2020-11-02T12:38:46-06:00 2019-12-31 990 2019-01-01 560928089 FORSYTH MEMORIAL HOSPITAL INC FORS 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT EVP & CFO 3367182803 2020-10-31 170.98.106.254 2020-10-31 09:10:24 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A2315309B7343EB998963AA05290CF11231D17E5 2019 2021-01-29 14:40:06Z NOVANT HEALTH FORSYTH MEDICAL CENTER CARL ARMATO 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 1507967237 0 X WWW.NOVANTHEALTH.ORG X 1968 NC SEE SCHEDULE O 15 12 8178 849 0 0 2758815 1764533 1404103334 1498133546 377048 -360296 9796685 7574138 1417035882 1507111921 1180904 1103779 0 0 548238589 584808516 0 0 0 747284720 813508722 1296704213 1399421017 120331669 107690904 1692009282 1827333103 95643703 128402528 1596365579 1698930575 X SEE SCHEDULE O 0 0 1138544025 1103779 1498804982 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 2019 THERE WERE 227,597 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 6 DAYS, AN AVERAGE DAILY CENSUS OF 624, AND 38,474 DISCHARGES. THERE WERE 25,466 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 459,224 OUTPATIENT ENCOUNTERS AND 90,165 EMERGENCY DEPARTMENT VISITS.(CONTINUED ON SCHEDULE O) 1138544025 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 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 8178 1 0 0 0 0 0 0 0 0 0 0 0 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 KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X LINDSAY JEFFERY FMR PRES - FMH/COO WS MKT 0.00 50.00 X 0 2114621 55112 MIHAL DENISE FMR PRES - FMH/COO WS MKT 0.00 50.20 X 0 1694262 44291 SMITH HARRY SVP HOSPITAL OPERATIONS 0.00 50.00 X 0 1328697 161733 NYCUM LAWRENCE MD SVP CHIEF CLINICAL OFFICER 50.00 0.20 X 902929 0 127809 GREGORY CHERE MD FMR SVP 0.00 50.00 X 0 856683 113774 COLLINS TIMOTHY ONCOLOGIST 45.00 0.00 X 863760 0 65682 FRIEDMAN ROLAND UROLOGIST 45.00 0.00 X 860654 0 66373 JEPSEN ERIN ONCOLOGIST 45.00 0.00 X 819768 0 60706 SETLIFF MICHAEL PRES & COO 50.00 0.20 X 713160 0 127270 ELLIOTT KATHLEEN ONCOLOGIST 45.00 0.00 X 744347 0 62489 CRAVEN BRANDON UROLOGIST 45.00 0.00 X 709350 0 63053 MANN JOHN PRESIDENT & COO 50.00 0.00 X 0 665984 95277 MOTEW STEPHEN MD FMR SVP 50.00 0.00 X 685077 0 28629 BERGER WILLIAM MD TRUSTEE 0.20 45.00 X 0 562485 60539 ROYSTER KIRSTEN PRES & COO KMC 50.00 0.00 X 583592 0 33639 EDWARDS JOEL MD TRUSTEE 45.00 0.00 X 542508 0 33716 MORRIS JOHN ASST SEC 0.20 45.00 X 0 395561 47121 BRIGHT JANET FMR VP NURSING & MARKET CNO 50.00 0.00 X 416917 0 24829 HEALY JOAN ASST SEC 0.20 0.00 X 0 247477 13596 LOBO LUIS VICE CHAIR 0.20 0.00 X X 0 67 0 BAREFOOT SAMUEL TRUSTEE 0.20 0.20 X 0 0 0 BROWN CANDICE TRUSTEE 0.20 0.00 X 0 0 0 CARROLL JOE TRUSTEE 0.20 0.00 X 0 0 0 FORIEST BRYANT TRUSTEE 0.20 0.40 X 0 0 0 HARDING LARI SEC/TREAS 0.20 0.00 X X 0 0 0 HAUSER CHARLES TRUSTEE 0.20 0.00 X 0 0 0 JOHNSON JOIA CHAIR 0.20 0.20 X X 0 0 0 LANDRY ROBERT TRUSTEE 0.20 0.00 X 0 0 0 LATHAM LINDA TRUSTEE 0.20 0.00 X 0 0 0 LEON CHRISTOPHER TRUSTEE 0.20 0.00 X 0 0 0 WELTON CHARLES TRUSTEE 0.20 0.00 X 0 0 0 WOLFE III JOHN TRUSTEE 0.20 0.00 X 0 0 0 7842062 7865837 1285638 694 1 1 0 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 16620545 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD MANAGEMENT SERVICES 11720039 MAGNOLIA CONSTRUCTION LLC 514 S STRATFORD RD STE 140 WINSTON SALEM NC 27103 CONSTRUCTION SERVICES 11456479 VANNOY CONSTRUCTION PO BOX 635 JEFFERSON NC 28640 CONSTRUCTION SERVICES 6309112 SPECTRUM MEDICAL GROUP PA 3001 LYNDHURST AVENUE WINSTON SALEM NC 27103 HEALTH SERVICES 6163724 97 1524877 239656 1764533 NET PATIENT REVENUE 622110 1435024348 1435024348 PHARMACY 446110 60801974 60801974 PASS-THRU PATIENT REV 621111 1377097 1377097 VALUE BASED INCENTIVE 900099 888079 888079 PHYSICIAN SERVICES 621111 42048 42048 1498133546 125783 125783 510711 0 510711 510711 510711 306529 792608 -486079 -486079 -486079 104342 62708 41634 41634 CAFETERIA MEALS 722514 3758090 3758090 CHILD DEVELOPMENT CENTER 624410 1640002 1640002 MISCELLANEOUS REVENUE 900099 975893 671401 304492 647808 35 647773 7021793 1507111921 1498804982 0 6542406 973572 973572 130207 130207 4220075 4220075 462185672 443698245 18487427 18890808 18135176 755632 69748633 66958686 2789947 29763328 28572795 1190533 82545 82545 274 274 110781336 95066708 15714628 1078185 1048866 29319 5818738 4583071 1235667 9185110 9047219 137891 28665406 27522391 1143015 1471300 1417453 53847 223663 214716 8947 16712970 16712970 26270614 24130652 2139962 2151993 1919299 232694 CORPORATE SUPPORT 196388415 196388415 MEDICAL SUPPLIES 140632477 140316650 315827 PHARMACEUTICALS 135989593 135989593 BAD DEBT 87071420 87071420 50984683 35034336 15950347 1399421017 1138544025 260876992 0 37164 393328 160863070 263760491 13452882 14921289 23191358 23973728 799157 967602 603788660 343236771 233714472 260551889 13275998 14422125 31015047 31015047 1215660134 1217327604 1692009282 1827333103 65310957 68765444 98891 30233855 59637084 95643703 128402528 X 1596365216 1698930125 363 450 1596365579 1698930575 1692009282 1827333103 X 107690904 -136043 -4989865 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 314 0 1 58234 58548 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. 363 87 450 363 363 0.00000 1.00000 0.00000 0 0 10727897 10727897 165784284 40973977 124810307 16975234 10740020 6235214 354898962 272736390 82162572 55402283 18786384 36615899 260551889 DUE FROM AFFILIATE 1194469713 OTHER ASSETS 54809 RIGHT OF USE ASSETS 22803082 1217327604 0 THIRD PARTY PAYMENT PAYABLE 9380914 NOTES PAYABLE 17697847 PATIENT REFUNDS 9184139 OPERATING LEASE 23374184 59637084 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, 2019 AND 2018. 1 1 X 1 X 300.000000000000 0 0 1 1 0 1 1 46369928 0 46369928 0.03530 170136357 121717595 48418762 0.03690 2256507 1906004 350503 0.00030 218762792 123623599 95139193 0.07250 395526 4580 390946 0.00030 8906245 1440454 7465791 0.00570 26745958 14144912 12601046 0.00960 1348851 0 1348851 0.00100 498230 0 498230 0.00040 37894810 15589946 22304864 0.01700 256657602 139213545 117444057 0.08950 62500 0 62500 0.00000 226630 0 226630 0.00020 26738 0 26738 0.00000 123368 0 123368 0.00010 439236 439236 0.00030 1 87071420 0 222829086 230133451 -7304365 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 19 1 0 0 1 X SEE SECTION C X 1 19 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 1 NOVANT HEALTH REHABILITATION HOSPITAL 1 1 0 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:SEVERAL SOCIAL, BEHAVIORAL, AND CLINICAL HEALTH NEEDS WERE IDENTIFIED 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 ACCORDING TO THE YEARS OF POTENTIAL LIFE LOST 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. THE PRIORITIZED IDENTIFIED HEALTH NEEDS AND SUPPORTING DATA ARE THEN REVIEWED AND DELIBERATED UPON FURTHER BY THE BOARD. AN IMPLEMENTATION PLAN IS CREATED FOR CERTAIN OF THE PRIORITIZED, IDENTIFIED HEALTH NEEDS AND ASSESSED REGULARLY THROUGHOUT THE COMMUNITY HEALTH NEEDS ASSESSMENT LIFE CYCLE. COMMUNITY PARTNERS WHO ARE CURRENTLY DOING THE WORK 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 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 COMMUNITY MEETINGS, STAKEHOLDER'S INTERVIEWS, AND SOLICITED THROUGH WRITTEN COMMENTS THROUGHOUT THE SURVEY PERIOD UNTIL THE FINAL COMMUNITY PRIORITY SETTING MEETING(S) AND 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. FORSYTH MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 7D: FORSYTH MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 7BHTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPXFORSYTH MEMORIAL HOSPITAL, INC.PART V, SECTION B, LINE 10AHTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPX 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, AND KEY STRENGTHS 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 AND CONSISTENT ACROSS COMMUNITIES. 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 (IE. DENTAL WORK) 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 SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE; REFER TO THE URL GIVEN PREVIOUSLY 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/HOME/PATIENTS--VISITORS/YOUR-HEALTHCARE-COSTS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPXSCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP APART V, LINE 16B, FAP APPLICATION:HTTPS://WWW.NOVANTHEALTH.ORG/PORTALS/92/NOVANT_HEALTH/DOCUMENTS/PATIENTS_VISITORS/FINANCIAL_SERVICES/FINANCIAL%20ASSISTANCE%20APPLICATIONS/2019/FINANCIAL_ASSISTANCE/FAA_APP_ENGLISH.PDFSCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP APART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:HTTPS://WWW.NOVANTHEALTH.ORG/PORTALS/92/NOVANT_HEALTH/DOCUMENTS/PATIENTS_VISITORS/FINANCIAL_SERVICES/FINANCIAL%20ASSISTANCE%20APPLICATIONS/2019/PLAIN_LANGUAGE/NOVANT%20HEALTH%20ACUTE%20PLS%20ENGLISH.PDF FORSYTH MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 24: IT IS POSSIBLE FOR A FINANCIAL ASSISTANCE POLICY (FAP) ELIGIBLE PATIENT TO BE CHARGED AN AMOUNT EQUAL TO THE GROSS CHARGE FOR A NON-EMERGENCY OR NON-MEDICALLY NECESSARY SERVICE. HOWEVER, IF THE SERVICE IS DEEMED AN EMERGENCY OR A MEDICAL NECESSITY, THEN THE FAP ELIGIBLE PATIENT WOULD NOT BE CHARGED FOR CARE AND WOULD NOT RECEIVE A BILL ONCE FAP ELIGIBILITY HAD BEEN ESTABLISHED. 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 2: NOVANT HEALTH REHABILITATION HOSPITAL OPENED IN OCTOBER 2018. NOVANT HEALTH REHABILITATION HOSPITAL PART V, SECTION B, LINE 13H: SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP BPART V, LINE 16A, FAP WEBSITE:HTTPS://WWW.ENCOMPASSHEALTH.COM/-/MEDIA/HEALTHSOUTH/PROJECT/HEALTHSOUTH/FILES/FINANCIAL-ASSISTANCE/2019-FINANCIAL-POLICY/NOVANT_FA_POLICY.PDF?LA=EN&HASH=77C51099FE74B3549A26469D6B5C465479CC77FASCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP BPART V, LINE 16B, FAP APPLICATION:HTTPS://WWW.ENCOMPASSHEALTH.COM/-/MEDIA/HEALTHSOUTH/PROJECT/HEALTHSOUTH/FILES/FINANCIAL-ASSISTANCE/2019_APPLICATION/NOVANT_FA_INST_APP.PDF?LA=EN&HASH=C17E842E930B98DF8A794D58BEF97AF1CA5C3310SCHEDULE H, PART V, SECTION B. FACILITY REPORTING GROUP BPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY:HTTPS://WWW.ENCOMPASSHEALTH.COM/-/MEDIA/HEALTHSOUTH/PROJECT/HEALTHSOUTH/FILES/FINANCIAL-ASSISTANCE/2019_PLAIN_LANGUAGE/NOVANT_FA_PLAIN_LANG_2.PDF?LA=EN&HASH=4B1FC5F7C19BAE59694B321B07BCB4E4FB2AA6A1 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. 55 1 - NH ARCADIA FAMILY MEDICINE 12208 NC HWY 150 NORTH WINSTONSALEM NC 27127 PHYSICIAN CLINIC 2 - NH BREAST CENTER 2025 FRONTIS PLAZA BLVD SUITE 123 WINSTONSALEM NC 27103 IMAGING CENTER 3 - NH CARDIOLOGY CLEMMONS 7114 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 PHYSICIAN CLINIC 4 - NH CARDIOLOGY KERNERSVILLE 1710 KERNERSVILLE MED PKWY STE 205 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 5 - NH CARDIOLOGY MT AIRY 694 RIVERSIDE DR MOUNT AIRY NC 27030 PHYSICIAN CLINIC 6 - NH CARDIOLOGY WINSTON-SALEM 186 KIMEL PARK DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 7 - NH CHAIR CITY FAMILY MEDICINE 903 RANDOLPH ST THOMASVILLE NC 27360 PHYSICIAN CLINIC 8 - NH CLEMMONS FAMILY MEDICINE 6301 STADIUM DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC 9 - NH CLEMMONS OUTPATIENT SURGERY 7210 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 AMBULATORY SURGERY CENTER 10 - NH DAVIE MEDICAL ASSOCIATES 485 VALLEY ROAD MOCKSVILLE NC 27028 PHYSICIAN CLINIC 11 - NH FORSYTH ENDOCRINE CONSULTANTS 755 HIGHLAND OAKS DRIVE SUITE 201 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 12 - NH FORSYTH FAMILY MEDICINE 400 JONESTOWN ROAD WINSTONSALEM NC 27104 PHYSICIAN CLINIC 13 - NH FORSYTH INTERNAL MEDICINE 1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 14 - NH GATEWAY FAMILY MEDICINE 390 SALEM AVENUE WINSTONSALEM NC 27101 PHYSICIAN CLINIC 15 - NH HAWTHORNE OUTPATIENT SURGERY 1999 S HAWTHORNE ROAD WINSTONSALEM NC 27103 AMBULATORY SURGERY CENTER 16 - NH HILLSDALE MEDICAL ASSOCIATES 121 MEDICAL DRIVE ADVANCE NC 27006 PHYSICIAN CLINIC 17 - NH IMAGING KERNERSVILLE 445 PINEVIEW DRIVE SUITE 100 KERNERSVILLE NC 27284 IMAGING CENTER 18 - NH IMAGING MAPLEWOOD 3155 MAPLEWOOD AVENUE WINSTONSALEM NC 27103 IMAGING CENTER 19 - NH INFECTIOUS DISEASE SPECIALISTS 1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 20 - NH INPATIENT CARE SPECIALISTS KERNERSVILLE 1750 KERNERSVILLE MEDICAL PKWY KERNERSVILLE NC 27284 PHYSICIAN CLINIC 21 - NH INTENSIVE DIABETES MANAGEMENT 1400 WESTGATE CENTER DRIVE STE 130 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 22 - NH KERNERSVILLE FAMILY MEDICINE 291 BROAD STREET WINSTONSALEM NC 27284 PHYSICIAN CLINIC 23 - NH KERNERSVILLE OUTPATIENT SURGERY 1730 KERNERSVILLE MED PKWY STE 304 KERNERSVILLE NC 27284 AMBULATORY SURGERY CENTER 24 - NH LEWISVILLE FAMILY MEDICINE 1225 LEWISVILLE-CLEMMONS ROAD LEWISVILLE NC 27023 PHYSICIAN CLINIC 25 - NH LEXINGTON PRIMARY CARE 110 WEST MEDICAL PARK DRIVE LEXINGTON NC 27292 PHYSICIAN CLINIC 26 - NH MAPLEWOOD FAMILY MEDICINE ROBINHOOD MEDICAL PLAZA BLDG 100 WINSTONSALEM NC 27106 PHYSICIAN CLINIC 27 - NH MOUNTAINVIEW MEDICAL 216 MOORE ROAD KING NC 27021 PHYSICIAN CLINIC 28 - NH NEW GARDEN MEDICAL ASSOCIATES 1941 NEW GARDEN RD SUITE 216 GREENSBORO NC 27410 PHYSICIAN CLINIC 29 - NH NORTH POINT MEDICAL ASSOCIATES 1995 BETHABARA ROAD WINSTONSALEM NC 27106 PHYSICIAN CLINIC 30 - NH NORTHWEST FAMILY MEDICINE 7607 NC HIGHWAY 68 N STE B OAK RIDGE NC 27310 PHYSICIAN CLINIC 31 - NH ONCOLOGY SPECIALISTS 1213 LEXINGTON AVENUE STE B LEXINGTON NC 27360 PHYSICIAN CLINIC 32 - NH ONCOLOGY SPECIALISTS 1710 KERNERSVILLE MED PKWY STE 116 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 33 - NH ONCOLOGY SPECIALISTS 276 OLD MOCKSVILLE ROAD STE 800 STATESVILLE NC 28625 PHYSICIAN CLINIC 34 - NH ONCOLOGY SPECIALISTS 865 WESTLAKE DRIVE MOUNT AIRY NC 27030 PHYSICIAN CLINIC 35 - NH PFAFFTOWN FAMILY MEDICINE 4611 YADKINVILLE ROAD PFAFFTOWN NC 27040 PHYSICIAN CLINIC 36 - NH PILOT MOUNTAIN MEDICAL CARE 207 MEDICAL STREET PILOT MOUNTAIN NC 27041 PHYSICIAN CLINIC 37 - NH PREMIER MEDICAL ASSOCIATES 3333 BROOKVIEW HILLS BLVD STE202-20 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 38 - NH PSYCHIATRIC MEDICINE 175 KIMEL PARK DRIVE SUITE 100 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 39 - NH PSYCHIATRIC MEDICINE 309 PINEYWOOD ROAD THOMASVILLE NC 27360 PHYSICIAN CLINIC 40 - NH RHEUMATOLOGY AND ARTHRITIS 1551 WESTBROOK PLAZA DR SUITE 200 WINSTONSALEM NC 27106 PHYSICIAN CLINIC 41 - NH SALEM FAMILY MEDICINE 105 VEST MILL CIRCLE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 42 - NH SPINE SPECIALISTS 5380 US HIGHWAY 158 SUITE 110 ADVANCE NC 27006 PHYSICIAN CLINIC 43 - NH SURRY MEDICAL ASSOCIATES 2133 ROCKFORD ST SUITE 1400 MOUNT AIRY NC 27030 PHYSICIAN CLINIC 44 - NH SURRY MEDICAL ASSOCIATES 865 WESTLAKE DRIVE MOUNT AIRY NC 27030 PHYSICIAN CLINIC 45 - NH THOMASVILLE MEDICAL ASSOCIATES 309 PINEYWOOD ROAD THOMASVILLE NC 27360 PHYSICIAN CLINIC 46 - NH TRIAD ENDOCRINE 500 PINEVIEW DR SUITE 101 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 47 - NH UROLOGY 140 KIMEL PARK DR SUITE 100 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 48 - NH UROLOGY 1730 KERNERSVILLE MED PKWY STE 303 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 49 - NH UROLOGY 2010 BALDWIN LANE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 50 - NH VILLAGE POINT FAMILY MEDICINE 7130 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 PHYSICIAN CLINIC 51 - NH WEST FORSYTH INTERNAL MED & PED 105 STADIUM OAKS DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC 52 - NH WINSTON-SALEM HEALTH CARE 175 KIMEL PARK DRIVE SUITE 250 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 53 - NH WINSTON-SALEM HEALTH CARE 250 CHARLOIS BLVD WINSTONSALEM NC 27103 PHYSICIAN CLINIC 54 - NH WOUND CARE & HYPERBARIC MEDICINE 1901 S HAWTHORNE ROAD SUITE 220 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 55 - NH YADKIN MEDICAL ASSOCIATES 305 EAST LEE AVENUE YADKINVILLE NC 27055 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/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPX. 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 HOSPITAL 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 $87,071,420. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESS THE UNDERLYING CAUSES OF HEALTH PROBLEMS AND IMPACTS THE HEALTH OF OUR COMMUNITY THROUGH PARTNERSHIPS WITH LOCAL AGENCIES DEDICATED TO IMPROVING THE LIVES OF ALL INDIVIDUALS. OUTREACH INCLUDES PROVIDING SUPPORT 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 OUTREACH METHODS WE ARE ABLE TO SUCCESSFULLY WORK TOWARDS BRIDGING THE GAP OF NEED WITHIN OUR IDENTIFIED IMPACTED COMMUNITIES. 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 BENEFIT DEPARTMENT ("CBE DEPARTMENT") COMPRISED OF COMMUNITY BENEFIT PROFESSIONALS. THE CBE 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 BENEFIT 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 REPRESENTING THE MEDICALLY UNDERSERVED, UNITED WAY, 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 PARTNERSHIPS WITH OTHER COMMUNITY ORGANIZATIONS WE ARE ABLE TO DRAW INFERENCE OF THE NEEDS NOT MET WITHIN THE IMMEDIATE COMMUNITIES WE SERVE, AND MEET AND EXCEED THOSE COMMUNITY MEMBER'S NEEDS. 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. ORGANIZATIONAL PARTNERSHIPS ESTABLISHED BY THE COMMUNITY BENEFIT DEPARTMENT ARE OFTEN LEVERAGED TO ADDRESS NEEDS THAT WERE IDENTIFIED IN THE CHNA, BUT WERE UNADDRESSED BY THE FACILITY IMPLEMENTATION PLAN. 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. HOMELESSNESS2. DECEASED WITH NO ESTATE3. MENTAL INCAPACITATION WITH NO ONE TO ACT ON PATIENT'S BEHALF4. 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; ONE WITH FACILITIES IN THREE LOCATIONS: FORSYTH MEMORIAL HOSPITAL, INC. DBA 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.FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH FORSYTH MEDICAL CENTER AND NOVANT HEALTH REHABILITATION HOSPITALTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA FOR NOVANT HEALTH FORSYTH MEDICAL CENTER AND NOVANT HEALTH REHABILITATION HOSPITAL IS DEFINED BY THE ZIP CODES THAT REPRESENT MORE THAN 75% OF THE HOSPITAL'S IN-PATIENT POPULATION. THIS INCLUDES CITY OF WINSTON-SALEM, THE TOWNS OF KERNERSVILLE, LEWISVILLE, RURAL HALL, WALNUT COVE, THE UNINCORPORATED COMMUNITY OF PFAFFTOWN, AND THE VILLAGE OF CLEMMONS, ALL OF WHICH ARE LOCATED IN FORSYTH COUNTY, NORTH CAROLINA. THE PRIMARY SERVICE AREA ALSO INCLUDES THE CITY OF LEXINGTON IN DAVIDSON COUNTY, THE TOWNS OF ADVANCE AND MOCKSVILLE, BOTH IN DAVIE COUNTY, THE CITY OF KING IN STOKES COUNTY, THE CITY OF MOUNT AIRY IN SURRY COUNTY, AND THE TOWN OF EAST BEND AND YADKINVILLE, BOTH IN YADKIN COUNTY. FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH CLEMMONS MEDICAL CENTERTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA FOR NOVANT HEALTH CLEMMONS MEDICAL CENTER IS DEFINED BY THE ZIP CODES THAT REPRESENT MORE THAN 75% OF THE HOSPITAL'S IN-PATIENT POPULATION. THIS INCLUDES CITY OF WINSTON-SALEM, THE TOWN OF LEWISVILLE, AND THE VILLAGE OF CLEMMONS, ALL OF WHICH ARE LOCATED IN FORSYTH COUNTY, NORTH CAROLINA. THE PRIMARY SERVICE AREA ALSO INCLUDES THE TOWNS OF ADVANCE AND MOCKSVILLE, BOTH IN DAVIE COUNTY, NORTH CAROLINA, AND THE TOWNS OF EAST BEND AND YADKINVILLE, BOTH IN YADKIN COUNTY, NORTH CAROLINA.THE SECONDARY SERVICE AREA FOR NOVANT HEALTH CLEMMONS MEDICAL CENTER COVERS DAVIDSON AND STOKES COUNTIES. 66% OF THE PATIENTS IN THE PRIMARY SERVICE AREA RESIDE IN FORSYTH COUNTY AND 30% RESIDE IN DAVIE COUNTY, WHILE 66% OF THE PATIENTS IN THE PRIMARY AND SECONDARY SERVICE AREAS RESIDE IN FORSYTH COUNTY.FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH KERNERSVILLE MEDICAL CENTERTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA FOR NOVANT HEALTH KERNERSVILLE MEDICAL CENTER IS DEFINED BY THE ZIP CODES THAT REPRESENT MORE THAN 75% OF THE HOSPITAL'S IN-PATIENT POPULATION. THIS INCLUDES CITY OF WINSTON-SALEM, THE TOWNS OF KERNERSVILLE, WALKERTOWN, WALNUT COVE, AND THE TOWNSHIP OF BELEWS CREEK, ALL OF WHICH ARE LOCATED IN FORSYTH COUNTY, NORTH CAROLINA. THE PRIMARY SERVICE AREA ALSO INCLUDES THE TOWN OF STOKESDALE IN GUILDFORD COUNTY, NORTH CAROLINA.THE SECONDARY SERVICE AREA FOR NOVANT HEALTH KERNERSVILLE MEDICAL CENTER COVERS DAVIDSON AND STOKES COUNTIES.FORSYTH COUNTY IS MOSTLY URBAN IN NATURE, WITH ONLY 7.4% OF THE POPULATION LIVING IN RURAL AREAS. THE COUNTY CONSISTS OF A LARGE URBAN CENTER SURROUNDED BY SMALLER, MORE RURAL COMMUNITIES. BASED ON 2018 ESTIMATES, FORSYTH COUNTY REMAINED THE FOURTH LARGEST COUNTY IN THE STATE OF NORTH CAROLINA WITH 379,099 RESIDENTS. FROM 2020 TO 2030, THE POPULATION OF FORSYTH COUNTY IS PROJECTED TO GROW BY 4.0% WHICH IS DOWN FROM 7.0% FOR THE 2010-2020 PERIOD. ADOLESCENTS (INDIVIDUALS 18 AND YOUNGER) MAKE UP AN ESTIMATED 22.9% OF THE POPULATION IN FORSYTH COUNTY, WHILE SENIORS (INDIVIDUALS 65 AND OLDER) MAKE UP 16.0% OF THE POPULATION. MEDIAN AGE CONTINUES TO INCREASE, AND WE CAN SEE A SHIFT IN THE POPULATION FROM ADOLESCENTS TO SENIORS AS OUR POPULATION CONTINUES TO AGE. THIS TREND MAY PUT A STRAIN ON HEALTHCARE SERVICES IN FORSYTH COUNTY BECAUSE HEALTH CARE FOR OLDER PERSONS IS DIFFERENT FROM THAT PROVIDED TO OTHER AGE GROUPS IN SEVERAL RESPECTS: GREATER RESOURCE DEMANDS, THE INTERTWINING OF PROFESSIONAL HEALTH SERVICES WITH SOCIAL SERVICES, THE FREQUENT OCCURRENCE OF IMPORTANT ETHICAL CONUNDRUMS, AND A HIGHER PREVALENCE OF PHYSICAL AND MENTAL DISABILITIES. NON-WHITE MINORITIES CURRENTLY MAKE UP ALMOST HALF (43.5%) OF THE RACIAL DEMOGRAPHIC IN FORSYTH COUNTY. THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC 56.5%; BLACK/AFRICAN-AMERICAN 27.5%; HISPANIC OR LATINO 13.0%; OTHER 3.0%.ACCORDING TO THE US CENSUS BUREAU DATA (2018), THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $48,369 IN FORSYTH COUNTY. THE POVERTY RATE FOR FORSYTH COUNTY IS 19.1%.THERE ARE FOUR LICENSED HOSPITAL FACILITIES IN THE COMMUNITY, TWO OF WHICH ARE PART OF THE NOVANT HEALTH SYSTEM AND ONE IS A SPECIALITY HOSPITAL OPERATED BY THE FILING ENTITY THROUGH A JOINT VENTURE. THERE IS ALSO ONE ACADEMIC TEACHING HOSPITAL. STATISTICAL INFORMATION 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 ORGANIZATION'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT AT:HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPX. 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/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPX.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 HOSPITAL 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 CAROLINA, SOUTH CAROLINA, AND VIRGINIA. 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/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNITY-BENEFIT.ASPX. 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 HOSPITAL 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 CAROLINA, SOUTH CAROLINA, AND VIRGINIA AND FIVE 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 HOSPITAL 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 CLEMMONS COMMUNITY FOUNDATION INC PO BOX 567 CLEMMONS NC 27012 043795285 501(C)(3) 10000 COMMUNITY OUTREACH MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVENUE WHITE PLAINS NY 10605 131846366 501(C)(3) 13000 COMMUNITY OUTREACH AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 127720 COMMUNITY OUTREACH THE LEUKEMIA & LYMPHOMA SOCIETY INC 3 INTERNATIONAL DR RYE BROOK NY 10573 135644916 501(C)(3) 10100 COMMUNITY OUTREACH THE SHALOM PROJECT INC 639 SOUTH GREEN STREET WINSTONSALEM NC 27101 202136431 501(C)(3) 12000 COMMUNITY OUTREACH HOSPITAL HOSPITATLITY HOUSE OF WINSTON-SALEM 1970 BALDWIN LANE WINSTONSALEM NC 27103 203604576 501(C)(3) 17380 COMMUNITY OUTREACH JDRF INTERNATIONAL 26 BROADWAY 15TH FL NEW YORK NY 10004 231907729 501(C)(3) 15000 COMMUNITY OUTREACH CRISIS CONTROL MINISTRY INC 200 EAST TENTH STREET WINSTONSALEM NC 27101 237348168 501(C)(3) 12500 COMMUNITY OUTREACH UNITED WAY OF FORSYTH COUNTY INC 301 N MAIN STREET SUITE 1700 WINSTONSALEM NC 27101 237357234 501(C)(3) 40000 COMMUNITY OUTREACH GO FAR INC 2011 SANDY RIDGE ROAD COLFAX NC 27235 262059189 501(C)(3) 15000 COMMUNITY OUTREACH CROSBY SCHOLARS COMMUNITY PARTNERSHIP 2701 UNIVERSITY PARKWAY WINSTONSALEM NC 27105 311523230 501(C)(3) 30000 COMMUNITY OUTREACH WINSTON-SALEM ALLIANCE 100 N MAIN STREET WINSTONSALEM NC 27101 311726654 501(C)(6) 35000 COMMUNITY OUTREACH GREATER WINSTON-SALEM CHAMBER OF COMMERCE INC 411 WEST FOURTH STREET STE 211 WINSTONSALEM NC 27101 560459820 501(C)(6) 10000 COMMUNITY OUTREACH BUSINESS HIGH POINT INC PO BOX 5025 HIGH POINT NC 27262 560473292 501(C)(6) 10000 COMMUNITY OUTREACH OLD HICKORY COUNCIL INC 6600 SILAS CREEK PKWY WINSTONSALEM NC 27106 560529985 501(C)(3) 6860 COMMUNITY OUTREACH YOUNG MEN'S CHRISTIAN ASSOCIATION OF NORTHWEST NORTH CAROLINA 301 N MAIN STREET SUITE 1900 WINSTONSALEM NC 27101 560530015 501(C)(3) 45400 COMMUNITY OUTREACH CROSSNORE SCHOOL & CHILDREN'S HOME PO BOX 249 CROSSNORE NC 28616 560567980 501(C)(3) 10000 COMMUNITY OUTREACH CANCER SERVICES INC 3175 MAPLEWOOD AVENUE WINSTONSALEM NC 27103 560656375 501(C)(3) 25000 COMMUNITY OUTREACH FAMILY SERVICES INC 1200 SOUTH BROAD STREET WINSTONSALEM NC 27101 560689235 501(C)(3) 25000 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) 10000 COMMUNITY OUTREACH ADDICTION RECOVERY CARE ASSOCIATION INC 1931 UNION CROSS ROAD WINSTONSALEM NC 27107 560948408 501(C)(3) 25000 COMMUNITY OUTREACH FORSYTH TECHNICAL COMMUNITY COLLEGE 2100 SILAS CREEK PARKWAY WINSTONSALEM NC 27103 561070364 501(C)(3) 83368 COMMUNITY OUTREACH SENIOR SERVICES INC 2895 SHOREFAIR DRIVE WINSTONSALEM NC 27105 561085968 501(C)(3) 46000 COMMUNITY OUTREACH FORSYTH FUTURES 100 N CHERRY STREET WINSTONSALEM NC 27101 561092807 501(C)(3) 50000 COMMUNITY OUTREACH BIG BROTHERS BIG SISTERS SERVICES INC PO BOX 21646 WINSTONSALEM NC 27120 561161118 501(C)(3) 6250 COMMUNITY OUTREACH THE SHEPHERD'S CENTER OF KERNERSVILLE INC PO BOX 2044 KERNERSVILLE NC 27285 561471510 501(C)(3) 10000 COMMUNITY OUTREACH SAMARITAN MINISTRIES 414 E NORTHWEST BLVD WINSTONSALEM NC 27105 561490019 501(C)(3) 10000 COMMUNITY OUTREACH SHEPHERD'S CENTER OF GREATER WINSTON-SALEM INC 1700 EBERT STREET WINSTONSALEM NC 27103 561646960 501(C)(3) 10000 COMMUNITY OUTREACH PIEDMONT TRIAD PARTNERSHIP PO BOX 2672 HIGH POINT NC 27261 561750279 501(C)(3) 25000 COMMUNITY OUTREACH WINSTON-SALEM FOUNDATION 751 WEST FOURTH STREET SUITE 200 WINSTONSALEM NC 27101 566037615 501(C)(3) 50300 COMMUNITY OUTREACH UNIVERSITY OF NORTH CAROLINA SCHOOL OF THE ARTS FOUNDATION INC 1533 SOUTH MAIN STREET WINSTONSALEM NC 27127 566064850 501(C)(3) 15000 COMMUNITY OUTREACH HOSPICE & PALLIATIVE CARECENTER 101 HOSPICE LANE WINSTONSALEM NC 27103 581343313 501(C)(3) 20000 COMMUNITY OUTREACH COMMUNITY CARE CENTER FOR FORSYTH COUNTY 2135 NEW WALKERTOWN ROAD WINSTONSALEM NC 27101 581403699 501(C)(3) 25000 COMMUNITY OUTREACH EXCHANGE CLUB CENTER FOR PREVENTION OF CHILD ABUSE OF NC INC 500 WEST NORTHWEST BLVD WINSTONSALEM NC 27105 581443692 501(C)(3) 8738 COMMUNITY OUTREACH RONALD MCDONALD HOUSE OF WINSTON-SALEM 419 S HAWTHORNE ROAD WINSTONSALEM NC 27103 581454715 501(C)(3) 10000 COMMUNITY OUTREACH SECOND HARVEST FOOD BANK OF NORTHWEST NC INC 3655 REED STREET WINSTONSALEM NC 27107 581457912 501(C)(3) 20860 COMMUNITY OUTREACH LEADERSHIP WINSTON-SALEM 624 W SIXTH STREET SUITE 110 WINSTONSALEM NC 27101 581574887 501(C)(3) 8000 COMMUNITY OUTREACH ABC OF NC FOUNDATION 905 FRIEDBERG CHURCH ROAD WINSTONSALEM NC 27127 911963813 501(C)(3) 18000 COMMUNITY OUTREACH 35 3 PATIENT ASSISTANCE 22 8072 MEDICATION FOR INDIGENT PATIENTS 1023 61020 FMV MEDICATION FOR INDIGENT PATIENTS PATIENT TRANSPORTATION 4247 58015 FMV CAB FARES FOR INDIGENT PATIENTS ZOLL LIFE VEST 1 3100 FMV ZOLL LIFE VEST 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 1 1 0 0 0 0 0 0 0 LINDSAY JEFFERY FMR PRES - FMH/COO WS MKT 0 987316 0 836381 0 290924 0 24300 0 30812 0 2169733 0 7500 MIHAL DENISE FMR PRES - FMH/COO WS MKT 0 728775 0 640413 0 325074 0 24300 0 19991 0 1738553 0 7500 SMITH HARRY SVP HOSPITAL OPERATIONS 0 611704 0 409752 0 307241 0 120187 0 41546 0 1490430 0 94406 NYCUM LAWRENCE MD SVP CHIEF CLINICAL OFFICER 455061 0 271830 0 176038 0 96007 0 31802 0 1030738 0 65438 0 GREGORY CHERE MD FMR SVP 0 425491 0 270240 0 160952 0 80914 0 32860 0 970457 0 52500 COLLINS TIMOTHY ONCOLOGIST 489495 0 334326 0 39939 0 24300 0 41382 0 929442 0 7500 0 FRIEDMAN ROLAND UROLOGIST 326187 0 451365 0 83102 0 24300 0 42073 0 927027 0 0 0 JEPSEN ERIN ONCOLOGIST 492910 0 317606 0 9252 0 24300 0 36406 0 880474 0 0 0 SETLIFF MICHAEL PRES & COO 430461 0 210634 0 72065 0 92511 0 34759 0 840430 0 0 0 ELLIOTT KATHLEEN ONCOLOGIST 430846 0 292183 0 21318 0 24300 0 38189 0 806836 0 7500 0 CRAVEN BRANDON UROLOGIST 301778 0 346077 0 61495 0 24300 0 38753 0 772403 0 7500 0 MANN JOHN PRESIDENT & COO 0 433197 0 124470 0 108317 0 53113 0 42164 0 761261 0 7500 MOTEW STEPHEN MD FMR SVP 186865 0 299112 0 199100 0 20191 0 8438 0 713706 0 65438 0 BERGER WILLIAM MD TRUSTEE 0 407036 0 122488 0 32961 0 24300 0 36239 0 623024 0 7488 ROYSTER KIRSTEN PRES & COO KMC 320244 0 175983 0 87365 0 21984 0 11655 0 617231 0 0 0 EDWARDS JOEL MD TRUSTEE 381049 0 130209 0 31250 0 16800 0 16916 0 576224 0 0 0 MORRIS JOHN ASST SEC 0 228652 0 126620 0 40289 0 22287 0 24834 0 442682 0 7500 BRIGHT JANET FMR VP NURSING & MARKET CNO 200410 0 108871 0 107636 0 12895 0 11934 0 441746 0 0 0 HEALY JOAN ASST SEC 0 208472 0 36956 0 2049 0 12245 0 1351 0 261073 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 ACCOUNT CAN BE USED ONLY FOR AN APPROVED LIST OF EXPENDITURES. ALL OPTIONS OTHER THAN A DEFERRED, AT-RISK, COMPENSATION OPTION ARE CONSIDERED TAXABLE AND ARE INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. 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, LINES 4A-B PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE BRIGHT, JANET $34,192 NONQUALIFIED GREGORY, CHERE $52,500 MOTEW, STEPHEN $57,938 NYCUM, LAWRENCE $57,938 SMITH, HARRY $86,906 EQUITY-BASED NONE PART I, LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS BASED ON ANNUAL COMPENSATION FOR A SPECIFIED PERIOD OF TIME. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. 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. ELIGIBLE EXECUTIVES WILL BE NOMINATED BY THE CEO AND APPROVED BY THE NOVANT HEALTH COMPENSATION AND LEADERSHIP COMMITTEE ("THE COMMITTEE") TO PARTICIPATE. 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 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. FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES FORSYTH MEMORIAL HOSPITAL, INC. DOING BUSINESS AS NOVANT HEALTH FORSYTH MEDICAL CENTER ("NHFMC"), NOVANT HEALTH CLEMMONS MEDICAL CENTER ("NHCMC"), AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER ("KMC") 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. NOVANT HEALTH CONSISTS OF MORE THAN 1,600 PHYSICIANS AND OVER 29,000 EMPLOYEES WHO MAKE HEALTHCARE REMARKABLE AT NEARLY 700 LOCATIONS, INCLUDING 15 MEDICAL CENTERS AND HUNDREDS OF OUTPATIENT FACILITIES AND PHYSICIAN CLINICS. HEADQUARTERED IN WINSTON-SALEM, NC, NOVANT HEALTH IS COMMITTED TO MAKING HEALTHCARE REMARKABLE FOR PATIENTS AND COMMUNITIES, SERVING MORE THAN FIVE MILLION PATIENTS ANNUALLY. NOVANT HEALTH IS RANKED AS ONE OF THE NATION'S TOP 25 INTEGRATED HEALTH SYSTEMS BY SK&A. IN 2019, THE NOVANT HEALTH SYSTEM REPORTED $5.43 BILLION IN REVENUES. GENERAL INFORMATION NOVANT HEALTH FORSYTH MEDICAL CENTER, NOVANT HEALTH CLEMMONS MEDICAL CENTER, AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER EXIST TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE WITH A VISION OF PROVIDING A REMARKABLE PATIENT EXPERIENCE IN EVERY DIMENSION, EVERY TIME. THEY ACCOMPLISH THAT MISSION BY PROVIDING HEALTHCARE SERVICES TO ALL WHO ENTRUST THEIR CARE TO THEM AND BY SUPPORTING THE GREATER WINSTON-SALEM AND KERNERSVILLE COMMUNITIES THROUGH PARTNERSHIPS AND OUTREACH. THE HOSPITALS SUPPORT ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION, AND ASSISTANCE TO THE UNINSURED AND THE OVERALL COMMUNITY. NOVANT HEALTH FORSYTH MEDICAL CENTER AFFILIATE HOSPITAL, NOVANT HEALTH KERNERSVILLE MEDICAL CENTER IN KERNERSVILLE, NORTH CAROLINA, FOCUSED ON PROVIDING A REMARKABLE PATIENT EXPERIENCE VIA A FAST-ACCESS EMERGENCY DEPARTMENT, GENERAL, ORTHOPEDIC, AND EYE SURGICAL SERVICES, CONSISTENT QUALITY, AND EXCELLENT SERVICE TO RESIDENTS IN THE KERNERSVILLE AREA, WESTERN GUILFORD AND ROCKINGHAM COUNTIES OF NORTH CAROLINA, AS WELL AS EASTERN STOKES AND FORSYTH COUNTIES OF NORTH CAROLINA. NOVANT HEALTH FORSYTH MEDICAL CENTER'S AFFILIATE HOSPITAL, NOVANT HEALTH CLEMMONS MEDICAL CENTER IN CLEMMONS, NORTH CAROLINA FOCUSED ON PROVIDING A REMARKABLE PATIENT EXPERIENCE VIA A FAST-ACCESS EMERGENCY DEPARTMENT, GENERAL, ORTHOPEDIC, PODIATRIC, TRANSITIONAL/INFUSION SERVICES AND EAR, NOSE AND THROAT SURGICAL SERVICES, CONSISTENT QUALITY, AND EXCELLENT SERVICE TO RESIDENTS IN WESTERN FORSYTH COUNTY, DAVIE COUNTY AND YADKIN COUNTY. IN ADDITION TO OUR QUALITY OF SERVICES AND COMPREHENSIVE CATEGORIES OF SERVICES, WE'RE 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 KERNERSVILLE MEDICAL CENTER, AND NOVANT HEALTH CLEMMONS MEDICAL CENTER. EACH YEAR, OUR PHYSICIANS, NURSES AND STAFF HOLD SCREENINGS, TEACH PROGRAMS, HOST SEMINARS, AND VOLUNTEER COUNTLESS HOURS TO HELP IMPROVE THE LIVES OF THOSE THE TRIAD AND SURROUNDING COUNTIES IN MANY UNIQUE WAYS. A FEW EXAMPLES OF THIS ARE AS FOLLOWS: FREE COMMUNITY SCREENINGS - IN 2019, NOVANT HEALTH FORSYTH MEDICAL CENTER HELD 190 FREE SCREENING EVENTS THAT SERVED MORE THAN 43,000 SCREENING PARTICIPANTS. LOCATIONS INCLUDE NOVANT HEALTH TRIAD FACILITIES, LOCAL PUBLIC SCHOOLS, YMCA/YWCA, HOMELESS SHELTERS, CORPORATIONS, FAITH COMMUNITIES, AND SENIOR CENTERS. THE VARIOUS EVENTS SCREENED FOR A1C, ABI, BONE DENSITY, BLOOD PRESSURE, BREAST CANCER, AND HEART HEALTH. COMMUNITY EDUCATION - AS ACTIVE COMMUNITY PARTNERS, NOVANT HEALTH FORSYTH MEDICAL CENTER, NOVANT HEALTH CLEMMONS MEDICAL CENTER, AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER REGULARLY HOST AND/OR DELIVER GENERAL HEALTH EDUCATION SESSIONS AND WELLNESS PROGRAMS THROUGHOUT THE YEAR. IN 2019, 254 FREE EDUCATIONAL EVENTS SERVED OVER 4,000 INDIVIDUALS. LOCATIONS INCLUDE CAMPUS FACILITIES, PUBLIC SCHOOLS, YMCA/YWCA, RECREATION CENTERS, PUBLIC LIBRARIES, SENIOR CENTERS, CORPORATIONS, HOMELESS SHELTERS, FAITH COMMUNITIES, AND NEIGHBORHOOD EVENTS. IN 2019, OVER 200 INDIVIDUALS RECEIVED WELLNESS COACH SESSIONS WITH A CERTIFIED COACH, EITHER IN 1:1 OR GROUP SETTINGS. SUPPORT GROUPS - NOVANT HEALTH FORSYTH MEDICAL CENTER HOSTED A FULL RANGE OF SUPPORT GROUPS THAT PROVIDE EMOTIONAL SUPPORT SERVICES TO THOSE IMPACTED BY A VARIETY OF CHRONIC DISEASES AND HEALTHCARE ISSUES. FROM DIABETES AND WEIGHT MANAGEMENT, PROSTATE CANCER, AND NURSING MOTHERS BREASTFEEDING, THE HOSPITAL OFFERS OPPORTUNITIES FOR INDIVIDUALS TO MAKE CONNECTIONS WITH OTHERS FACING SIMILAR HEALTH ISSUES AND CHALLENGES. ALL SUPPORT GROUPS ARE FREE AND OPEN TO ANYONE IN THE COMMUNITY. IN 2019, 163 SUPPORT GROUPS WERE PROVIDED TO MORE THAN 3,000 ATTENDEES. ARTS & HEALING - NOVANT HEALTH FORSYTH MEDICAL CENTER OFFERS HEALING THROUGH MUSIC IN THE FORM OF PARTNERSHIPS WITH THE WINSTON-SALEM SYMPHONY AS WELL AS VOLUNTEER PERCUSSIONISTS AND PIANISTS. MUSIC IS AVAILABLE WEEKLY WHERE MUSICIANS ROTATE THROUGH LOBBY AND PATIENT CARE AREAS, INCLUDING PALLIATIVE SPACES. HEALING IS ALSO AVAILABLE IN THE FORM OF ART CLASSES, WHICH ARE HELD WEEKLY FOR EXPECTANT MOTHERS IN THE ANTE-PARTUM UNIT. SCHOOL PARTNERSHIPS - NOVANT HEALTH HAS PARTNERED WITH THE DAVIE, DAVIDSON, AND ROWAN-SALISBURY SCHOOL SYSTEMS TO PROVIDE ATHLETIC TRAINERS AND RAPID PHYSICIAN ACCESS TO 14 SCHOOLS. THESE ATHLETIC TRAINERS PROVIDE ONGOING SPORTS PERFORMANCE, INJURY AND SAFETY MANAGEMENT THROUGH THE SCHOOL YEAR TO STUDENT ATHLETES. AS PART OF THIS INITIATIVE, NOVANT HEALTH DONATED AUTOMATED EXTERNAL DEFIBRILLATORS TO PARTNER SCHOOLS SO THAT THEY ARE BETTER EQUIPPED TO MANAGE ON-CAMPUS MEDICAL EMERGENCIES. MOBILE MAMMOGRAM - IMPROVING ACCESS TO MAMMOGRAMS IS A LONG-TERM GOAL FOR NOVANT HEALTH. IN 2019, NOVANT HEALTH LAUNCHED ONLINE SCHEDULING FOR MAMMOGRAMS, WHICH MEANS PATIENTS CAN NOW CHOOSE THE LOCATION AND DATE MOST CONVENIENT FOR THEM. IN 2019, OUR MAMMOGRAPHY COACH PROVIDED MORE THAN 5,000 MAMMOGRAMS TO WOMEN ACROSS THE REGION. WE EXPECT TO SERVE AN ADDITIONAL 3,000 WOMEN WITH THE SUPPORT OF OUR NEW COACH. KERNERSVILLE MEDICAL CENTER NOVANT HEALTH KERNERSVILLE MEDICAL CENTER, THE COMMUNITY'S FIRST HOSPITAL, OPENED IN MARCH 2011 AND IS A STATE-OF-THE-ART MEDICAL/SURGICAL FACILITY WITH 50 IN-PATIENT ROOMS, AN EMERGENCY DEPARTMENT WHICH IS OPEN 24/7, CRITICAL CARE BEDS AND SURGICAL SUITES. SOME KEY SERVICES INCLUDE: INTERMEDIATE CARE UNIT - NEWLY EXPANDED IN 2019, NOVANT HEALTH KERNERSVILLE MEDICAL CENTER HAS AN INTERMEDIATE CARE UNIT TO BRIDGE THE GAP BETWEEN THE INTENSIVE CARE UNIT AND THE MEDICAL/SURGICAL FLOOR. THIS UNIT HAS 12 BEDS AND PROVIDES SPECIALTY CARE FOR PATIENTS IN THE KERNERSVILLE COMMUNITY. RESPIRATORY AND PULMONARY SERVICES - NOVANT HEALTH KERNERSVILLE MEDICAL CENTER SPECIALISTS TREAT A WIDE RANGE OF RESPIRATORY AND PULMONARY DISEASES AND CONDITIONS INCLUDING: ASTHMA, CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), EMPHYSEMA, LUNG CANCER, PNEUMONIA, SLEEP APNEA, SNORING AND MANY OTHERS. BREAST CENTER - NOVANT HEALTH BREAST CENTER OFFERS COMPREHENSIVE BREAST HEALTH CARE, INCLUDING MAMMOGRAPHY SCREENINGS, DIAGNOSTIC AND STEREOTACTIC PROCEDURES, BIOPSIES, CHEMOTHERAPY, RADIATION TREATMENT AND GENERAL AND PLASTIC SURGERY. FORM 990, PI, L1: CONTINUED NOVANT HEALTH KERNERSVILLE MEDICAL CENTER RECENTLY PARTNERED WITH HIGH POINT UNIVERSITY ("HPU") TO PROVIDE COMPREHENSIVE WELLNESS SERVICES FOR STUDENTS, INCLUDING ORTHOPEDIC AND SPORTS MEDICINE CARE FOR THE UNIVERSITY'S NATIONAL COLLEGIATE ATHLETIC ASSOCIATION ATHLETES. STUDENTS NEEDING ACUTE CARE SERVICES ARE BROUGHT TO NOVANT HEALTH KERNERSVILLE MEDICAL CENTER WHICH IS LOCATED IN CLOSE PROXIMITY TO THE CAMPUS. THROUGH THE PARTNERSHIP, NOVANT HEALTH WILL OPEN THE FIRST YEAR-ROUND, FULL-SERVICE STUDENT HEALTH CLINIC ON HPU CAMPUS. IN ADDITION TO THE STUDENT WELLNESS SERVICES, HPU AND NOVANT HEALTH HAVE COMMITTED TO EXPANDING CLINICAL ROTATION AVAILABILITY FOR HEALTH CARE STUDENTS IN THE AREAS OF WOMEN'S HEALTH, PEDIATRICS, FAMILY MEDICINE, ACUTE CARE, GENERAL SURGERY AND EMERGENCY MEDICINE. THIS PARTNERSHIP WITH HIGH POINT UNIVERSITY IS NOT ONLY INVESTMENT IN THE HEALTH OF CURRENT STUDENTS BUT ALSO THE LONG-TERM HEALTH OF OUR COMMUNITIES. HPU IS TRAINING THE HEALTH CARE LEADERS OF TOMORROW, MANY OF WHOM WILL BUILD CAREERS AND CARE FOR PATIENTS HERE IN THE TRIAD. NOVANT HEALTH IS COMMITTED TO ENRICHING HPU'S STUDENT TRAINING THROUGH CLINICAL ROTATIONS FOR OUR COMMUNITY'S FUTURE PROVIDERS. NOVANT HEALTH KERNERSVILLE MEDICAL OFFICE BUILDING AND OUTPATIENT SURGERY CENTER- IN FALL 2016, NOVANT HEALTH BEGAN CONSTRUCTION ON A MEDICAL OFFICE BUILDING LOCATED ON THE CAMPUS OF NOVANT HEALTH KERNERSVILLE MEDICAL CENTER. THE NEW BUILDING, COMPLETED IN 2017, IS 60,000-SQUARE-FEET AND HOUSES PHYSICIAN OFFICES AND SUITES, TWO OPERATING ROOMS AND A PROCEDURE ROOM. THE AMBULATORY SURGERY CENTER, LOCATED ON THE SECOND FLOOR OF THE MEDICAL OFFICE BUILDING WAS COMPLETED IN 2019. NOVANT HEALTH CLEMMONS MEDICAL CENTER CLEMMONS SURGICAL PLAZA OPENED IN FALL OF 2019. THE FACILITY IS A THREE-STORY, 60,000-SQUARE-FOOT MEDICAL OFFICE BUILDING THAT WILL SERVE AS A MULTI-SPECIALTY AMBULATORY SURGICAL CENTER FOR COMMUNITY MEMBERS. THE AMBULATORY SURGICAL CENTER MODEL LEADS TO SHORTER HOSPITAL STAYS AND LOWER HEALTHCARE COSTS FOR CLEMMONS PATIENTS. NEW TECHNOLOGY & SERVICES A CONCURRENT ELECTRONIC HEATH RECORD (EHR) INITIATIVE HAS BEEN IMPLEMENTED BY BOTH THE ACUTE AND AMBULATORY FACILITIES IN THE NOVANT HEALTH SYSTEM. CLINICIANS CAN SHARE PATIENTS' MEDICAL INFORMATION BETWEEN PHYSICIAN OFFICES, OUTPATIENT CENTERS, HOSPITALS. THIS SHARING OF INFORMATION IMPROVES SAFETY AND COORDINATION OF CARE AND PROMOTES CONNECTIVITY AND COMMUNICATION BETWEEN HOSPITAL CAREGIVERS, SPECIALISTS, AND PRIMARY CARE PROVIDERS. EMBARKING ON THE JOURNEY TO CREATE A SHARED EHR IS THE MOST SIGNIFICANT AND IMPORTANT INVESTMENT NOVANT HEALTH HAS EVER MADE FOR ITS PATIENTS AND TEAM MEMBERS. AWARDS, RECOGNITIONS & CERTIFICATIONS/RECERTIFICATIONS MAGNET RECOGNITION - THE AMERICAN NURSES CREDENTIALING CENTER'S MAGNET RECOGNITION PROGRAM HAS RECOGNIZED THE NURSING PROGRAMS AT ALL THREE MEDICAL CENTERS FOR EXCELLENCE AND QUALITY IN NURSING CARE. ONLY 8% OF HOSPITALS NATIONWIDE ARE RECOGNIZED AS MAGNET HOSPITALS. RESEARCH HAS SHOWN THAT PATIENTS OF MAGNET HOSPITALS HAVE BETTER OUTCOMES, ARE HAPPIER ABOUT THE CARE THEY RECEIVED AND ARE ABLE TO GO HOME SOONER. NATIONAL COMMITTEE FOR QUALITY ASSURANCE - THE HEART STROKE RECOGNITION PROGRAM (HSRP) ASSESSES KEY QUALITY PERFORMANCE MEASURES THAT ARE BASED ON NATIONAL EVIDENCE BASED GUIDELINES FOR SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE AND STROKE. PROGRAM MEASURES INCLUDE, BLOOD PRESSURE CONTROL, USE OF ASPIRIN, SMOKING AND TOBACCO USE CESSATION ASSISTANCE, BODY MASS INDEX SCREENING, AND MORE. NATIONAL COMMITTEE FOR QUALITY ASSURANCE ("NCQA") - PATIENT-CENTERED MEDICAL HOME RECOGNITION NCQA'S PATIENT-CENTERED MEDICAL HOME PREVALIDATION PROGRAM EVALUATES ELECTRONIC HEALTH RECORD (EHR) SYSTEMS, ADVANCED REGISTRIES, POPULATION HEALTH MANAGEMENT TOOLS AND OTHER RELATED TECHNOLOGY SOLUTIONS TO IDENTIFY ALIGNMENT WITH PATIENT-CENTERED MEDICAL HOME RECOGNITION STANDARDS REQUIREMENT. AWARDS INCLUDE: GET WITH THE GUIDELINES STROKE AWARDS NOVANT HEALTH FORSYTH MEDICAL CENTER: GOLD PLUS WITH TARGET STROKE ELITE PLUS HONOR ROLL GET WITH THE GUIDELINES HEART FAILURE AWARDS NOVANT HEALTH FORSYTH MEDICAL CENTER: GOLD PLUS WITH TARGET HEART FAILURE HONOR ROLL ADDITIONAL CERTIFICATIONS FOR FORSYTH MEDICAL CENTER INCLUDE: -AMERICAN ASSOCIATION FOR CARDIOVASCULAR AND PULMONARY REHABILITATION -AMERICAN DIABETES ASSOCIATION - SELF MANAGEMENT EDUCATION RECOGNITION -CENTER OF EXCELLENCE IN MINIMALLY INVASIVE GYNECOLOGY (AAGL) -INTERNATIONAL ASSOCIATION FOR HEALTHCARE SECURITY AND SAFETY -NORTH CAROLINA DIVISION OF MEDICAL ASSISTANCE - MEDICAID -ONCOLOGY REHAB PARTNERS STAR PROGRAM CERTIFICATION -TJC - HIP FRACTURE CERTIFICATION -TJC - ADVANCED PALLIATIVE CARE PROGRAM CERTIFICATION -TJC - COMPREHENSIVE STROKE CENTER -TJC - MINIMALLY INVASIVE COLORECTAL SURGERY CENTER ADDITIONAL CERTIFICATIONS FOR KERNERSVILLE MEDICAL CENTER INCLUDE: -INTERNATIONAL ASSOCIATION FOR HEALTHCARE SECURITY AND SAFETY -NORTH CAROLINA DIVISION OF MEDICAL ASSISTANCE - MEDICAID ADDITIONAL CERTIFICATIONS FOR EACH HOSPITAL INCLUDE: -COLLEGE OF AMERICAN PATHOLOGY -UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - CLIA -UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES - MEDICARE ACCREDITATION THE JOINT COMMISSION - NOVANT HEALTH FORSYTH MEDICAL CENTER, NOVANT HEALTH KERNERSVILLE MEDICAL CENTER, AND NOVANT HEALTH CLEMMONS MEDICAL CENTER HAVE ALL BEEN ACCREDITED BY THE JOINT COMMISSION, AN INDEPENDENT ORGANIZATION THAT EVALUATES A HEALTHCARE ORGANIZATION'S PERFORMANCE IN AREAS THAT MOST AFFECT PATIENT HEALTH AND SAFETY. THE AMERICAN NURSES CREDENTIALING CENTER (ANCC) - THE ANCC AWARDED THE NURSING PROGRAMS AT NOVANT HEALTH FORSYTH MEDICAL CENTER AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER FOR ITS EXCELLENCE AND QUALITY IN NURSING CARE BY NAMING IT WITH MAGNET RECOGNITION. ONLY FIVE PERCENT OF ALL HOSPITALS NATIONWIDE HAVE EARNED THIS HIGH HONOR, WHICH RECOGNIZES FACILITIES THAT PROVIDE THE HIGHEST LEVEL OF NURSING CARE. THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION - NOVANT HEALTH FORSYTH MEDICAL CENTER IS RECOGNIZED AS AN ADVANCED COMPREHENSIVE STROKE CENTER, FOCUSING ON COMPREHENSIVE CARE OF THE COMPLEX STROKE PATIENT. SOCIETY OF CHEST PAIN CENTERS - NOVANT HEALTH FORSYTH MEDICAL CENTER RECEIVED THE CHEST PAIN ACCREDITATION BY THE SOCIETY OF CHEST PAIN CENTERS - THIS ACCREDITATION DEMONSTRATES A SEAMLESS AND STANDARDIZED PROCESS OF QUALITY CARE DELIVERY AT NOVANT HEALTH CHEST PAIN FACILITIES. ADDITIONAL ACCREDITATIONS FOR NOVANT HEALTH FORSYTH MEDICAL CENTER INCLUDE: -AMERICAN COLLEGE OF RADIOLOGY -AMERICAN COLLEGE OF RADIOLOGY - RADIATION ONCOLOGY -AMERICAN COLLEGE OF SURGEONS - CANCER CENTER -AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS -COMMISSION OF ACCREDITATION OF REHABILITATION FACILITIES -INTERSOCIETAL ACCREDITATION COMMISSION CAROTID STENTING -INTERSOCIETAL ACCREDITATION COMMISSION ECHOCARDIOGRAPHY LABORATORIES -NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS -COLLEGE OF AMERICAN PATHOLOGY FORM 990, PI, L1: CONTINUED ADDITIONAL ACCREDITATIONS FOR KERNERSVILLE MEDICAL CENTER INCLUDE: -AMERICAN COLLEGE OF RADIOLOGY -AMERICAN COLLEGE OF RADIOLOGY - MAMMOGRAPHY -INTERSOCIETAL ACCREDITATION COMMISSION ECHOCARDIOGRAPHY LABORATORIES -NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS -COLLEGE OF AMERICAN PATHOLOGY COMMUNITY BENEFIT REPORT HTTPS://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMMUNITY-ENGAGEMENT/COMMUNIT Y-BENEFIT.ASPX 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 HOSPITAL 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 $993,000,000, INCLUDING $152,000,000 IN FINANCIAL ASSISTANCE FOR 2019. FORM 990, PART III, LINE 1: MISSION, VISION, AND VALUES MISSION NOVANT HEALTH EXISTS TO IMPROVE THE HEALTH OF 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 BY SHOWING THEM 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 ONE ANOTHER 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 WE APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL THAT WE DO. -TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN THAT WHICH 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. 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. OUR PROMISE TO PATIENTS WE ARE MAKING YOUR HEALTHCARE EXPERIENCE REMARKABLE. WE WILL BRING YOU WORLD-CLASS CLINICIANS, CARE AND TECHNOLOGY - WHEN AND WHERE YOU NEED THEM. WE ARE REINVENTING THE HEALTHCARE EXPERIENCE TO BE SIMPLER, MORE CONVENIENT AND MORE AFFORDABLE, SO THAT YOU CAN FOCUS ON GETTING BETTER AND STAYING HEALTHY. FORM 990, PART III, LINE 4A: PROGRAM SERVICE ACCOMPLISHMENTS KMC HAS 50 LICENSED BEDS. DURING 2019 THERE WERE 10,976 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3 DAYS, AN AVERAGE DAILY CENSUS OF 30, AND 3,303 DISCHARGES. THERE WERE 3,326 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 58,330 OUTPATIENT ENCOUNTERS AND 38,760 EMERGENCY DEPARTMENT VISITS. CMC HAS 36 LICENSED BEDS. DURING 2019 THERE WERE 4,758 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 2 DAYS, AN AVERAGE DAILY CENSUS OF 13, AND 2,436 DISCHARGES. THERE WERE 3,612 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 32,244 OUTPATIENT ENCOUNTERS AND 21,846 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 TO ALL MATTERS. IN ADDITION TO THESE POWERS, MEMBER RESERVES CERTAIN POWERS TO 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 XI, LINE 9: CONTRIBUTIONS: -1,316,707. MALPRACTICE INSURANCE: -1,250,515. AFFILIATE TRANSFERS: -796,333. PARTNERSHIP ADJUSTMENT: -1,625,944. BOOK ADJUSTMENT: -366. 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