2023-08-14T11:03:52-05:00 2022-09-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2021-10-01 560642846 HUGH CHATHAM MEMORIAL HOSPITAL INC HUGH 3365277000 180 PARKWOOD DR ELKIN NC 28621 PAUL H HAMMES CEO 3365277000 2023-08-14 1 PAUL HAMMES 999009999 AMY BIBBY P00445891 8282542254 2023-08-14 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z PAUL H HAMMES 180 PARKWOOD DR ELKIN NC 28621 155415691 0 X WWW.HUGHCHATHAM.ORG X 1930 NC TO PROVIDE BIRTHING AND ACUTE CARE SERVICES IN ADDITION TO SKILLED NURSING, RETIREMENT COMMUNITY, HOME HEALTH, AND HOSPICE SERVICES PRIMARILY TO THE RESIDENTS OF AND SURROUNDING COUNTIES TO SURRY COUNTY, NORTH CAROLINA. 12 11 1095 12 0 0 2800000 6647181 136807043 135635601 17281643 11390499 1214838 1397765 158103524 155071046 8883 87359 0 0 65578740 70246289 0 0 112925 74016679 75449198 139604302 145782846 18499222 9288200 281613706 255924917 75713171 76467441 205900535 179457476 X TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. 0 0 132057495 87359 135635601 WHILE 2021 WAS A YEAR TO NEVER FORGET, HUGH CHATHAM MEMORIAL HOSPITAL CONTINUED THEIR LEGACY OF PROVIDING HEALTHCARE TO ALL WITHIN THE COMMUNITY DURING THE GLOBAL PANDEMIC, COVID-19. THE ORGANIZATION'S VISION, "TO BE THE BEST COMMUNITY HEALTH SYSTEM IN THE NATION WITH SERVICE AS OUR GUIDING PRINCIPLE," DECLARES THAT EVERY MEMBER OF THE STAFF PROVIDES THE HIGHEST LEVEL OF CARE FOR EVERY PATIENT, AT EVERY LOCATION. HUGH CHATHAM MAKES A DIFFERENCE EVERY DAY FOR LOCAL CITIZENS AND EMPLOYERS. THE NONPROFIT HEALTH CARE SYSTEM HAS RECENTLY RECEIVED MANY PRESTIGIOUS AWARDS THAT ACCENTUATE ITS COMMITMENT TO EXCELLENCE.- WOMEN'S CHOICE AWARD FOR BEST IN PATIENT SAFETY AND STROKE CARE FOR 2022- AMERICAN HEART ASSOCIATION 2021 GET WITH THE GUIDELINES: STROKE SILVER PLUS WITH HONOR ROLL ELITE AND TARGET: TYPE 2 DIABETES- JOINT COMMISSION'S GOLD SEAL OF APPROVAL FOR THE ADVANCED CERTIFICATION FOR TOTAL HIP AND KNEE REPLACEMENT- NATIONALLY RECOGNIZED AS AN "A" GRADE FOR PATIENT SAFETY BY THE LEAPFROG GROUP SPRING 2021- YADKIN VALLEY HOME HEALTH RANKS IN THE TOP 20% IN PATIENT SATISFACTION AMONG 4,000+ AGENCIES NATIONWIDE.- HUGH CHATHAM MEMORIAL HOSPITAL RANKED IN THE TOP 10% AMONG NORTH CAROLINA HOSPITALS FOR PATIENT SATISFACTION.HUGH CHATHAM ACKNOWLEDGED THAT HELPING OUR COMMUNITY WAS ESSENTIAL IN COMBATTING COVID-19 AND TO PROTECT THE PEOPLE WHO MAKE HUGH CHATHAM'S HEALTH SYSTEM SO IMPACTFUL. THE ORGANIZATION PROVIDED COVID-19 VACCINE CLINICS FOR EMPLOYEES AND THE COMMUNITY. IN ADDITION, HUGH CHATHAM PROVIDED EDUCATION TO DECREASE THE SPREAD OF THE VIRUS TO COMMUNITY MEMBERS. HUGH CHATHAM MEDICAL GROUP ALSO OPENED THREE NEW PHYSICIAN PRACTICES AND EXPANDED EXPRESS CARE SERVICES, PROVIDING GREATER ACCESS TO HEALTHCARE THROUGHOUT THE AREA. OUR COMMUNITY RALLIED TO ENSURE SAFETY FOR ALL. HUGH CHATHAM CREATED PARTNERSHIPS WITH LOCAL ORGANIZATIONS TO PROVIDE PERSONAL PROTECTION EQUIPMENT (PPE) TO PROTECT OUR STAFF WHILE THEY PROVIDED EXCEPTIONAL CARE TO PATIENTS. IN HUGH CHATHAM'S RAPID RESPONSE TO COVID-19, THE HEALTH SYSTEM CREATED A VIRTUAL CARE PLATFORM TO PROVIDE CARE TO PATIENTS WHO WERE IN QUARANTINE, DID NOT WANT TO BE AT RISK FOR COVID-19, OR OTHERWISE HOME-BOUND. HUGH CHATHAM VIRTUAL CARE ALLOWS ACCESS TO PROVIDERS VIA WEBSITE OR APPLICATION.A COMPLETE LISTING OF SERVICES IS AVAILABLE ON THE HEALTH SYSTEM'S WEBSITE AT WWW.HUGHCHATHAM.ORG. FOR REAL-TIME UPDATES AND STORIES ABOUT THE PEOPLE WHO MAKE THIS HEALTH SYSTEM SUCCESSFUL, VISIT HUGH CHATHAM MEMORIAL HOSPITAL ON FACEBOOK, INSTAGRAM, TWITTER AND LINKEDIN. 132057495 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 172 0 1 1095 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X KAYLA WAGONER 3365277542 PO BOX 560 ELKIN NC 28621 DR SARBA KUNDU PHYSICIAN 40.00 X 894006 0 69251 DR DOMINICK CARBONE PHYSICIAN 40.00 X 789825 0 70251 DR JOHNATHAN WHITAKER PHYSICIAN 40.00 X 763031 0 66051 DR JONATHAN SNYDER PHYSICIAN 40.00 X 740293 0 63361 DR MURUG SUBBIAH BOARD MEMBER 1.00 X 674312 0 69224 PAUL HAMMES CEO 40.00 2.00 X 488370 0 66974 DR MARC STEVENS PHYSICIAN 40.00 X 483304 0 49059 MARY BLACKBURN CNO 40.00 X 263013 0 63295 ANDREW TATE CPO & VP AMB SERVICES 40.00 X 224943 0 27114 KENT THOMPSON CFO 40.00 2.00 X 211432 0 24687 TERRY DARNELL CHAIRMAN 1.00 X X 0 0 0 CYNTHIA GONZALEZ VICE CHAIRMAN 1.00 X X 0 0 0 BILL JOHNSON TREASURER 1.00 1.00 X X 0 0 0 PHIL HARRIS SECRETARY 1.00 X X 0 0 0 BOB BALL ASST SECRETARY/TREASURER 1.00 X X 0 0 0 DAVID ACKERMAN BOARD MEMBER 1.00 X 0 0 0 DR WILL BALLARD BOARD MEMBER 1.00 X 0 0 0 DAVID CLINE BOARD MEMBER 1.00 X 0 0 0 MYRA COX BOARD MEMBER 1.00 X 0 0 0 BOB MIDKIFF BOARD MEMBER 1.00 X 0 0 0 ELENA THOMASSON BOARD MEMBER 1.00 X 0 0 0 5532529 0 569267 91 0 1 0 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 30353 DIETARY & HOUSEKEEPING SERVICES 4320333 QUALIVIS LLC PO BOX 123847 DALLAS TX 75312 CONTRACT LABOR 4010439 CARDINAL PHARMACY 25025 NETWORK PLACE CHICAGO IL 60673 PHARMACEUTICALS 2328575 CARDINAL HEALTH PO BOX 70539 CHICAGO IL 60673 MEDICAL SUPPLIES 1994854 HORIZON CSA LLC 265 PITT RD MOORESVILLE NC 28115 EQUIPMENT MAINTENANCE 1844433 14 6204681 442500 6647181 PATIENT CARE SERVICES 621400 135105144 135105144 OTHER OPERATING REVENUE 621400 301597 301597 NET HOSPICE INVESTMENT 623000 225764 225764 EHR MEANINGFUL USE REVENUE 621400 3096 3096 135635601 3553479 3553479 1719833 326700 1393133 1393133 1393133 7854965 0 17945 7854965 -17945 7837020 7837020 CAFETERIA & VENDING 900099 4632 4632 4632 155071046 135635601 0 12788264 X 87359 87359 1821512 455377 1275060 91075 78786 78786 54753973 50398027 4355946 885285 795871 87991 1423 8936337 8033767 888204 14366 3770396 3389586 374749 6061 68004 68004 100135 100135 314346 314346 677777 677777 22709268 20336104 2373164 541903 331733 210170 11899535 10697682 1201853 1659097 1491528 167569 257853 224568 33285 1319852 1186547 133305 5912599 5315427 597172 645152 645152 BAD DEBT EXPENSE 17482019 17482019 MEDICAL SUPPLIES 8494272 8494272 PROVIDER TAX 1963893 1963893 MISCELLANEOUS 1069935 649797 420138 333558 333558 145782846 132057495 13612426 112925 331953 15836662 22017763 1093409 1150113 2786184 2594853 152452014 97348281 54105478 55103733 187810784 153471273 13871090 15200212 5778146 6386970 281613706 255924917 13074451 21067909 756797 175658 53554980 50383569 8326943 4840305 75713171 76467441 X 202675123 176232064 3225412 3225412 205900535 179457476 281613706 255924917 X 9288200 -41017503 -312914 5599158 X X 0 1 X 1 0 X 1 1 13223 13223 0 PART II-B, LINE 1: PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS TO LEGISLATIVE BODIES ON BEHALF OF THEIR MEMBERSHIP BASES. EACH YEAR, A PORTION OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ENDEAVORS. FOR THE CURRENT YEAR, THE PORTION OF DUES PAID ALLOCATED TO LOBBYING IS APPROXIMATELY $ 13,223. 4189614 4189614 89221038 48925333 40295705 47537131 40061644 7475487 11504231 8361304 3142927 55103733 INVESTMENT IN HOSPICE OF SURRY COUNTY 15200212 C 15200212 INTEREST PAYABLE 191586 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1700000 PHYSICIAN GUARANTEE 632980 INTEREST RATE SWAP 336330 RESIDENT TRUST FUNDS 87276 LEASE LIABILITY 758350 OPERATING ACCOUNT OVERDRAFT 1133783 4840305 X PART X, LINE 2: THE HOSPITAL, FOUNDATION, AND AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE HOSPITAL 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 0 1260219 1260219 0.00980 13322146 11955682 1366464 0.01070 14582365 11955682 2626683 0.02050 6673 6673 0.00010 46520 46520 0.00040 154631 154631 0.00120 207824 207824 0.00170 14790189 11955682 2834507 0.02220 88197 88197 0.00070 88197 88197 0.00070 1 17484373 1910324 71477303 71477303 X 1 0 1 1 HUGH CHATHAM MEMORIAL HOSPITAL 180 PARKWOOD DRIVE ELKIN NC 28621 X X X DISPROPORTIONATE SHARE HOSPITAL HUGH CHATHAM MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X SEE DISCLOSURE X 1 21 1 SEE DISCLOSURE 0 1 X 200.000000000000 200.000000000000 X X X X X X 1 1 X X X X 1 X SEE DISCLOSURE X SEE DISCLOSURE X SEE DISCLOSURE X X X X X X 1 X 0 X X X 1 X 0 0 HUGH CHATHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: EXPERTS IN THE FIELD OF PUBLIC HEALTH, HOSPICE CARE, NURSES, PHYSICIANS, CASE MANAGEMENT, EDUCATION, AND PHILANTHROPY WERE CHOSEN FOR THE FOCUS GROUP. THE FOCUS GROUPS WERE DESIGNED AROUND THE KEY ISSUES THAT EMERGED FROM THE MEETINGS. HUGH CHATHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: HUGH CHATHAM MEMORIAL HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN OUR COMMUNITY, WITH A SPECIAL FOCUS ON THE UNDERSERVED. AS SUCH, COMMUNITY BENEFIT PLANNING IS INTEGRATED INTO OUR HOPSITAL'S ANNUAL PLANNING AND BUDGETING PROCESSES TO ENSURE WE CONTINUE TO EFFECTIVELY SUPPORT COMMUNITY BENEFITS. PART V, SECTION B, LINE 7A AND 10A: WEBSITE ADDRESSES FOR CHNA AND IMPLEMENTATION STRATEGYHTTPS://WWW.HTTPS://HUGHCHATHAM.ORG/WP-CONTENT/UPLOADS/2023/01/2022_COMMUNITYHEALTHNEEDS-PLAN_1.PDFHTTPS://WWWHTTPS://HUGHCHATHAM.ORG/WP-CONTENT/UPLOADS/2023/01/2022-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-IMPLEMENTATION-PLAN.PDF 25 1 - YADKIN VALLEY HOME HEALTH 213 WINSTON RD ELKIN NC 28642 HOME HEALTH 2 - TRI COUNTY ORTHOPEDIC AND SPORTS MEDICIN 400 JOHNSON RIDGE RD ELKIN NC 28621 PHYSICIAN OFFICE 3 - YADKIN VALLEY UROLOGY 200 JOHNSON RIDGE MEDICAL PARK ELKIN NC 28621 PHYSICIAN OFFICE 4 - YADKIN VALLEY ADULT MEDICINE 500 CHATHAM MEDICAL PARK ELKIN NC 28621 PHYSICIAN OFFICE 5 - CLINGMAN MEDICAL CENTER 3369 CLINGMAN RD ELKIN NC 28670 PHYSICIAN OFFICE 6 - YADKIN VALLEY GASTROENTEROLOGY 201 WEST MAIN STREET ELKIN NC 28621 PHYSICIAN OFFICE 7 - JONESVILLE URGENT CARE CENTER 546 WINSTON ROAD JONESVILLE NC 28642 PHYSICIAN OFFICE 8 - G I CLINIC 201 WEST MAIN STREET ELKIN NC 28621 PROCEDURE CLINIC 9 - YADKIN VALLEY DERMATOLOGY 201A ELDON PARK DRIVE ELKIN NC 28621 PHYSICIAN OFFICE 10 - HUGH CHATHAM FAMILY MEDICINE ELKIN 600 CHATHAM MEDICAL PARK ELKIN NC 28621 PHYSICIAN OFFICE 11 - HUGH CHATHAM SURICAL 201B ELDON PARK DRIVE ELKIN NC 28621 PHYSICIAN OFFICE 12 - HUGH CHATHAM NEUROLOGY 100 CHATHAM MEDICAL PARK ELKIN NC 28621 PHYSICIAN OFFICE 13 - HUGH CHATHAM BEHAVIORAL 690 PARKWOOD MEDICAL PARK ELKIN NC 28621 PHYSICIAN OFFICE 14 - YADKIN VALLEY PULMONARY 180 PARKWOOD DRIVE ELKIN NC 28621 PHYSICIAN OFFICE 15 - HUGH CHATHAM FAMILY MED BOOMER 156 BOOMER COMMUNITY CENTER RD BOOMER NC 28606 PHYSICIAN OFFICE 16 - HUGH CHATHAM FAMILY MED MT VIEW 5229 ROCK CREEK RD MT VIEW NC 28602 PHYSICIAN OFFICE 17 - HUGH CHATHAM WOMEN'S CENTER 150 PARKWOOD DRIVE ELKIN NC 28621 PHYSICIAN OFFICE 18 - HUGH CHATHAM PODIATRIC MEDICINE AND SURG 150 CHATHAM MEDICAL PARK ELKIN NC 28621 PHYSICIAN OFFICE 19 - HUGH CHATHAM EXPRESS CARE DOBSON 911 E ATKINS ST DOBSON NC 28621 PHYSICIAN OFFICE 20 - PARKWOOD PLACE RETIREMENT CENTER 601 JOHNSON RIDGE RD ELKIN ELKIN NC 28621 RETIREMENT CENTER 21 - HUGH CHATHAM FAMILY MEDICINE INDEPEDENCE 127 EAST MAIN STREET INDEPENENCE VA 24348 PHYSICIAN OFFICE 22 - HUGH CHATHAM FAMILY MEDICINE WOODLAWN 22 TRAINING CENTER RD WOODLAWN VA 24381 PHYSICIAN OFFICE 23 - HUGH CHATHAM FAMILY MEDICINE DOBSON 911 E ATKINS ST DOBSON NC 28621 PHYSICIAN OFFICE 24 - HUGH CHATHAM FAMILY MEDICINE JONESVILLE 546 WINSTON ROAD JONESVILLE NC 28642 PHYSICIAN OFFICE 25 - HUGH CHATHAM ENDOCRINOLOGY AND DIABETES 500 CHATHAM MEDICAL PARK ELKIN NC 28621 PHYSICIAN OFFICE PART I, LINE 7: THE ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM WAS USED TO COMPUTE A COST-TO-CHARGES RATIO THAT WAS USED TO CALCULATE COSTS USED IN PART I, LINE 7. PART I, LN 7 COL(F): THE TOTAL EXPENSE AMOUNT LISTED ON FORM 990, PART IX, LINE 26 CONTAINS BAD DEBT EXPENSE OF $17,484,373 THAT WAS REMOVED FOR THE PURPOSE OF CALCULATING TOTAL CHARITY CARE PERCENTAGE ON LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: HUGH CHATHAM ACKNOWLEDGED THAT HELPING OUR COMMUNITY WAS ESSENTIAL IN COMBATTING COVID 19 AND TO PROTECT THE PEOPLE WHO MAKE HUGH CHATHAM'S HEALTH SYSTEM SO IMPACTFUL. THE ORGANIZAITON PROVIDED COVID-10 VACCINE CLINICS FOR EMPLOYEES AND THE COMMUNITY. IN ADDTION HCMH PROVIDED EDUCATION TO DECREASE THE SPREAD OF THE VIRUS TO COMMUNITY MEMBERS. HCMH ALSO OPENED THREE NEW PHYSICIAN PRACTICES AND EXPANDED EXPRESS CARE SERVICES. WE RALLIED TO ENSURE SAFETY FOR ALL. WE CREATED PARTNERSHIPS WITH LOCAL ORGANIZATIONS TO PROVIDE PERSONAL PROTECTION EQUIPMENT. PART III, LINE 2: THE OUTSTANDING ACCTS RECEIVABLE IS SEGREGATED BY AGE. A PERCENTAGE, DETERMINED BY HISTORICAL DATA, OF EACH AGING GROUP IS RESERVED FOR BAD DEBT AND EXPENSED MONTHLY. WHAT WE CALL TRADITIONAL MEDICARE AND CROSSOVER BAD DEBT ARE EXPENSED AT 100%. PART III, LINE 3: $5,458,069 WHICH IS THE BAD DEBT AMOUNT STATED ABOVE TIMES THE COST TO CHARGE RATIO. 35% WOULD QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE GROSS BAD DEBT EXPENSE PER AUDITED FINANCIAL STATEMENTS REDUCED TO COST USING AN INTERNALLY COMPUTED COST-TO-CHARGES RATIO FROM THE ORGANIZATION'S COST ACCOUNTING SYSTEMS.DUE TO THE FACT THAT APPROXIMATELY 30% OF THE SURROUNDING COMMUNITY'S RESIDENTS ARE CONSIDERED TO BE LIVING BELOW THE POVERTY LINE, IN COMBINATION WITH THE FACT THAT THE UNEMPLOYMENT PERCENTAGE FOR THE AREA IS APPROXIMATELY 12.7%, THE ORGANIZATION FEELS THAT APPROXIMATELY 35% OF BAD DEBT IS AN APPROPRIATE ESTIMATION OF THE AMOUNT OF BAD DEBT THAT MAY CONSTITUTE A COMMUNITY BENEFIT. PART III, LINE 8: AN INTERNAL COST-TO-CHARGE RATIO WAS USED TO COMPUTE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6. PART III, LINE 9B: HCMH MAKES EVERY EFFORT TO EVALUATE PATIENTS PRIOR TO PLACEMENT WITH A COLLECTIONS AGENCY TO SEE IF THEY ARE QUALIFIED FOR MEDICAID OR HOSPITAL CHARITY CARE. WE HAVE AN IN-HOUSE EMPLOYEE DESIGNATED TO ASSISTING PATIENTS ELIGIBLE FOR MEDICAID AND/OR FINANCIAL ASSISTANCE. AT THE POINT OF THE PATIENT NOT BEING ELIGIBLE AND FAILURE TO RESPOND FOR OUR PAYMENT PLAN OPTIONS, THE ACCOUNT IS PLACED WITH A COLLECTION AGENCY AND THE AGENCY MAKES AN EFFORT FOR 30 DAYS PRIOR TO PLACING ON THE CREDIT SCORE, TO OBTAIN PAYMENT. PART VI, LINE 2: THE ORGANIZATION TRACKS THE RESULTS OF HEALTH SCREENINGS PROVIDED THROUGH ITS HEALTH FAIRS AND LOOKS FOR TRENDS. THESE SCREENINGS PROVIDE INSIGHT INTO FURTHER MEDICAL NEEDS OF THE COMMUNITY MEMBERS. THE FAIRS ARE HELD PERIODICALLY THROUGH THE YEAR AND ARE ATTENDED BY HUNDREDS OF PEOPLE WHO ARE OFFERED VARIOUS HEALTH SCREENINGS. THIS YEAR OUR SCREENINGS WERE COVID RELATED. THE ORGANIZATION ALSO SUBSCRIBES TO NATIONAL AFFILIATED ORGANIZATIONS THAT PROVIDE DATA ON REGIONAL HEALTH NEEDS. THE LAST COUPLE OF YEARS OUR FOCUS HAS BEEN ON STROKE EDUCATION, WITH STROKE CERTIFICATION FOR OUR FACILITY. WE RECEIVED THE STROKE SILVER WITH HONOR ROLL ELITE AND TARGET. WE ALSO RECEIVED JOINT COMMSIONS'S GOLD SEAL OF APRROVAL FOR THE ADVANCED CERTIFICATION FOR TOTAL HIP AND KNEE REPLACEMENT. REACHING INTO THE BUSINESS COMMUNITY WITH EDUCATIONAL MATERIALS AND SCREENINGS BEING PROVIDED. THE HUGH CHATHAM VIRTUAL CARE PROGRAM ALLOWS ACCESS TO PROVIDERS VIA WEBSITE OR APPLICATION IN ORDER TO PROVIDE CARE TO PATIENTS THAT DO NOT WANT TO BE AT RISK FOR COVID-19 OR OTHERWISE HOMEBOUND.THE 2022 CHNA PRIMARILY FOCUSED ON SURRY, WILKES, YADKIN, AND ALLEGHANY COUNTIES. THESE COUNTIES ARE CONSIDERED OUR "COMMUNITY" AS GREATER THAN EIGHTY-EIGHT (88) PERCENT OF THE HCMH INPATIENT POPULATION RESIDES WITHIN THESE FOUR COUNTIES. PRIMARY DATA FOR THE ASSESSMENT WAS GATHERED THROUGH A SURVEY TOOL WITH MORE THAN TWO HUNDRED AND EIGHTY-FIVE (285) SUBMISSIONS. PARTICIPANTS REPRESENTED MULTIPLE ORGANIZATIONS AND INCLUDED INDIVIDUALS WHO HAVE A BROAD KNOWLEDGE OF THE COMMUNITY AND/OR HAD SPECIFIC EXPERTISE OR KNOWLEDGE. SECONDARY DATA WAS OBTAINED FROM LOCAL AND NATIONAL DATA PUBLISHED IN GOVERNMENT AND PRIVATE SOURCES. A COMPREHENSIVE LIST OF IDENTIFIED HEALTH ISSUES WAS COMPILED AND RECOMMENDATIONS WERE MADE TO HCMH'S EXECUTIVE LEADERSHIP FOR FURTHER REVIEW AND PRIORITIZATION. PRIORITIES WERE ASSESSED AND RANKED BASED ON ISSUE PREVALENCE, ISSUE SEVERITY, AND ABILITY TO IMPACT. FINAL PRIORITIZATION AS DETERMINED BY THE EXECUTIVE LEADERSHIP WAS APPROVED BY THE HCMH BOARD OF TRUSTEES.THE UNPRECEDENTED PANDEMIC OF COVID-19, SHOCKED OUR NATION AND HAD AN UNFATHOMABLE IMPACT ON HEALTHCARE SYSTEMS. HCMH UTILIZED THEIR STRENGTHS AS A COMMUNITY HEALTHCARE SYSTEM TO QUICKLY PIVOT TO PRIORITIZE CARE THAT EMBRACED NEW STRATEGIES TO DIAGNOSE AND TREAT THIS EMERGING INFECTIOUS DISEASE. WHILE MANY ELECTIVE SERVICES WERE LIMITED IN ORDER TO PROVIDE ADEQUATE RESOURCES OF SUPPLIES AND PERSONNEL WHERE THEY WERE MOST NEEDED, HCMH WAS CONSIDERED A LEADER IN THEIR RESPONSE TO PATIENT AND COMMUNITY NEEDS. PART VI, LINE 3: FINANCIAL ASSISTANCE EDUCATION IS MADE AVAILABLE AT ADMISSION AND ON THE WEBSITE. AT REGISTRATION THERE ARE BROCHURES WITH FINANCIAL ASSISTANCE INFORMATION MADE AVAILABLE. SIGNAGE IS LOCATED THROUGHOUT THE FACILITY TO INFORM AND EDUCATE THE PUBLIC OF THEIR FINANCIAL RIGHTS. HUGH CHATHAM MEMORIAL HOSPITAL OFFERS A LANGUAGE LINE FOR THE NON-ENGLISH SPEAKING COMMUNITY AND PHONETREE ASSISTANCE WHERE NEEDED. PART VI, LINE 4: THE PRIMARY SERVICE AREA OF THE HOSPITAL INCLUDES NINE ZIP CODES. ROUGHLY A FIFTEEN MILE DIAMETER AROUND ELKIN, NC. THE SECONDARY SERVICE AREA INCLUDES AN ADDITIONAL FIVE ZIP CODES WIDENING THE DIAMTER TO THIRTY MILES AROUND ELKIN. BOTH OF THESES MARKETS INCLUDE PART, BUT NOT ALL, OF THE NORTH CAROLINA COUNTIES OF WILKES, ALLEGHANY, YADKIN AND SURRY. SOUTHERN VIRGINIA COUNTIES OF GRAYSON, PATRICK, AND CARROLL ARE ALSO INCLUDED. PART VI, LINE 5: HCMH SPENT OVER 2.1 MILLION IN UPDATES TO CAPITAL PROJECTS RELATED TO PATIENT CARE.NEW RADIOLOGY EQUIPMENT ADDED INTO OPERATION TO FURTHER ENHANCE OUR IMAGING DEPARTMENTS, LAB SERVICES AND EQUIPMENT TO ENHANCE OUR PATIENT TESTING AND MONITORING SYSTEMS IN PATIENT CARE AREAS THAT WILL ENABLE OUR STAFF TO MONITOR AND IMPROVE PATIENT OUTCOMES. PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 TUITION LOAN ASSISTANCE 4 5848 PART I, LINE 2: GRANTS ARE MADE IN ACCORDANCE WITH HUGH CHATHAM MEMORIAL HOSPITAL'S MISSION STATEMENT TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. X 0 0 X X X X 0 0 0 0 0 1 0 0 0 DR SARBA KUNDU PHYSICIAN 590813 0 302833 0 360 0 39000 0 30251 0 963257 0 0 0 DR DOMINICK CARBONE PHYSICIAN 721814 0 66979 0 1032 0 39000 0 31251 0 860076 0 0 0 DR JOHNATHAN WHITAKER PHYSICIAN 470760 0 292055 0 216 0 39000 0 27051 0 829082 0 0 0 DR JONATHAN SNYDER PHYSICIAN 551440 0 188493 0 360 0 37310 0 26051 0 803654 0 0 0 DR MURUG SUBBIAH BOARD MEMBER 503135 0 170625 0 552 0 38973 0 30251 0 743536 0 0 0 PAUL HAMMES CEO 391810 0 90532 0 6028 0 39000 0 27974 0 555344 0 0 0 DR MARC STEVENS PHYSICIAN 86892 0 395860 0 552 0 19508 0 29551 0 532363 0 0 0 MARY BLACKBURN CNO 218934 0 42923 0 1156 0 32394 0 30901 0 326308 0 0 0 ANDREW TATE CPO & VP AMB SERVICES 214286 0 10474 0 183 0 9207 0 17907 0 252057 0 0 0 KENT THOMPSON CFO 210586 0 0 0 846 0 12600 0 12087 0 236119 0 0 0 PART I, LINE 1A THE HOSPITAL JOINED HIGH MEADOWS COUNTRY CLUB. THERE HAS BEEN NO CHANGE IN THE POLICY SINCE ITS INCEPTION IN 2018. IT IS USED FOR BUSINESS PURPOSES ONLY. PART I, LINE 6 THE PHYSICIANS IN CHARGE OF THE UROLOGY PRACTICE, GASTROENTEROLOGY PRACTICE, AND DERMATOLOGY CLINIC ARE ELIGIBLE TO RECEIVE A PORTION OF THE NET PROFIT FROM THEIR PRACTICE. ANY PROFITS RESULTING FROM PHYSICIANS' PROFESSIONAL SERVICES AFTER ALL THE PRACTICE AND PHYSICIAN EXPENSES, SHALL BE SHARED. THE PHYSICIANS RECEIVE UP TO AN 85% ALLOCATION WITH THE REMAINDER GOING TO THE EMPLOYER. THE HOSPITALIST BONUS IS BASED ON PERFORMANCE GOALS AND MAY BE UP TO AS MUCH AS 20% OF THEIR SALARY. ANOTHER PHYSICIAN IN CHARGE OF THE HOSPITALIST GROUP IS ELIGIBLE TO RECEIVE UP TO 20% OF THEIR BASE SALARY DEPENDING ON PERFORMANCE MEASURES OF THE HOSPITALIST GROUP. AMOUNTS PAID OUT TO INDIVIDUALS LISTED ON PART VII OF THE FORM 990 FOR 2021 WERE: $66,979 DOMINICK CARBONE, MD $188,493 JONATHAN SNYDER, MD $302,833 SARBA KUNDU, MD $292,055 JONATHAN WHITAKER, DO $395,860 MARC STEVENS, MD A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DAF8 2008-09-24 45455000 NEW STRUCTURES, EQUIPMENT 1 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 2015-12-16 25495000 REFUNDING REVENUE BONDS 0 0 0 A 8940000 42235000 46276755 3493414 435743 513249 42448072 2010 0 0 1 1 B 11760000 25214951 280049 25214951 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 1 1 1 WELLS FARGO 30.000000000000 1 0 0 0 0 B 0 0 0 1 1 0 0 0 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 08/28/2018 SCH K, PART II, LINE 11, COLUMN B THE OTHER SPENT PROCEEDS OF $25,214,951 WERE USED TO CURRENTLY REFUND PRIOR BONDS ISSUED. LAURA OAKES RELATED TO BOARD MEMBER BOB MIDKIFF 78786 COMPENSATED AS DIRECTOR OF MARKETING 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE IMMEDIATE PAST CHAIRMAN AND ONE (1) OR MORE ADDITIONAL MEMBERS WHO WILL BE NOMINATED BY THE CHAIRMAN FOR THE ELECTION BY THE BOARD OF TRUSTEES. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. THE EXECUTIVE COMMITTEE SHALL ALSO ANNUALLY REVIEW THE PERFORMANCE, COMPENSATION AND TERMS OF EMPLOYEMENT OF THE CHIEF EXECUTIVE OFFICER AND MAKE RECOMMENDATIONS TO THE BOARD CONCERNING COMPENSATION AND TERMS OF THE EMPLOYMENT OF THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH SUPERVISION AND ASSISTANCE BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DELIVERED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL. THE RETURN WAS THEN PRESENTED AT A SCHEDULED MEETING OF THE BOARD OF DIRECTORS BY A REPRESENTATIVE OF THE ACCOUNTING FIRM, AND EACH VOTING MEMBER OF THE BOARD WAS PROVIDED A COPY FOR DISCUSSION AND QUESTIONS. FOLLOWING THE MEETING AND A PERIOD OF TIME FOR COMMENT, THE RETURN WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL VOTING BOARD MEMBERS ARE PRESENTED WITH THE GOVERNANCE POLICIES CONCERNING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. UPON REVIEW AND DISCUSSION CONCERNING RELATIONSHIPS WITH THE ORGANIZATION, ITS AFFILIATES, OR AMONGST EACH OTHER, THE BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE POLICY STATEMENT TO THE ADMINISTRATION. THESE STATEMENTS ARE REVIEWED BY THE BOARD CHAIR AND ARE PRESENTED TO THE AUDITORS DURING THE ANNUAL AUDIT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD USES MERCER, WHO USES DATA TO BENCHMARK HUGH CHATHAM'S COMPENSATION AGAINST SIMILAR ORGANIZATIONS. THE SALARIES OF THE TOP EXECUTIVES AND OTHER MEMBERS OF THE ADMINISTRATIVE DEPARTMENT ARE DETERMINED IN THE CONTRACT NEGOTIATIONS. A REVIEW OF ALL SALARIES, TOP TO BOTTOM, WAS ULTIMATELY APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 7,193,630. MANAGEMENT AND GENERAL EXPENSES 1,880,910. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,074,540. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 7,013,105. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,013,105. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 4,379,216. MANAGEMENT AND GENERAL EXPENSES 653. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,379,869. CENTRALIZED BILLING: PROGRAM SERVICE EXPENSES 1,431,347. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,431,347. OTHER FEES: PROGRAM SERVICE EXPENSES 318,806. MANAGEMENT AND GENERAL EXPENSES 491,601. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 810,407. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SWAP AGREEMENT 5,647,413. LOSS ON IMPAIRMENT OF GOODWILL -48,255. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC 180 PARKWOOD DRIVE ELKIN NC 28621 562049537 FUNDRAISING NC 501(C)(3) LINE 12A, I HUGH CHATHAM MEMORIAL HOSPITAL 1 HUGH CHATHAM MEMORIAL HOSPITAL AUXILIARY 180 PARKWOOD DRIVE ELKIN NC 28621 561199949 THRIFT/GIFT SHOP NC 501(C)(3) LINE 12A, I HUGH CHATHAM MEMORIAL HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0