2018-06-22T14:44:36-05:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-10-01 560989789 HALIFAX REGIONAL MEDICAL CENTER INC HALI 2525358011 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 SHERRY JENSEN CFO 2525358011 2018-06-22 1 Amy Bibby P00445891 8282542254 2018-06-06 2016 2022-09-23 18:48:47Z WILL MAHONE 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 105258487 0 X www.halifaxmedicalcenter.org X 1972 NC TO PROVIDE MEDICAL SERVICES TO THE RESIDENTS OF HALIFAX COUNTY AND SURROUNDING COUNTIES. 15 13 953 62 748904 -313527 1007257 574602 106482433 103894758 378817 324166 19385 46453 107887892 104839979 0 0 0 0 42512423 41947327 0 0 0 55961361 58424782 98473784 100372109 9414108 4467870 93448891 98761838 42360559 47493119 51088332 51268719 X PLACING PATIENTS FIRST BY PROVIDING EXCELLENT AND COMPASSIONATE HEALTHCARE SERVICES. 0 0 93773089 103970673 PROVIDING QUALITY HEALTHCARE IS ONLY PART OF THE HOSPITAL'S CONTRIBUTION TO THE COMMUNITY. WITH OVER 1,000 EMPLOYEES, HALIFAX REGIONAL IS ONE OF THE REGION'S LARGEST EMPLOYERS. MANY OF THE APPROXIMATELY 60 PHYSICIANS ON THE HOSPITAL STAFF HIRE THEIR OWN EMPLOYEES AS WELL AND INVEST IN DEVELOPING THEIR PRACTICES, EXTENDING ECONOMIC IMPACT. THE MEDICAL CENTER PURCHASES MILLIONS OF DOLLARS OF GOODS AND SERVICES FROM THE REGION.PLEASE SEE SCHEDULE O FOR A CONTINUATION OF THE PROGRAM SERVICE ACCOMPLISHMENTS- Implemented year three of management service agreement with Adept Health (Novant) providing consulting services for quality, discharge planning, physician leadership, revenue cycle, clinical documentation, physician practice management, practice information systems, facility and engineering services. Annual savings from purchasing and service discounts were $1,173,659 and $673,659 net of fee.- Halifax Regional extended its management services agreement with Adept Health for 10 years with performance measures.- Recruited 3 new physicians and providers for Emergency Services.- Recruited a new Manager, Erin White, as Director for Therapy Services.- Performed assessment and implemented recommendations to reduce Hospital Acquired Infections or Conditions (HACs).- Implemented Length of Stay reduction program with Adept Health to decrease average length of stay by 0.5 days.- Purchased and installed a new Urology table.- Expanded Halifax Works to provide Urgent Care Services for not only occupational health clients but all patients. Added on site imaging services.- Dr. Holder began skin-to-skin contact in recovery area for C-Section patients. This increases bonding of mother, father, and baby in the recovery area.- Implemented second year of 2 year grant from Kate B Reynolds Trust to develop a Diabetes Resource Center for low income, uninsured and underinsured minority communities in our service area.- Reduced overall all payer readmission rates and identified high risk patients for follow up home visit within 3 days of discharge.- Marketing of Woodside was expanded by Lisa Turner, Nurse Manager of Woodside Behavioral Health Unit, with visits to Martin County, Tarboro, Scotland Neck, Henderson, and Oxford hospitals to offer our services. A second provider began working with Dr Ijaz, Scott Morelli, PA- Received an unqualified financial and operational audit for FY2016 with no audit adjustments.- Employee fundraising campaigns raised $14, 023 for the United Way to support the important services of the United Way.- Implemented Vincari software to assist surgeons with electronic documentation.- The Respiratory Care Team members recertified for Advanced Cardiac Life Support (ACLS) and Neonatal Resuscitation Program (NRP) and performed the first bronchoscopy since 2015 with Dr Duggan.- Successfully implemented new ShoreTel enterprise phone system at a cost of $460,000.- Implemented PolicyStat software to house all enterprise wide policies for effective online access and use.- Implemented ICNET Pharmacy system software as clinical surveillance system for infection prevention. - Planned and implemented the Birthing Center Breastfeeding Support Group for patients.- Gwen Davis RN encouraged and trained Drs Tiwari, Vallani, Bhagwandass, Dorsey, Rajan, Wier, Ketoff and Martin to enter their own computerized order entry.- Met all 2017 Meaningful Use goals for Hi Tech stimulus funds of $459,000.- Workplace Violence Committee led by Barbara Moore RN continued to identify strategies to improve workplace safety. With a significant grant from the Halifax Regional Foundation, $45,000 of safety facility improvements are being implemented in the Emergency Services area.- Reorganized Quality and Risk Management for concurrent quality reviews.- One of our nurses was recognized as a Great 100 Nurses in North Carolina for 2017. Amy Joseph, our OB Services Nurse Manager has been recognized this year.- Reaccredited in Laboratory for Clinical Laboratory Improvement Amendments (CLIA) through 2019 and installed new chemistry and immunoassay analyzers providing additional tests.- Installed three new patient educational channels called the GetWell Network.- Completed implementation of Antibiotic Stewardship Program to monitor antibiotic usage, educate staff and make formulary recommendations to Pharmacy and Therapeutics Committee.- Began reporting clinical data to LeapFrog Quality Rating Service after achieving a hospital patient safety score of "B".- Reassigned Patient Safety to the Risk Management staff and developed a "Good Catch" program to reward staff who report quality opportunities to improve.- Patients are pleased to be able to pay and communicate online for their bills with PatientCo software. Over 43% or 4300 patient services payments were made online.- Implemented a new weight loss program in conjunction with Halifax Works to serve employees and those of area businesses.- Implemented conversion from computed radiology (CR) to digital radiology (DR) for all radiology equipment. This received Board of Directors' approval for $1,129,558.- Renovated all 7 bathrooms in Radiology and replaced all flooring for improved appearance.- Continued to implement plan for replacement of emergency electrical generators and boilers. This received Board of Directors' approval for $5,184,500.- Achieved American College of Radiology (ACR) reaccreditations for all areas certified by the ACR ie CT, Nuclear Medicine, MRI, Mammography, and Ultrasound services.- Wound Care Service earned Center of Distinction award from Healogics by achieving a wound healing rate of 93%.- Medical Staff completely rewrote the Medical staff Bylaws and Rules and Regulations for Medical Staff using draft of Novant Health Medical Staff Bylaws.- Began reviewing new USP 800 Standards for two Pharmacy hoods with Novant Health facility staff. One hood is to assure safety for staff with dangerous chemotherapy and antibiotic drugs and the other hood is to assure sanitary conditions for other compounding. These new standards may require renovation costs exceeding $400,000 in FY18.- Recruited 10 new volunteers for a total of 62 volunteers who provided 7725.5 volunteer hours for our patients. The Auxiliary donated $29,824 to Halifax Regional for items requested by hospital departments. Leah and Elle, our Pet Therapy team, continue to visit the hospital. The volunteer program funded two $300 scholarships to area high schools and one $2000 scholarship for nursing students. They donated $1000 to the Halifax Regional Foundation. New Volunteer areas: Outpatient Registration and Risk Management. Volunteers continue to staff blood drives at the hospital.- Applied and received the following financial grants in FY2017:Kate B Reynolds Get Fit Stay Fit Grant $108,250Halifax Regional Foundation Annual Contribution 30,476Halifax Regional Auxiliary Annual Contribution 29,824Access East-Medicare Community Based Care Transitions Program 68,964Susan G Komen Grant 50,000Kate B Reynolds Diabetes Grant 93,500 Total $381,014 93773089 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 0 1 144 0 1 953 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X SHERRY JENSEN 2525358005 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 Tom Lynch Chairman 1.00 1.00 X X 1800 0 0 Fannie Greene Vice Chairwoman 1.00 1.00 X X 1200 0 0 Drewery Beale Treasurer 1.00 1.00 X 1500 0 0 Dr Natarajan Rajan Secretary 1.00 1.00 X 1150 0 0 Bob Patterson Past Chairman 1.00 1.00 X 1350 0 0 Dr Joey Thomas Chief of Staff 1.00 1.00 X 7452 0 0 Dr Sandeep Tiwari Past Chief of Staff 1.00 1.00 X 1800 0 0 William Mahone President/CEO 40.00 1.50 X X 0 0 0 Hugh Bazemore Board Member 1.00 1.00 X 950 0 0 James Pierce Board Member 1.00 1.00 X 650 0 0 Johnny Draper Board Member 1.00 1.00 X 500 0 0 Vernon Bryant Board Member 1.00 1.00 X X 800 0 0 Evelyn Dawson Board Member 1.00 X 450 0 0 Rev Randy Martin Board Member 1.00 X 550 0 0 Sherry Jensen VP of Finance/CFO 40.00 1.50 X 279598 0 15487 William Hodge Board Member 1.00 1.00 X 1400 0 0 Karen Daniels VP/CNO 40.00 1.00 X 205170 0 7779 Bruce Robistow VP 40.00 0.50 X 171749 0 15008 Steven Hill CRNA 40.00 X 228954 0 15582 Kenneth Hartz CRNA 40.00 X 219355 0 18760 Steven Ulsas CRNA 40.00 X 203389 0 1476 Elizabeth Crawley CRNA 40.00 X 194975 0 13027 Claude Dietrich CRNA 40.00 X 173571 0 18675 1698313 0 105794 30 0 1 0 Novant Health 2085 Frontis Plaza Winston Salem NC 27103 Management 2071897 TherexDBA Rehabcare PO Box 502096 St Louis MO 631502096 PT/ST/OT Services 1082350 Sodexo PO Box 360170 Pittsburgh PA 631502096 Dietary Services 896892 O C Mitchell 1411 South Miami Blvd Durham NC 27703 Contractor 514672 Diversified Clinical Services 28525 Network Place Chicago IL 606731285 Wound Care Services 424005 40 58325 516277 574602 NET PATIENT SERVICE REV 541380 103123292 102377810 745482 OTHER PATIENT SERVICES 900099 575509 575509 PURCHASE DISCOUNTS 541900 161145 161145 PHARMACY 446110 34812 34812 103894758 678249 3422 674827 76361 64425 11936 11936 11936 333153 20930 -333153 -20930 -354083 -354083 MISCELLANEOUS INCOME 900099 17813 17813 FOOD/VENDING REVENUE 900099 16704 16704 34517 104839979 103149276 748904 367197 X 703697 340713 362984 33074453 30334049 2740404 1374279 1236103 138176 4373494 3933762 439732 2421404 2177945 243459 500001 500001 95204 95204 191310 191310 94544 94544 14864309 14147620 716689 348719 348719 2973419 2194685 778734 1504614 1476861 27753 1004382 1004382 188143 162897 25246 572614 572614 4210451 4210451 914903 692900 222003 BAD DEBT EXPENSE 15167058 15167058 MEDICAL SUPPLIES 9436751 9436635 116 DRUG EXPENSE 3180834 3180834 MISCELLANEOUS EXPENSES 2556173 2508362 47811 621353 551955 69398 100372109 93773089 6599020 0 20279542 25345379 216682 9333749 9646155 1483479 1575397 856148 1561198 85889504 57570532 28426814 28318972 12373954 12401434 491983 830648 19986540 19082655 93448891 98761838 23403011 23799874 14715000 13128358 1129603 6579200 3112945 3985687 42360559 47493119 X 50809056 51065358 279276 203361 51088332 51268719 93448891 98761838 X 4467870 -239089 -4048394 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10000 10000 0 Part II-B, Line 1: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE NORTH CAROLINA HOSPITAL ASSOCIATION. A PORTION OF DUES PAID TO THE ORGANIZATION IS ALLOCATED TO LOBBYING EFFORTS ON BEHALF OF THE MEMBERSHIP BODY. THE APPROXIMATE PORTION OF DUES PAID TO THESE ORGANIZATIONS FOR THE YEAR THAT CONSTITUED LOBBYING WAS $10,000. 867707 867707 27005070 18410444 8594626 16807037 11458034 5349003 38633339 26337904 12295435 2576351 1364150 1212201 28318972 OTHER RECEIVABLES 821646 DUE FROM ROANOKE VALLEY HEALTH SERVICES, INC. 18261009 19082655 THIRD PARTY PAYOR SETTLEMENT 3985687 3985687 X 85362909 -239089 64425 -174664 85537573 94544 19207862 19302406 104839979 85182522 64425 64425 85118097 94544 15159468 15254012 100372109 Part X, Line 2: THE MEDICAL CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE MEDICAL CENTER HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2017. Part XI, Line 2d - Other Adjustments: RENTAL EXPENSES NET W/ REVENUES 64,425. Part XI, Line 4b - Other Adjustments: TRANSFER OF EQUITY 3,600,000. BAD DEBT EXPENSE IN REVENUE 15,159,468. CHANGE IN VALUE OF DEFINED PENSION PLAN 448,394. LOSS ON EXTINGUISHMENT OF DEBT Part XII, Line 2d - Other Adjustments: RENTAL EXPENSES NET W/ REVENUES 64,425. Part XII, Line 4b - Other Adjustments: BAD DEBT EXPENSE IN REVENUE 15,159,468. 1 1 X 1 X 1 X 1 1 1 0 1 1 3391184 3391184 0.03980 15485639 12874860 2610779 0.03060 82627 39664 42963 0.00050 18959450 12914524 6044926 0.07090 473498 426 473072 0.00560 2650 2650 0.00000 476148 426 475722 0.00560 19435598 12914950 6520648 0.07650 1194 1194 0.00000 3000 3000 0.00000 4194 4194 0.00000 1 15159469 452467 34818690 33347074 1471616 X 1 1 1 1 HALIFAX REGIONAL MEDICAL CENTER 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 X X X DISPROPORTIONATE SHARE HOSPITAL HALIFAX REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X www.halifaxmedicalcenter.org X 1 15 1 www.halifaxmedicalcenter.org 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X www.halifaxmedicalcenter.org X www.halifaxmedicalcenter.org X http://www.halifaxmedicalcenter.org/charity.html X X X X X 1 X 0 X X X 1 X 0 1 HALIFAX REGIONAL MEDICAL CENTER Part V, Section B, Line 5: Primary data was obtained from community-wide health surveys conducted by Halifax and Northampton County Health Departments from October 2014 to January 2015. Surveys were distributed across the counties in an effort to include the opinions of a diverse population. The final analysis included 810 surveys from Halifax and 335 from Northampton Co. State of Our County Listening Sessions were also held in seven communities in Halifax County from April 16 to May 20, 2015. The results were summarized and presented to each of these communities from October 1 to October 20, 2015. HALIFAX REGIONAL MEDICAL CENTER Part V, Section B, Line 11: The top priority addressed in this CHNA was identified as overweight/obesity. The objectives to addressing this need include: increase awareness of the obesity epidemic and promote healthy lifestyles, become a leading partner with the Roanoke Valley Community Health Initiative, and create a community resource directory of available resources to help lead a healthy lifestyle. The other risk factors that were identified include: diet, physical inactivity, high blood cholesterol/hypertension, substance abuse, and stress. These other risk factors are being addressed by other agencies in the area. Also, addressing this top priority of obesity will also help with the other factors identified. HALIFAX REGIONAL MEDICAL CENTER Part V, Section B, Line 16j: ON THE BACK OF THE BILLING STATEMENT, THE ORGANIZATION LISTS THE CHARITY POLICY AND PROVIDES THE PATIENT WITH A FINANCIAL COUNSELOR TO DISCUSS THEIR ABILITY TO PAY THE INVOICE/RECEIVE CHARITY CARE. HALIFAX REGIONAL MEDICAL CENTER Part V, Section B, Line 20e: Signage is placed in various places in the hospital including admissions and Emergency Dept. Part I, Line 7: THE ORGANIZATION USED WORKSHEET 2 OF THE 2014 SCHEDULE H INSTRUCTIONS TO COMPUTE CHARITY CARE, UNREIMBURSED MEDICAID, AND SUBSIDIZED HEALTH SERVICES AT COST FOR PURPOSES OF PART I, LINE 7. Part I, Ln 7 Col(f): THE TOTAL EXPENSE LISTED ON FORM 990, PART XI, LINE 25 CONTAINS BAD DEBT EXPENSE OF $14,043,783 WHICH HAS BEEN REMOVED FOR PURPOSES OF THE CALCULATION OF CHARITY CARE PERCENTAGE FOR PART I, LINE 7, COLUMN (F). PART I, LINE 7(E) THE COMMUNITY HEALTH IMPROVEMENTS SERVICES ON PART I, LINE 7(E) INCLUDE THE FOLLOWING:PATIENT EDUCATION $121,387LIBRARY FOR PATIENT EDUCATION $ 5,903CASE MANAGMENT HEART FAILURE $168,777THE COMMUNITY BENEFIT OPERATIONS SERVICES ON PART I, LINE 7(E) INCLUDE THE FOLLOWING:GRANT WRITING $ 56,000 Part II, Community Building Activities: HOSPITAL EMPLOYEES ROUTINELY DEVOTE THEIR TIME TO SERVICE ON THE CITY COUNCIL AND THE LOCAL CHAMBER OF COMMERCE TO PROMOTE COMMUNITY ECONOMIC DEVELOPMENT. THE HOSPITAL SPONSORS NUMEROUS EDUCATIONAL PROGRAMS INCLUDING DIABETES AND CHILDHOOD OBESITY PROJECTS. OUR WEBSITE OFFERS HEALTHY LIFE STYLE TIPS AND TOOLS TO IMPROVE HEALTHY LIVING AS WELL AS SENDS OUT EMAILS FOR THIS PROMOTION. WE PROMOTE FAMILY FEST TO ENCOURAGE EXERCISE AND HEALTHY EATING FOR THE CHILDREN OF OUR COMMUNITY. Part III, Line 4: THERE IS NOT A FOOTNOTE IN THE ORGANIZATION'S FINANCIAL STATEMENTS TO DISCUSS THE BAD DEBT EXPENSE.TOTAL BAD DEBT CONSISTS OF TOTAL CHARGES WRITTEN OFF TO BAD DEBT LESS ANY RECOVERIES AND PASS-THROUGH AMOUNTS FROM MEDICARE. In our community, the populations of people who live below the poverty level is about 27%. People without health insurance is 13.7% in the area. Based on our past experience with charity care and bad debt, about 10% of the people that are currently in bad debt would qualify for financial assistance. Part III, Line 8: APPROXIMATELY 50% OF THE HOSPITAL'S TOTAL CHARGES ARE FROM MEDICARE. APPROXIMATELY 18% OF THE POPULATION OF HALIFAX COUNTY IS AGE 65 AND OVER. THE HOSPITAL HAS A RESPONSIBILITY TO THE COMMUNITY TO PROVIDE QUALITY CARE, AND A SHORTFALL WHEN APPLICABLE FOR OUR MEDICARE COST OF CARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT. Part III, Line 9b: HALIFAX REGIONAL MEDICAL CENTER WORKS TO QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE BEFORE ASSIGNING UNPAID ACCOUNTS TO OUTSIDE COLLECTION AGENCIES. THE HOSPITAL HAS PURCHASED SOFTWARE SERIVCES TO MAKE IT EASIER TO QUALIFY PATIENTS FOR CHARITY CARE. WE ALSO WORK WITH VANGUARD SERVICES TO HELP PATIENTS QUALIFY FOR MEDICAID AND OTHER INSURANCES. HRMC STRIVES TO HELP PATIENTS QUALIFY FOR APPROPRIATE FINANCIAL ASSISTANCE BEFORE SENDING ACCOUNTS TO BAD DEBT COLLECTION AGENCIES.WHEN A PATIENT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, NO COLLECTION EFFORTS ARE MADE FOR THE PATIENT'S ACCOUNTS. Part VI, Line 2: The hospital is part of the Roanoke Valley Community Health Initiative (RV-CHI).This team is comprised of representatives from the Halifax and Northampton County Health Departments, area schools, Rural Health Group clinic, Our Community Hospital, Co-op Extension office, and Halifax Regional. This group meets quarterly to discuss community health issues and how they are being addressed by these community organizations. The RV-CHI also has a coordinating group that meets monthly. Our education director attends this monthly meeting as well. Also, our board is comprised of local community leaders who bring issues to the board and senior management. Part VI, Line 3: Our Financial Assistance Policy is on our website, and signage is posted throughout the hospital to inform patients about our policy. The process and phone numbers to call are also noted on our patient statements. We have staff from our Collections Department available to discuss the process with patients. The Collections Dept applies the policy as appropriate when assisting patients in qualifying for charity care or collecting payments from our patients. We also use software to help determine if patients qualify for charity care. This makes it easier for patients to qualify without having to present a lot of paperwork. Part VI, Line 4: Our primary service area consists of Halifax, Northampton, and Warren counties. The percentage of the hospital patients with Medicare and Medicaid is 71% of our total revenue. The total population estimates July 2017 are 51,310 Halifax; 19,862 Northampton; and 19,883 Warren. Persons age 65 and older July 2017 are 19.6% Halifax; 24.1% Northampton; and 22.9% Warren. People living in poverty are 27% Halifax; 22.4% Northampton; and 26.4% Warren. The population under age 65 living with a disability are 15.8% Halifax; 17.6% Northampton; and 16.6% Warren. Persons without health insurance are 13.7% Halifax; 12.0% Northampton; and 16.6% Warren. Part VI, Line 5: HALIFAX REGIONAL MEDICAL CENTER WORKS CLOSELY WITH THE AREA COUNTY HEALTH DEPARTMENTS TO DO COMMUNITY HEALTH ASSESSMENTS AND DETERMINE HEALTH NEEDS IN THE AREA. HRMC ALSO WORKS CLOSELY WITH THE RURAL HEALTH GROUP AND HAS IMPLEMENTED A CASE MANAGEMENT PROGRAM FOR HEART FAILURE PATIENTS. HRMC PROVIDES COMMUNITY HEALTH INFORMATION, EDUCATION, AND EXERCISE THROUGH OUR HEALTHLINKS IN THE LOCAL MALL. ON THE HRMC WEBSITE, THERE IS A LINK TO SIGN UP FOR FREE HEALTH-ED EMAILS THAT CONTAIN FREE TIPS FOR A HEALTHY LIFESTYLE AND NOTICES ABOUT HEALTHY ACTIVITIES AND EDUCATION.A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR MANY OF ITS DEPARTMENTS.ANY SURPLUS OF FUNDS IS REINVESTED INTO THE HOSPITAL BY PURCHASE NEW EQUIPMENT AND REPLACE EXISTING EQUIPMENT, UPDATE THE BUILDING STRUCTURE, AND IMPROVE OPERATIONS. WE ALSO USE FUNDS TO IMPROVE QUALITY OF CARE AND PROVIDE EDUCATIONAL OPPORTUNITIES FOR STAFF MEMBERS. Part VI, Line 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. Part VI, Line 7, Reports Filed With States NC X X X X 0 0 0 0 0 0 0 0 0 Sherry Jensen VP of Finance/CFO 231366 0 48232 0 0 0 1639 0 13848 0 295085 0 0 0 Karen Daniels VP/CNO 180284 0 24886 0 0 0 856 0 6923 0 212949 0 0 0 Bruce Robistow VP 149723 0 22026 0 0 0 1160 0 13848 0 186757 0 0 0 Steven Hill CRNA 227454 0 1500 0 0 0 1734 0 13848 0 244536 0 0 0 Kenneth Hartz CRNA 219055 0 300 0 0 0 1429 0 17331 0 238115 0 0 0 Steven Ulsas CRNA 203144 0 245 0 0 0 1476 0 0 0 204865 0 0 0 Elizabeth Crawley CRNA 194725 0 250 0 0 0 1258 0 11769 0 208002 0 0 0 Claude Dietrich CRNA 173321 0 250 0 0 0 1344 0 17331 0 192246 0 0 0 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2011-07-28 6500000 CAPITAL ACQUISITION 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2016-09-27 8845000 REFUNDING BONDS 0 0 0 A 870000 6502377 130000 6372043 2013 0 0 1 1 B 1131250 8845135 145064 8699936 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 1 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 A 0 B 0 PART II, LINE 3: TOTAL PROCEEDS TOTAL PROCEEDS ON LINE 3 INCLUDE INVESTMENT EARNINGS TO DATE OF $ 2,488. LYNCH'S OFFICE SUPPLY BOARD MEMBER, TOM LYNCH, OWNS THE COMPANY 170715 PURCHASES OF OFFICE SUPPLIES 0 Form 990, Part VI, Section A, line 3 DURING MARCH OF 2014 THE HOSPITAL SYSTEM ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH NOVANT HEALTH INC. THAT CONTINUES THROUGH FEBRUARY 2017. THE BOARD OF HRMC CONTINUES TO OVERSEE THE OPERATIONS OF THE HEALTHCARE FACILITY AND RELATED EXEMPT ACTIVITIES. HRMC RECEIVES MANAGEMENT SERVICES AS WELL AS EXPENSE SAVINGS FOR AN ANNUAL MANAGEMENT FEE. NOVANT PROVIDES HRMC WITH A CEO AND HRMC PROVIDES REIMBURSEMENT FOR THOSE COSTS. DURING THE YEAR, NOVANT PAID COMPENSATION OF $486,665 TO THE ORGANIZATION'S CEO. Form 990, Part VI, Section B, line 11b THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. THE HOSPITAL PROVIDED EVERY VOTING BOARD MEMBER A COPY OF THE DRAFT 990 PRIOR TO A SCHEDULED MEETING. DETAILS OF THE RETURN WERE DISCUSSED WITH MANAGEMENT AND THE FINANCE COMMITTEE OF THE BOARD, WHO THEN DELIVERED A REPORT TO THE FULL BOARD PRIOR TO FILING THE RETURN WITH THE IRS. Form 990, Part VI, Section B, line 12c (BYLAWS, ARTICLE 2, SECTION 3) "ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER SHALL BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD THROUGH AN ANNUAL PROCEDURE AND ALSO WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY GOVERNING BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHALL NOT VOTE OR USE PERSONAL INFLUENCE ON THAT MATTER, AND SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. ANY EXISTING OR APPARENT CONFLICT OF INTEREST WILL BE REFERRED TO THE EXECUTIVE COMMITTEE OF THE BOARD FOR RESOLUTION." THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. BOARD MEMBERS AND HOSPITAL MANAGEMENT PERSONNEL ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE EACH YEAR. Form 990, Part VI, Section B, line 15 An outside consultant is used to determine the appropriate compensation based on comparable positions and benchmarks. The consultant evaluates the salaries for the VPs. The CEO approves the VP Salaries. Novant determines the compensation for the CEO. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. Form 990, Part VI, Section C, line 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. Form 990, Part IX, line 11g PURCHASED SERVICES: Program service expenses 3,233,523. Management and general expenses 55,974. Fundraising expenses 0. Total expenses 3,289,497. MAINTENANCE CONTRACTS: Program service expenses 1,904,639. Management and general expenses 1,683. Fundraising expenses 0. Total expenses 1,906,322. CONTRACT SERVICES: Program service expenses 2,742,538. Management and general expenses 530,950. Fundraising expenses 0. Total expenses 3,273,488. SUPPORT FEES: Program service expenses 23,404. Management and general expenses 0. Fundraising expenses 0. Total expenses 23,404. NURSING SERVICES: Program service expenses 1,462,738. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,462,738. PHYSICIAN FEES: Program service expenses 4,763,564. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,763,564. OTHER PROFESSIONAL FEES: Program service expenses 17,214. Management and general expenses 0. Fundraising expenses 0. Total expenses 17,214. CONSULTING FEES: Program service expenses 0. Management and general expenses 128,082. Fundraising expenses 0. Total expenses 128,082. Form 990, Part XI, line 9: CHANGE IN VALUE OF DEFINED PENSION PLAN -448,394. TRANSFER OF EQUITY -3,600,000. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HALIFAX REGIONAL MEDICAL CENTER CRNA BILLING LLC 250 SMITH CHURCH ROAD rOANOKE RAPIDS NC 27870 461929125 BILLING SUPPORT NC 1861903 HALIFAX REGIONAL MEDICAL CENTER INC HALIFAX REGIONAL MEDICAL CENTER FOUNDATION INC 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 561698825 FUNDRAISING FOR ASSOCIATED CHARITABLE ORGANIZATION NC 501(c)(3) Line 7 HALIFAX REGIONAL MEDICAL CENTER INC 1 ROANOKE VALLEY HEALTH SERVICES INC 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 561925492 HEALTHCARE NC 501(c)(3) Line 3 HALIFAX REGIONAL MEDICAL CENTER INC 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 ROANOKE VALLEY HEALTH SERVICES B 3600000 CASH HALIFAX REGIONAL MEDICAL CENTER FOUNDATION C 58325 CASH ROANOKE VALLEY HEALTH SERVICES R 11412082 CASH ROANOKE VALLEY HEALTH SERVICES S 6566572 CASH