINGS IDENTIFIED THROUGHOUT OUR SURVEY. COLUMBUS REGIONAL HEALTHCARE SYSTEM PART V, SECTION B, LINE 6B: COLUMBUS REGIONAL, COLUMBUS COUNTY HEALTH DEPARTMENT, COLUMBUS COUNTY PARTNERSHIP FOR CHILDREN, COL CO COOPERATIVE EXTENSION, WACCAMAW-SIOUAN TRIBE, LOWER CAPE FEAR COLUMBUS REGIONAL HEALTHCARE SYSTEM PART V, SECTION B, LINE 11: COLUMBUS REGIONAL HEALTHCARE SYSTEM IS ADDRESSING THE FOLLOWING SIGNIFICANT NEEDS THAT WERE IDENTIFIED IN THE MOST RECENT CHNA:-HEART DISEASE AND STROKE: COMMUNITY EDUCATION, CODE STROKE INITIATIVE, EXPANDED RELATIONSHIP WITH CAPE FEAR HEART ASSOCIATES, CARE TRANSITIONS PROGRAM, AND PARTNERSHIP WITH THE COLUMBUS COUNTY FARMERS MARKET-CANCER: INCREASING EDUCATION TO THE COMMUNITY AND IMPLEMENTING CANCER SCREENING PROGRAMS INTO CURRENT COMMUNITY BENEFIT RELATED ACTIVITIES THROUGH THE DONAYRE CARE CENTER AND PARTNERSHIP WITH LEVINE CANCER INSTITUTE.-DIABETES: INCREASING EDUCATION AND PARTICIPATING IN AND OFFERING COMMUNITY EVENTS TO PROVIDE FREE SCRENINGS FOR PATIENTS AT RISK FOR THIS CHRONIC DISEASE WHILE OFFERING RESOURCES FOR MANAGEMENT AND TREATMENT OPTIONS. SCHEDULE H, PART V SECTION B, LINES 7A AND 10A: WEBSITE ADDRESS FOR COMMUNITY HEALTH NEEDS ASSESSMENT ANDIMPLEMENTATION STRATEGY:HTTP://WWW.CRHEALTHCARE.ORG/COMMUNITY-OUTREACH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V SECTION B, LINES 16A, 16B, AND 16C: FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION:HTTP://WWW.CRHEALTHCARE.ORG/PATIENTS-VISITORS/CRHS-FINANCIAL-ASSISTANCE/ 10 1 - ADVANCED PRIMARY CARE - WHITEVILLE 619 JEFFERSON STREET WHITEVILLE NC 28472 OTHER OUTPATIENT CLINIC 2 - ADVANCED ORTHOPEDICS 701 JEFFERSON ST WHITEVILLE NC 28472 OTHER OUTPATIENT CLINIC 3 - ADVANCED PEDIATRICS 36 MCNEILL PLAZA WHITEVILLE NC 28472 OTHER OUTPATIENT CLINIC 4 - ADVANCED UROLOGY - WHITEVILLE 320 JEFFERSON STREET WHITEVILLE NC 28472 OTHER OUTPATIENT CLINIC 5 - ADVANCED PRIMARY CARE - TABOR CITY 14508 JAMES B WHITE HWY SOUTH TABOR CITY NC 28463 OTHER OUTPATIENT CLINIC 6 - ADVANCED IMAGING - WHITEVILLE 619 JEFFERSON STREET WHITEVILLE NC 28472 DIAGNOSTIC CLINIC 7 - BALDWIN WOODS DIAGNOSTICS 619 JEFFERSON STREET WHITEVILLE NC 28472 DIAGNOSTIC CLINIC 8 - ADVANCED UROLOGY - LELAND 144 POOLE RD SUITE 102 LELAND NC 28451 OTHER OUTPATIENT CLINIC 9 - ADVANCED PRIMARY CARE - LELAND 509 OLDE WATERFORD WAY SUITE 305 LELAND NC 28451 OTHER OUTPATIENT CLINIC 10 - ADVANCED ORTHOPEDICS - LELAND 509 OLDE WATERFORD WAY SUITE 102 LELAND NC 28451 OTHER OUTPATIENT CLINIC PART I, LINE 7: THE ORGANIZATION USED WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. PART I, LN 7 COL(F): TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBTEXPENSE OF $23,798,063 THAT HAS BEEN REMOVED FOR PURPOSES OF COMPUTINGPERCENTAGE OF TOTAL EXPENSE ON COLUMN (F). PART III, LINE 3: THE ORGANIZATION MULTIPLIED BAD DEBT EXPENSE BY THE COST TO CHARGE RATIO. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE FOOTNOTE ON BADDEBT EXPENSE. PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO CALCULATE THE OVERALL SHORTFALL. THE ORGANIZATION BELIEVES THE ENTIRE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. PART VI, LINE 2: CRHS COMPLETES A NEEDS ASSESSMENT EVERY THREE YEARS. PART VI, LINE 3: A PATIENT PRESENTED AS SELF PAY IS ASKED TO SPEAK WITH A FINANCIAL COUNSELOR OR THE CONTRACTED MEDICAID ELIGIBILITY SPECIALIST WHO WILL EVALUATE FOR MEDICAID ELIGIBILITY. IF NOT ELIGIBLE FOR MEDICAID, CHARITY CARE GUIDELINES ARE REVIEWED WITH PATIENT AND PROCESSED AS NEEDED. PART VI, LINE 4: THE PERIODIC COMMUNITY NEEDS ASSESSMENT PERFORMED TAKES INTO ACCOUNT GEOGRAPHIC AND DEMOGRAPHIC DATA FOCUSED ON CONSTITUENCY IN COLUMBUS COUNTY AND THE SURROUNDING APPLLICABLE COUNTIES IN THE REGION. DATA PARTS INCLUDE AGE, GENDER, MIGRATION TRENDS, THE ECONOMIC ENVIRONMENT, ETC. PART VI, LINE 5: THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THECOMMUNITY BY EXTENDING MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR MOST OF ITS DEPARTMENTS. THE SURPLUS OF FUNDS, IF ANY, ARE USED TO PURCHASE MEDICAL EQUIPMENT AND IMPROVING PATIENT CARE. THE ORGANIZATION'S BOARD IS COMPRISED OF MOSTLY UNRELATED, LOCAL RESIDENTS TO ENSURE THAT THE VOICE OF COMMUNITY IS HEARD. X 0 0 X 0 0 0 0 0 1 0 1 0 JEFFREY SAVAGE CRNA 271395 0 5218 0 43403 0 7226 0 9826 0 337068 0 0 0 SHANNON MORGAN-BAEHR CRNA 277581 0 522 0 22128 0 9093 0 270 0 309594 0 0 0 GLORIA MILLER CRNA 222841 0 563 0 24536 0 7240 0 13305 0 268485 0 0 0 WARREN BECK CEO/FORMER COO 163944 0 31299 0 42962 0 6221 0 16722 0 261148 0 0 0 JOHN SCACHERI CRNA 193532 0 507 0 11241 0 6015 0 22415 0 233710 0 0 0 TERESA VENEZIANO CNO 164691 0 33723 0 16153 0 6214 0 12483 0 233264 0 0 0 HEATHER HINSON CRNA 204118 0 512 0 5871 0 0 0 225 0 210726 0 0 0 RACHEL DUNBAR COO/FORMER ADMIN CHIEF OF STAFF 132545 0 27542 0 10779 0 5286 0 22181 0 198333 0 0 0 PART I, LINE 1A TRAVEL EXPENSES RELATED TO ANNUAL BOARD RETREAT PART I, LINE 6 THE BONUS IS BASED ON PERFORMANCE IN QUALITY, PATIENT SERVICE, TEAMMATE ENGAGEMENT, AND STRATEGIC GROWTH INITIATIVES. PART I, LINE 7 BONUSES ARE DISCRETIONARY AND BASED ON KEY PERFORMANCE INDICATORS AND QUALITY MEASURES. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DQR5 2013-02-07 26188219 SEE PART VI 0 0 0 A 6320000 26188379 1789132 521980 16486469 7390817 2014 0 0 0 1 A 0 0 0 0 0 0 0 A 1 0 0 0 0 1 A 0 SCHEDULE K, PART I, COLUMN F THE PURPOSE OF THE SERIES 2013A BONDS ARE TO: 1. PAY OR REIMBURSE THE SYSTEM FOR PAYING, A PORTION OF THE COST OF THE PROJECT, 2. REFINANCE CERTAIN INDEBTEDNESS INCURRED ON BEHALF OF THE SYSTEM, 3. FUND A DEBT SERVICE RESERVE FUND, AND 4. PAY CERTAIN EXPENSES OF ISSUING THE 2013A BONDS. X 1 216500 FORM 8283 1 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE NOVEMBER 26, 2007, CRHS ENTERED INTO A NINE-YEAR MANAGEMENT SERVICES AGREEMENT WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY WHICH DOES BUSINESS AS ATRIUM HEALTH TO MANAGE THE SYSTEM ON A DAY-TO-DAY BASIS. A RENEWAL TO THE MSA WAS APPROVED BY THE SYSTEM IN FISCAL YEAR 2021 FOR A PERIOD OF FIVE YEARS. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION'S AFFAIRS SHALL BE MANAGED BY A BOARD OF DIRECTORS ("BOARD") COMPOSED OF NOT LESS THAN THREE (3) DIRECTORS. THE BOARD SHALL HAVE, AND MAY EXERCISE, ANY AND ALL POWERS PROVIDED BY LAW AND IN THE ARTICLES OF INCORPORATION THAT ARE NECESSARY OR CONVENIENT TO CARRY OUT THE PURPOSES OF THE CORPORATION, AND WHICH SUPPORT AND FURTHER THE PURPOSES OF THE CORPORATION AS ESTABLISHED IN THESE BYLAWS. EXCEPT FOR RESIGNATIONS, REMOVALS, OR DEATH, EACH DIRECTOR DULY NOMINATED AND ELECTED SHALL HOLD OFFICE UNTIL HIS SUCCESSOR IS NOMINATED, ELECTED, AND QUALIFIED BY ATTENDING A MEETING AND BEING DULY RECOGNIZED AND PLACED ON THE OFFICIAL RECORDS OF THE CORPORATION BY THE SECRETARY. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS SHALL BE ELECTED BY THE AFFIRMATIVE VOTE OF THE BOARD OF DIRECTORS OF COLUMBUS REGIONAL HEALTHCARE SYSTEM. THE DIRECTORS OF THE CORPORATION EACH SHALL SERVE A THREE (3) YEAR TERM OF OFFICE FROM THE TIME OF ELECTION, WHICH TERM SHALL COMMENCE ON THE DAY OF THEIR ELECTION. DIRECTORS OF THE BOARD SHALL BE ELIGIBLE TO SERVE FOUR (4) SUCCESSIVE TERMS OF THREE (3) YEARS EACH, SUBJECT TO THE PROVISIONS. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN POWERS SHALL BE RESERVED EXCLUSIVELY UNTO THE SOLE MEMBER OF THE CORPORATION, COLUMBUS REGIONAL HEALTHCARE SYSTEM, WHICH SHALL EXERCISE SUCH POWERS IN ACCORDANCE WITH LAW AND THE AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS OF ITS BOARD OF DIRECTORS, AS THEN CONSTITUTED; SUCH POWERS TO BE: (1) TO MERGE OR CONSOLIDATE THE CORPORATION WITH ANY OTHER NONPROFIT CORPORATION; (2) TO ACQUIRE OR CREATE ANOTHER CORPORATION; (3) TO MAKE A CAPITAL EXPENDITURE OVER A SPECIFIED DOLLAR LIMIT TO BE ESTABLISHED FROM TIME TO TIME BY THE SOLE MEMBER; (4) TO SELL CAPITAL ASSETS VALUED OVER A SPECIFIED DOLLAR LIMIT TO BE ESTABLISHED FROM TIME TO TIME BY THE SOLE MEMBER; (5) TO APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS; (6) PERMISSION TO DISSOLVE THE CORPORATION; AND (7) TO APPOINT THE MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS AS PROVIDED IN ARTICLE III, SECTION 2 AND FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S 990 WAS REVIEWED BY MANAGEMENT AND PROVIDED TO THE MEMBERS OF THE BOARD FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES COMPLETES A CONFLICT OF INTEREST FORM ANNUALLY. ALL EMPLOYEES AT ORIENTATION AND ANNUALLY, DURING HEALTH AND SAFETY EDUCATION ARE SURVEYED REGARDING ANY SITUATIONS THAT MAY CONSTITUTE AS A CONFLICT OF INTEREST. ANY EMPLOYEE FORMS WITH AN AFFIRMATIVE RESPONSE ARE FORWARDED TO THE COMPLIANCE OFFICER FOR REVIEW. THE BOARD OF TRUSTEES FORMS ARE SUBMITTED TO THE COMPLIANCE OFFICER FOR REVIEW AS WELL. ANY QUESTIONS OR CONCERNS ARE DISCUSSED WITH CEO. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE CEO AND CFO ARE DETERMINED BY ATRIUM HEALTH BY EXTERNAL INFORMATION EACH YEAR. THE BOARD OF TRUSTEES REVIEWS AND APPROVES THE COMPENSATION. THE BOARD OF TRUSTEES CONSIDERS RECOMMENDATIONS BASED ON AVAILABLE MARKET DATA AS THEY REVIEW AND APPROVE COMPENSATION FOR OTHER MEMBERS OF CRHS EXECUTIVE STAFF ON AN ANNUAL BASIS. ALL DECISIONS REGARDING COMPENSATION ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND ON WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 CRHS MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, THE CONFLICT OF INTEREST STATEMENT IS AVAILABILE IN PATIENT LITERATURE. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 169,580. MANAGEMENT AND GENERAL EXPENSES 16,450. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 186,030. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 8,345,587. MANAGEMENT AND GENERAL EXPENSES 589,962. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,935,549. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 13,759,822. MANAGEMENT AND GENERAL EXPENSES 1,625,047. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,384,869. FORM 990, PART XI, LINE 9: OTHER CHANGES IN NET ASSETS 52,945. DONATED LAND -216,500. 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