2019-11-15T07:36:40-06:00 2018-12-31 990 2018-01-01 560928089 FORSYTH MEMORIAL HOSPITAL INC FORS 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT EVP & CFO 3367182803 2019-11-11 170.98.106.254 2019-11-11 12:11:29 ES P 188B3C7D3A98A2E439561FF9EFF6E804112DA9D7 A2315309B7343EB998963AA05290CF11231D17E5 2018 2020-04-17 16:48:07Z NOVANT HEALTH FORSYTH MEDICAL CENTER CARL ARMATO 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 1417283176 0 X WWW.NOVANTHEALTH.ORG X 1968 NC SEE SCHEDULE O 15 13 7907 769 254048 -4983 5895007 2758815 1307553317 1404103334 698869 377048 12224669 9796685 1326371862 1417035882 900964 1180904 0 0 486715719 548238589 0 0 0 712590014 747284720 1200206697 1296704213 126165165 120331669 1544644500 1692009282 82153583 95643703 1462490917 1596365579 X SEE SCHEDULE O 0 0 1071982101 1180904 1407512229 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 2018 THERE WERE 235,639 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 6 DAYS, AN AVERAGE DAILY CENSUS OF 646, AND 39,834 DISCHARGES. THERE WERE 25,835 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 1,154,748 OUTPATIENT ENCOUNTERS AND 84,972 EMERGENCY DEPARTMENT VISITS.(CONTINUED ON SCHEDULE O) 1071982101 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 7907 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 13 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 BAREFOOT SAMUEL TRUSTEE 2.00 X 0 0 0 BROWN CANDICE TRUSTEE 2.00 X 0 0 0 CARROLL JOE TRUSTEE 2.00 X 0 0 0 EDWARDS JOEL MD TRUSTEE 2.00 X 548967 0 36480 ELY JOSEPH CHAIR 2.00 X X 0 0 0 FORIEST BRYANT TRUSTEE 2.00 X 0 0 0 HARDING LARI TRUSTEE 2.00 X 0 0 0 HAUSER CHARLES TRUSTEE 2.00 X 0 0 0 JOHNSON JOIA VICE CHAIR 2.00 X X 0 0 0 LAMBE CLARENCE SEC/TREAS 2.00 X X 0 0 0 LATHAM LINDA TRUSTEE 2.00 X 0 0 0 LEON CHRISTOPHER TRUSTEE 2.00 X 0 0 0 LOBO LUIS TRUSTEE 2.00 X 0 0 0 THOMASON JASON MD TRUSTEE 2.00 X 0 0 0 WOLFE III JOHN TRUSTEE 2.00 X 0 0 0 MORRIS JOHN ASST SEC 2.00 X 0 393030 47612 SANZ SEAN FMR PRES & COO 60.00 X 427205 0 24159 SETLIFF MICHAEL PRES & COO FMH INCL KMC 60.00 X 529052 0 73480 SMITH HARRY SVP HOSPITAL OPERATIONS 60.00 X 0 1131009 154164 BRIGHT JANET CNO 60.00 X 246687 0 18101 MOTEW STEPHEN SVP 60.00 X 867372 0 126435 NYCUM LAWRENCE SVP 60.00 X 791442 0 124147 ROYSTER KIRSTEN PRES & COO KMC 60.00 X 27635 409049 32954 BRAVO JULIO RHEUMATOLOGIST 40.00 X 775154 0 61567 MCDONALD COLIN NEUROLOGIST 40.00 X 726529 0 58534 NOUREDDINE NIZAR CARDIOLOGIST 40.00 X 719011 0 58909 PRELI ROBERT CARDIOLOGIST 40.00 X 728277 0 60397 ZEYLIKMAN YURIY NEUROLOGIST 40.00 X 1008046 0 58811 LINDSAY JEFFERY FMR PRES - FMH/COO WS MKT 0.00 X 0 1905834 54246 MIHAL DENISE FMR PRES - FMH/COO WS MKT 0.00 X 0 1457418 43808 GREGORY CHERE FMR SVP 0.00 X 0 743181 110198 JARRETT-PULLIAM KIMBERLY FMR CNO 0.00 X 0 342132 23934 7395377 6381653 1167936 625 1 1 0 LABORATORY CORPORATION OF AMERICA HOLDIN PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 14362411 CROSS COUNTRY STAFFING PO BOX 404674 ATLANTA GA 30384 STAFFING SERVICES 13119382 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD MANAGEMENT SERVICES 11238945 CROTHALL HEALTH CARE INC 1500 LIBERTY RIDGE DR STE 210 WAYNE PA 19087 FACILITY SERVICES 11236179 SPECTRUM MEDICAL GROUP PA 3001 LYNDHURST AVE WINSTON SALEM NC 27103 HEALTH SERVICES 5969990 98 2521373 237442 2758815 NET PATIENT REVENUE 622110 1356252739 1356252739 PHARMACY 446110 46995099 46995099 MOBILE MRI SERVICES 621512 2902974 2902974 LAB SERVICES 621511 938695 938695 VALUE BASED INCENTIVE 900099 912860 912860 -3899033 -3899033 1404103334 230691 230691 261661 0 261661 261661 261661 316264 169907 146357 146357 146357 87799 77387 10412 10412 CAFETERIA MEALS 722514 3636259 3636259 DIALYSIS SERVICES 621492 2066090 2066090 CHILD DEVELOPMENT CENTER 624410 1684492 254048 1430444 2137771 1342805 794966 9524612 1417035882 1407512229 254048 6510790 X 1076131 1076131 104773 104773 3863572 3863572 432761617 419043074 13718543 20670228 20014982 655246 63026636 61028692 1997944 27916536 27031582 884954 8050 8050 1487 1487 111059849 106071431 4988418 1015276 1015276 5666625 5267192 399433 8693526 8693526 26903154 26903154 1582134 886937 695197 243847 243847 13904168 13904168 25925258 25925258 2049175 1852862 196313 CORPORATE SUPPORT 183906642 183906642 MEDICAL SUPPLIES 133572306 133572306 DRUGS 119593919 119593919 ACCRUED UBIT -40438 -40438 113199742 99996838 13202904 1296704213 1071982101 224722112 0 -35834 37164 152939255 160863070 11777628 13452882 22911348 23191358 602988 799157 566597406 332882934 227353001 233714472 436444 13275998 31015047 31015047 1097644623 1215660134 1544644500 1692009282 54688468 65310957 149755 98891 27315360 30233855 82153583 95643703 X 1462490917 1596365216 0 363 1462490917 1596365579 1544644500 1692009282 X 120331669 -1469 13544462 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 59660 59660 0 LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 0 363 0 0 0 0 363 0.00000 1.00000 0.00000 0 0 10727897 10727897 158569260 34187077 124382183 14091040 10602121 3488919 341647490 269273182 72374308 41561719 18820554 22741165 233714472 DUE FROM AFFILIATE 1215636632 FEDERAL INCOME TAX RECEIVABLE 23502 1215660134 0 THIRD PARTY PAYMENT PAYABLE 9300551 NOTES PAYABLE 16052025 PATIENT REFUNDS 4881279 30233855 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, 2018 AND 2017. 1 1 X 1 X 300.000000000000 0 0 1 1 0 1 1 48008023 48008023 0.03900 166250005 112176299 54073706 0.04400 2500181 2271678 228503 0.00020 216758209 114447977 102310232 0.08320 976909 83329 893580 0.00070 12965472 2984616 9980856 0.00810 36676511 26276107 10400404 0.00850 1170719 460 1170259 0.00100 428550 0 428550 0.00030 52218161 29344512 22873649 0.01860 268976370 143792489 125183881 0.10180 15000 15000 0.00000 166799 166799 0.00010 237386 237386 0.00020 2670 2670 0.00000 8500 8500 0.00000 456 456 0.00000 116090 116090 0.00010 546901 546901 0.00040 1 66870056 0 216420737 215211037 1209700 X 1 0 3 1 FMH DBA NOVANT HEALTH FORSYTH MEDICAL CENTER 3333 SILAS CREEK PARKWAY WINSTONSALEM NC 27103 WWW.NOVANTHEALTH.ORG X X X A 2 FMH DBA NOVANT HEALTH KERNERSVILLE MED CENTER 1750 KERNERSVILLE MEDICAL PARKWAY KERNERSVILLE NC 27284 WWW.NOVANTHEALTH.ORG X X X A 3 FMH DBA NOVANT HEALTH CLEMMONS MEDICAL CENTER 6915 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 WWW.NOVANTHEALTH.ORG X X X A FORSYTH MEMORIAL HOSPITAL INC 0 0 1 X X X X X X X X 16 1 0 0 1 X WWW.NOVANTHEALTH.ORG X 1 16 1 WWW.NOVANTHEALTH.ORG 0 1 X 300.000000000000 0.000000000000 X X X X 0 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 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. FURTHER PRIORITIZATION OCCURRED WITH THE REVIEW BY THE ORGANIZATION'S BOARD. 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, STAKEHOLDERS 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. 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. IT WAS DETERMINED THAT THERE ARE 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 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 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:HTTPS://WWW.NOVANTHEALTH.ORG/HOME/PATIENTS--VISITORS/YOUR-HEALTHCARE-COSTS/FINANCIAL-ASSISTANCE-FOR-THE-UNINSURED.ASPX 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. 57 2 - NH ARCADIA FAMILY MEDICINE 12208 NC HWY 150 NORTH WINSTONSALEM NC 27127 PHYSICIAN CLINIC 3 - NH BREAST CENTER 2025 FRONTIS PLAZA BLVD SUITE 123 WINSTONSALEM NC 27103 IMAGING CENTER 4 - NH CARDIOLOGY CLEMMONS 7114 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 PHYSICIAN CLINIC 5 - NH CARDIOLOGY KERNERSVILLE 1710 KVILLE MEDICAL PKWY STE 205 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 6 - NH CARDIOLOGY MT AIRY 694 RIVERSIDE DR MOUNT AIRY NC 27030 PHYSICIAN CLINIC 7 - NH CARDIOLOGY WINSTON-SALEM 186 KIMEL PARK DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 8 - NH CHAIR CITY FAMILY MEDICINE 903 RANDOLPH ST THOMASVILLE NC 27360 PHYSICIAN CLINIC 9 - NH CLEMMONS FAMILY MEDICINE 6301 STADIUM DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC 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 KVILLE 1750 KERNERSVILLE MEDICAL PKWY KERNERSVILLE NC 27284 PHYSICIAN CLINIC 21 - NH KERNERSVILLE FAMILY MEDICINE 291 BROAD STREET WINSTONSALEM NC 27284 PHYSICIAN CLINIC 22 - NH KERNERSVILLE OUTPATIENT SURGERY 1730 KVILLE MEDICAL PKWY STE 304 KERNERSVILLE NC 27284 AMBULATORY SURGERY CENTER 23 - NH LEWISVILLE FAMILY MEDICINE 1225 LEWISVILLE-CLEMMONS ROAD LEWISVILLE NC 27023 PHYSICIAN CLINIC 24 - NH LEXINGTON PRIMARY CARE 110 WEST MEDICAL PARK DRIVE LEXINGTON NC 27292 PHYSICIAN CLINIC 25 - NH MAPLEWOOD FAMILY MEDICINE ROBINHOOD MEDICAL PLAZA BLDG 100 WINSTONSALEM NC 27106 PHYSICIAN CLINIC 26 - NH METCALF RHEUMATOLOGY 1551 WESTBROOK PLAZA DR SUITE 200 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 27 - NH MOUNTAINVIEW MEDICAL 216 MOORE ROAD KING NC 27021 PHYSICIAN CLINIC 28 - NH NEW GARDEN MEDICAL ASSOCIATES 1941 NEW GARDEN RD SUITES 212 216 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 KVILLE MEDICAL PKWY STE 116 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 33 - NH ONCOLOGY SPECIALISTS 276 OLD MOCKSVILLE ROAD SUITE 800 STATESVILLE NC 28625 PHYSICIAN CLINIC 34 - NH ONCOLOGY SPECIALISTS 865 WESTLAKE DRIVE MOUNT AIRY NC 27030 PHYSICIAN CLINIC 35 - NH ORTHOPEDICS & SPORTS MEDICINE 211 OLD LEXINGTON RD THOMASVILLE NC 27360 PHYSICIAN CLINIC 36 - NH PFAFFTOWN FAMILY MEDICINE 4611 YADKINVILLE ROAD PFAFFTOWN NC 27040 PHYSICIAN CLINIC 37 - NH PILOT MOUNTAIN MEDICAL CARE 207 MEDICAL STREET PILOT MOUNTAIN NC 27041 PHYSICIAN CLINIC 38 - NH PREMIER MEDICAL ASSOCIATES 3333 BROOKVIEW HILLS BLVD STE 202-204 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 39 - NH PSYCHIATRIC MEDICINE 175 KIMEL PARK DRIVE SUITE 100 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 40 - NH PSYCHIATRIC MEDICINE 309 PINEYWOOD ROAD THOMASVILLE NC 27360 PHYSICIAN CLINIC 41 - NH RHEUMATOLOGY AND ARTHRITIS 1551 WESTBROOK PLAZA DR SUITE 200 WINSTONSALEM NC 27106 PHYSICIAN CLINIC 42 - NH SALEM FAMILY MEDICINE 105 VEST MILL CIRCLE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 43 - NH SPINE SPECIALISTS 5380 US HIGHWAY 158 SUITE 110 ADVANCE NC 27006 PHYSICIAN CLINIC 44 - NH SPORTS MEDICINE 2337 WINTERHAVEN LANE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 45 - NH SURRY MEDICAL ASSOCIATES 2133 ROCKFORD ST SUITE 1400 MOUNT AIRY NC 27030 PHYSICIAN CLINIC 46 - NH SURRY MEDICAL ASSOCIATES 865 WESTLAKE DRIVE MOUNT AIRY NC 27030 PHYSICIAN CLINIC 47 - NH THOMASVILLE MEDICAL ASSOCIATES 309 PINEYWOOD ROAD THOMASVILLE NC 27360 PHYSICIAN CLINIC 48 - NH TRIAD ENDOCRINE 500 PINEVIEW DR SUITE 101 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 49 - NH UROLOGY 140 KIMEL PARK DR SUITE 100 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 50 - NH UROLOGY PARTNERS 1710 KVILLE MEDICAL PKWY STE 201 KERNERSVILLE NC 27284 PHYSICIAN CLINIC 51 - NH UROLOGY PARTNERS 2010 BALDWIN LANE WINSTONSALEM NC 27103 PHYSICIAN CLINIC 52 - NH VILLAGE POINT FAMILY MEDICINE 7130 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 PHYSICIAN CLINIC 53 - NH WEST FORSYTH INTERNAL MED & PED 105 STADIUM OAKS DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC 54 - NH WINSTON-SALEM CARDIOLOGY 445 PINEVIEW DRIVE SUITE 220 WINSTONSALEM NC 27284 PHYSICIAN CLINIC 55 - NH WINSTON-SALEM HEALTH CARE 175 KIMEL PARK DRIVE SUITE 250 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 56 - NH WINSTON-SALEM HEALTH CARE 250 CHARLOIS BLVD WINSTONSALEM NC 27103 PHYSICIAN CLINIC 57 - NH WOUND CARE & HYPERBARIC MEDICINE 1901 S HAWTHORNE ROAD SUITE 220 WINSTONSALEM NC 27103 PHYSICIAN CLINIC 58 - 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-INVOLVEMENT/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 $66,870,056 PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION'S COMMUNITY BUILDING ACTIVITIES ADDRESSES 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. PART III, LINE 2: IMPLICIT PRICE CONCESSIONS (ANALOGOUS TO 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 (ANALOGOUS TO BAD DEBT EXPENSE) 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 7 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 ("CB DEPARTMENT") COMPRISED OF COMMUNITY BENEFIT PROFESSIONALS AND AN ASSOCIATED ADVISORY WORKING GROUP ("THE COMMUNITY BENEFIT GROUP") THAT INCLUDES REPRESENTATIVES FROM INTERNAL AUDIT, LEGAL, AND TAX. THE CB 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 GROUP 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. IN ADDITION TO ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA, EACH HOSPITAL MAY RESPOND TO REQUESTS FOR SPECIFIC COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS. PART VI, LINE 3: PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE ORGANIZATION IS COMMITTED TO PROVIDING OUTSTANDING HEALTHCARE TO ALL MEMBERS OF OUR COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. OUR FINANCIAL COUNSELING TEAMS ARE CONSTANTLY WORKING WITH THE PATIENTS WITHIN OUR COMMUNITIES TO UNDERSTAND THEIR NEEDS AND ENSURE THAT OUR POLICIES AND PROCESSES ADDRESS THESE NEEDS. WE ALSO MAINTAIN CONTRACTS WITH MEDICAID ELIGIBILITY VENDORS AND THESE TEAMS OFFER ADDITIONAL SUPPORT IN PROCESSING AND ASSESSING HOW WE SERVE THE FINANCIAL NEEDS OF OUR PATIENTS. BASED ON THE ASSESSMENTS OF OUR COMMUNITIES, THE ORGANIZATION HAS DEVELOPED FINANCIAL ASSISTANCE POLICIES AND PROGRAMS THAT ADDRESS THE FINANCIAL NEEDS OF OUR PATIENTS. WE PRIDE OURSELVES ON THE TRANSPARENCY OF OUR PROGRAMS AND THE EDUCATION WE OFFER OUR PATIENTS AROUND OUR FINANCIAL ASSISTANCE POLICIES. OUR PROGRAMS ARE DOCUMENTED ON OUR WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE ORGANIZATION'S FACILITIES AND PHYSICIAN OFFICES. OUR PATIENT ACCESS SPECIALISTS, FINANCIAL COUNSELORS AND BUSINESS OFFICE TEAMS WORK WITH ALL ELIGIBLE PATIENTS TO EDUCATE THEM ON THE VARIOUS OPTIONS AVAILABLE VIA OUR FINANCIAL ASSISTANCE PROGRAMS OR GOVERNMENT SPONSORED CARE. THEY ALSO REFERENCE OUR FINANCIAL ASSISTANCE POLICY IN ALL CONVERSATIONS RELATED TO PATIENTS BILLS. FINALLY, WE WORK WITH LOCAL AREA FREE HEALTH CLINICS AND OTHER CHARITABLE ORGANIZATIONS TO PROVIDE CONTINUATION OF CARE FOR THEIR PATIENTS. IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED ON THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED FPG FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. 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 ONE LICENSED HOSPITAL 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. THE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREAS OF THE FACILITIES LISTED ABOVE INCLUDE THE CITY OF WINSTON-SALEM, THE TOWNS OF BETHANIA, KERNERSVILLE, LEWISVILLE, RURAL HALL, WALKERTOWN, AND THE VILLAGE OF CLEMMONS, ALL OF WHICH ARE LOCATED IN FORSYTH COUNTY, NORTH CAROLINA. THE SECONDARY SERVICE AREA COVERS A SEVEN COUNTY RADIUS INCLUDING: DAVIDSON, DAVIE, GUILFORD, STOKES, SURRY, WILKES, AND YADKIN COUNTIES. FORSYTH COUNTY IS MORE URBAN IN NATURE. THE COUNTY CONSISTS OF A LARGE URBAN CENTER SURROUNDED BY SMALLER, MORE RURAL COMMUNITIES. ACCORDING TO THE US CENSUS BUREAU DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $49,402.ACCORDING TO SG2 DATA, THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) FOR THE PRIMARY AND SECONDARY SERVICE AREAS ARE AS FOLLOWS:PRIMARY SERVICE AREAETHNICITY POPULATION % OF POPULATIONWHITE 233,910 58.76%BLACK/AFRICAN AMERICAN 94,848 23.83%HISPANIC/LATINO 50,160 12.60%ASIAN/PACIFIC ISLANDERS 9,946 2.50%OTHER 9,203 2.31%TOTAL POPULATION 398,067 100%SECONDARY SERVICE AREAETHNICITY POPULATION % OF POPULATIONWHITE 560,152 65.90%BLACK/AFRICAN AMERICAN 171,235 20.15%HISPANIC/LATINO 70,425 8.29%ASIAN/PACIFIC ISLANDERS 28,614 3.37%OTHER 19,586 2.30%TOTAL POPULATION 850,012 100%ACCORDING TO SG2 DATA, THE AGE BREAKDOWN FOR THE PRIMARY AND SECONDARY SERVICE AREAS IS AS FOLLOWS:PRIMARY SERVICE AREAETHNICITY POPULATION % OF POPULATION0-17 92,161 23.15%18-64 242,138 60.83%65+ 63,768 16.02%TOTAL POPULATION 398,067 100.00%SECONDARY SERVICE AREAETHNICITY POPULATION % OF POPULATION0-17 186,347 21.92%18-64 514,730 60.56%65+ 148,935 17.52%TOTAL POPULATION 850,012 100.00%THERE ARE FIVE NONPROFIT ACUTE CARE HOSPITAL FACILITIES IN THE COMMUNITY, FOUR OF WHICH ARE PART OF THE NOVANT HEALTH SYSTEM. THERE IS ALSO ONE ACADEMIC TEACHING HOSPITAL. 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 HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL-PROFILE/COMMUNITY-BENEFIT-REPORT.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-INVOLVEMENT/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 ABC OF NC FOUNDATION 905 FRIEDBERG CHURCH ROAD WINSTONSALEM NC 27127 911963813 501(C)(3) 15000 0 COMMUNITY OUTREACH AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(C)(3) 105000 0 COMMUNITY OUTREACH CANCER SERVICES INC 3175 MAPLEWOOD AVENUE WINSTONSALEM NC 27103 560656375 501(C)(3) 10000 0 COMMUNITY OUTREACH COMMUNITY CARE CENTER FOR FORSYTH COUNTY 2135 NEW WALKERTOWN ROAD WINSTONSALEM NC 27101 581403699 501(C)(3) 25000 0 COMMUNITY OUTREACH CRISIS CONTROL MINISTRY INC 200 EAST TENTH STREET WINSTONSALEM NC 27101 237348168 501(C)(3) 15000 0 COMMUNITY OUTREACH DAVIE COMMUNITY FOUNDATION INC 107 N SALISBURY STREET MOCKSVILLE NC 27028 581850531 501(C)(3) 11250 0 COMMUNITY OUTREACH EXPERIMENT IN SELF-RELIANCE INC PO BOX 135 WINSTONSALEM NC 27102 566060100 501(C)(3) 15000 0 COMMUNITY OUTREACH FAMILY SERVICES INC 1200 SOUTH BROAD STREET WINSTONSALEM NC 27101 560689235 501(C)(3) 25000 0 COMMUNITY OUTREACH FORSYTH TECHNICAL COMMUNITY COLLEGE 2100 SILAS CREEK PARKWAY WINSTONSALEM NC 27103 561070364 501(C)(3) 100000 0 COMMUNITY OUTREACH GREENSBORO AREA CHAMBER OF COMMERCE 111 W FEBRUARY ONE PLACE GREENSBORO NC 27401 560245040 501(C)(6) 50000 0 COMMUNITY OUTREACH HANDS ON NORTHWEST NORTH CAROLINA 751 WEST FOURTH STREET SUITE 200 WINSTONSALEM NC 27101 260824793 501(C)(3) 26000 0 COMMUNITY OUTREACH HOSPICE & PALLIATIVE CARECENTER 101 HOSPICE LANE WINSTONSALEM NC 27103 581343313 501(C)(3) 12500 0 COMMUNITY OUTREACH HOSPITAL HOSPITALITY HOUSE OF WINSTON-SALEM 1970 BALDWIN LANE WINSTONSALEM NC 27103 203604576 501(C)(3) 10000 0 COMMUNITY OUTREACH INSIGHT HUMAN SERVICES INC 665 WEST FOURTH STREET WINSTONSALEM NC 27101 560951129 501(C)(3) 20000 0 COMMUNITY OUTREACH JDRF INTERNATIONAL 26 BROADWAY 15TH FL NEW YORK NY 10004 231907729 501(C)(3) 15000 0 COMMUNITY OUTREACH LEADERSHIP WINSTON-SALEM 624 W SIXTH STREET SUITE 110 WINSTONSALEM NC 27101 581574887 501(C)(3) 6456 0 COMMUNITY OUTREACH MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVENUE WHITE PLAINS NY 10605 131846366 501(C)(3) 13000 0 COMMUNITY OUTREACH MEDASSIST OF MECKLENBURG DBA NC MEDASSIST 4428 TAGGART CREEK ROAD CHARLOTTE NC 28208 562018957 501(C)(3) 7500 0 COMMUNITY OUTREACH NATIONAL CYCLING CENTER INC 145 KIMEL PARK DR WINSTONSALEM NC 27103 472950622 501(C)(3) 10000 0 COMMUNITY OUTREACH OLD HICKORY COUNCIL INC 6600 SILAS CREEK PKWY WINSTONSALEM NC 27106 560529985 501(C)(3) 14360 0 COMMUNITY OUTREACH PIEDMONT TRIAD PARTNERSHIP PO BOX 2672 HIGH POINT NC 27261 561750279 501(C)(3) 25000 0 COMMUNITY OUTREACH RONALD MCDONALD HOUSE OF WINSTON-SALEM 419 S HAWTHORNE ROAD WINSTONSALEM NC 27103 581454715 501(C)(3) 10000 0 COMMUNITY OUTREACH SAMARITAN MINISTRIES 414 E NORTHWEST BLVD WINSTONSALEM NC 27105 561490019 501(C)(3) 10000 0 COMMUNITY OUTREACH SECOND HARVEST FOOD BANK OF NORTHWEST NC INC 3655 REED STREET WINSTNSALEM NC 27107 581457912 501(C)(3) 20000 0 COMMUNITY OUTREACH SENIOR SERVICES INC 2895 SHOREFAIR DRIVE WINSTONSALEM NC 27105 561085968 501(C)(3) 45000 0 COMMUNITY OUTREACH SUSAN G KOMEN NORTHWEST NC 1106 BURKE STREET WINSTONSALEM NC 27101 752891104 501(C)(3) 10000 0 COMMUNITY OUTREACH THE SCIENCE CENTER AND ENVIRONMENTAL PARK OF FORSYTH COUNTY DBA SCIWORKS 400 W HANES MILL ROAD WINSTONSALEM NC 27105 560815746 501(C)(3) 9100 0 COMMUNITY OUTREACH THE SHALOM PROJECT INC 639 SOUTH GREEN STREET WINSTONSALEM NC 27101 202136431 501(C)(3) 12000 0 COMMUNITY OUTREACH THE SHEPHERD'S CENTER OF KERNERSVILLE INC PO BOX 2044 KERNERSVILLE NC 27285 561471510 501(C)(3) 7500 0 COMMUNITY OUTREACH UNITED WAY OF FORSYTH COUNTY INC 301 N MAIN STREET SUITE 1700 WINSTONSALEM NC 27101 237357234 501(C)(3) 40000 0 COMMUNITY OUTREACH UNIVERSITY OF NORTH CAROLINA SCHOOL OF THE ARTS FOUNDATION INC 1533 SOUTH MAIN STREET WINSTONSALEM NC 27127 566064850 501(C)(3) 8300 0 COMMUNITY OUTREACH WAKE FOREST UNIVERSITY HEALTH SCIENCES MEDICAL CENTER BLVD WINSTONSALEM NC 27157 223849199 501(C)(3) 150000 0 COMMUNITY OUTREACH WINSTON-SALEM ALLIANCE 100 N MAIN STREET WINSTONSALEM NC 27101 311726654 501(C)(6) 35000 0 COMMUNITY OUTREACH WINSTON-SALEM FOUNDATION 751 WEST FOURTH STREET SUITE 200 WINSTONSALEM NC 27101 566037615 501(C)(3) 50500 0 COMMUNITY OUTREACH WINSTON-SALEM POLICE FOUNDATION INC PO BOX 24011 WINSTONSALEM NC 27114 475289473 501(C)(3) 25000 0 COMMUNITY OUTREACH WINSTON-SALEM SYMPHONY ASSOCIATION 201 NORTH BROAD STREET SUITE 200 WINSTONSALEM NC 27101 560692826 501(C)(3) 15000 0 COMMUNITY OUTREACH YOUNG MEN'S CHRISTIAN ASSOCIATION OF NORTHWEST NORTH CAROLINA 301 N MAIN STREET SUITE 1900 WINSTONSALEM NC 27101 560530015 501(C)(3) 16000 0 COMMUNITY OUTREACH MORAVIAN HOME INCORPORATED 1000 SALEMTOWNE DRIVE WINSTONSALEM NC 27106 560963926 501(C)(3) 40000 COMMUNITY OUTREACH 36 2 PATIENT ASSISTANCE 22 20840 MEDICATION FOR INDIGENT PATIENTS 551 36231 FMV MEDICATION FOR INDIGENT PATIENTS PATIENT TRANSPORTATION 3085 47702 FMV CAB FARES FOR INDIGENT PATIENTS PART I, LINE 2 : PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS THE FILING ORGANIZATION IS PART OF THE INTEGRATED HEALTHCARE SYSTEM OPERATED BY NOVANT HEALTH, INC. ("NOVANT HEALTH"), THE PARENT ORGANIZATION. NOVANT HEALTH'S BYLAWS AUTHORIZE IT TO ESTABLISH CERTAIN POLICIES FOR ALL OF ITS SUBSIDIARIES WITHIN THE SYSTEM. NOVANT HEALTH HAS ESTABLISHED A SYSTEM-WIDE CORPORATE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE FILING ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET. X X X X 1 1 0 1 0 0 0 0 0 0 0 EDWARDS JOEL MD TRUSTEE 391343 0 125621 0 32003 0 16500 0 19980 0 585447 0 0 0 MORRIS JOHN ASST SEC 0 258746 0 101077 0 33207 0 24000 0 23612 0 440642 0 7500 SANZ SEAN FMR PRES & COO 85208 0 257849 0 84148 0 15201 0 8959 0 451365 0 25550 0 SETLIFF MICHAEL PRES & COO FMH INCL KMC 324981 0 168313 0 35758 0 45450 0 28030 0 602532 0 0 0 SMITH HARRY SVP HOSPITAL OPERATIONS 0 590928 0 386327 0 153754 0 116199 0 37965 0 1285173 0 84750 BRIGHT JANET CNO 185469 0 36075 0 25143 0 7446 0 10655 0 264788 0 0 0 MOTEW STEPHEN SVP 457344 0 275852 0 134176 0 95850 0 30585 0 993807 0 63750 0 NYCUM LAWRENCE SVP 437172 0 268532 0 85738 0 92949 0 31198 0 915589 0 35625 0 ROYSTER KIRSTEN PRES & COO KMC 7398 260633 0 131192 20237 17224 21591 0 817 10546 50043 419595 0 0 BRAVO JULIO RHEUMATOLOGIST 450437 0 296199 0 28518 0 23688 0 37880 0 836722 0 7500 0 MCDONALD COLIN NEUROLOGIST 390729 0 17205 0 318595 0 16500 0 42034 0 785063 0 0 0 NOUREDDINE NIZAR CARDIOLOGIST 461490 0 225200 0 32321 0 22533 0 36375 0 777919 0 7500 0 PRELI ROBERT CARDIOLOGIST 478472 0 219466 0 30339 0 24000 0 36397 0 788674 0 7500 0 ZEYLIKMAN YURIY NEUROLOGIST 358868 0 14320 0 634858 0 24000 0 34811 0 1066857 0 0 0 LINDSAY JEFFERY FMR PRES - FMH/COO WS MKT 0 915320 0 762396 0 228118 0 24000 0 30246 0 1960080 0 7500 MIHAL DENISE FMR PRES - FMH/COO WS MKT 0 676022 0 583872 0 197524 0 24000 0 19808 0 1501226 0 7500 GREGORY CHERE FMR SVP 0 406827 0 250606 0 85748 0 78427 0 31771 0 853379 0 60000 JARRETT-PULLIAM KIMBERLY FMR CNO 0 132377 0 182864 0 26891 0 16173 0 7761 0 366066 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, LINE 4B PART I, LINES 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED GREGORY, CHERE MD 52,500 MOTEW, STEPHEN 56,250 NYCUM, LAWRENCE 28,125 SANZ, SEAN 25,550 SMITH, HARRY 77,250 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 ("NHKMC") 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 28,000 EMPLOYEES WHO MAKE HEALTHCARE REMARKABLE AT OVER 640 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 FOUR MILLION PATIENTS ANNUALLY. NOVANT HEALTH IS RANKED AS ONE OF THE NATION'S TOP 25 INTEGRATED HEALTH SYSTEMS BY SK&A. IN 2018, THE NOVANT HEALTH SYSTEM REPORTED $5 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, CLEMMONS AND KERNERSVILLE, NC COMMUNITIES THROUGH PARTNERSHIPS AND OUTREACH. THE HOSPITALS SUPPORT ORGANIZATIONS THAT PROVIDE HEALTH SERVICES, EDUCATION AND ASSISTANCE TO THE UNINSURED AND THE OVERALL COMMUNITY. IN ITS SEVENTH FULL YEAR OF OPERATION, NOVANT HEALTH FORSYTH MEDICAL CENTER AFFILIATE HOSPITAL, NOVANT HEALTH KERNERSVILLE MEDICAL CENTER IN KERNERSVILLE, NC 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, NC 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, PROVIDING CONSISTENT QUALITY AND EXCELLENT SERVICE TO RESIDENTS IN WESTERN FORSYTH COUNTY, DAVIE COUNTY AND YADKIN COUNTY OF NORTH CAROLINA. 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 IN THE TRIAD AND SURROUNDING COUNTIES IN MANY UNIQUE WAYS. A FEW EXAMPLES OF THIS ARE AS FOLLOWS: FREE COMMUNITY SCREENINGS - IN 2018, NOVANT HEALTH FORSYTH MEDICAL CENTER HELD 426 FREE SCREENING EVENTS THAT SERVED MORE THAN 4,300 SCREENING PARTICIPANTS. LOCATIONS INCLUDE NOVANT HEALTH TRIAD CAMPUSES, 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 2018, 431 FREE EDUCATIONAL EVENTS SERVED MORE THAN 9,000 INDIVIDUALS. LOCATIONS INCLUDE CAMPUS FACILITIES, PUBLIC SCHOOLS, YMCA/YWCA, RECREATION CENTERS, PUBLIC LIBRARIES, SENIOR CENTERS, CORPORATIONS, HOMELESS SHELTERS, FAITH COMMUNITIES, AND NEIGHBORHOOD EVENTS. IN 2018, NEARLY 700 WELLNESS COACH SESSIONS WERE PROVIDED WITH A CERTIFIED COACH, EITHER IN 1:1 OR GROUP SETTINGS. SUPPORT GROUPS - NOVANT HEALTH FORSYTH MEDICAL CENTER AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER HOST 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 HOSPITALS OFFER 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 2018, 81 SUPPORT GROUPS WERE PROVIDED TO MORE THAN 2,000 ATTENDEES. FORM 990, PART I, LINE 1 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. 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 2018, 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. TRANSITIONAL CARE & INFUSION SERVICES - KERNERSVILLE MEDICAL CENTER HAS ALSO ADDED TRANSITIONAL CARE, WHICH IS A NEW HEALTHCARE DELIVERY MODEL THAT ALLOWS PATIENTS TO RECEIVE CARE AT THE MEDICAL CENTER DURING THE DAY AND GO HOME AT NIGHT. THIS MODEL LEADS TO SHORTER HOSPITAL STAYS AND LOWER HEALTHCARE COSTS. DURING A TRANSITIONAL CARE APPOINTMENT, PROVIDERS EVALUATE A PATIENT'S SYMPTOMS, PROVIDE MEDICATIONS IF NEEDED, ORDER ANY NECESSARY TESTS AND ANSWER ANY QUESTIONS A PATIENT MAY HAVE. RESPIRATORY AND PULMONARY SERVICES - 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. 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 2018. NOVANT HEALTH CLEMMONS MEDICAL CENTER BEGAN CONSTRUCTION ON 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 HEALTH 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 AND 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 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 - 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 FORM 990, PART I, LINE 1 HEALTH INFORMATION AND MANAGEMENT SYSTEMS SOCIETY (HIMSS) STAGE 7 ACUTE CARE AWARD - THIS RECOGNITION REPRESENTS NOVANT HEALTH KERNERSVILLE MEDICAL CENTER'S ACHIEVEMENT OF THE HIGHEST LEVEL ON THE ELECTRONIC MEDICAL RECORD ADOPTION MODEL (EMRAM), WHICH MEANS THAT WE ARE UTILIZING ELECTRONIC MEDICAL RECORD TECHNOLOGY TO ITS FULLEST POTENTIAL TO PROVIDE ACCESS AND CARE TO OUR PATIENTS. LEADERS IN LGBTQ HEALTHCARE EQUALITY - NOVANT HEALTH FORSYTH MEDICAL CENTER AND NOVANT HEALTH KERNERSVILLE MEDICAL CENTER HAVE BEEN RECOGNIZED AS "LEADER IN LGBTQ HEALTHCARE EQUALITY" BY THE HUMAN RIGHTS CAMPAIGN FOUNDATION, THE EDUCATIONAL ARM OF THE COUNTRY'S LARGEST LESBIAN, GAY, BISEXUAL AND TRANSGENDER CIVIL RIGHTS ORGANIZATION. FACILITIES AWARDED THIS TITLE MEET KEY CRITERIA, INCLUDING PATIENT AND EMPLOYEE NONDISCRIMINATION POLICIES, A GUARANTEE OF EQUAL VISITATION FOR SAME-SEX PARTNERS AND PARENTS, AND LGBTQ HEALTH EDUCATION FOR KEY STAFF MEMBERS. 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 - THE JOINT COMMISSION - HIP FRACTURE CERTIFICATION - THE JOINT COMMISSION - TOTAL HIP JOINT REPLACEMENT CERTIFICATION - THE JOINT COMMISSION - ADVANCED PALLIATIVE CARE PROGRAM CERTIFICATION - THE JOINT COMMISSION - COMPREHENSIVE STROKE CENTER - THE JOINT COMMISSION - 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 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-INVOLVEMENT/COMMUNI TY-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 $884,000,000, INCLUDING $155,000,000 IN FINANCIAL ASSISTANCE FOR 2018. 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 2018 THERE WERE 10,955 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3 DAYS, AN AVERAGE DAILY CENSUS OF 30, AND 3,251 DISCHARGES. THERE WERE 4,368 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 51,849 OUTPATIENT ENCOUNTERS AND 35,997 EMERGENCY DEPARTMENT VISITS. CMC HAS 36 LICENSED BEDS. DURING 2018 THERE WERE 4,219 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 2 DAYS, AN AVERAGE DAILY CENSUS OF 12, AND 2,118 DISCHARGES. THERE WERE 3,298 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 27,739 OUTPATIENT ENCOUNTERS AND 20,062 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). 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 A, COLUMN B: RELATED ORGANIZATIONS THE ORGANIZATION EMPLOYS CERTAIN EXECUTIVES WHOSE ROLES ARE SUCH THAT THEY PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE HEALTHCARE SYSTEM. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS GEOGRAPHIC MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE SYSTEM. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE SYSTEM. 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 IX, LINE 6: COMPENSATION OF DISQUALIFIED PERSONS THE AMOUNTS REPORTED HERE INCLUDE AMOUNTS ATTRIBUTABLE TO DISQUALIFIED PERSONS (DQP) AS DEFINED IN THE INSTRUCTIONS, BUT NOW ALSO INCLUDES AMOUNTS ATTRIBUTABLE TO INDIVIDUALS THAT MAY NOT DEFINITIVELY BE CONSIDERED DQPS UNDER THE 4958 RULES. WE HAVE OPTED TO TAKE A MORE EXPANSIVE APPROACH AS TO WHO MAY BE CONSIDERED A DQP AND REPORT THEM HERE AS WELL. FORM 990, PART XI, LINE 9: CONTRIBUTIONS: -1,401,008. MALPRACTICE INSURANCE: -390,232. AFFILIATE TRANSFERS: -1,510,878. PARTNERSHIP ADJUSTMENT: 16,846,580. 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