2023-11-14T16:12:14-06:00 2022-12-31 346565596 ERNST & YOUNG US LLP 55 IVAN ALLEN JR BLVD SUITE 1000 ATLANTA GA 30308 990 2022-01-01 560928089 FORSYTH MEMORIAL HOSPITAL INC FORS 3362772411 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 GEOFFREY GARDNER CFO 3362772411 2023-11-14 1 GEOFFREY GARDNER 999009999 0 AERRIAL M ORR P01598400 4048748300 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z NOVANT HEALTH FORSYTH MEDICAL CENTER CARL ARMATO 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 1378214906 0 X WWW.NOVANTHEALTH.ORG X 1968 NC SEE SCHEDULE O 15 12 7944 256 0 0 14032668 22273285 1647610868 1347574893 598751 945729 5947312 7070517 1668189599 1377864424 1862571 2104271 0 0 599289975 590311344 0 0 0 926406949 817030092 1527559495 1409445707 140630104 -31581283 2202894341 2102000445 260706800 196380928 1942187541 1905619517 X SEE SCHEDULE O 0 0 1129907265 2104271 1348438890 FORSYTH MEMORIAL HOSPITAL, INC. (FMH), KERNERSVILLE MEDICAL CENTER (KMC), AND CLEMMONS MEDICAL CENTER (CMC) CARRY OUT THE PURPOSE OF THE FORSYTH COUNTY BOARD OF COMMISSIONERS BY ADVANCING AND SUPPORTING THE PROMOTION OF THE HEALTH OF THE INHABITANTS OF FORSYTH COUNTY AND THE KERNERSVILLE AREA OF NC. FMH, KMC, AND CMC MAINTAIN AN OPEN DOOR POLICY, ACCEPTING ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. FMH HAS 859 LICENSED BEDS. DURING 2022 THERE WERE 204,175 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 7 DAYS, AN AVERAGE DAILY CENSUS OF 559, AND 30,702 DISCHARGES. THERE WERE 19,446 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 1,025,145 OUTPATIENT ENCOUNTERS AND 74,155 EMERGENCY DEPARTMENT VISITS. (CONTINUED ON SCHEDULE O) 1129907265 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 0 0 7944 1 0 0 0 0 0 0 0 0 0 0 1 0 X 15 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 NC X X WENDI STOCKSTILL 3362772411 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X ASHLEY PERROTT MD TRUSTEE/SENIOR PHYSICIAN EXECUTIVE 45.20 0.00 X 526679 0 39903 FRANKLIN CHEN MD TRUSTEE/CLINICAL PHYSICIAN EXECUTIVE 45.20 0.00 X 652755 0 53370 SAMUEL BAREFOOT TRUSTEE 0.20 0.00 X 0 0 0 LARI HARDING CHAIR 0.20 0.20 X X 0 0 0 CHARLES HAUSER TRUSTEE 0.20 0.00 X 0 0 0 MIKE HORN TRUSTEE 0.20 0.00 X 0 0 0 ROBERT LANDRY TRUSTEE 0.20 0.00 X 0 0 0 LINDA LATHAM VICE CHAIR 0.20 0.00 X X 0 0 0 CHRISTOPHER LEON TRUSTEE 0.20 0.00 X 0 0 0 TRACEY MARTIN TRUSTEE 0.20 0.00 X 0 0 0 MARK OWENS TRUSTEE 0.20 0.00 X 0 0 0 CHARLES WELTON TRUSTEE 0.20 0.00 X 0 0 0 IMEN CLARK TRUSTEE 0.20 0.00 X 0 0 0 AVERY HALL SECRETARY/TREASURER 0.20 0.00 X X 0 0 0 WILLIAM HALL TRUSTEE 0.20 0.00 X 0 0 0 FRED HARGETT EVP & CFO 0.20 50.00 X 0 2355664 61852 MICHAEL SETLIFF PRESIDENT NHFMC & GWM 50.00 0.20 X 1024957 0 152593 ALISHA HUTCHENS COO 50.00 0.00 X 448808 0 51362 JOHN MANN PRES & COO 45.00 0.00 X 979412 0 160617 ROLAND FRIEDMAN UROLOGIST 45.00 0.00 X 973165 0 56134 KATHLEEN ELLIOTT ONCOLOGIST 45.00 0.00 X 833763 0 56134 STANLEY FULLER SVP CHIEF CLINICAL OFFICER 45.00 0.00 X 790038 0 142649 BRANDON CRAVEN UROLOGIST 45.00 0.00 X 734434 222051 55937 KIRSTEN ROYSTER FMR PRES & COO KMC (SEE SCHEDULE O) 50.00 0.00 X 689224 0 94124 7653235 2577715 924675 907 1 1 0 AYA HEALTHCARE INC PO BOX 123519 DALLAS TX 75312 TRAVEL NURSING SERVICES 87941387 VANNOY CONSTRUCTION PO BOX 635 JEFFERSON NC 28640 CONSTRUCTION SERVICES 74617568 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 14841757 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD MANAGEMENT SERVICES 13846025 THE CHRISTMAN COMPANY 408 SOUTH ELM STREET GREENSBORO NC 27401 CONSTRUCTION SERVICES 12663251 107 2048073 19905140 320072 22273285 NET PATIENT REVENUE 622110 1314490849 1314490849 PHARMACY 622110 30417311 30417311 PASS-THRU PATIENT REVENUE 621111 2003354 2003354 VALUE BASED INCENTIVE 900099 663379 663379 1347574893 698686 698686 381622 0 381622 381622 381622 573332 326289 247043 247043 247043 40323 24193 16130 16130 CAFETERIA MEALS 722514 3568487 3568487 CHILD DEVELOPMENT CENTER 624410 1483819 1483819 PARKING 812930 341204 341204 1279255 863997 415258 6672765 1377864424 1348438890 0 7152249 1592121 1592121 512150 512150 2950427 2950427 1930450 1930450 465264504 446653922 18610582 17277250 16586161 691089 73121421 70196564 2924857 29767292 28576600 1190692 3878 3878 117151667 100953591 16198076 869873 845245 24628 4714966 3807943 907023 8710855 8509559 201296 29836230 28713134 1123096 839812 801864 37948 224005 215045 8960 11396899 11396899 32618864 29941743 2677121 7915314 7141941 773373 CORPORATE SUPPORT 217459832 217459832 MEDICAL SUPPLIES 156433331 156077986 355345 CONTRACT LABOR 104932198 100734910 4197288 PHARMACEUTICALS 89182609 89182609 34739759 27467278 7272481 1409445707 1129907265 279538442 0 72732 95308 521472775 216795688 12497356 11460024 28833696 30572456 2048318 974990 726900923 370283958 301145693 356616965 19465393 35543671 31015047 1559385 1286343331 1448381958 2202894341 2102000445 192893752 141893082 128664 67813048 54359182 260706800 196380928 X 1942187091 1905619067 450 450 1942187541 1905619517 2202894341 2102000445 X -31581283 -4986741 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 6704 0 1 65211 71915 0 PART II-B, LINE 1: LINE 1A THERE IS LIMITED ENGAGEMENT OF THE BOARD. LINE 1B THERE IS MINIMAL TIME OF SENIOR LEADERS. LINE 1G THERE IS LIMITED CONTACT MADE BY SENIOR LEADERS DURING LOBBYING ACTIVITIES. LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 450 450 450 450 450 450 363 87 450 363 363 0.00000 1.00000 0.00000 0 0 10727897 10727897 167571386 60804702 106766684 14688568 8302143 6386425 386789980 288431967 98358013 147123092 12745146 134377946 356616965 OTHER ASSETS 484564 DUE FROM AFFILIATE 1424170592 RIGHT OF USE ASSETS 23726802 1448381958 0 OTHER LIABILITIES 13959181 PATIENT REFUNDS 7334739 THIRD PARTY PAYMENT PAYABLE 7923301 OPERATING LEASE 25141961 54359182 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD FOR COMMUNITY ENGAGEMENT. PART X, LINE 2: PART X, LINE 2: LIABILITY UNDER FIN 48 (ASC 740) FOOTNOTE THE AUDIT FOR NOVANT HEALTH AND ITS AFFILIATES IS PREPARED ON A CONSOLIDATED BASIS. THE COMPANY IS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF OUR FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. 1 1 X 1 X 300.000000000000 0 0 1 0 1 1 49807945 49807945 0.03530 172629908 118228095 54401813 0.03860 2321912 1921220 400692 0.00030 224759765 120149315 104610450 0.07420 711385 77391 633994 0.00040 6980400 478920 6501480 0.00460 34927011 17140010 17787001 0.01260 1569704 1569704 0.00110 1160900 1160900 0.00080 45349400 17696321 27653079 0.01950 270109165 137845636 132263529 0.09370 60287 60287 0.00010 62000 62000 0.00010 2200 2200 0.00000 16000 16000 0.00000 11034 11034 0.00000 40000 40000 0.00000 161583 161583 0.00010 10000 10000 0.00000 363104 363104 0.00030 1 0 0 177605340 196769141 -19163801 X 1 0 4 1 FMH DBA NOVANT HEALTH FORSYTH MEDICAL CENTER 3333 SILAS CREEK PARKWAY WINSTONSALEM NC 27103 WWW.NOVANTHEALTH.ORG H0209 X X X A 2 FMH DBA NOVANT HEALTH KERNERSVILLE MED CENTER 1750 KERNERSVILLE MEDICAL PARKWAY KERNERSVILLE NC 27284 WWW.NOVANTHEALTH.ORG H0209 X X X A 3 FMH DBA NOVANT HEALTH CLEMMONS MEDICAL CENTER 6915 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 WWW.NOVANTHEALTH.ORG H0209 X X X A 4 NOVANT HEALTH REHABILITATION HOSPITAL 2475 HILLCREST CENTER CIRCLE WINSTONSALEM NC 27103 WWW.ENCOMPASSHEALTH.COM/LOCATIONS/NOVA H0291 X SPECIALTY - REHABILITATION B FORSYTH MEMORIAL HOSPITAL INC 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE SECTION C X 1 22 1 SEE SECTION C 0 1 X 300.000000000000 0.000000000000 X X X X 1 1 X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 NOVANT HEALTH REHABILITATION HOSPITAL 0 0 1 X X X X X X X X X 22 1 0 0 1 X SEE SECTION C X 1 22 1 SEE SECTION C 0 1 X 300.000000000000 0.000000000000 X X 1 1 X X X 1 X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X 1 X 0 X X X X 0 X X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: FMH DBA NOVANT HEALTH FORSYTH MEDICAL CENTER, - FACILITY 2: FMH DBA NOVANT HEALTH KERNERSVILLE MED CENTER, - FACILITY 3: FMH DBA NOVANT HEALTH CLEMMONS MEDICAL CENTER FORSYTH MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 3J: FORSYTH MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 3E:VARIOUS SOCIAL, BEHAVIORAL, AND CLINICAL HEALTH NEEDS WERE IDENTIFIED THROUGH PRIMARY AND SECONDARY DATA IN THE NEEDS ASSESSMENT. ONCE THE HEALTH NEEDS WERE IDENTIFIED, SURVEYS AND COMMUNITY MEETINGS WERE CONDUCTED IN WHICH THE VARIOUS COMMUNITY STAKEHOLDERS RANKED THE HEALTH ISSUES BASED ON AVAILABLE DATA INCLUDING SEVERITY OF NEED AND MAGNITUDE OF IMPACT. THE INFORMATION GATHERED WAS THEN MATRIXED AND SCORED IN ORDER TO RANK THE FOCUS AREAS AND PRIORITIZE THE IDENTIFIED HEALTH NEEDS, BASED ON CAREFUL CONSIDERATION OF ESTIMATED FEASIBILITY AND EFFECTIVENESS OF POSSIBLE INTERVENTIONS. THE PRIORITIZED IDENTIFIED HEALTH NEEDS AND SUPPORTING DATA ARE THEN REVIEWED AND DELIBERATED UPON FURTHER BY THE BOARD BEFORE FINAL APPROVAL. AN IMPLEMENTATION PLAN WAS CREATED FOR THE PRIORITIZED HEALTH NEEDS AND PROGRESS TOWARD MEETING IMPLEMENTATION PLAN GOALS IS ASSESSED REGULARLY THROUGHOUT THE COMMUNITY HEALTH NEEDS ASSESSMENT LIFE CYCLE. COMMUNITY PARTNERS WHO ARE CURRENTLY SERVING COMMUNITY NEEDS ARE IDENTIFIED AS POTENTIAL PARTNERS FOR COLLABORATION ON THOSE IDENTIFIED NEEDS THAT ARE NOT PART OF THE IMPLEMENTATION PLAN. FORSYTH MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY(IES) SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY MEMBERS AND REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, CHURCHES, COLLEGES/UNIVERSITIES, COMMUNITY COALITIONS AND OTHER SOCIAL SERVICE AGENCIES. INPUT WAS GATHERED THROUGH A COMMUNITY SURVEY (DISTRIBUTED THROUGH A VARIETY OF PARTNERS, METHODS AND CHANNELS), COMMUNITY MEETINGS AND/OR FOCUS GROUPS, STAKEHOLDER'S INTERVIEWS, AND SOLICITED THROUGH WRITTEN COMMENTS THROUGHOUT THE SURVEY PERIOD UNTIL THE FINAL COMMUNITY PRIORITY SETTING MEETING(S) AND/OR SURVEY. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. DATA DERIVED FROM THESE EXERCISES IS BOTH QUANTITATIVE AND QUALITATIVE IN SCOPE. FOR MORE DETAILED INFORMATION, INCLUDING RELEVANT DATES FOR SOLICITING CHNA DATA AND FEEDBACK, REFER TO THE PUBLICLY AVAILABLE CHNA AND IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE, VIA THE URL PROVIDED FOR THE POSTING OF THE PLAN. FORSYTH MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 7D: FORSYTH MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 7BHTTPS://WWW.NOVANTHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS/FORSYTH MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 10AHTTPS://WWW.NOVANTHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS/ FORSYTH MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE HOSPITAL FACILITY(IES) IS/ARE A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE CHNA RESOURCE GROUP AND SUBSEQUENTLY BY EACH FACILITY'S BOARD. THEY EVALUATED EACH DOCUMENTED NEED AND ITS INTERSECTION WITH THE ORGANIZATION'S VISION, COMMITMENTS, KEY STRENGTHS AND AVAILABLE RESOURCES BEFORE FURTHER PRIORITIZING THE HEALTH NEEDS AND AGREEING UPON THE TOP HEALTH PRIORITIES TO BE ADDRESSED. WHERE POSSIBLE, WE HAVE LEVERAGED THE SYSTEM'S STRENGTHS AND RESOURCES TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY BASED ON SCOPE, SEVERITY, HEALTH DISPARITIES ASSOCIATED WITH THE NEED, AND THE ESTIMATED FEASIBILITY AND EFFECTIVENESS OF POSSIBLE INTERVENTIONS. NOVANT HEALTH AND EACH OF ITS HOSPITAL FACILITIES HAVE ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZED COMMUNITY HEALTH NEEDS FROM THE CHNAS. THE IMPLEMENTATION STRATEGIES OUTLINE THE PLAN THAT THE HOSPITAL FACILITY(IES) WILL UNDERTAKE TO MEET THOSE HEALTH NEEDS IN EACH OF ITS COMMUNITIES. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. CERTAIN OF THE NEEDS NOT ADDRESSED FALL OUTSIDE OF THE SCOPE OF TRADITIONAL HEALTHCARE (I.E. DENTAL WORK, VIOLENCE PREVENTION) AND OTHERS ARE CANDIDATES FOR COLLABORATIVE WORK AND HAVE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND EXPERTISE. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE CHNA AND IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE, VIA THE URL PROVIDED FOR THE POSTING OF THE PLAN. FORSYTH MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 13H: OTHER ELIGIBILITY CRITERIA EXPLAINED IN THE FAP INCLUDE THE FOLLOWING: FREE CARE IS ONLY APPLICABLE TO MEDICALLY NECESSARY SERVICES; PROVIDER BASED PHYSICIAN CLINICS REQUIRE THAT PATIENTS MUST HAVE BEEN TREATED BY AN AFFILIATED MEDICAL GROUP PRIMARY CARE PHYSICIAN WITHIN THE PREVIOUS THREE YEARS; PATIENTS MUST BE UNABLE TO ACCESS ENTITLEMENT PROGRAMS; PATIENTS WITH SPECIAL CIRCUMSTANCES SUCH AS BANKRUPTCY MAY ALSO BE ELIGIBLE FOR CHARITY CARE. SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP APART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.NOVANTHEALTH.ORG/FOR-PATIENTS/BILLING--INSURANCE/FINANCIAL-ASSISTANCE/SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP APART V, LINE 16B, FAP APPLICATION:HTTPS://WWW.NOVANTHEALTH.ORG/GLOBALASSETS/BUTTONS-AND-DOCUMENTS-CTASLINKS/DOCUMENTS-PDFS/FAA_APP_ENGLISH.PDFSCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP APART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:HTTPS://WWW.NOVANTHEALTH.ORG/GLOBALASSETS/BUTTONS-AND-DOCUMENTS-CTASLINKS/DOCUMENTS-PDFS/NOVANT-HEALTH-ACUTE-PLS-ENGLISH.PDF PART V, SECTION B FACILITY REPORTING GROUP B FACILITY REPORTING GROUP B CONSISTS OF: - FACILITY 4: NOVANT HEALTH REHABILITATION HOSPITAL NOVANT HEALTH REHABILITATION HOSPITAL PART V, SECTION B, LINE 3J: NOVANT HEALTH REHABILITATION HOSPITALPART V, SECTION B, LINE 3E:VARIOUS SOCIAL, BEHAVIORAL, AND CLINICAL HEALTH NEEDS WERE IDENTIFIED THROUGH PRIMARY AND SECONDARY DATA IN THE NEEDS ASSESSMENT. ONCE THE HEALTH NEEDS WERE IDENTIFIED, SURVEYS AND COMMUNITY MEETINGS WERE CONDUCTED IN WHICH THE VARIOUS COMMUNITY STAKEHOLDERS RANKED THE HEALTH ISSUES BASED ON AVAILABLE DATA INCLUDING SEVERITY OF NEED AND MAGNITUDE OF IMPACT. THE INFORMATION GATHERED WAS THEN MATRIXED AND SCORED IN ORDER TO RANK THE FOCUS AREAS AND PRIORITIZE THE IDENTIFIED HEALTH NEEDS, BASED ON CAREFUL CONSIDERATION OF ESTIMATED FEASIBILITY AND EFFECTIVENESS OF POSSIBLE INTERVENTIONS. THE PRIORITIZED IDENTIFIED HEALTH NEEDS AND SUPPORTING DATA ARE THEN REVIEWED AND DELIBERATED UPON FURTHER BY THE BOARD BEFORE FINAL APPROVAL. AN IMPLEMENTATION PLAN WAS CREATED FOR THE PRIORITIZED HEALTH NEEDS AND PROGRESS TOWARD MEETING IMPLEMENTATION PLAN GOALS IS ASSESSED REGULARLY THROUGHOUT THE COMMUNITY HEALTH NEEDS ASSESSMENT LIFE CYCLE. COMMUNITY PARTNERS WHO ARE CURRENTLY SERVING COMMUNITY NEEDS ARE IDENTIFIED AS POTENTIAL PARTNERS FOR COLLABORATION ON THOSE IDENTIFIED NEEDS THAT ARE NOT PART OF THE IMPLEMENTATION PLAN. NOVANT HEALTH REHABILITATION HOSPITAL PART V, SECTION B, LINE 5: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY(IES) SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY MEMBERS AND REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, CHURCHES, COLLEGES/UNIVERSITIES, COMMUNITY COALITIONS AND OTHER SOCIAL SERVICE AGENCIES. INPUT WAS GATHERED THROUGH A COMMUNITY SURVEY (DISTRIBUTED THROUGH A VARIETY OF PARTNERS, METHODS AND CHANNELS), COMMUNITY MEETINGS AND/OR FOCUS GROUPS, STAKEHOLDER'S INTERVIEWS, AND SOLICITED THROUGH WRITTEN COMMENTS THROUGHOUT THE SURVEY PERIOD UNTIL THE FINAL COMMUNITY PRIORITY SETTING MEETING(S) AND/OR SURVEY. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. DATA DERIVED FROM THESE EXERCISES IS BOTH QUANTITATIVE AND QUALITATIVE IN SCOPE. FOR MORE DETAILED INFORMATION, INCLUDING RELEVANT DATES FOR SOLICITING CHNA DATA AND FEEDBACK, REFER TO THE PUBLICLY AVAILABLE CHNA AND IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE, VIA THE URL PROVIDED FOR THE POSTING OF THE PLAN. NOVANT HEALTH REHABILITATION HOSPITAL PART V, SECTION B, LINE 7D: NOVANT HEALTH REHABILITATION HOSPITALPART V, SECTION B, LINE 7BHTTPS://ENCOMPASSHEALTH.COM/LOCATIONS/NOVANTHEALTHREHABNOVANT HEALTH REHABILITATION HOSPITALPART V, SECTION B, LINE 10AHTTPS://ENCOMPASSHEALTH.COM/LOCATIONS/NOVANTHEALTHREHAB NOVANT HEALTH REHABILITATION HOSPITAL PART V, SECTION B, LINE 11: THE FORSYTH MEMORIAL HOSPITAL, INC. INCLUDES THE OPERATIONS OF TWO LICENSED HOSPITALS; ONE WITH FACILITIES IN THREE LOCATIONS: FORSYTH MEMORIAL HOSPITAL, INC. DOING BUSINESS AS NOVANT HEALTH FORSYTH MEDICAL CENTER, AS NOVANT HEALTH KERNERSVILLE MEDICAL CENTER, AND AS NOVANT HEALTH CLEMMONS MEDICAL CENTER; AND NOVANT HEALTH REHABILITATION HOSPITAL, A LICENSED HOSPITAL OPERATED THROUGH A JOINT VENTURE. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE CHNA RESOURCE GROUP AND SUBSEQUENTLY BY EACH FACILITY'S BOARD. THEY EVALUATED EACH DOCUMENTED NEED AND ITS INTERSECTION WITH THE ORGANIZATION'S VISION, COMMITMENTS, KEY STRENGTHS AND AVAILABLE RESOURCES BEFORE FURTHER PRIORITIZING THE HEALTH NEEDS AND AGREEING UPON THE TOP HEALTH PRIORITIES TO BE ADDRESSED. WHERE POSSIBLE, WE HAVE LEVERAGED THE SYSTEM'S STRENGTHS AND RESOURCES TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY BASED ON SCOPE, SEVERITY, HEALTH DISPARITIES ASSOCIATED WITH THE NEED, AND THE ESTIMATED FEASIBILITY AND EFFECTIVENESS OF POSSIBLE INTERVENTIONS. NOVANT HEALTH AND EACH OF ITS HOSPITAL FACILITIES HAVE ADOPTED AND EXECUTED AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE PRIORITIZED COMMUNITY HEALTH NEEDS FROM THE CHNAS. THE IMPLEMENTATION STRATEGIES OUTLINE THE PLAN THAT THE HOSPITAL FACILITY(IES) WILL UNDERTAKE TO MEET THOSE HEALTH NEEDS IN EACH OF ITS COMMUNITIES. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. CERTAIN OF THE NEEDS NOT ADDRESSED FALL OUTSIDE OF THE SCOPE OF TRADITIONAL HEALTHCARE (I.E. DENTAL WORK, VIOLENCE PREVENTION) AND OTHERS ARE CANDIDATES FOR COLLABORATIVE WORK AND HAVE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND EXPERTISE. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE CHNA AND IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE, VIA THE URL PROVIDED FOR THE POSTING OF THE PLAN. NOVANT HEALTH REHABILITATION HOSPITAL PART V, SECTION B, LINE 13H: NOVANT HEALTH REHABILITATION HOSPITALSCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP BPART V, LINE 16A, FAP WEBSITE:HTTPS://ENCOMPASSHEALTH.COM/LOCATIONS/NOVANTHEALTHREHAB/FINANCIAL-ASSISTANCESCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP BPART V, LINE 16B, FAP APPLICATION:HTTPS://ENCOMPASSHEALTH.COM/-/MEDIA/HEALTHSOUTH/PROJECT/HEALTHSOUTH/FILES/FINANCIAL-ASSISTANCE/INSTRUCTIONS_APPLICATIONS/NOVANT-INSTRUCTIONS-AND-APPLICATION.PDFSCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP BPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:HTTPS://ENCOMPASSHEALTH.COM/-/MEDIA/HEALTHSOUTH/PROJECT/HEALTHSOUTH/FILES/FINANCIAL-ASSISTANCE/PLAIN_LANGUAGE/NOVANT-PLAIN-LANGUAGE-SUMMARY.PDF?LA=EN&HASH=AD3A4F1C74510B86183F143C1D5087B438C5F627 NOVANT HEALTH REHABILITATION HOSPITAL PART V, SECTION B, LINE 21D: NOVANT HEALTH REHABILITATION HOSPITAL DOES NOT HAVE A DEDICATED EMERGENCY DEPARTMENT. THE HOSPITAL WILL APPRAISE EMERGENCIES, PROVIDE INITIAL TREATMENT, AND REFER OR TRANSFER AN INDIVIDUAL TO ANOTHER HOSPITAL/FACILITY, WHEN APPROPRIATE, WITHOUT DISCRIMINATION AND WITHOUT REGARD TO WHETHER THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE.NOVANT HEALTH REHABILITATION HOSPITAL WILL NOT ENGAGE IN ACTIONS THAT DISCOURAGE INDIVIDUALS FROM SEEKING EMERGENCY MEDICAL CARE, SUCH AS DEMANDING THAT AN INDIVIDUAL PAY BEFORE RECEIVING INITIAL TREATMENT FOR EMERGENCY MEDICAL CONDITIONS OR PERMITTING DEBT COLLECTION ACTIVITIES THAT INTERFERE WITH HOSPITAL'S APPRAISAL AND PROVISION, WITHOUT DISCRIMINATION, OF SUCH INITIAL TREATMENT. 51 1 - NH ARCADIA FAMILY MEDICINE 12208 NC HWY 150 NORTH WINSTONSALEM NC 27127 PHYSICIAN CLINIC 2 - NH BREAST CENTER WINSTON-SALEM 2025 FRONTIS PLAZA BLVD SUITE 123 WINSTONSALEM NC 27103 IMAGING CENTER 3 - NH CANCER INSTITUTE - KERNERSVILLE 1710 KERNERSVILLE MEDICAL PKWY STE 116 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 4 - NH CANCER INSTITUTE - MOUNT AIRY 1908 CAUDLE DR SUITE 200 MOUNT AIRY NC 27030 PHYSICIAN CLINIC 5 - NH CANCER INSTITUTE - STATESVILLE 276 OLD MOCKSVILLE ROAD SUITE 800 STATESVILLE NC 28625 PHYSICIAN CLINIC 6 - NH CANCER INSTITUTE - THOMASVILLE 1213 LEXINGTON AVENUE STE B LEXINGTON NC 27360 PHYSICIAN CLINIC 7 - NH CARDIOLOGY - CLEMMONS 7114 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 PHYSICIAN CLINIC 8 - NH CARDIOLOGY - KERNERSVILLE 1710 KERNERSVILLE MEDICAL PKWY SUITE 205 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 9 - NH CARDIOLOGY - KIMEL PARK ANNEX 185 KIMEL PARK DR WINSTONSALEM NC 27103 PHYSICIAN CLINIC 10 - NH CARDIOLOGY - KIMEL PARK MAIN 186 KIMEL PARK DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 11 - NH CARDIOLOGY - MOUNT AIRY 694 RIVERSIDE DR MOUNT AIRY NC 27030 PHYSICIAN CLINIC 12 - NH CHAIR CITY FAMILY MEDICINE 903 RANDOLPH ST THOMASVILLE NC 27360 PHYSICIAN CLINIC 13 - NH CLEMMONS OUTPATIENT SURGERY 7210 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 AMBULATORY SURGERY CENTER 14 - NH DAVIE MEDICAL ASSOCIATES 485 VALLEY ROAD MOCKSVILLE NC 27028 PHYSICIAN CLINIC 15 - NH FORSYTH ENDOCRINE CONSULTANTS 755 HIGHLAND OAKS DRIVE SUITE 201 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 16 - NH FORSYTH FAMILY MEDICINE 400 JONESTOWN ROAD WINSTONSALEM NC 27104 PHYSICIAN CLINIC 17 - NH FORSYTH HEART AND WELLNESS 725 HIGHLAND OAKS DRIVE SUITE 200 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 18 - NH FORSYTH INTERNAL MEDICINE 1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 19 - NH FORSYTH MEDICAL CENTER AUDIOLOGY 3155 MAPLEWOOD AVE WINSTON SALEM NC 27103 PHYSICIAN CLINIC 20 - NH HAWTHORNE OUTPATIENT SURGERY CENTER 1999 S HAWTHORNE ROAD WINSTONSALEM NC 27103 AMBULATORY SURGERY CENTER 21 - NH IMAGING KERNERSVILLE 445 PINEVIEW DRIVE SUITE 100 KERNERSVILLE NC 27284 IMAGING CENTER 22 - NH IMAGING MAPLEWOOD 3155 MAPLEWOOD AVENUE WINSTONSALEM NC 27103 IMAGING CENTER 23 - NH INFECTIOUS DISEASE SPECIALISTS 1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 24 - NH KERNERSVILLE FAMILY MEDICINE 291 BROAD STREET WINSTONSALEM NC 27284 PHYSICIAN CLINIC 25 - NH KERNERSVILLE MEDICAL CENTER 1750 KERNERSVILLE MEDICAL PKWY KERNERSVILLE NC 27284 PHYSICIAN CLINIC 26 - NH KERNERSVILLE OUTPATIENT SURGERY 1730 KERNERSVILLE MEDICAL PKWY STE 304 KERNERSVILLE NC 27284 AMBULATORY SURGERY CENTER 27 - NH LEWISVILLE FAMILY MEDICINE 1225 LEWISVILLE-CLEMMONS ROAD LEWISVILLE NC 27023 PHYSICIAN CLINIC 28 - NH LEXINGTON PRIMARY CARE 110 WEST MEDICAL PARK DRIVE LEXINGTON NC 27292 PHYSICIAN CLINIC 29 - NH MAPLEWOOD FAMILY MEDICINE ROBINHOOD MEDICAL PLAZA BLDG 100 WINSTONSALEM NC 27106 PHYSICIAN CLINIC 30 - NH MOUNTAINVIEW MEDICAL 216 MOORE ROAD KING NC 27021 PHYSICIAN CLINIC 31 - NH NORTH POINT MEDICAL ASSOCIATES 1995 BETHABARA ROAD WINSTONSALEM NC 27106 PHYSICIAN CLINIC 32 - NH PFAFFTOWN FAMILY MEDICINE 4611 YADKINVILLE ROAD PFAFFTOWN NC 27040 PHYSICIAN CLINIC 33 - NH PILOT MOUNTAIN MEDICAL CARE 207 MEDICAL STREET PILOT MOUNTAIN NC 27041 PHYSICIAN CLINIC 34 - NH PREMIER MEDICAL ASSOCIATES 3333 BROOKVIEW HILLS BLVD STES 202-204 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 35 - NH PRIMARY CARE CLEMMONS 6301 STADIUM DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC 36 - NH PSYCHIATRIC MEDICINE - OUTPATIENT 175 KIMEL PARK DRIVE SUITE 100 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 37 - NH PSYCHIATRIC MEDICINE - THOMASVILLE 309 PINEYWOOD ROAD THOMASVILLE NC 27360 PHYSICIAN CLINIC 38 - NH RHEUMATOLOGY & ARTHRITIS - WESTBROOK 1551 WESTBROOK PLAZA DR SUITE 200 WINSTONSALEM NC 27106 PHYSICIAN CLINIC 39 - NH SALEM FAMILY MEDICINE 105 VEST MILL CIRCLE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 40 - NH SURRY MEDICAL ASSOCIATES - WESTLAKE 865 WESTLAKE DRIVE MOUNT AIRY NC 27030 PHYSICIAN CLINIC 41 - NH THOMASVILLE MEDICAL ASSOCIATES 309 PINEYWOOD ROAD THOMASVILLE NC 27360 PHYSICIAN CLINIC 42 - NH TRIAD ENDOCRINE - KERNERSVILLE 500 PINEVIEW DR SUITE 101 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 43 - NH UROLOGY 1730 KERNERSVILLE MEDICAL PKWY STE 303 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 44 - NH UROLOGY - BALDWIN 2010 BALDWIN LANE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 45 - NH UROLOGY - KIMEL PARK 140 KIMEL PARK DR SUITE 100 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 46 - NH WEST FORSYTH INTERNAL MEDICINE 105 STADIUM OAKS DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC 47 - NH WINSTON-SALEM HEALTH CARE - DERMATOLOGY 175 KIMEL PARK DRIVE SUITE 250 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 48 - NH WOUND CARE - KERNERSVILLE 1710 KERNERSVILLE MEDICAL PKWY SUITE 220 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 49 - NH WOUND CARE & HYPERBARIC MEDICINE 1901 S HAWTHORNE ROAD SUITE 220 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 50 - NH YADKIN MEDICAL ASSOCIATES 305 EAST LEE AVENUE YADKINVILLE NC 27055 PHYSICIAN CLINIC 51 - WINSTON SALEM HEALTH CARE 250 CHARLOIS BLVD WINSTONSALEM NC 27103 PHYSICIAN CLINIC PART I, LINE 3C: OTHER CRITERIA BESIDES INCOME AND FPG USED IN DETERMINING ELIGIBILITY FOR FREE CARE INCLUDE: (1) RESIDENCY - PATIENTS MUST RESIDE WITHIN THE SERVICE AREA OF THE HOSPITAL; (2) THE KIND OF SERVICE PROVIDED - ONLY MEDICALLY NECESSARY SERVICES ARE COVERED; (3) PATIENT STATUS - IN PROVIDER BASED PHYSICIAN CLINICS, PATIENTS MUST HAVE BEEN TREATED BY AN AFFILIATED MEDICAL GROUP PRIMARY CARE PHYSICIAN WITHIN THE PREVIOUS THREE YEARS; AND (4) ACCESS TO HEALTH CARE COVERAGE - PATIENTS MUST BE UNABLE TO ACCESS EMPLOYER SPONSORED HEALTH PLANS OR ENTITLEMENT PROGRAMS. LASTLY, THE PATIENT MUST BE WITHOUT SUBSTANTIAL LIQUID ASSETS (I.E. CASH-ON-HAND). ASSETS SUCH AS HOUSES, CARS, PENALIZED RETIREMENT SAVINGS FUNDS, ETC. ARE NOT CONSIDERED LIQUID ASSETS. SUBSTANTIAL ASSETS ARE DEFINED AS ENOUGH CASH-ON-HAND TO COVER THE MEDICAL EXPENSES WITHOUT PLACING A HARDSHIP ON THE PATIENT. PATIENTS WITH SPECIAL CIRCUMSTANCES SUCH AS BANKRUPTCY MAY ALSO BE ELIGIBLE FOR CHARITY CARE; DETERMINATION IS MADE ON A CASE BY CASE BASIS UNDER THESE CIRCUMSTANCES. PART I, LINE 6A: PART I, LINE 6A:THE ORGANIZATION IS A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. THE COMMUNITY BENEFIT REPORT, REFERRED TO AS A COMMUNITY IMPACT REPORT, IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. IS THE PARENT COMPANY AND PRODUCES A COMMUNITY BENEFIT REPORT REPRESENTING THE HEALTH SYSTEM AS A WHOLE. THE REPORT CAN BE FOUND AT HTTPS://WWW.NOVANTHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS/. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HEALTHCARE ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. PART I, LINE 7: COSTS REPORTED IN THE TABLE FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (CCR). PART I, LN 7 COL(F): PART I, LN 7 COL(F):THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $0. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESS THE UNDERLYING CAUSES OF HEALTH PROBLEMS AND IMPACT THE HEALTH OF OUR COMMUNITY THROUGH PARTNERSHIPS WITH LOCAL AGENCIES DEDICATED TO IMPROVING THE LIVES OF ALL INDIVIDUALS. WE PROVIDE FINANCIAL SUPPORT AND OTHER RESOURCES TO ORGANIZATIONS SUCH AS LOCAL YMCA'S, UNITED WAY PARTNER AGENCIES, CHAMBERS OF COMMERCE AND OTHER LOCAL COMMUNITY ORGANIZATIONS, ASSISTING WITH COMMUNITY AND COUNTY COALITIONS, AND PROVIDING EDUCATION SEMINARS AND TRAINING FOR COMMUNITY WORKFORCES. THROUGH THESE PARTNERSHIPS AND OUTREACH METHODS WE ARE ABLE TO SUCCESSFULLY BRIDGE THE GAP OF NEED FOR RESOURCES BEYOND TRADITIONAL HEALTHCARE SERVICES WITHIN THE COMMUNITIES WE SERVE. PART III, LINE 2: IMPLICIT PRICE CONCESSIONS (FORMERLY LABELED BAD DEBT EXPENSE) ARE DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF CONTRACTUAL AGREEMENTS, DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. PART III, LINE 4: THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS (FORMERLY LABELED BAD DEBT EXPENSE, AT COST) ON LINE 2 IS CALCULATED USING THE SAME METHODOLOGY AS CHARITY CARE AND OTHER COMMUNITY BENEFITS USING AN ENTITY SPECIFIC COST TO CHARGE RATIO (CCR). FOOTNOTE 2 (ACCOUNTS RECEIVABLE) ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS DESCRIBES PRICE CONCESSIONS. PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A COST TO CHARGE RATIO ("CCR") IS DEVELOPED FOR EACH COST CENTER. THE CCR IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED. IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED. EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS; OTHERS PROVIDE SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION ON THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY DOES EXPLAIN ACTIONS AGAINST PATIENTS WHO HAVE OUTSTANDING DELINQUENT AMOUNTS, BUT THE POLICY DOES NOT CONTAIN PROVISIONS FOR COLLECTION PRACTICES AGAINST PATIENTS WHO ARE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) BECAUSE FAP ELIGIBLE PATIENTS RECEIVE 100% FREE CARE AND THEREFORE DO NOT RECEIVE BILLS ONCE FAP ELIGIBILITY HAS BEEN ESTABLISHED. PART VI, LINE 2: PART VI, LINE 2: NEEDS ASSESSMENTTHE ORGANIZATION IS PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM, WHICH HAS A COMMUNITY ENGAGEMENT DEPARTMENT THAT FACILITATES COMMUNITY BENEFIT ACROSS THE SYSTEM. THE COMMUNITY ENGAGEMENT DEPARTMENT IS RESPONSIBLE FOR COORDINATING THE PREPARATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) FOR EACH HOSPITAL WITHIN THE SYSTEM, INCLUDING THE CHNAS REPORTED IN PART V, SECTION B. EACH HOSPITAL AND THE COMMUNITY ENGAGEMENT DEPARTMENT WORK TOGETHER TO IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY THAT CONTRIBUTE TO THE PROCESS. THESE ORGANIZATIONS AND RESOURCES INCLUDE PUBLIC HEALTH DEPARTMENTS, LOCAL COMMUNITY COALITIONS AND CLINICS REPRESENTING THE MEDICALLY UNDERSERVED, UNITED WAY, YMCAS, LOCAL UNIVERSITIES, ETC. COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY ARE USED IN COMBINATION WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO PREPARE THE HOSPITAL'S CHNA. THROUGH DATA AND COMMUNITY PARTNERSHIPS, WE ARE ABLE TO ASSESS UNMET NEEDS AND WORK TO DIRECTLY SUPPORT OUR COMMUNITIES AND OUR PARTNERS IN ADDRESSING THOSE NEEDS. ORGANIZATIONAL PARTNERSHIPS ESTABLISHED BY THE COMMUNITY ENGAGEMENT DEPARTMENT ARE OFTEN LEVERAGED TO ADDRESS NEEDS THAT WERE IDENTIFIED IN THE CHNA, BUT WERE NOT PRIORITIZED BY THE FACILITY IMPLEMENTATION PLAN. IN ADDITION TO ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA, EACH HOSPITAL MAY RESPOND TO REQUESTS FOR SPECIFIC COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS. PART VI, LINE 3: PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE ORGANIZATION IS COMMITTED TO PROVIDING OUTSTANDING HEALTHCARE TO ALL MEMBERS OF OUR COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. OUR FINANCIAL COUNSELING TEAMS ARE CONSTANTLY WORKING WITH THE PATIENTS WITHIN OUR COMMUNITIES TO UNDERSTAND THEIR NEEDS AND ENSURE THAT OUR POLICIES AND PROCESSES ADDRESS THESE NEEDS. WE ALSO MAINTAIN CONTRACTS WITH MEDICAID ELIGIBILITY VENDORS AND THESE TEAMS OFFER ADDITIONAL SUPPORT IN PROCESSING AND ASSESSING HOW WE SERVE THE FINANCIAL NEEDS OF OUR PATIENTS. BASED ON THE ASSESSMENTS OF OUR COMMUNITIES, THE ORGANIZATION HAS DEVELOPED FINANCIAL ASSISTANCE POLICIES AND PROGRAMS THAT ADDRESS THE FINANCIAL NEEDS OF OUR PATIENTS. WE PRIDE OURSELVES ON THE TRANSPARENCY OF OUR PROGRAMS AND THE EDUCATION WE OFFER OUR PATIENTS AROUND OUR FINANCIAL ASSISTANCE POLICIES. OUR PROGRAMS ARE DOCUMENTED ON OUR WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE ORGANIZATION'S FACILITIES AND PHYSICIAN OFFICES. OUR PATIENT ACCESS SPECIALISTS, FINANCIAL COUNSELORS AND BUSINESS OFFICE TEAMS WORK WITH ALL ELIGIBLE PATIENTS TO EDUCATE THEM ON THE VARIOUS OPTIONS AVAILABLE VIA OUR FINANCIAL ASSISTANCE PROGRAMS OR GOVERNMENT SPONSORED CARE. THEY ALSO REFERENCE OUR FINANCIAL ASSISTANCE POLICY IN ALL CONVERSATIONS RELATED TO PATIENTS BILLS. FINALLY, WE WORK WITH LOCAL AREA FREE HEALTH CLINICS AND OTHER CHARITABLE ORGANIZATIONS TO PROVIDE CONTINUATION OF CARE FOR THEIR PATIENTS. IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED ON THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED FPG FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. NOVANT HEALTH REHABILITATION HOSPITAL HAS ADDITIONAL CRITERIA; PATIENTS ARE PRESUMED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, WITHOUT COMPLETING AN APPLICATION, IN THE FOLLOWING CIRCUMSTANCES:1. HOMELESSNESS 2. DECEASED WITH NO ESTATE 3. MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF 4. RECENT MEDICAID COVERAGE, I.E. COVERAGE WITHIN THREE (3) MONTHS OF ADMISSION OR DISCHARGE. OUR POLICIES ARE CONSIDERED FLUID AND ARE UPDATED FREQUENTLY BASED ON LOCAL AND NATIONAL MARKET STANDARDS AND NATIONAL ECONOMIC CONDITIONS. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE ORGANIZATION'S BOARD. PART VI, LINE 4: PART VI, LINE 4: COMMUNITY INFORMATIONTHE FORSYTH MEMORIAL HOSPITAL, INC. FORM 990 INCLUDES THE OPERATIONS OF TWO LICENSED HOSPITALS: NOVANT HEALTH REHABILITATION HOSPITAL (A LICENSED HOSPITAL OPERATED THROUGH A JOINT VENTURE) AND FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH FORSYTH MEDICAL CENTER. FORSYTH MEMORIAL HOSPITAL, INC. HAS FACILITIES IN THREE LOCATIONS: 1. NOVANT HEALTH FORSYTH MEDICAL CENTER, 2. NOVANT HEALTH CLEMMONS MEDICAL CENTER, AND3. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER THE PRIMARY SERVICE AREA IS DEFINED BY THE ZIP CODES THAT REPRESENT AT LEAST 75% OF THE HOSPITAL'S IN-PATIENT POPULATION. FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH FORSYTH MEDICAL CENTER AND NOVANT HEALTH REHABILITATION HOSPITAL:FORSYTH MEDICAL CENTER: THERE ARE 6 COUNTIES IN THE PRIMARY SERVICE AREA (PSA): DAVIDSON, DAVIE, FORSYTH, STOKES, SURRY AND YADKIN COUNTIES. 50% OF PATIENTS RESIDE IN THE PSA OF FORSYTH COUNTY AND 51% OF PATIENTS RESIDE IN THE PRIMARY AND SECONDARY SERVICE AREAS OF FORSYTH COUNTY. THE PSA DOES NOT INCLUDE MORE THAN 6.5% OF THE TOTAL IN-PATIENT POPULATION FROM ANY OTHER COUNTY. MOST PATIENTS RESIDE IN FORSYTH COUNTY, AND IT REPRESENTS THE HIGHEST POPULATION OF POTENTIALLY UNDERSERVED, LOW-INCOME AND MINORITY INDIVIDUALS FROM THE PRIMARY SERVICE AREA. REHABILITATION HOSPITAL: THERE ARE 10 COUNTIES IN THE PRIMARY SERVICE AREA (PSA): DAVIDSON, DAVIE, FORSYTH, GALAX CITY, GUILFORD, ROCKINGHAM, STOKES, SURRY, WILKES, AND YADKIN. 46.6% OF PATIENTS RESIDE IN THE PSA OF FORSYTH COUNTY AND 48% OF PATIENTS RESIDE IN THE PRIMARY AND SECONDARY SERVICES AREAS OF FORSYTH COUNTY. THE PSA DOES NOT INCLUDE MORE THAN 8% OF THE TOTAL IN-PATIENT POPULATION FROM ANY OTHER COUNTY. MOST PATIENTS RESIDE IN FORSYTH COUNTY AND IT REPRESENTS THE HIGHEST POPULATION OF POTENTIALLY UNDERSERVED, LOW-INCOME AND MINORITY INDIVIDUALS.NOVANT HEALTH FORSYTH MEDICAL CENTER SHARES THE MUCH OF THE SAME PRIMARY SERVICE AREA AS NOVANT HEALTH REHABILITATION HOSPITAL, AND THEY ARE LOCATED WITHIN 5 MILES OF EACH OTHER.FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH CLEMMONS MEDICAL CENTERNOVANT HEALTH CLEMMONS MEDICAL CENTER'S PRIMARY SERVICE AREA (PSA) INCLUDES DAVIDSON, DAVIE, FORSYTH, STOKES, SURRY AND YADKIN COUNTIES. 49.6% OF PATIENTS RESIDE IN THE PSA OF FORSYTH COUNTY AND 50.3% OF PATIENTS RESIDE IN THE PRIMARY AND SECONDARY SERVICE AREAS OF FORSYTH COUNTY. THE PSA DOES NOT INCLUDE MORE THAN 11.6% OF THE TOTAL IN-PATIENT POPULATION FROM ANY OTHER COUNTY. MOST PATIENTS RESIDE IN FORSYTH COUNTY, AND IT REPRESENTS THE HIGHEST POPULATION OF POTENTIALLY UNDERSERVED, LOW-INCOME AND MINORITY INDIVIDUALS FROM THE PRIMARY SERVICE AREA.FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH KERNERSVILLE MEDICAL CENTERNOVANT HEALTH KERNERSVILLE MEDICAL CENTER'S PRIMARY SERVICE AREA (PSA) INCLUDES FORSYTH, GUILFORD AND STOKES COUNTIES. 59% OF PATIENTS RESIDE IN THE PSA OF FORSYTH COUNTY, WHILE 62% OF PATIENTS RESIDE IN THE PRIMARY AND SECONDARY SERVICE AREAS OF FORSYTH COUNTY. MOST PATIENTS RESIDE IN FORSYTH COUNTY, AND IT REPRESENTS THE HIGHEST POPULATION OF POTENTIALLY UNDERSERVED, LOW-INCOME AND MINORITY INDIVIDUALS FROM THE PRIMARY SERVICE AREA.ALL FACILITIES:ACCORDING TO THE VIZIENT VULNERABILITY INDEX RELEASED IN JANUARY 2022, PATIENTS ADMITTED TO FORSYTH MEDICAL CENTER EXPERIENCE THE MOST PROFOUND SOCIAL RISKS IF THEY LIVE IN 27105, 27101, 27110, 27030, 27292. THESE ZIP CODES EXPERIENCE DISPROPORTIONATELY HIGH SOCIAL RISKS WHEN COMPARED TO THEIR COUNTERPART NEIGHBORHOODS. AREAS OF PARTICULAR CONCERN INCLUDE ACCESS TO HEALTHCARE, POVERTY, ACCESS TO TRANSPORTATION, AND FOOD INSECURITY. FORSYTH COUNTY INCLUDES WINSTON SALEM, THE MOST POPULATED CITY, AND THE COUNTY SEAT. IT HAS A POPULATION OF 385,523 COMPARED TO THE TOTAL NORTH CAROLINA POPULATION OF 10,551,162. IN FORSYTH COUNTY:- 65.9% OF THE POPULATION IS WHITE, 27.8% IS BLACK/AFRICAN AMERICAN, AND 13.9% IS HISPANIC- THE MEDIAN INCOME IS $53,583- THE POVERTY RATE IS 13%- THE LEADING CAUSES OF DEATH ARE CANCER AND HEART DISEASE- 12.2% OF THE POPULATION UNDER AGE 65 DOES NOT HAVE HEALTH INSURANCE - 18% OF THE POPULATION IS FACING FOOD HARDSHIP- THE DEMOGRAPHIC GROUPS FACING THE MOST SIGNIFICANT HOUSING HARDSHIP ARE HISPANIC AND BLACK POPULATIONS. MOST NOTABLY, 33% OF THE HISPANIC POPULATION IN FORSYTH COUNTY FACES A HOUSING HARDSHIP.DATA FOR THE CHNA WAS GATHERED FROM VARIOUS STATE AND FEDERAL SOURCES, BUT PRIMARILY THE US CENSUS BUREAU. SPECIFIC REFERENCES AND OTHER SUPPORTING INFORMATION CAN BE FOUND IN THE MOST RECENT CHNA HERE:HTTPS://WWW.NOVANTHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS/ PART VI, LINE 5: PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1. ADOPTING A FINANCIAL ASSISTANCE POLICY;2. REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHER GOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORY MANNER TO SUCH BENEFICIARIES;3. OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4. MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVE CONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGE OR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5. MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6. ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7. PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS;8. PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES;9. PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES IT SERVES;10. PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES;11. PROVIDING HEALTHCARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION, INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES AND ASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) AND MEDICAID TO THE COMMUNITIES IT SERVES;12. PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES;13. PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14. GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.PLEASE SEE THE NOVANT HEALTH COMMUNITY BENEFIT REPORT, LOCATED AT HTTPS://WWW.NOVANTHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS/.PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HEALTHCARE ASSOCIATION REPORTING GUIDELINES. PART VI, LINE 6: PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMTHE ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, A NOT-FOR-PROFIT INTEGRATED GROUP OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. NOVANT HEALTH IS RANKED AS ONE OF OUR NATION'S TOP 20 INTEGRATED HEALTHCARE SYSTEMS CARING FOR PATIENTS AND COMMUNITIES IN NORTH AND SOUTH CAROLINA. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. THE COMMUNITY BENEFIT OF THE SYSTEM AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTPS://WWW.NOVANTHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS/. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HEALTHCARE ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN NOVANT HEALTH WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL.IN ADDITION TO HOSPITALS, NOVANT HEALTH INCLUDES A PHYSICIAN ORGANIZATION WITH PRACTICES IN NORTH AND SOUTH CAROLINA, AND SIX HOSPITAL FOUNDATIONS WHICH SUPPORT AND ENHANCE THE ACTIVITIES IN THOSE HOSPITALS' COMMUNITIES. FURTHER, NOVANT HEALTH INCLUDES AMBULATORY SURGERY CENTERS, IMAGING CENTERS, REHABILITATION CENTERS, AND OTHER OUTPATIENT FACILITIES; ALL DEDICATED TO PROMOTING THE HEALTH OF THEIR RESPECTIVE COMMUNITIES. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT NOVANT HEALTH, INC. FILES A SYSTEM-WIDE COMMUNITY BENEFIT REPORT PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HEALTHCARE ASSOCIATION REPORTING GUIDELINES WITH THE NORTH CAROLINA MEDICAL CARE COMMISSION AS PART OF THE DOCUMENTATION REQUIRED FOR THE ISSUANCE OF TAX EXEMPT BOND FINANCING. 1 ABC OF NC FOUNDATION 905 FRIEDBERG CHURCH ROAD WINSTONSALEM NC 27127 911963813 501(C)(3) 17000 0 COMMUNITY OUTREACH AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 96900 0 COMMUNITY OUTREACH CANCER SERVICES INC 3175 MAPLEWOOD AVENUE WINSTONSALEM NC 27103 560656375 501(C)(3) 56000 0 COMMUNITY OUTREACH CLEMMONS FOOD PANTRY INC PO BOX 871 CLEMMONS NC 27012 454522542 501(C)(3) 8000 0 COMMUNITY OUTREACH CRISIS CONTROL MINISTRY INC 200 EAST TENTH STREET WINSTONSALEM NC 27101 237348168 501(C)(3) 15000 0 COMMUNITY OUTREACH CROSBY SCHOLARS COMMUNITY PARTNERSHIP 2701 UNIVERSITY PARKWAY WINSTONSALEM NC 27105 311523230 501(C)(3) 30000 0 COMMUNITY OUTREACH DAVIE COMMUNITY FOUNDATION INC 107 N SALISBURY STREET MOCKSVILLE NC 27028 581850531 501(C)(3) 25000 0 COMMUNITY OUTREACH EXCHANGE CLUB CENTER FOR PREVENTION OF CHILD ABUSE OF NC INC 500 WEST NORTHWEST BLVD WINSTONSALEM NC 27105 581443692 501(C)(3) 15000 0 COMMUNITY OUTREACH FAMILY SERVICES INC 1200 SOUTH BROAD STREET WINSTONSALEM NC 27101 560689235 501(C)(3) 15000 0 COMMUNITY OUTREACH FORSYTH FUTURES 100 N CHERRY STREET WINSTONSALEM NC 27101 561092807 501(C)(3) 40000 0 COMMUNITY OUTREACH GO FAR INC 2011 SANDY RIDGE ROAD COLFAX NC 27235 262059189 501(C)(3) 15000 0 COMMUNITY OUTREACH GREATER WINSTON-SALEM CHAMBER OF COMMERCE INC 411 WEST FOURTH STREET STE 211 WINSTONSALEM NC 27101 560459820 501(C)(6) 30000 0 COMMUNITY OUTREACH GREENSBORO AREA CHAMBER OF COMMERCE 111 W FEBRUARY ONE PLACE GREENSBORO NC 27401 560245040 501(C)(6) 10000 0 COMMUNITY OUTREACH GREENSBORO SCIENCE CENTER 4301 LAWNDALE DR GREENSBORO NC 27455 560885727 501(C)(3) 15000 0 COMMUNITY OUTREACH HABITAT FOR HUMANITY OF FORSYTH COUNTY 339 WITT STREET WINSTON SALEM NC 27103 561448955 501(C)(3) 25000 0 COMMUNITY OUTREACH HANDS OF HOPE MEDICAL CLINIC 320 W MAPLE STREET YADKINVILLE NC 27055 275569145 501(C)(3) 8000 0 COMMUNITY OUTREACH HOPE OF WINSTON-SALEM INC 844 GLEN ECHO TRAIL WINSTONSALEM NC 27106 463772491 501(C)(3) 8000 0 COMMUNITY OUTREACH LEAD GIRLS OF NC INC 500 W 4TH STREET WINSTONSALEM NC 27101 820984711 501(C)(3) 10000 0 COMMUNITY OUTREACH LEADERSHIP WINSTON-SALEM 624 W SIXTH STREET SUITE 110 WINSTONSALEM NC 27101 581574887 501(C)(3) 16000 0 COMMUNITY OUTREACH LOVE OUT LOUD 502 N BROAD ST WINSTONSALEM NC 27101 474085418 501(C)(3) 10000 0 COMMUNITY OUTREACH MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVENUE WHITE PLAINS NY 10605 131846366 501(C)(3) 37500 0 COMMUNITY OUTREACH MEDASSIST OF MECKLENBURG DBA NC MEDASSIST 4428 TAGGART CREEK ROAD CHARLOTTE NC 28208 562018957 501(C)(3) 10000 0 COMMUNITY OUTREACH NEIGHBORHOODS HANDS 1713 N LIBERTY ST WINSTONSALEM NC 27105 845011438 501(C)(3) 25000 0 COMMUNITY OUTREACH PIEDMONT TRIAD PARTNERSHIP PO BOX 2672 HIGH POINT NC 27261 561750279 501(C)(3) 25000 0 COMMUNITY OUTREACH RONALD MCDONALD HOUSE OF WINSTON-SALEM 419 S HAWTHORNE ROAD WINSTONSALEM NC 27103 581454715 501(C)(3) 7500 0 COMMUNITY OUTREACH SAMARITAN MINISTRIES 414 E NORTHWEST BLVD WINSTONSALEM NC 27105 561490019 501(C)(3) 15000 0 COMMUNITY OUTREACH SECOND HARVEST FOOD BANK OF NORTHWEST NC INC 3655 REED STREET WINSTONSALEM NC 27107 581457912 501(C)(3) 25000 0 COMMUNITY OUTREACH SENIOR SERVICES INC 2895 SHOREFAIR DRIVE WINSTONSALEM NC 27105 561085968 501(C)(3) 150000 0 COMMUNITY OUTREACH SHEPHERD'S CENTER OF GREATER WINSTON-SALEM INC 1700 EBERT STREET WINSTONSALEM NC 27103 561646960 501(C)(3) 20000 0 COMMUNITY OUTREACH THE CENTERS FOR EXCEPTIONAL CHILDREN INC 2315 COLISEUM DRIVE WINSTONSALEM NC 27106 560615188 501(C)(3) 10000 0 COMMUNITY OUTREACH THE LEUKEMIA & LYMPHOMA SOCIETY INC 3 INTERNATIONAL DR RYE BROOK NY 10573 135644916 501(C)(3) 105000 0 COMMUNITY OUTREACH THE SCIENCE CENTER AND ENVIRONMENTAL PARK OF FORSYTH COUNTY DBA SCIWORKS 400 W HANES MILL ROAD WINSTONSALEM NC 27105 560815746 501(C)(3) 420000 0 COMMUNITY OUTREACH THE SHALOM PROJECT INC 639 SOUTH GREEN STREET WINSTONSALEM NC 27101 202136431 501(C)(3) 25000 0 COMMUNITY OUTREACH THE VOLUNTEER CENTER OF THE TRIAD 1500 YANCEYVILLE STREET GREENSBORO NC 27406 561134052 501(C)(3) 10000 0 COMMUNITY OUTREACH TOWN OF KERNERSVILLE PO DRAWER 728 KERNERSVILLE NC 27285 561013949 GOVERNMENT 35000 0 COMMUNITY OUTREACH UNITED WAY OF FORSYTH COUNTY INC 301 N MAIN STREET SUITE 1700 WINSTONSALEM NC 27101 237357234 501(C)(3) 40000 0 COMMUNITY OUTREACH WINSTON-SALEM ALLIANCE 100 N MAIN STREET WINSTONSALEM NC 27101 311726654 501(C)(6) 35000 0 COMMUNITY OUTREACH WINSTON-SALEM STATE UNIVERSITY FOUNDATION INC 601 S MARTIN LUTHER KING JR DR SUITE 304 WINSTONSALEM NC 27110 560989620 501(C)(3) 25000 0 COMMUNITY OUTREACH YOUNG WOMEN'S CHRISTIAN ASSOCIATION OF THE CENTRAL CAROLINAS INC 3420 PARK RD CHARLOTTE NC 28209 560532139 501(C)(3) 30000 0 COMMUNITY OUTREACH WINSTON-SALEM TEACHER RESIDENCY 851 W 5TH ST WINSTON SALEM NC 27101 832058023 501(C)(3) 15000 0 COMMUNITY OUTREACH 37 3 PATIENT ASSISTANCE 16 29237 MEDICATION FOR INDIGENT PATIENTS 293 52140 FMV MEDICATION FOR INDIGENT PATIENTS PATIENT TRANSPORTATION 9687 404445 FMV CAB FARES FOR INDIGENT PATIENTS ZOLL LIFE VESTS 3 9650 FMV ZOLL LIFE VESTS FOR INDIGENT PATIENTS SCHOLARSHIPS 15 16678 PART I, LINE 2 : PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT HEALTH HAS ESTABLISHED A SYSTEM-WIDE CORPORATE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE FILING ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET. X X X X 1 1 0 1 0 0 0 0 0 0 0 FRED HARGETT EVP & CFO 0 1092939 0 843828 0 418897 0 18300 0 43552 0 2417516 0 7500 MICHAEL SETLIFF PRESIDENT NHFMC & GWM 608168 0 345135 0 71654 0 113628 0 38965 0 1177550 0 28950 0 JOHN MANN PRES & COO 596981 0 322622 0 59809 0 112545 0 37733 10339 1129690 10339 0 7500 ROLAND FRIEDMAN UROLOGIST 323031 0 555893 0 94241 0 18300 0 37834 0 1029299 0 7500 0 BRANDON CRAVEN UROLOGIST 389513 0 283475 0 61446 222051 18300 0 37637 0 790371 222051 7500 0 STANLEY FULLER SVP CHIEF CLINICAL OFFICER 523375 0 210136 0 56527 0 100958 0 41691 0 932687 0 0 7500 KATHLEEN ELLIOTT ONCOLOGIST 490471 0 318565 0 24727 0 18300 0 37834 0 889897 0 7500 0 KIRSTEN ROYSTER FMR PRES & COO KMC (SEE SCHEDULE O) 401451 0 235329 0 52444 0 79096 0 15028 0 783348 0 7500 0 FRANKLIN CHEN MD TRUSTEE/CLINICAL PHYSICIAN EXECUTIVE 574281 0 29867 0 48607 0 18300 0 35070 0 706125 0 7500 0 ASHLEY PERROTT MD TRUSTEE/SENIOR PHYSICIAN EXECUTIVE 406759 0 98400 0 21520 0 18300 0 21603 0 566582 0 0 0 ALISHA HUTCHENS COO 371642 0 63228 0 13938 0 18300 0 33062 0 500170 0 0 0 PART I, LINE 1A FRINGE OR EXPENSE EXPLANATION FIRST-CLASS OR CHARTER TRAVEL: FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES FOR COMMERCIAL FLIGHTS. HOWEVER, CHARTER TRAVEL IS AVAILABLE TO CERTAIN EXECUTIVES, BOARD MEMBERS, AND APPROVED BUSINESS PERSONNEL MEETING APPLICABLE POLICY CRITERIA. TRAVEL FOR COMPANIONS: COMPANIONS ARE ALLOWED ON CERTAIN CHARTER FLIGHTS PAID FOR BY THE ORGANIZATION. IN THAT CASE, THE VALUE OF THE COMPANION'S FLIGHT IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. DISCRETIONARY SPENDING ACCOUNT: CERTAIN EXECUTIVES RECEIVE A DISCRETIONARY SPENDING ACCOUNT. THE DOLLAR AMOUNT IN THE ACCOUNT IS PRE-APPROVED BY THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD OF TRUSTEES. THE EXECUTIVE MAY DEFER THE AMOUNT TO A RETIREMENT ACCOUNT OR THE AMOUNT IS TREATED AS COMPENSATION AND IS SPREAD OUT OVER THE COURSE OF THE YEAR IN THE EXECUTIVE'S PAYCHECKS AS TAXABLE INCOME. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: WE PROVIDE TEMPORARY HOUSING ALLOWANCES IN CERTAIN EXECUTIVE RECRUITMENT AND RELOCATION PACKAGES. THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. PART I, LINE 3 THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, AN INTEGRATED HEALTHCARE SYSTEM AND RELIES UPON NOVANT HEALTH, INC., THE PARENT ORGANIZATION, TO USE THE PROCESS DESCRIBED IN PART VI, LINE 15A/15B OF THIS RETURN TO ESTABLISH COMPENSATION FOR CERTAIN EXECUTIVES. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. PART I, LINE 4B PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONE NONQUALIFIED FRANKLIN CHEN $11,800 BRANDON CRAVEN $11,522 KATHLEEN ELLIOT $10,793 ROLAND FRIEDMAN $11,015 STANLEY FULLER $11,326 FRED HARGETT $11,892 JOHN MANN $11,846 KIRSTEN ROYSTER $11,892 MICHAEL SETLIFF $31,278 EQUITY-BASED NONE PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR AND ARE REPORTED IN COLUMN (C) OF SCHEDULE J. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("COMMITTEE") WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS. MURPHY TAYLOR WILLIAM FAMILY MEMBER OF TRACEY MARTIN, BOARD MEMBER 17412 COMPENSATION PAID BY THE FILING ORGANIZATION TO THE INTERESTED PERSON. 0 FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES FORSYTH MEMORIAL HOSPITAL, INC. DOING BUSINESS AS NOVANT HEALTH FORSYTH MEDICAL CENTER ("NHFMC") IS AN INTEGRAL PART OF THE NOVANT HEALTH SYSTEM (COLLECTIVELY KNOWN AS "NOVANT HEALTH"), A NOT-FOR-PROFIT INTEGRATED GROUP OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. THE NOVANT HEALTH NETWORK CONSISTS OF MORE THAN 1,800 PHYSICIANS AND OVER 35,000 TEAM MEMBERS THAT PROVIDE CARE AT NEARLY 800 LOCATIONS, INCLUDING 15 MEDICAL CENTERS AND HUNDREDS OF OUTPATIENT FACILITIES AND PHYSICIAN CLINICS. HEADQUARTERED IN WINSTON SALEM, NORTH CAROLINA, NOVANT HEALTH IS COMMITTED TO MAKING HEALTHCARE REMARKABLE FOR PATIENTS AND COMMUNITIES PROVIDING NEARLY SIX MILLION PATIENT VISITS ANNUALLY. IN 2022, THE NOVANT HEALTH SYSTEM REPORTED $7.6 BILLION IN REVENUES. GENERAL INFORMATION NOVANT HEALTH FORSYTH MEDICAL CENTER IS AN 859-BED HOSPITAL OFFERING A WIDE RANGE OF SERVICES IN EMERGENCY, MEDICAL, SURGERY, NEUROLOGY, CRITICAL CARE, ONCOLOGY, WOMEN'S HEALTH AND WELLNESS AND BEHAVIORAL HEALTH. CENTERS OF EXCELLENCE INCLUDE THE MAY ANGELOU WOMEN'S HEALTH AND WELLNESS CENTER, HEART AND VASCULAR INSTITUTE, DERRICK L. DAVIS CANCER INSTITUTE, STROKE AND NEUROSCIENCES CENTER, ORTHOPEDIC CENTER AND BEHAVIORAL HEALTH. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER IS A 50-BED HOSPITAL OFFERING A WIDE RANGE OF SERVICES IN EMERGENCY, SURGERY, CARDIOVASCULAR, DIAGNOSTIC AND CANCER CARE CLOSE TO HOME FOR LOCAL RESIDENTS. NOVANT HEALTH CLEMMONS MEDICAL CENTER IS A 36-BED HOSPITAL OFFERING EMERGENCY, IMAGING, LABORATORY, MEDICAL, SURGERY AND ORTHOPEDIC SERVICES. THE MEDICAL CENTER FIRST OPENED IN APRIL 2013 AND WAS EXPANDED TO A FULL-SERVICE HOSPITAL IN AUGUST 2017. BY BRINGING TOGETHER WORLD-CLASS TECHNOLOGY AND CLINICIANS TO PROVIDE QUALITY CARE, WE ARE COMMITTED TO CREATING A HEALTHCARE EXPERIENCE THAT IS SIMPLER, MORE CONVENIENT AND MORE AFFORDABLE SO PATIENTS CAN FOCUS ON GETTING BETTER AND STAYING HEALTHY. IN ADDITION TO OUR QUALITY OF SERVICES AND COMPREHENSIVE CATEGORIES OF SERVICES, WE ARE VERY PROUD OF OUR PATIENT FINANCIAL ASSISTANCE PROGRAM. WE WORK WITH PATIENTS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL, OR PROVIDE FREE CARE FOR THOSE THAT QUALIFY FOR FINANCIAL ASSISTANCE. COMMUNITY OUTREACH COMMUNITY OUTREACH IS A CRITICAL COMPONENT TO THE MISSION OF NOVANT HEALTH FORSYTH MEDICAL CENTER, NOVANT HEALTH CLEMMONS MEDICAL CENTER AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER. NOVANT HEALTH PROVIDES HUNDREDS OF PROGRAMS THAT SERVE PATIENTS, NEIGHBORS AND SOME OF OUR COMMUNITIES' MOST VULNERABLE CITIZENS. WE ALSO PROVIDE CHARITY MEDICAL CARE FOR THE UNINSURED, SERVICES TO INDIVIDUALS WITH MEDICAID COVERAGE REIMBURSED AT LESS THAN COST, COMMUNITY HEALTH EDUCATION, MEDICAL SERVICES THAT LOSE MONEY BUT ARE IMPORTANT FOR THE COMMUNITY, SUPPORT GROUPS, OUTREACH SERVICES, COMMUNITY EVENTS AND SCREENINGS. IN ADDITION, WE PARTICIPATE IN MEDICAL RESEARCH, ACADEMIC HEALTH PROGRAMS AND PARTNERSHIPS WITH A DIVERSE GROUP OF ORGANIZATIONS TO PROVIDE OTHER COMMUNITY INITIATIVES. NOVANT HEALTH FORSYTH MEDICAL CENTER SUPPORTED THE COMMUNITY IN 2022 THROUGH RESOURCES, SCREENINGS/CLINICS, HEALTH EDUCATION INITIATIVES AND CLASSES, SOCIAL AND ENVIRONMENTAL IMPROVEMENT ACTIVITIES, COMMUNITY BUILDING ACTIVITIES, IN-KIND DONATIONS, AND MORE. RESOURCES INCLUDED MYCOMMUNITY ACCESS AND PRINTED RESOURCE CARDS FOR ANYONE TO SEARCH FOR LOCAL FREE AND REDUCED COST SERVICES, 'ASK THE EDUCATOR IN ENGLISH AND SPANISH', AND HISPANIC OUTREACH SPECIFICALLY FOR NAVIGATING HEALTHCARE. SCREENINGS/CLINICS PROVIDED WERE FOR BLOOD PRESSURE/HYPERTENSION MOBILE CLINICS AND SCREENINGS, CHOLESTEROL SCREENINGS, A1C SCREENINGS, AND BREAST CANCER & MAMMOGRAPHY SCREENINGS. MATERNAL & INFANT HEALTH INITIATIVES INCLUDED CHILDBIRTH PREPARATION, BREASTFEEDING, INFANT SAFETY & CPR, CAR SEAT SAFETY, NEWBORN CARE (IN ENGLISH AND SPANISH), SIBLING PREPARATION, DAD'S 411, FINANCIAL CHECKLIST FOR NEW PARENT CLASSES, AND INCREASING COMFORT IN LABOR, POSTPARTUM 101. SUPPORT GROUPS ESTABLISHED WERE FOR POSTPARTUM, GI WELLNESS, GYN ONCOLOGY, AND NURSING MOTHERS (BABY CAF). NUTRITION, EXERCISE & WELLNESS PROGRAMS PROVIDE WERE PREGNANCY YOGA, MOMMY & BABY YOGA, CHAIR YOGA, TRADITIONAL YOGA, BREAST CANCER NUTRITION PREVENTION, AND SURVIVORSHIP CLASSES. SOCIAL AND ENVIRONMENTAL IMPROVEMENT ACTIVITIES & COMMUNITY BUILDING WERE LEADERSHIP WINSTON SALEM HEALTHCARE DAY, SENIOR ACADEMY DAY DROPOUT PREVENTION PROGRAM, LEADERSHIP WINSTON SALEM MENTORSHIP, BRIDGES TO HEALTHCARE INTERN SUPPORT, TEAM MEMBER NON-PROFIT BOARD SERVICE, ADVISORY COUNCIL SERVICE, AND A COMMITTEE/COALITION SERVICE. IN-KIND GIFTS CAME FOR FIRST-AID PERSONNEL AT COMMUNITY EVENTS. ADDITIONAL ACTIVITIES INCLUDED CANCER EDUCATION CLASSES, CPR/FIRST AID TRAINING, HEALTH FAIRS, HEART HEALTH TALKS, BARIATRIC SOLUTIONS FOR SENIORS HEALTH TALK, MONKEY POX VACCINE EDUCATION, AND VARIOUS WELLNESS WEBINARS. NOVANT HEALTH CLEMMONS MEDICAL CENTER PROVIDED MYCOMMUNITY ACCESS AND PRINTED RESOURCE CARDS FOR ANYONE TO SEARCH FOR LOCAL FREE AND REDUCED COST SERVICES. SCREENINGS/CLINICS PROVIDED WERE FOR BLOOD PRESSURE AND BODY FAT MEASUREMENTS. HEALTH EDUCATION INCLUDED GENERAL WELLNESS HEALTH EDUCATION EVENTS, AND A HEALTHY AGING PROGRAM. IN-KIND DONATIONS WERE MADE AT FOOD DRIVES AND FOR PHYSICALS FOR PARTICIPATION IN SCHOOL-BASED SPORTS. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER PROVIDED MYCOMMUNITY ACCESS AND PRINTED RESOURCE CARDS FOR ANYONE TO SEARCH FOR LOCAL FREE AND REDUCED COST SERVICES. SCREENINGS/CLINICS PROVIDED WERE FOR BLOOD PRESSURE AND HYPERTENSION SCREENING. HEALTH EDUCATION INITIATIVES INCLUDED A WELLNESS WEBINAR, HEALTHY LIVING EXPO & OTHER HEART HEALTH PROGRAMMING, AND AN 'ASK AN EDUCATOR' EVENT. NEW TECHNOLOGY & SERVICES NOVANT HEALTH FORSYTH MEDICAL CENTER ADDED BARIATRIC SURGERY AS A SERVICE TO MAKE WEIGHT-LOSS SURGERY MORE ACCESSIBLE FOR PATIENTS IN THE TRIAD. BARIATRIC SURGERY IS THE MOST EFFECTIVE AND DURABLE TREATMENT FOR SEVERE OBESITY AND RELATED MEDICAL CONDITIONS. IN ADDITION TO WEIGHT LOSS, THE PROCEDURE OFFERS MANY HEALTH BENEFITS, INCLUDING DECREASED RISK OF HEART DISEASE, JOINT PAIN, HIGH BLOOD PRESSURE, SLEEP APNEA, SEVERAL TYPES OF CANCER AND IN SOME CASES, COMPLETELY CURING TYPE 2 DIABETES. TO EXPAND ACCESS TO CARE, TWO BOARD-CERTIFIED SURGEONS, DR. JOSHUA RICKEY AND DR. PAUL CHANDLER, OF NOVANT HEALTH SALEM SURGICAL ASSOCIATES, PERFORM LEADING-EDGE ROBOTIC-ASSISTED BARIATRIC PROCEDURES AT FORSYTH MEDICAL CENTER. NOVANT HEALTH SALEM SURGICAL ASSOCIATES HAS CONVENIENT LOCATIONS IN WINSTON-SALEM AND CLEMMONS. THE ADDITION OF NOVANT HEALTH SALEM SURGICAL ASSOCIATES STRENGTHENS NOVANT HEALTH'S ROBUST BARIATRIC SURGERY OFFERINGS IN THE TRIAD. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER ADDED THE TECHNOLOGIES OF CT PERFUSION AND HIPPO GLASSES. CT PERFUSION SHOWS WHICH AREAS OF THE BRAIN ARE ADEQUATELY SUPPLIED WITH BLOOD AND PROVIDES DETAILED INFORMATION ABOUT BLOOD FLOW TO THE BRAIN. HIPPO' GLASSES ARE A HANDS-FREE, VOICE-ACTIVATED, WEARABLE COMPUTING SOLUTION THAT DELIVERS A "THROUGH THE EYES OF THE CLINICIAN" VIEWPOINT ALLOWING HEALTHCARE PRACTITIONERS AND EDUCATORS TO COMMUNICATE IN REAL-TIME WITH REMOTE COLLEAGUES. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS NOVANT HEALTH FORSYTH MEDICAL CENTER "A" RATED HOSPITAL FOR SAFETY THE LEAPFROG GROUP (2022) GOLD PLUS RATED HOSPITAL AMERICAN HEART ASSOCIATION (2020, 2021, 2022) ONE OF THE "TOP 10% HOSPITALS FOR CARDIAC SURGERY" SOCIETY OF THORACIC SURGEONS, 3-STARS ADVANCED COMPREHENSIVE STROKE CERTIFICATION THE JOINT COMMISSION "BABY-FRIENDLY" DESIGNATED HOSPITAL THE WORLD HEALTH ORGANIZATION AND THE UNITED NATIONS CHILDREN'S FUND 5-STAR-RATED HOSPITAL FOR "BREASTFEEDING FRIENDLINESS" NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES LEADER IN LGBTQ HEALTHCARE EQUALITY HUMAN RIGHTS CAMPAIGN (2017, 2018, 2019, 2020, 2022) CLINICAL EXCELLENCE AWARD VIZIENT MAGNET RECOGNITION PROGRAM DESIGNATED HOSPITAL THE AMERICAN NURSES CREDENTIALING CENTER ADDITIONAL CERTIFICATIONS FOR NOVANT HEALTH FORSYTH MEDICAL CENTER INCLUDE: - NORTH CAROLINA DIVISION OF MEDICAL ASSISTANCE - MEDICAID - TJC - COMPREHENSIVE STROKE CENTER CERTIFICATION - UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - CLIA - UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - MEDICARE NOVANT HEALTH KERNERSVILLE MEDICAL CENTER "A" RATED HOSPITAL FOR SAFETY THE LEAPFROG GROUP (2022) GOLD PLUS RATED HOSPITAL AMERICAN HEART ASSOCIATION (2020, 2021, 2022) TOP AMBULATORY SURGERY CENTER (ASC) THE LEAP GROUP (2021) LEADER IN LGBTQ HEALTHCARE EQUALITY HUMAN RIGHTS CAMPAIGN (2017, 2018, 2019, 2020, 2022) STAGE 7 EMRAM AWARD HIMSS ANALYTICS (2018) MAGNET RECOGNITION PROGRAM DESIGNATED HOSPITAL THE AMERICAN NURSES CREDENTIALING CENTER FORM 990, PI, L1: CONTINUED ADDITIONAL CERTIFICATIONS FOR NOVANT HEALTH KERNERSVILLE MEDICAL CENTER INCLUDE: - ANCC MAGNET RECOGNITION PROGRAM DESIGNATION - METABOLIC & BARIATRIC SURGERY ACCREDITATION AND QUALITY IMPROVEMENT PROGRAM - FDA MQSA CERTIFICATION - INTERNATIONAL ASSOCIATION FOR HEALTHCARE SECURITY AND SAFETY - NORTH CAROLINA DIVISION OF MEDICAL ASSISTANCE - MEDICAID - TJC - ACUTE STROKE READY HOSPITAL - UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - CLIA - UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - MEDICARE NOVANT HEALTH CLEMMONS MEDICAL CENTER GOLD SAFETY AWARD NORTH CAROLINA DEPARTMENT OF LABOR LEADER IN LGBTQ HEALTHCARE EQUALITY HUMAN RIGHTS CAMPAIGN (2017, 2018, 2019, 2020, 2022) GUARDIAN OF EXCELLENCE AWARD PRESS GANEY ASSOCIATES (2018, 2019) HIP AND KNEE JOINT REPLACEMENT CERTIFICATION THE JOINT COMMISSION MAGNET RECOGNITION PROGRAM DESIGNATION AMERICAN NURSES CREDENTIALING CENTER ADDITIONAL CERTIFICATIONS FOR NOVANT HEALTH CLEMMONS MEDICAL CENTER INCLUDE: - INTERNATIONAL ASSOCIATION FOR HEALTHCARE SECURITY AND SAFETY - NORTH CAROLINA DIVISION OF MEDICAL ASSISTANCE - MEDICAID - TJC - HIP JOINT REPLACEMENT CERTIFICATION - TJC - KNEE JOINT REPLACEMENT CERTIFICATION - UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - CLIA - UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - MEDICARE ACCREDITATION NOVANT HEALTH FORSYTH MEDICAL CENTER, NOVANT HEALTH CLEMMONS MEDICAL CENTER, AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER HAVE BEEN FULLY ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS THAT MOST AFFECT PATIENT HEALTH AND SAFETY. IN ADDITION, WE HAVE EARNED SOME OF THE NATION'S TOP HONORS IN QUALITY CARE, INCLUDING BREAST CENTER ACCREDITATION. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER ALSO MEETS ALL CRITERIA AS A COMPREHENSIVE CENTER UNDER THE METABOLIC AND BARIATRIC SURGERY ACCREDITATION AND QUALITY IMPROVEMENT PROGRAM (MBSAQIP), A JOINT PROGRAM OF THE AMERICAN COLLEGE OF SURGEONS (ACS) AND THE AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY (ASMBS). THE MBSAQIP STANDARDS ENSURE THAT BARIATRIC SURGICAL PATIENTS RECEIVE A MULTIDISCIPLINARY PROGRAM, NOT JUST A SURGICAL PROCEDURE, WHICH IMPROVES PATIENT OUTCOMES AND LONG-TERM SUCCESS. ADDITIONAL ACCREDITATIONS FOR NOVANT HEALTH FORSYTH MEDICAL CENTER: - AMERICAN ASSOCIATION OF BLOOD BANKS - AMERICAN COLLEGE OF RADIOLOGY: RADIATION ONCOLOGY - AMERICAN NURSES CREDENTIALING CENTER - NURSE RESIDENCY PROGRAM - AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS - PHARMACY RESIDENCY PROGRAM - COLLEGE OF AMERICAN PATHOLOGY - INTERSOCIETAL ACCREDITATION COMMISSION ECHOCARDIOGRAPHY LABORATORIES - NOVANT HEALTH CANCER INSTITUTE - NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS - NATIONAL ASSOCIATION EPILEPSY CENTERS ADDITIONAL ACCREDITATIONS FOR NOVANT HEALTH CLEMMONS MEDICAL CENTER - AMERICAN ASSOCIATION OF BLOOD BANKS - AMERICAN NURSES CREDENTIALING CENTER - NURSE RESIDENCY PROGRAM - COLLEGE OF AMERICAN PATHOLOGY ADDITIONAL ACCREDITATIONS FOR NOVANT HEALTH KERNERSVILLE MEDICAL CENTER - AMERICAN ASSOCIATION OF BLOOD BANKS - AMERICAN COLLEGE OF RADIOLOGY: MAMMOGRAPHY - AMERICAN COLLEGE OF RADIOLOGY: RADIATION ONCOLOGY - AMERICAN NURSES CREDENTIALING CENTER - NURSE RESIDENCY PROGRAM - COLLEGE OF AMERICAN PATHOLOGY - INTERSOCIETAL ACCREDITATION COMMISSION ECHOCARDIOGRAPHY LABORATORIES - NOVANT HEALTH CANCER INSTITUTE - NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS COMMUNITY BENEFIT REPORT HTTPS://WWW.NOVANTHEALTH.ORG/ABOUT/COMMUNITY/COMMUNITY-HEALTH-NEEDS/ THE COMMUNITY BENEFIT REPORT, REFERRED TO AS A COMMUNITY IMPACT REPORT, PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HEALTHCARE ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT, ITS COMMUNITY HEALTH NEEDS ASSESSMENT OR COMMUNITY BENEFIT IMPLEMENTATION STRATEGY. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $1,566,000,000, INCLUDING $213,000,000 IN FINANCIAL ASSISTANCE FOR 2022. FORM 990, PART III, LINE 1: MISSION, VISION, AND VALUES MISSION NOVANT HEALTH EXISTS TO IMPROVE THE HEALTH OF OUR COMMUNITIES, ONE PERSON AT A TIME. VISION WE, THE NOVANT HEALTH TEAM, WILL DELIVER THE MOST REMARKABLE PATIENT EXPERIENCE, IN EVERY DIMENSION, EVERY TIME. VALUES -COMPASSION: WE TREAT OUR CUSTOMERS AND THEIR FAMILIES, STAFF AND OTHER HEALTHCARE PROVIDERS AS FAMILY MEMBERS WITH KINDNESS, PATIENCE, EMPATHY AND RESPECT. -DIVERSITY AND INCLUSION: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND EACH OTHER AND OUR CUSTOMERS. BY ENGAGING THE STRENGTHS AND TALENTS OF EACH TEAM MEMBER, WE ENSURE A STRONG ORGANIZATION CAPABLE OF PROVIDING REMARKABLE HEALTHCARE TO OUR PATIENTS, FAMILIES AND COMMUNITIES. -PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY AND APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL WE DO. -TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN WHAT ONE PERSON'S SERVICE EFFORTS CAN SATISFY. WE SUPPORT EACH OTHER SO THAT TOGETHER AS A TEAM, WE CAN BE SUCCESSFUL IN THE EYE OF THE CUSTOMER AS A QUALITY SERVICE PROVIDER. -COURAGE: WE ACT BOLDLY IN MAKING THE CHANGES NECESSARY TO ACHIEVE OUR MISSION, VISION AND PROMISE OF DELIVERING REMARKABLE HEALTHCARE. -SAFETY: WE EMBRACE A CULTURE IN WHICH "FIRST, DO NO HARM" IS THE FOUNDATION OF REMARKABLE HEALTHCARE. OUR WORK ENVIRONMENT IS ONE OF OPEN COMMUNICATION, HIGH-RELIABILITY, AND A RELENTLESS QUEST TOWARD ZERO EVENTS OF PREVENTABLE HARM. OUR PEOPLE WE ARE AN INCLUSIVE TEAM OF PURPOSE-DRIVEN PEOPLE INSPIRED AND UNITED BY OUR PASSION TO CARE FOR EACH OTHER, OUR PATIENTS AND OUR COMMUNITIES. WE ALWAYS REMEMBER, OUR BUSINESS IS THE CARE OF ALL PEOPLE, STARTING WITH OUR TEAM MEMBERS. OUR PROMISE WE ARE RELENTLESSLY PURSUING REMARKABLE CARE EVERY DAY - SO YOU CAN EXPECT THE COMPASSIONATE, EXPERT, PERSONAL EXPERIENCE YOU DESERVE. FORM 990, PART III, LINE 4A: PROGRAM SERVICE ACCOMPLISHMENTS KMC HAS 50 LICENSED BEDS. DURING 2022 THERE WERE 11,382 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 5 DAYS, AN AVERAGE DAILY CENSUS OF 31, AND 2,378 DISCHARGES. THERE WERE 3,411 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 57,362 OUTPATIENT ENCOUNTERS AND 35,635 EMERGENCY DEPARTMENT VISITS. CMC HAS 36 LICENSED BEDS. DURING 2022 THERE WERE 5,309 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3 DAYS, AN AVERAGE DAILY CENSUS OF 15, AND 1,711 DISCHARGES. THERE WERE 4,106 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 38,237 OUTPATIENT ENCOUNTERS AND 24,214 EMERGENCY DEPARTMENT VISITS. FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). MEMBER HAS SOLE VOTING AUTHORITY OVER ALL MATTERS. IN ADDITION TO THESE POWERS, MEMBER HAS CERTAIN RIGHTS SUBJECT TO THE RESERVED POWERS OF NOVANT HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF MEMBERS AND THEIR RIGHTS NOVANT HEALTH, INC. ELECTS ALL MEMBERS OF THE GOVERNING BODY OF FORSYTH MEMORIAL HOSPITAL,INC. FORM 990, PART VI, SECTION A, LINE 7B FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS SUBJECT TO APPROVAL OF MEMBERS NOVANT HEALTH, INC. HAS CERTAIN RESERVED POWERS, SUCH AS APPROVAL OF AMENDMENTS TO THE ARTICLES AND BYLAWS OF THE CORPORATION, AND TO ADOPT CERTAIN POLICIES WHICH SHALL BE IMPLEMENTED BY THE CORPORATION BOARD. FORM 990, PART VI, SECTION B, LINE 11B FORM 990, PART VI, SECTION B, LINE 11: ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO NOVANT HEALTH'S BOARD OF TRUSTEES' AUDIT AND COMPLIANCE COMMITTEE ("THE COMMITTEE"), WHICH OVERSEES TAX MATTERS FOR ENTITIES IN THE NOVANT HEALTH SYSTEM. THE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE BEEN PROVIDED A PAPER OR ELECTRONIC COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE VICE PRESIDENT OF TAX AND LEGAL COUNSEL FOR NOVANT HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART VI, SECTION B, LINE 12C: MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS INCLUDING ANY APPLICABLE DISREGARDED ENTITIES. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE QUESTIONNAIRE. THE TRUSTEE ANNUAL DISCLOSURE QUESTIONNAIRES ARE REVIEWED BY THE COMPLIANCE DEPARTMENT. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A/15B: THE FILING ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, AN INTEGRATED HEALTHCARE SYSTEM COLLECTIVELY REFERRED TO AS "NOVANT HEALTH." NOVANT HEALTH, INC. IS THE PARENT ORGANIZATION AND INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH, INC. BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING AS OFFICERS, INCLUDING THE TOP MANAGEMENT OFFICIAL, OR KEY EMPLOYEES FOR NOVANT HEALTH ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT AND USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS TO ENSURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE NOVANT HEALTH SYSTEM ARE POSTED TO THE NOVANT HEALTH WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION B: INDEPENDENT CONTRACTORS THE FILING ENTITY IS PART OF THE NOT-FOR-PROFIT INTEGRATED HEALTHCARE SYSTEM KNOWN AS NOVANT HEALTH. NOVANT HEALTH, INC., THE PARENT ORGANIZATION, IS RESPONSIBLE FOR CERTAIN CORPORATE SUPPORT FUNCTIONS INCLUDING ACCOUNTS PAYABLE AND ISSUES FORMS 1099 FOR CERTAIN ENTITIES IN THE SYSTEM INCLUDING THE FILING ENTITY. INFORMATION REPORTED IN PART VII, SECTION B REPRESENTS THE EXPENSES PAID ON BEHALF OF THE FILING ENTITY TO INDEPENDENT CONTRACTORS OVER $100,000. FORM 990, PART VII, SECTION A, LINE 1A UPON INTERNAL ANALYSIS, WE HAVE DETERMINED ONE INDIVIDUAL THAT SHOULD NOT HAVE BEEN REPORTED AS A KEY EMPLOYEE ON PRIOR FORMS 990, THUS THEY ARE NOW DISCLOSED AS A FORMER KEY EMPLOYEE. FORM 990, PART XI, LINE 9: CONTRIBUTIONS: -1,489,510. AFFILIATE TRANSFERS: -541,580. INVESTMENT IN NORFOLK PARTNERSHIP: -2,955,651. 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