2022-08-15T14:05:36-05:00 2021-09-30 135565207 KPMG LLP 500 W 5TH ST STE 800 WINSTONSALEM NC 27101 990 2020-10-01 560845796 CUMBERLAND COUNTY HOSPITAL SYSTEM INC CUMB 9106154829 PO BOX 2000 FAYETTEVILLE NC 283022000 BRET JOHNSON CFO 9106154829 2022-08-15 1 BRET JOHNSON 999009999 ANDREW ROE P01876391 3362753394 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z MICHAEL NAGOWSKI CEO PO BOX 2000 FAYETTEVILLE NC 283022000 1281796831 0 X WWW.CAPEFEARVALLEY.COM X 1956 NC SEE SCHEDULE O 21 19 8179 157 260396 0 4971041 75418689 1132178813 1111084328 16818108 15810860 12555271 11527958 1166523233 1213841835 620833 285000 0 0 484409556 516866455 0 0 0 630299793 624721513 1115330182 1141872968 51193051 71968867 1384134000 1474757677 769734123 732954971 614399877 741802706 CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. EXISTS TO MEET THE HEALTH CARE NEEDS OF THE RESIDENTS OF CUMBERLAND, BLADEN, AND HOKE COUNTIES, AND THE SURROUNDING AREA IN NORTH CAROLINA. 0 0 986151819 285000 1110826221 AS PART OF MEETING THE HEALTH CARE NEEDS OF THE SERVICE AREA, CCHS, INC. ADMITTED 36,296 PATIENTS, PROVIDED 223,701 PATIENT DAYS OF CARE, HAD 176,458 EMERGENCY ROOM VISITS AND HAD OVER 550,000 OUTPATIENT VISITS FOR OTHER SERVICES. 986151819 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 405 0 1 8179 1 1 1 1 CJ 0 0 0 0 0 0 0 0 1 0 X 21 19 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X BRET JOHNSON 9106154829 PO BOX 2000 FAYETTEVILLE NC 283022000 CHUKWUEMEKA CHIMA MD TRUSTEE & PHYSICIAN 5.00 0.00 X 53750 0 0 BRADLEY J BROUSSARD BOARD CHAIR & PHYSICIAN 5.00 0.00 X X 34000 0 0 LARRY LANCASTER TRUSTEE 2.00 0.00 X 0 0 0 GLENN ADAMS TRUSTEE 2.00 0.00 X 0 0 0 JEANNETTE COUNCIL TRUSTEE 2.00 0.00 X 0 0 0 CHARLES EVANS TRUSTEE 2.00 0.00 X 0 0 0 JIMMY KEEFE TRUSTEE 2.00 0.00 X 0 0 0 WARREN MCDONALD PHD TRUSTEE 2.00 0.00 X 0 0 0 MURTIS WORTH SECRETARY 2.00 0.00 X X 0 0 0 MICHAEL BOOSE TRUSTEE 2.00 0.00 X 0 0 0 ALICIA MARKS BOARD VICE CHAIR 2.00 0.00 X X 0 0 0 PAMELA S STORY TRUSTEE 2.00 0.00 X 0 0 0 TAMMY S THURMAN TRUSTEE 2.00 0.00 X 0 0 0 GIRUM FEYISSA MD TRUSTEE & PHYSICIAN 2.00 0.00 X 0 0 0 TONI STEWART TRUSTEE 2.00 0.00 X 0 0 0 AMY CANNON TRUSTEE 2.00 0.00 X 0 0 0 AFUA ARHIN TRUSTEE 2.00 0.00 X 0 0 0 MARSHALL FAIRCLOTH TRUSTEE 2.00 0.00 X 0 0 0 RYAN AUL TRUSTEE 2.00 0.00 X 0 0 0 MICHAEL JONES TRUSTEE & PHYSICIAN 5.00 0.00 X 0 0 0 MYRON STRICKLAND TRUSTEE & PHYSICIAN 5.00 0.00 X 0 0 0 MICHAEL NAGOWSKI CEO 55.00 0.00 X 1454312 0 17684 SANDRA WILLIAMS CFO 55.00 0.00 X 869214 0 9493 SAMUEL FLEISCHMAN CMO 55.00 0.00 X 700873 0 16481 DANIEL WEATHERLY COO 55.00 0.00 X 638219 0 17828 CHARLES HAWORTH MD PHYSICIAN 40.00 0.00 X 1465760 0 19756 ROBERT MAUGHAN MD PHYSICIAN 40.00 0.00 X 1404191 0 12571 MICHAEL ZAPPA MEDICAL DIRECTOR 55.00 0.00 X 734845 0 10986 MELISSA STAMATES PHYSICIAN 40.00 0.00 X 930021 0 14993 TARIQ NAZIR PHYSICIAN 40.00 0.00 X 682918 0 17268 8968103 0 137060 694 0 1 0 AMN HEALTHCARE INC 4441 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACT LABOR 19426039 ARAMARK DALLAS LOCKBOX PO BOX 978839 DALLAS TX 75397 MANAGEMENT FEES 7664210 FRESENIUS MEDICAL CARE - BMA 16343 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACT LABOR 3501192 ALLIED UNIVERSAL SECURITY PO BOX 534265 ATLANTA GA 30353 SECURITY SERVICES 3314500 LABORATORY CORP PO BOX 12140 BURLINGTON NC 27216 CONTRACT LABOR 2696521 132 298646 74947123 172920 75418689 PATIENT SERVICE REVENU 900099 1056542663 1056542663 ANCILLARY MEDICAL SERV 900099 54509171 54251064 258107 EDUCATION/OUTREACH 611710 32494 32494 1111084328 12137656 2289 12135367 408602 96502 312100 312100 312100 71531698 67858494 3673204 3673204 3673204 CAFETERIA AND PARKING 900099 3165855 3165855 PURCHASE REBATES, DISC 812900 1647961 1647961 6402042 6402042 11215858 1213841835 1110826221 260396 27336529 285000 285000 3811854 3811854 420832244 383492277 37339967 19373742 19373742 45309008 45271316 37692 27539607 25011966 2527641 7360616 7360616 1241298 1241298 210000 210000 229106 149248 79858 978244 975994 2250 4198748 3852347 346401 17747623 41984 17705639 8057333 8057333 235914 207931 27983 544931 319575 225356 8365644 8165344 200300 35282321 28497617 6784704 15747159 660338 15086821 MEDICAL & OTHER SUPPLIE 196488212 192560657 3927555 BAD DEBT EXPENSE 142273897 142273897 CONTRACT LABOR 45904018 45425355 478663 INTEREST RATE SWAP 43705000 43705000 96151449 74169282 21982167 1141872968 986151819 155721149 0 228193159 270882682 20095128 20250854 97208614 95221475 14197514 15785059 5153255 6804471 939941571 500630493 429729131 439311078 411963685 477701598 177593514 148800460 1384134000 1474757677 176464814 150560537 43534310 7086730 217525441 152000000 87865019 188237317 244344539 235070387 769734123 732954971 X 0 0 0 0 614399877 741802706 614399877 741802706 1384134000 1474757677 71968867 52057962 3376000 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 229106 0 0 229106 0 PART II-B, LINE 1: EMPLOYEES OF THE HEALTH SYSTEM AND NCHA MEET WITH LOCAL, STATE, AND FEDERAL LEGISLATORS AND REGULATORS REGARDING MATTERS OF INTEREST TO THE HOSPITAL. 27216942 27216942 565734836 276477042 289257794 5791497 2320490 3471007 308414545 214869619 93544926 32783751 6963342 25820409 439311078 OTHER RECEIVABLES 13561996 SELF INSURANCE TRUSTS 69699645 BOND FUND TRUSTS 6679590 OTHER ASSETS 13797386 DEFERRED OUTFLOW 45061843 148800460 ESTIMATED CLAIM 45813552 DUE TO PAYOR AGENCIES 102769979 OTHER LIABILITIES 85054289 DEFERRED INFLOWS 1432567 235070387 X 1080017402 52057962 52057962 1027959440 185882395 185882395 1213841835 955990573 0 955990573 185882395 185882395 1141872968 PART X, LINE 2: THE HEALTH SYSTEM AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3). THE UNRELATED BUSINESS INCOME GENERATED BY THE HEALTH SYSTEM AND THE INCOME GENERATED BY THE HEALTH SYSTEM'S TAXABLE COMPONENT ARE NOT MATERIAL TO THE FINANCIAL STATEMENTS. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS REQUIRED IN THE ACCOMPANYING FINANCIAL STATEMENTS. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 142,273,897. RENT EXPENSE -96,502. INTEREST RATE SWAP 43,705,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 142,273,897. RENT EXPENSE -96,502. INTEREST RATE SWAP 43,705,000. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS CAPTIVE INSURANCE 64198763 0 0 0 0 0 0 64198763 0 64198763 1 0 1 0 0 0 PART I, LINE 3: THE ACCRUAL METHOD IS USED FOR INVESTMENTS. PART III ACCOUNTING METHOD: 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 47702473 6258591 41443882 0.04150 207510572 194644161 12866411 0.01290 1061565 597682 463883 0.00050 256274610 201500434 54774176 0.05490 25617845 3049135 22568710 0.02260 47373971 26143662 21230309 0.02130 72991816 29192797 43799019 0.04390 329266426 230693231 98573195 0.09880 248000 248000 0.00020 55700 55700 0.00010 303700 303700 0.00030 0 142273897 172362629 155026069 17336560 X 1 1 4 1 CAPE FEAR VALLEY HEALTH SYSTEM 1638 OWEN DRIVE FAYETTEVILLE NC 28304 WWW.CAPEFEARVALLEY.COM X X X A 2 HIGHSMITH RAINEY HOSPITAL 150 ROBESON STREET FAYETTEVILLE NC 28301 WWW.CAPEFEARVALLEY.COM X LONG TERM ACUTE CARE HOSPITAL A 3 BLADEN COUNTY HOSPITAL 501 SOUTH POPLAR STREET ELIZABETHTOWN NC 28337 WWW.CAPEFEARVALLEY.COM X X X A 4 HOKE HOSPITAL 210 MEDICAL PAVILION DRIVE RAEFORD NC 28376 WWW.CAPEFEARVALLEY.COM X A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 18 1 0 0 1 X HTTPS://WWW.CAPEFEARVALLEY.COM/DOWNLOADS/CHNA/CUMBERLAND-CHNA-2019.PDF X 1 18 0 0 0 1 X 200.000000000000 500.000000000000 X X 1 1 X X X 1 X HTTPS://WWW.CAPEFEARVALLEY.COM/PATIENTS/FINANCIAL-ASSISTANCE.HTML X HTTPS://WWW.CAPEFEARVALLEY.COM/PATIENTS/FINANCIAL-ASSISTANCE.HTML X HTTPS://WWW.CAPEFEARVALLEY.COM/PATIENTS/FINANCIAL-ASSISTANCE.HTML X X X X X X X 1 X 0 X X X X 1 X 0 0 CAPE FEAR VALLEY HEALTH SYSTEM PART V, SECTION B, LINE 3: CAPE FEAR VALLEY HEALTH SYSTEM (CFVHS) PERFORMED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT FOR FY 2019. FOR OUR 2019 CHNA WE COLLABORATED WITH HEALTHENC, A COLLABORATIVE OF 22 HOSPITALS AND 21 HEALTH DEPARTMENTS FROM ACROSS EASTERN NC, INCLUDING THE BLADEN, CUMBERLAND, AND HOKE COUNTY HEALTH DEPARTMENTS. COMMUNITY HEALTH ASSESSMENT TEAMS (CHAT) WERE DEVELOPED IN EACH OF THE RESPECTIVE COUNTIES. THE CHAT CONSISTED OF COMMUNITY MEMBERS, STAKEHOLDERS, AND THOSE WORKING IN PUBLIC HEALTH. THE CHATS WERE INSTRUMENTAL IN THE DISTRIBUTION OF OUR SURVEYS IN THE COMMUNITY IN ELECTRONIC AND PAPER FORMAT. UTILIZING THE SURVEYS (PRIMARY DATA) AND DATA FROM THE STATE PLUS FEDERAL SOURCES (SECONDARY DATA), AND CHAT LED FOCUSED GROUPS HEALTHENC CREATED A COMPREHENSIVE REPORT FOR EACH OF THE THREE COUNTIES CAPE FEAR VALLEY HAS A HOSPITAL. THERE WERE A FEW CONTINUOUS THEMES DESPITE THE GEOGRAPHICAL DIFFERENCES IN THE COUNTIES. WORKING WITH THE RESPECTIVE HEALTH DEPARTMENTS IN EACH COUNTY, CAPE FEAR VALLEY HEALTH SYSTEM IDENTIFIED COMMUNITY OUTREACH & SCREENING FOR EARLY INTERVENTION, ACCESS TO HEALTH SERVICES, AND SUBSTANCE ABUSE AS THE AREAS THAT NEEDED TO BE ADDRESSED. THESE AREAS ARE ALL AMONG THE MOST MENTIONED AREAS AMONGST OUR SURVEY RESPONDENTS AND FOCUS GROUP ATTENDEES.DURING THE PANDEMIC AND SINCE THE COVID VACCINE WAS MADE AVAILABLE, CFVHS HAS PROVIDED OVER 175,000 VACCINES. THE OUTPATIENT PHARMACIES AT CAPE FEAR VALLEY CONTINUED THE MISSION OF VACCINATING THE PUBLIC AGAINST COVID-19 WITH BOTH NEW VACCINATIONS AND BOOSTERS. THE EASE OF ONLINE SCHEDULING AND WALK-IN OPTIONS LED TO VERY SHORT WAIT TIMES AND INCREASED AVAILABILITY TO THESE LIFE-SAVING VACCINES. CAPE FEAR VALLEY NOT ONLY HOSTED REGULAR CLINICS AT OUR HOSPITAL, COMMUNITY PHARMACIES AND CLINICS, BUT ALSO HOSTED EVENTS AT LOCAL HIGH SCHOOLS FOR ADULTS AND STUDENTS, AS WELL AS MULTIPLE OTHER COMMUNITY EVENTS. OUR PHARMACIES AND CLINICS ALSO BEGAN OFFERING THE PEDIATRIC FORMULATION OF THE VACCINE AND HAVE GIVEN ALMOST 3000 PEDIATRIC DOSES SINCE THEIR APPROVALS. ADDITIONALLY, IN THE FIGHT AGAINST COVID, CAPE FEAR VALLEY'S HEALTH PAVILION NORTH OFFERED DRIVE THROUGH COVID TESTING, MEETING A CRITICAL DEMAND IN THE REGION BY PROVIDING TESTING TO OVER 3000 INDIVIDUALS.PHARMACY HAS ALSO EXPANDED INTO THE OUTPATIENT CLINICS AS WELL. CLINICAL PHARMACIST PRACTITIONERS, OR CPPS, ARE NOW AVAILABLE IN FOUR CAPE FEAR VALLEY OUTPATIENT CLINICS INCLUDING FAYETTEVILLE FAMILY, SENIOR HEALTH SERVICES, THE DIABETES AND ENDOCRINE CLINIC, AND THE MEDICAL ONCOLOGY CLINIC AT THE MAIN CAMPUS. THESE ADVANCED PRACTICE PROVIDERS OFFER OUR PATIENTS IN-DEPTH MEDICATION COUNSELING TO IMPROVE OUTCOMES AND HELP EASE THE BURDEN OF HEAVY CASELOADS FOR OUR PROVIDERS. SINCE THE INTRODUCTION OF THE CPP IN THE DIABETES AND ENDOCRINE CENTER, PATIENT A1C LEVELS WERE DRAMATICALLY DECREASED IN PATIENTS RECEIVING MEDICATION COUNSELING FROM THE PHARMACIST. THE CPP POSITION WAS SO WELL RECEIVED THAT ANOTHER CPP IS BEING PLACED IN THE CLINIC TO FURTHER HELP PATIENTS GET TO THEIR DIABETES GOALS. THE CPP IN THE MEDICAL ONCOLOGY CLINIC WAS ALSO INTRODUCED THIS PAST YEAR TO OFFER CHEMOTHERAPY COUNSELING AND MEDICATION ADVERSE EVENT MANAGEMENT TO THE PATIENTS OF THE CANCER CENTER. THIS HAS ALLOWED FOR THE MEDICAL ONCOLOGISTS, PHYSICIAN ASSISTANTS, AND NURSE PRACTITIONERS TO SEE MORE PATIENTS IN THIS EVER-GROWING CLINIC AND IMPROVES PATIENT UNDERSTANDING OF THEIR REGIMENS AND HOW TO COPE WITH THE ADVERSE EFFECTS OF CHEMOTHERAPY.OUR SPECIALTY PHARMACY AT CAPE FEAR VALLEY CONTINUES TO GROW THANKS TO THE ACCREDITATIONS FROM URAC AND ACHC. THIS MONUMENTAL ACHIEVEMENT ALLOWED FOR INCREASED ACCESS TO LIMITED DISTRIBUTION MEDICATIONS AND INSURANCE PROVIDERS. THE ADDITION OF THE PFIZER ONCOLOGY MEDICATIONS HAS ALLOWED FOR GREATER PATIENT AND PROVIDER SATISFACTION BY DECREASING THE WAIT TIME FROM TRADITIONAL MAIL-ORDER SPECIALTY PHARMACIES. THE STAFF OF THE SPECIALTY PHARMACY WORK EXTENSIVELY ON PATIENT FINANCIAL ASSISTANCE AND WAS ABLE TO SAVE THEIR PATIENTS OVER $400,000 THIS FISCAL YEAR.FINALLY, CAPE FEAR VALLEY'S RESIDENCY TEAM CONTINUES TO GIVE BACK TO THE COMMUNITY. PHARMACY RESIDENTS PROVIDE WEEKLY STAFFING FOR THE CARE CLINIC, A LOCAL NON-PROFIT THAT PROVIDES MEDICAL CARE AND PRESCRIPTIONS FOR FAYETTEVILLE'S UNINSURED POPULATION. IN ADDITION, IN PARTNERSHIP WITH BETTER HEALTH OF CUMBERLAND COUNTY, A NON-PROFIT THAT PROVIDES DIABETES EDUCATION TO FAYETTEVILLE AND SURROUNDING AREAS, THE RESIDENTS TEACH A 7-WEEK CLASS ENTITLED TAKE CHARGE OF DIABETES AS WELL AS TEACHING PATIENTS AT THE ANNUAL DIABETES SYMPOSIUM. CFVHS HOSTED MORE THAN 280 OUTREACH EVENTS IN THE COMMUNITY IN 2021 TO ADDRESS HEALTH ISSUES IN OUR SERVICE AREA. PREVENTIVE EDUCATION, SCREENINGS, AND SUPPORT GROUPS WERE JUST A FEW OF THE WAYS WE ADDRESSED OUR COMMUNITY NEEDS.CFVHS FRIENDS OF THE CANCER CENTER FUNDED OVER 239 SCREENING MAMMOGRAMS TO CATCH BREAST CANCER IN EARLIER STAGES. THIS IS A 28% INCREASE OVER THE PREVIOUS YEAR. HANDS-ONLY CPR INSTRUCTION AND BLOOD PRESSURE CHECKS ARE A SERVICE WE OFFER AT MOST OUTREACH EVENTS. OUR RESIDENCY PROGRAM FOSTERS OUTREACH AMONGST OUR RESIDENTS AND RAISE AWARENESS OF OUR RESIDENCY PROGRAM AND ITS EXPECTED IMPACT. WE WILL CONTINUE OUR AGGRESSIVE OUTREACH EFFORTS TO HELP EDUCATE OUR PATIENTS ABOUT THE VARIOUS RISK FACTORS ASSOCIATED WITH ALL THE IDENTIFIED NEEDS. THE HEALTH SYSTEM ADDED THREE PRIMARY CARE PRACTICES, TWO OF WHICH ARE RURAL COMMUNITIES, SO PATIENTS HAVE GREATER ACCESS TO PHYSICIANS. WE CONTINUE TO STRENGTHEN OUR RELATIONSHIPS WITH OUR LOCAL HEALTH DEPARTMENTS, AREA CHURCHES AND THE SCHOOL SYSTEMS TO BETTER IDENTIFY AREAS OF FUTURE COMMUNITY IMPACT. CAPE FEAR VALLEY HEALTH SYSTEM HAS ESTABLISHED A SYSTEM-WIDE OPIOID STEWARDSHIP PROGRAM. WE HAVE ESTABLISHED SEVERAL COMMUNITY PARTNERSHIPS TO ADDRESS SUBSTANCE ABUSE ISSUES IN OUR AREA SUCH AS (FIGHTING ADDICTION THROUGH COMMUNITY EMPOWERMENT TEAMS WITH SOUTHEASTERN REGIONAL AREA HEALTH EDUCATION CENTER (SRAHEC) & CUMBERLAND-FAYETTEVILLE OPIOID RESPONSE TEAMS). WITH THE SUPPORT OF OUR STATE AND THE DOROTHEA DIX FUNDS, CFVHS WORKED DILIGENTLY TO CONSTRUCT A STATE OF THE ART NEW 16 BED INPATIENT ADOLESCENT PSYCHIATRY UNIT LOCATED ON THE MAIN CAMPUS OF CAPE FEAR VALLEY MEDICAL CENTER IN FAYETTEVILLE, NC. CONSTRUCTION HAS JUST BEEN COMPLETED AND WILL OPEN FOR PATIENTS DURING THE SPRING OF 2022.CAPE FEAR VALLEY HEALTH SYSTEM IS CONSTANTLY EVOLVING TO MEET THE NEEDS OF THE COMMUNITIES WE SERVE. WE HAVE ALREADY BEGUN THE NEXT STEPS FOR OUR NEXT COMMUNITY NEEDS ASSESSMENT TO LEARN IF WE ARE HEADING IN THE RIGHT DIRECTION. OUR VISION IS TO IMPROVE THE QUALITY OF LIFE OF EVERY LIFE WE TOUCH. CAPE FEAR VALLEY HEALTH SYSTEMPART V, SECTION B, LINE 4: CAPE FEAR VALLEY AND HIGHSMITH RAINEY WORKED COLLABORATIVELY WITH ONE ANOTHER.PART V, SECTION B, LINE 5: COMMUNITY HEALTH ASSESSMENT TEAMS (CHAT) WERE DEVELOPED IN EACH OF THE RESPECTIVE COUNTIES. THE CHAT CONSISTED OF COMMUNITY MEMBERS, STAKEHOLDERS, AND THOSE WORKING IN PUBLIC HEALTH. THE CHAT'S DEVELOPED COMMUNITY HEALTH ASSESSMENT SURVEYS AND DISTRIBUTED THEM IN THE COMMUNITY IN ELECTRONIC AND PAPER FORMAT. UTILIZING THE SURVEYS (PRIMARY DATA) AND DATA FROM THE STATE PLUS FEDERAL SOURCES (SECONDARY DATA), CFVHS WAS ABLE TO IDENTIFY THE MOST PRESSING NEEDS IN OUR COMMUNITIES.PART V, SECTION B, LINE 11: CFVHS WILL CONTINUE OUR AGGRESSIVE OUTREACH EFFORTS TO HELP EDUCATE OUR PATIENTS ABOUT THE VARIOUS RISK FACTORS ASSOCIATED WITH ALL THE IDENTIFIED NEEDS. WE ARE STRENGTHENING OUR RELATIONSHIPS WITH OUR LOCAL HEALTH DEPARTMENTS AND IDENTIFYING POTENTIAL COLLABORATIONS WITH COMMUNITY STAKEHOLDERS. GOING FORWARD THE HOSPITAL IS DEVELOPING AN ADDITIONAL CARDIAC CATHETERIZATION LAB. OUR LUNG NODULE CLINIC HAS MOVED TO THE MAIN CAMPUS FOR BETTER COVERAGE OF POTENTIAL LUNG CANCER PATIENTS. CAPE FEAR VALLEY HEALTH SYSTEM PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3 HIGHSMITH RAINEY HOSPITAL PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3 BLADEN COUNTY HOSPITAL PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3 HOKE HOSPITAL PART V, SECTION B, LINE 16I: SEE THE RESPONSE TO PART VI, LINE 3 40 1 - CFV-REHABILITATION CENTER 1638 OWEN DRIVE FAYETTEVILLE NC 28304 REHABILITATION CENTER 2 - CUMBERLAND CTY EMS OF CFV 610 GILLESPIE STREET FAYETTEVILLE NC 28306 EMERGENCY MEDICAL SERVICES 3 - CFV BEHAVIOR HEALTH CENTER 3425 MELROSE ROAD FAYETTEVILLE NC 28304 BEHAVIOR HEALTH CENTER 4 - CFV DETOX CENTER 1724 ROXIE AVENUE FAYETTEVILLE NC 28304 DETOXICATION CENTER 5 - HEALTHPLEX WELLNESS CENTER 1930 SKIBO ROAD FAYETTEVILLE NC 28304 REHABILITATION CENTER 6 - HEALTH PAVILION NORTH 6387 RAMSEY STREET FAYETTEVILLE NC 28311 OUTPATIENT SERVICES 7 - HIGHSMITH-RAINEY EXPRESS CARE 150 ROBESON STREET FAYETTEVILLE NC 28311 EXPRESS CARE 8 - CAPE FEAR VALLEY EXPRESS CARE 1638 OWEN DRIVE FAYETTEVILLE NC 28304 EXPRESS CARE 9 - CAPE FEAR VALLEY OBGYN 1341 WALTHER REED ROAD FAYETTEVILLE NC 28304 OB/GYN SERVICES 10 - HEALTH PAVILION NORTH EXPRESS CARE 6387 RAMSEY STREET FAYETTEVILLE NC 28301 EXPRESS CARE 11 - CAPE FEAR VALLEY SLEEP MEDICINE 1213 WALTER REED ROAD FAYETTEVILLE NC 28304 SLEEP CENTER 12 - HEALTH PAVILION NORTH FAMILY CARE 6387 RAMSEY STREET FAYETTEVILLE NC 28311 FAMILY PRACTICE 13 - HOPE MILLS FAMILY CARE 4092 PROFESSIONAL DRIVE HOPE MILLS NC 28348 FAMILY PRACTICE 14 - CAPE FEAR VALLEY PERINATOLOGY 2109 VALLEYGATE DRIVE FAYETTEVILLE NC 28304 PERINATOLOGY 15 - BEHAVIORAL HEALTH CENTER 3425 MELROSE ROAD FAYETTEVILLE NC 28304 MENTAL HEALTH CLINIC INPATIENT 16 - VALLEY MEDICAL ASSOCIATES-HIGHSMITH 101 ROBESON STREET FAYETTEVILLE NC 28301 FAMILY PRACTICE 17 - CAPE FEAR VALLEY UROLOGY 2301 ROBESON STREET SUITE 203 FAYETTEVILLE NC 28305 UROLOGY 18 - HOKE FAMILY MEDICAL CENTER 405 SOUTH MAIN STREET RAEFORD NC 28376 FAMILY PRACTICE 19 - SENIOR HEALTH SERVICES 101 ROBESON STREET SUITE 202 FAYETTEVILLE NC 28310 GERIATRICS 20 - BLADEN MEDICAL ASSOC-ELIZABETHTOWN 300 A EAST MCKAY STREET ELIZABETHTOWN NC 28337 FAMILY PRACTICE 21 - STEDMAN MEDICAL CARE 114 FORTE ROAD STEDMAN NC 28391 FAMILY PRACTICE 22 - CAPE FEAR VALLEY NEUROSURGERY 3308 MELROSE ROAD FAYETTEVILLE NC 28304 NEUROSURGERY OUTPATIENT 23 - CAPE FEAR VALLEY WOUND CARE CENTER 101 ROBESON ST SUITE 210 FAYETTEVILLE NC 28301 WOUND CENTER 24 - CAPE FEAR VALLEY PEDIATRIC CARE 1262 OLIVER STREET FAYETTEVILLE NC 28304 PEDIATRIC CARE 25 - WESTSIDE MEDICAL CARE 1463 PAMALEE DRIVE FAYETTEVILLE NC 28303 FAMILY PRACTICE 26 - CAPE FEAR VALLEY INTERNAL MEDICINE 101 ROBESON STREET SUITE 100 FAYETTEVILLE NC 28301 INTERNAL MEDICINE 27 - WOMEN'S HEALTH SPECIALISTS 300 EAST MCKAY STREET SUITE F ELIZABETHTOWN NC 28337 OB/GYN 28 - THREE RIVERS MEDICAL CENTER 580 WEST MCLEAN STREET ST PAULS NC 28384 FAMILY PRACTICE 29 - BLADEN MEDICAL ASSOC - BLADENBORO 106 FOURTH STREET BLADENBORO NC 28302 FAMILY PRACTICE 30 - BLADEN MEDICAL ASSOCIATES-DUBLIN 106 FOURTH STREET DUBLIN NC 28332 FAMILY PRACTICE 31 - DIABETES & ENDOCRINE CENTER 101 ROBESON STREET SUITE 405 FAYETTEVILLE NC 28301 DIABETES & ENDOCRINOLOGY OUTPATIENT 32 - CFV PEDIATRIC ENDOCRINOLOGY 101 ROBESON STREET SUITE 410 FAYETTEVILLE NC 28301 DIABETES & ENDOCRINOLOGY OUTPATIENT 33 - BEHAVIORAL HEALTH CLINIC 3425 MELROSE ROAD FAYETTEVILLE NC 28304 MENTAL HEALTH OUTPATIENT CARE 34 - BLADEN SURGICAL SPECIALIST 107 EAST DUNHAM STREET ELIZABETHTOWN NC 28377 SURGICAL SPECIALIST 35 - HEALTH PAVILION NORTH PEDIATRIC CARE 6387 RAMSEY STREET SUITE 240 FAYETTEVILLE NC 28311 PEDIATRIC CARE 36 - HEALTH PAVILION HOKE PRIMARY CARE 300 MEDICAL PAVILION DRIVE SUITE 102 RAEFORD NC 28376 FAMILY PRACTICE 37 - HOKE OBGYN 300 MEDICAL PAVILION DRIVE SUITE 250 RAEFORD NC 28376 FAMILY PRACTICE 38 - HOKE EXPRESS CARE 300 MEDICAL PAVILION DRIVE SUIT 102 RAEFORD NC 28376 EXPRESS CARE 39 - CFV INFECTIOUS DISEASE CARE 101 ROBESON STREET SUITE 300 FAYETTEVILLE NC 28301 INFECTIOUS DISEASE 40 - CAPE FEAR VALLEY NEUROLOGY 3308 MELROSE ROAD FAYETTEVILLE NC 28304 NEUROLOGY PART I, LINE 6A: CUMBERLAND COUNTY HOSPITAL SYSTEM FILES A COMMUNITY BENEFIT REPORT ANNUALLY IN THE STATE OF NORTH CAROLINA TO THE NORTH CAROLINA HOSPITAL ASSOCIATION. PART I, LINE 7: EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE $142,273,897 IN BAD DEBT DEDUCTIONS WERE OFFSET FROM REVENUES IN THE FINANCIAL STATEMENTS. THERE IS NO NEED TO ADJUST THE TOTAL EXPENSE USED TO CALCULATE THE PERCENTAGES IN PART I, LINE 7, COLUMN (F).LINE 7A - CHARITY CARE COSTS WERE CALCULATED USING A MEDICAID SPECIFIC COST-TO-CHARGE RATIO (CCR) FROM THE MEDICARE COST REPORT. A MEDICAID CCR WAS USED BECAUSE THE MEDICAID POPULATION BETTER REPRESENTS THE UTILIZATION AND ACUITY OF THE CHARITY POPULATION THAN THE USE OF AN OVERALL CCR AS CALCULATED IN WORKSHEET 2. A CCR WAS USED INSTEAD OF A COST ACCOUNTING SYSTEM BECAUSE CHARITY, AS WELL AS BAD DEBTS, REPRESENT ONLY A PORTION OF A PATIENT ACCOUNT THAT IS BEING WRITTEN OFF. PART I, LINE 7G: LINE 7B, 7C & 7G - A MEDICAID CCR WAS USED TO ESTIMATE THE MEDICAID FFS & MEDICAID MANAGED CARE AMOUNTS REPORTED ON LN 7B, THE NC HEALTHCHOICE (NC SCHIP PROGRAM) REPORTED ON LN 7C AND THE SUBSIDIZED HEALTH SERVICES REPORTED ON LN 7G. THE COST ACCOUNTING SYSTEM DATA USED DID INCLUDE INFORMATION FROM ALL PATIENT SEGMENTS REGARDLESS OF PAYOR. LN 7G INCLUDES SUBSIDIZED SERVICES FOR FREESTANDING CLINICS AS WELL. PART II, COMMUNITY BUILDING ACTIVITIES: CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. ("CCHS") CONTINUES TO ENGAGE IN COALITION BUILDING AND WORKFORCE DEVELOPMENT ACTIVITIES IN THE COMMUNITY. COALITION BUILDING PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY NETWORKING WITH OTHER COMMUNITY AGENCIES TO ADDRESS THE HEALTH AND SAFETY ISSUES OF THE COMMUNITY. THE EMPLOYEES OF CCHS UTILIZE THEIR CLINICAL EXPERTISE TO COLLABORATE WITH OTHER COMMUNITY AGENCIES AND COUNTY AND STATE HEALTH DEPARTMENTS TO PROVIDE EDUCATION AND OTHER INITIATIVES THAT BENEFIT THE HEALTH OF PEOPLE IN THE COMMUNITY. WORKFORCE DEVELOPMENT ACTIVITIES INCLUDE THE RECRUITMENT OF PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO MEDICAL SHORTAGE AREAS. PART III, LINE 2: IN THE CURRENT YEAR, BAD DEBTS ARE REPORTED AT CHARGES WRITTEN OFF IN THE PERIOD PLUS AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS. SEE THE LINE 4 NOTE BELOW FOR A MORE DETAILED DESCRIPTION OF THE METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 2 PER THE FINANCIAL STATEMENT FOOTNOTE RELATED TO "PROVISION FOR UNCOLLECTIBLE ACCOUNTS". DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE REFLECTED IN THE PATIENT BALANCE PRIOR TO ACCOUNTS BEING WRITTEN OFF TO BAD DEBT. PART III, LINE 4: AUDITED FINANCIAL STATEMENT FOOTNOTE -THE HEALTH SYSTEM'S PATIENT ACCOUNTS RECEIVABLE IS RECORDED NET OF ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS OF $253,708,000 AT SEPTEMBER 30, 2021. THE HEALTH SYSTEM'S NET PATIENT SERVICE REVENUE IS PRESENTED NET OF PROVISION OF UNCOLLECTIBLE ACCOUNTS OF $186,174,000 FOR THE YEAR ENDED SEPTEMBER 30, 2021. PART III, LINE 8: THE COST REPORTED ON LINE 6 ARE PER THE MEDICARE COST REPORT AND WERE CALCULATED BASED ON COST-TO-CHARGE RATIOS. SINCE THE AMOUNTS REPORTED ON LINES 5 & 6 ONLY INCLUDE MEDICARE PART A COSTS AND PAYMENTS, THE OTHER MEDICARE (I.E. - MEDICARE PT C, PHYSICIAN SERVICES, FEE SCHEDULE, NON-ALLOWABLE) COSTS AND PAYMENTS ARE INCLUDED IN THE ATTACHED MEDICARE RECONCILIATION. 0 OF THE MEDICARE SHORTFALL, IF APPLICABLE, REPORTED ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT SINCE THAT PORTION OF THE SHORTFALL WAS RELATED TO THOSE PATIENTS THAT HAD MEDICAID AS A SECONDARY PAYOR AND THEREFORE DEEMED INDIGENT FOR MEDICARE BAD DEBT PURPOSES. PART III, LINE 9B: IF PATIENTS ARE DETERMINED TO QUALIFY FOR CHARITY, THEN THE ACCOUNT IS TREATED AS CHARITY RATHER THAN BAD DEBT. PART VI, LINE 2: THE MISSION OF CAPE FEAR VALLEY HEALTH SYSTEM IS TO STRENGTHEN THE HEALTH AND WELL-BEING OF THE GREATER CAPE FEAR VALLEY REGION THROUGH HIGH-QUALITY, COMPASSIONATE CARE PROVIDED TO ALL WHO NEED IT. AS A COMMUNITY NOT-FOR-PROFIT ORGANIZATION, WE TAKE SERIOUSLY OUR RESPONSIBILITY TO INVEST OUR RESOURCES AND ENERGIES INTO UNDERSTANDING AND MEETING THE DIVERSE HEALTH CARE NEEDS OF ALL, AND ENSURE THAT EVERYONE, REGARDLESS OF THEIR ABILITY TO PAY, RECEIVES THE CARE THEY NEED. THE SENIOR ADMINISTRATIVE TEAM SERVES IN VARIOUS CAPACITIES ON SEVERAL LOCAL COMMUNITY BOARDS AND GROUPS. AS MEMBERS OF THESE VARIOUS GROUPS, THEY ARE ABLE TO GAIN INSIGHT TO NEEDS OF THE COMMUNITY. OUR COMMUNITY PARTNERS ARE CRITICAL TO HELPING US IMPROVE THE HEALTH AND WELL-BEING OF THE CAPE FEAR VALLEY REGION. TOGETHER, WE CAN COMBINE RESOURCES AND STRENGTHS, POSITIVELY IMPACTING THE GREATEST NUMBER OF PEOPLE. BY WORKING CLOSELY WITH THE COMMUNITY LEADERS, WE ALSO BUILD A GREATER SENSE OF COMMUNITY AND A SHARED COMMITMENT TOWARD OUR COMMON GOAL OF IMPROVING THE COMMUNITY'S HEALTH. THE RESULTS HELP US TO DETERMINE OUR SHORT AND LONG TERM PRIORITIES AS WELL AS STRATEGIES FOR IMPROVING COMMUNITY HEALTH. THOSE COMMUNITY GROUPS AND PARTNERS CCCC, SRAHEC, CCMAP, CHAMBER OF COMMERCE, FAYETTEVILLE AREA PR ALLIANCE, CUMBERLAND FCOUNTY EDUCATION FOUNDATION, COMMUNITIES IN SCHOOLS OF NC, FORT BRAGG REGIONAL ALLIANCE, CARE CLINIC, AND THE METHODIST UNIVERSITY PHYSICIAN ASSISTANT PROGRAM. PART VI, LINE 3: UNINSURED PATIENTS ARE SCREENED AT THE TIME OF REGISTRATION FOR THEIR ABILITY TO PAY FOR THEIR HEALTH CARE SERVICES. IF THE PATIENT HAS NO ABILITY TO PAY AND IS DEEMED INELIGIBLE FOR GOVERNMENT PROGRAMS (MEDICARE, MEDICAID, ETC.) THEN THEY ARE INFORMED OF THE HOSPITAL CHARITY PROGRAM. THEY ARE PROVIDED WITH AN APPLICATION AND A LISTING OF THE APPROPRIATE DOCUMENTS NECESSARY TO ESTABLISH ELIGIBILITY FOR THE HOSPITAL CHARITY PROGRAM. ALL PATIENTS RECEIVE A COPY OF OUR CHARITY CARE APPLICATION ACCOMPANYING THE FIRST BILLING STATEMENT. PART VI, LINE 4: CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. ("CCHS") DOING BUSINESS AS CAPE FEAR VALLEY MEDICAL CENTER ("CFVMC") IS THE FLAGSHIP OF CAPE FEAR VALLEY HEALTH SYSTEM ("CFVHS"). CFVHS OPERATES A VARIETY OF THE HEALTHCARE FACILITIES FROM ITS HEADQUARTERS IN FAYETTEVILLE, NORTH CAROLINA INCLUDING A TERTIARY ACUTE CARE HOSPITAL, A LONG-TERM ACUTE CARE HOSPITAL, A CRITICAL ACCESS HOSPITAL, AN INPATIENT REHABILITATION FACILITY, COUNTY EMERGENCY MEDICAL SERVICES, AN OUTPATIENT PSYCHIATRIC FACILITY, A DETOXIFICATION FACILITY, A WELLNESS CENTER, 14 PRIMARY CARE CLINICS, 16 SPECIALTY CARE CLINICS, 4 WALK-IN CLINICS, AND HEALTH PAVILION NORTH, AN OUTPATIENT COMPLEX. CAPE FEAR VALLEY HEALTH SYSTEM SERVES A SIX-COUNTY SERVICE AREA MADE UP OF THE FIVE COUNTIES CONTIGUOUS TO CUMBERLAND COUNTY, NC, WHICH IS ITS PRIMARY SERVICE AREA. PER INFORMATION FROM THE 2012 ESTIMATED CENSUS DATA, CUMBERLAND HAS A POPULATION OF OVER 326,000 RESIDENTS; THIS WAS A GROWTH OF 6.9% FROM THE 2000 CENSUS DATA. APPROXIMATELY 54.2% OF THE 326,000 RESIDENTS IN OUR PRIMARY SERVICE AREA ARE MINORITIES, COMPARED TO 35.6% FOR THE STATE. PART VI, LINE 5: CHRONIC DISEASES LIKE DIABETES AND OBESITY ARE INCREASING WITHIN OUR COMMUNITY. OUR FACILITY HAS OPENED A DIABETES AND ENDOCRINE CLINIC TO HELP THOSE PATIENTS DIAGNOSED WITH DIABETES. OUR HEALTHPLEX PROVIDES BOTH NUTRITIONAL AND EXERCISE PROGRAMS TO HELP THOSE IN THE COMMUNITY ADDRESS THE PROBLEM OF OBESITY. THE GOAL IS TO HELP ALL RESIDENTS LEARN TO MANAGE THEIR CONDITIONS AND LIVE HEALTHIER LIVES BY ADDRESSING THE CHALLENGES ASSOCIATED WITH THESE CONDITIONS. EXAMPLE OF PROGRAM AT CAPE FEAR VALLEY: CAPE FEAR VALLEY HEALTH SYSTEM'S "TAKE CHARGE OF YOUR HEALTH" PROGRAM BEGAN AS AN INITIATIVE TO CLOSE THE HEALTHCARE GAP BETWEEN AFRICAN-AMERICANS AND NON-HISPANIC WHITES IN CUMBERLAND COUNTY THROUGH PUBLIC SERVICE ANNOUNCEMENTS, HEALTH FAIRS, SCREENINGS AND SPEAKING ENGAGEMENTS. IT HAS SINCE BROADENED ITS FOCUS TO ALL OF CUMBERLAND COUNTY. DARVIN JONES IS THE COORDINATOR OF THE "TAKE CHARGE OF YOUR HEALTH" PROGRAM. HE SERVES ON THE BOARD OF DIRECTORS OF COMMUNITY HEALTH INTERVENTIONS & SICKLE CELL AGENCY, A NON-PROFIT THAT WORKS WITH INDIVIDUALS WITH SICKLE CELL DISEASE, HYPERTENSION AND DIABETES. DARVIN IS ALSO A MEMBER OF THE CUMBERLAND COUNTY COUNCIL FOR HEALTHY LIVING, A GROUP ASSEMBLED BY THE HEALTH DEPARTMENT, AND THE CUMBERLAND COUNTY SCHOOLS SCHOOL HEALTH ADVISORY COUNCIL. TAKE CHARGE OF YOUR HEALTH IS AFFILIATED WITH EAT SMART, MOVE MORE NORTH CAROLINA, A STATEWIDE INITIATIVE. AT CAPE FEAR VALLEY HEALTH SYSTEM, IT IS IMPORTANT TO US TO GIVE BACK TO OUR COMMUNITY. IN ADDITION TO EMPLOYEE UNITED WAY DONATIONS AND VOLUNTEER TIME, OUR EMPLOYEES PARTICIPATE IN A VARIETY OF COMMUNITY SERVICE INITIATIVES, TO INCLUDE THE HABITAT FOR HUMANITY AND THE FRIENDS OF CANCER RIVER WALK. LAST YEAR OUR EMPLOYEES GAVE OVER $250,000 IN DONATIONS TO VARIOUS COMMUNITY ORGANIZATIONS. PART VI, LINE 6: CUMBERLAND COUNTY HOSPITAL SYSTEM IS A STAND-ALONE HEALTH CARE ORGANIZATION AND IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 CAPE FEAR VALLEY MEDICAL FOUNDATION PO BOX 87526 FAYETTEVILLE NC 28304 561947017 501(C)(3) 240000 GENERAL SUPPORT CHILD ADVOCACY CENTER PO BOX 488 FAYETTEVILLE NC 283020488 562161682 501(C)(3) 7500 GENERAL SUPPORT STANTON HOSPITALITY HOUSE 1617 ROXIE AVENUE FAYETTEVILLE NC 28304 463444289 501(C)(3) 37500 GENERAL SUPPORT 3 PART I, LINE 2: CUMBERLAND COUNTY HOSPITAL SYSTEM AWARDS GRANTS TO THE CAPE FEAR VALLEY MEDICAL FOUNDATION FOR THE PURPOSE OF ASSISTING PATIENTS IN PAYING VARIOUS BILLS AND OTHER EXPENSES WHICH PATIENTS CANNOT PAY DUE TO THEIR EXCESSIVE MEDICAL EXPENSES REQUIRED FOR TREATING ILLNESS. PATIENTS APPLY AND APPLICATIONS ARE REVIEWED BY HOSPITAL SOCIAL WORKERS. ANY FUNDS GRANTED ARE PAID DIRECTLY TO THE ORGANIZATION FOR WHICH PATIENT OWES THE BILL AND/OR EXPENSE. ALL GRANT FUNDING REQUESTS MUST BE MADE IN WRITING. MEETINGS ARE HELD TO ENSURE THE GOALS OF THE HEALTH SYSTEM ARE MAINTAINED. X X X X X 0 0 0 0 0 0 0 1 0 CHARLES HAWORTH MD PHYSICIAN 899995 0 475910 0 89855 0 8550 0 11206 0 1485516 0 0 0 MICHAEL NAGOWSKI CEO 1020001 0 430668 0 3643 0 8550 0 9134 0 1471996 0 0 0 ROBERT MAUGHAN MD PHYSICIAN 770000 0 559436 0 74755 0 8550 0 4021 0 1416762 0 0 0 MELISSA STAMATES PHYSICIAN 830000 0 0 0 100021 0 8550 0 6443 0 945014 0 0 0 SANDRA WILLIAMS CFO 569702 0 291768 0 7744 0 8550 0 943 0 878707 0 0 0 MICHAEL ZAPPA MEDICAL DIRECTOR 608154 0 81370 0 45321 0 8550 0 2436 0 745831 0 0 0 SAMUEL FLEISCHMAN CMO 466385 0 115920 0 118568 0 8550 0 7931 0 717354 0 0 0 TARIQ NAZIR PHYSICIAN 537495 0 126025 0 19398 0 8550 0 8718 0 700186 0 0 0 DANIEL WEATHERLY COO 526616 0 111603 0 0 0 8550 0 9278 0 656047 0 0 0 PART I, LINE 7 THE HOSPITAL PROVIDES INCENTIVE COMPENSATION TO ITS EXECUTIVES, WHICH IS BASED ON THE QUANTITATIVE AND QUALITATIVE PERFORMANCE OF THE HOSPITAL. THE DETERMINATION OF INCENTIVE COMPENSATION FOLLOWS THE HOSPITAL'S COMPENSATION PROCEDURES AS OUTLINED IN FORM 990, PART VI, SECTION B, LINE 15. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DPP0 2012-12-19 124978739 SEE DETAIL 1 0 0 B PUBLIC FINANCE AUTHORITY 273866124 000000000 2020-12-10 152000000 SEE DETAIL 0 0 0 A 54305000 53890000 124978739 1630191 123348548 2012 0 1 1 1 B 152000000 152000000 1 0 1 1 A 0 0 1 1 0 0.00360 0.00360 0 0 1 B 0 0 1 1 0 0.00360 0.00360 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 SCHEDULE K, PART I, COLUMN F - DESCRIPTION OF PURPOSE BOND A ISSUED 12/19/2012 - TO PARTIALLY REFUND BONDS ISSUED 9/23/2008 BOND B ISSUED 12/10/2020 - $50,000,000 ISSUED TO REFUND A PORTION OF THE $152,000,000 BONDS ISSUED IN 2017 TO PARTIALLY REFUND BONDS ISSUED 9/23/2008, AND $102,000,000 DEEMED TO CURRENTLY REFUND A PORTION OF THOSE 2017 BONDS UPON CONVERSION TO A NEW MODE AND REISSUED, BECOMING ONE ISSUE FOR FEDERAL INCOME TAX PURPOSES. SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: (A) ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 02/19/2018 SCHEDULE K, SUPPLEMENTAL INFORMATION: PART IV, LINE 6, COLUMN A THIS QUESTION IS BEING ANSWERED WITHOUT REGARD TO A YIELD-RESTRICTED ADVANCE REFUNDING ESCROW FINANCED WITH PROCEEDS OF THE BONDS. SCHEDULE K, PART IV, ARBITRAGE, LINE 7: INVESTMENT OF BOND PROCEEDS ARE BEING MONITORED THROUGH THE WRITTEN PROCEDURE REQUIREMENTS OF SECTION 148. FORM 990, PART I, LINE 1 CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. EXISTS TO MEET THE HEALTH CARE NEEDS OF THE RESIDENTS OF CUMBERLAND AND BLADEN COUNTIES, AND THE SURROUNDING AREA IN NORTH CAROLINA. FORM 990, PART VI, SECTION A, LINE 7A THE CUMBERLAND COUNTY BOARD OF COMMISSIONERS, WHICH IS A GOVERNMENTAL UNIT, APPOINTS THE MAJORITY OF THE CUMBERLAND COUNTY HOSPITAL SYSTEM. THE BOARD OF TRUSTEES OF CUMBERLAND COUNTY HOSPITAL SYSTEM IS COMPRISED OF SEVEN TRUSTEES WHO ARE THE SEVEN MEMBERS OF THE BOARD OF COMMISSIONERS. THE BOARD OF TRUSTEES WILL ALSO HAVE EIGHT AT LARGE TRUSTEES WHO ARE APPOINTED BY THE BOARD OF COMMISSIONERS. THE REMAINING FIVE AT LARGE MEMBERS ARE APPOINTED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S FORM 990 IS PREPARED BY KPMG, THEN IT IS REVIEWED BY THE FINANCE DEPARTMENT OF CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. UPON COMPLETION OF THE FORM 990, IT IS PROVIDED TO THE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATE POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. FORM 990, PART VI, SECTION B, LINE 15 A HUMAN RESOURCES CONSULTING FIRM IS RETAINED BY CUMBERLAND COUNTY HOSPITAL SYSTEMS, INC. TO REVIEW THE COMPETITIVENESS AND REASONABLENESS OF THE COMPENSATION PROVIDED TO THE CEO AND OTHER TOP MANAGEMENT PERSONNEL. FORM 990, PART VI, SECTION B, LINE 16B: HOSPITAL REGULARLY EVALUATES THE JOINT VENTURES IN WHICH IT PARTICIPATES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC UPON REQUEST. ORGANIZATION'S FORM 990 IS OPEN FOR PUBLIC INSPECTION, PROVIDES FINANCIAL INFORMATION, AND ADDRESSES ISSUES OF GOVERNANCE SUCH AS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNANCE DOCUMENTS. BLADEN COUNTY HEALTHCARE LLC PO BOX 2000 FAYETTEVILLE NC 28302 800164702 HEALTH SERVICES NC 42708726 36697487 CCHS CUMBERLAND HEALTH AFF LLC (INACTIVE) PO BOX 2000 FAYETTEVILLE NC 28302 562275588 HEALTH SERVICES NC 0 0 CCHS VALLEY HEALTH FACILITIES LLC (INACTIVE) PO BOX 2000 FAYETTEVILLE NC 28302 204268819 HEALTH SERVICES NC 0 0 CCHS HOKE HEALTHCARE LLC PO BOX 2000 FAYETTEVILLE NC 28302 272763125 HEALTH SERVICES NC 77963883 126448474 CCHS CAPE FEAR VALLEY MEDICAL FOUNDATION PO BOX 87526 FAYETTEVILLE NC 28304 561947017 FUNDRAISING NC 501(C)(3) 7 CCHS 1 BLADEN COUNTY HOSPITAL FOUNDATION INC PO BOX 398 ELIZABETHTOWN NC 28337 561833893 FUNDRAISING NC 501(C)(3) 7 CCHS 1 HARNETT HEALTH SYSTEM INC PO BOX 1706 DUNN NC 28335 560603898 HEALTH SERVICES NC 501(C)(3) 3 CCHS 1 HARNETT HEALTH SYSTEM FOUNDATION 800 TILGMAN DRIVE DUNN NC 28334 201929953 FUNDRAISING NC 501(C)(3) 7 N/A 0 FAYETTEVILLE AMB SURGERY CENTER 1781 METROMEDICAL DRIVE FAYETTEVILLE NC 28304 561754482 HEALTHCARE NC CCHS RELATED 1014896 6421310 0 1 0.68320 THE MED IMAGING CENTER LLC 3186 VILLAGE DRIVE STE 101 FAYETTEVILLE NC 28304 264473832 HEALTHCARE NC CCHS RELATED 481808 474613 0 0 0.67800 HIGHSMITH-RAINEY MED ARTS CENTER ASSOC PO BOX 2000 FAYETTEVILLE NC 28302 561747424 RENTAL ASSOC. NC CCHS C 100732 724998 1.00000 1 CUMBERLAND HLTH PARTNERS INC (INACTIVE) PO BOX 2000 FAYETTEVILLE NC 28302 562043978 BEHAVIORAL HEALTH NC CCHS C 1.00000 1 CAPE FEAR INSURANCE LTD PO BOX 30600 SMB WEST BAY RD GRAND CAYMAN CJ 980449284 INSURANCE CJ CCHS C -5674134 64198763 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 CAPE FEAR VALLEY MEDICAL FOUNDATION B 240000 CASH CAPE FEAR VALLEY MEDICAL FOUNDATION C 260691 CASH CAPE FEAR VALLEY MEDICAL FOUNDATION N 8168 CASH CAPE FEAR VALLEY MEDICAL FOUNDATION O 295692 CASH