2018-05-15T14:47:48-05:00 2017-06-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2016-07-01 561484844 WAYNE MEMORIAL HOSPITAL INC WAYN 9197316142 PO BOX 8001 GOLDSBORO NC 27533 REBECCA CRAIG CFO 9197316142 2018-05-15 1 JOHN NORMAN P01506766 7049985200 2018-05-15 2016 2022-09-23 18:48:47Z JANIE JABERG PO BOX 8001 GOLDSBORO NC 27533 282657299 0 X WWW.WAYNEHEALTH.ORG X 1896 NC TO PROVIDE THE COMMUNITY QUALITY HEALTHCARE SERVICES. 12 11 1908 100 0 0 55808 902137 196972399 276676044 3967662 4265088 282420 369228 201278289 282212497 0 417615 0 0 91887024 124495874 0 0 0 89346891 133516545 181233915 258430034 20044374 23782463 327118395 373312144 167374573 149552979 159743822 223759165 THE MISSION OF WAYNE MEMORIAL HOSPITAL IS TO PROVIDE THE COMMUNITY QUALITY HEALTHCARE SERVICES THROUGH THE COMPASSIONATE HANDS OF WELL-TRAINED STAFF IN A TECHNOLOGICALLY ADVANCED, COST-EFFECTIVE MANNER. 0 0 240999046 417615 277045272 PROVIDING COMPASSIONATE PROGRESSIVE HEALTHCARE INCLUDING INPATIENT, OUTPATIENT, INTENSIVE CARE, AND EMERGENCY CARE. 240999046 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 137 0 1 1908 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X X REBECCA CRAIG CFO 9197316142 PO BOX 8001 GOLDSBORO NC 27533 SHIRLEY HARKEY CHIEF OPERATIONS OFFICER 40.00 X X 343957 0 53364 DONNA WIMBERLY CHIEF NURSING OFFICER 40.00 X X 249727 0 42726 RICHARD ROGERS VICE-PRESIDENT HUMAN RESOURCES 40.00 1.00 X 262740 0 47283 C MUNROE BEST JR CHAIRMAN 1.00 2.00 X X 0 0 0 ELLEN BRUBECK MD BOARD MEMBER 1.00 1.00 X 0 0 0 FREEMAN HARDISON BOARD MEMBER 0.00 1.00 X 0 0 0 SAMER KASBARI MD BOARD MEMBER 0.00 1.00 X 0 0 0 STEPHEN C LIES MD BOARD MEMBER 0.00 1.00 X 0 0 0 DIMITRIOS LINTZERIS MD BOARD MEMBER 0.00 1.00 X 0 0 0 SUSAN H MCCALL BOARD MEMBER 0.00 2.00 X 0 0 0 BILL PATE BOARD MEMBER 0.00 2.00 X 0 0 0 JAMES C PARKER BOARD MEMBER 0.00 1.00 X 0 0 0 ANITA SHREENATH BOARD MEMBER 0.00 2.00 X 0 0 0 ROBERT WALKER JR VICE CHAIRMAN 0.00 1.00 X X 0 0 0 JANIE JABERG CHIEF EXECUTIVE OFFICER 40.00 1.00 X 0 0 0 REBECCA W CRAIG CHIEF FINANCIAL OFFICER 40.00 1.00 X 318583 0 64255 DANIEL BROCK CRNA 40.00 X 254000 0 13910 RICHARD MIDDLETON CRNA 40.00 X 229200 0 37546 BETTY ROUSE CRNA 40.00 X 227267 0 24267 JAMIE RICHARDS CRNA 40.00 X 222001 0 43036 AMY WILLOUGHBY CRNA 40.00 X 219970 0 32513 J WILLIAM PAUGH CEO (RETIRED) 0.00 X 650775 0 10656 THOMAS W BRADSHAW COO (RETIRED) 0.00 X 439056 0 37265 3417276 0 406821 69 1 1 0 DANIS CONSTRUCTION CO 5511 CAPITAL CENTER DRIVE RALEIGH NC 27606 CONSTRUCTION 3529314 EASTERN MEDICAL ASSOCIATES 2609 MEDICAL OFFICE PLACE GOLDSBORO NC 27534 HOSPITALISTS 2114651 T A LOVING P O DRAWER 919 GOLDSBORO NC 27533 CONSTRUCTION 1042316 SODEXO INC P O BOX 360170 PITTSBURGH PA 15213 CONTRACT MGMT 846157 GOLDSBORO EMERGENCY MEDICAL P O BOX K GOLDSBORO NC 27533 EMERGENCY MEDICINE 510901 5 902137 902137 PATIENT REVENUE 621110 264939474 264939474 11736570 11736570 276676044 4709890 4709890 387666 57136 -387666 -57136 -444802 -444802 MRI INCOME 621500 369228 369228 369228 282212497 277045272 0 4265088 150000 150000 267615 267615 1016000 1016000 76744094 71966987 4777107 11186058 10171348 1014710 29354878 26660285 2694593 6194844 5606334 588510 1179137 1179137 409226 409226 123500 123500 3988552 3988552 420046 420046 1130596 512278 618318 5288117 4785747 502370 72397 67814 4583 332721 255176 77545 2147452 2147452 11683768 11666977 16791 2374491 2374491 MEDICAL SUPPLIES 50272622 50272622 BAD DEBT EXPENSE 22750114 22750114 PURCHASED SERVICES 19403987 19403987 ALL OTHER EXPENSE 7799652 7799652 4140167 4140167 258430034 240999046 17430988 0 18558686 1653920 21001455 23446609 5547251 5719205 2714958 2684137 263365526 143048022 114278645 120317504 126499152 168706507 38518248 50784262 327118395 373312144 36389025 45723206 49383396 48960544 81602152 54869229 167374573 149552979 X 159254566 223270230 489256 488935 159743822 223759165 327118395 373312144 X 23782463 11715203 28517677 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: A PORTION OF THE DUES THE HOSPITAL PAYS TO THE NORTH CAROLINA HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 1 130321861 59302055 71019806 7780109 5861764 1918345 114336323 77884203 36452120 10927233 10927233 120317504 INVESTMENTS 168706507 F 168706507 OTHER ISSUANCE COSTS, NET 546039 INVESTMENT IN AFFILIATE 2662438 OTHER RECEIVABLES 5235476 DUE FROM AFFILIATE 40030974 LONG-TERM RECEIVABLES 2309335 50784262 OTHER LIABILITIES 15287735 MINIMUM PENSION LIABILITY 33184119 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 5856611 CAPITAL LEASE OBLIGATIONS 540764 54869229 X PART V, LINE 4: ALL ENDOWMENT FUNDS HELD BY WELLS FARGO ARE USED FOR THE CHARITABLE PURPOSES OF WAYNE MEMORIAL HOSPITAL. PART X, LINE 2: WAYNE MEMORIAL HOSPITAL ("WMH") IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. WMH ADOPTED THE PROVISIONS OF THE INCOME TAX STANDARD THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. THIS GUIDANCE PRESCRIBES A RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. WMH HAS DETERMINED THAT THERE ARE NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2017. 1 1 1 X 1 X 1 1 1 0 0 1 X 1 1 1 WAYNE MRI LLC MRI 0.66700 0.33300 1 1 WAYNE MEMORIAL HOSPITAL INC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 X X X WAYNE MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 0 1 1 SEE PART V, SECTION C X SEE PART V, SECTION C X 1 15 1 SEE PART V, SECTION C 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 0 1 X 1 0 WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: THE CHNA WAS CONDUCTED IN CONJUCTION WITH WAYNE COUNTY DEPARTMENT OF HEALTH. THE CHNA TEAM ELICITED FEEDBACK FROM KEY STAKEHOLDER GROUPS BY CONDUCTING FOCUS GROUPS IN UNDER REPRESENTED GROUPS, AS WELL AS CONDUCTING A HEALTH OPINION SURVEY. THE HEALTH OPINION SURVEY WAS ADAPTED FROM THE COMMUNITY HEALTH ASSESSMENT GUDEBOOK, NC DIVISION OF PUBLIC HEALTH AND WAS SIMILAR TO THE 2012 SURVEY. MORE THAN 500 PEOPLE SUBMITTED THEIR OPINIONS.THE STAKEHOLDER GROUPS MET PERIODICALLY AND SCHEDULED EXTRA MEETINGS, IN EARLY 2016, TO COMPLETE THE PROCESS. SIX FOCUS GROUPS WERE HELD IN SPECIFIC LOCATIONS TO DISCOVER THE COMMUNITY MEMBERS' PERCEPTION AND SUGGESTIONS FOR IMPROVING HEALTH WITHIN THE COMMUNITY. THERE WERE A TOTAL OF 53 FOCUS GROUP PARTICIPANTS. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: REPRESENTATIVES FROM THE WAYNE COUNTY HEALTH DEPARTMENT, WAYNE MEMORIAL HOSPITAL, WAYNE COUNTY BOARD OF HEALTH, WATCH AND ECU COOPERATIVELY CONDUCTED THE COMMUNITY HEALTH ASSESSMENT. THE COLLABORATION IDENTIFIED THE TYPES AND SOURCES OF DATA TO BE COLLECTED, DETERMINED THE METHODS FOR COLLECTING INPUT FROM THE COMMUNITY AND KEY STAKEHOLDERS CONCERNING HEALTH RELATED ISSUES AS WELL AS COMMUNICATING THIS INFORMATION TO THE VARIOUS STAKEHOLDERS IN ORDER TO PRIORITIZE COMMUNITY HEALTH CONCERNS. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: WAYNE MEMORIAL HOSPITAL PARTNERS WITH OUR COMMUNITY IN MANY WAYS. WE BELIEVE HEALTH AND WELLNESS ARE THE FOUNDATION TO LIVING WELL. IN 2016-17, OUR STRATEGY TO ADDRESS SOME OF THE NEEDS IDENTIFIED IN THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDED SEVERAL PROGRAMS AND INITIATIVES DESIGNED TO HELP IMPROVE THE HEALTH OF THOSE IN OUR COMMUNITY WITH THE GREATEST NEED, AS FOLLOWS:GOAL 1: IMPROVE ACCESS TO HEALTHCARE FOR THE UNDERSERVED AND YOUTH -- WAYNE ACTION TEAMS FOR COMMUNITY HEALTH (WATCH) HEALTHCARE PROGRAM: THIS PROGRAM OPERATES ONE MOBILE AND TWO STATIONARY CLINICAL SITES, PROVIDING A FREE MEDICAL HOME TO THE COUNTY'S UNINSURED. WAYNE MEMORIAL HOSPITAL PARTICIPATES WITH OTHER COMMUNITY ORGANIZATIONS IN THE WAYNE INITIATIVE FOR SCHOOL BASED HEALTH (WISH), A NONPROFIT THAT PROVIDES COMPREHENSIVE HEALTH SERVICES FOR MIDDLE AND HIGH SCHOOL STUDENTS IN SIX SCHOOL-BASED HEALTH CENTERS, WITH PARENTAL CONSENT. ALL WISH CENTERS ARE STAFFED BY NURSE PRACTITIONERS, REGISTERED NURSES AND CLERICAL STAFF, WITH A LOCAL PEDIATRICIAN SERVING AS THE WISH MEDICAL DIRECTOR.WAYNE MEMORIAL HOSPITAL PARTNERS WITH WAYNE COUNTY PUBLIC SCHOOLS TO PROVIDE SCHOOL HEALTH NURSING SERVICES. ON AVERAGE WAYNE COUNTY HAS ONE SCHOOL NURSE FOR EVERY 1,074 STUDENTS. THE NATIONAL SCHOOL NURSE-TO-STUDENT RECOMMENDED RATIO IS 1 NURSE FOR 750 STUDENTS.GOAL 2: PROVIDE COMMUNITY-BASED HEALTH EDUCATION -- WATCH HEALTH EDUCATORS WORK WITH YOUTH IN LOCAL HIGH SCHOOLS, HELPING TO DECREASE THE INCIDENCE OF TEEN PREGNANCY.GOWAYNEGO: THIS GRASSROOTS GROUP IS DEDICATED TO EDUCATING THE COMMUNITY ABOUT HEALTHY EATING AND INCREASED PHYSICAL ACTIVITY. THE PROGRAM ASSISTS WITH IMPLEMENTING RELATED PROGRAMS AT LOCAL CHURCHES AND FACILITATING DEVELOPMENT OF WORKSITE WELLNESS PROGRAMS FOR EMPLOYEES. THE GROUP ALSO BEGAN THE GOWAYNEGO WALKING SERIES AND DEVELOPED A HEALTHY RESTAURANT EATING GUIDE AND PHYSICAL ACTIVITY RESOURCE GUIDE.LIVEWELL COMMUNITY EDUCATION: WAYNE MEMORIAL HOSPITAL HOSTS WAYNE COUNTY RESIDENTS AT A SERIES OF FREE COMMUNITY HEALTH EDUCATION EVENTS AND ACTIVITIES.GOAL 3: IMPROVE CHRONIC DISEASE MANAGEMENT -- WATCH INITIATIVE FOR LIFE: MEMBERS WORK WITH A HEALTH EDUCATOR/TRAINER TO DEVELOP A SELF-MANAGEMENT PLAN TO DECREASE THE INCIDENCE OF OBESITY THROUGH EXERCISE AND HEALTHY EATING.SUPPORT GROUPS: WAYNE MEMORIAL HOSPITAL HOSTS VARIOUS CHRONIC DISEASE SUPPORT GROUPS.THE CENTER FOR NUTRITION AND DIABETES HEALTH: OFFERS OUTPATIENT EDUCATION TO HELP PATIENTS MANAGE THEIR DIABETES. THE CENTER ALSO PROVIDES NUTRITION COUNSELING TO ASSIST PATIENTS WITH CHRONIC DISEASE MANAGEMENT, TOBACCO CESSATION, A DIABETES SUPPORT GROUP AND WEIGHT LOSS. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16J: ALL SELF PAY INPATIENTS RECEIVE VISITS FROM FINANCIAL COUNSELORS, AND THE CHARITY POLICY IS REVIEWED AT THAT TIME. SELF PAY OUTPATIENTS ARE SENT LETTERS OFFERING FINANCIAL ASSISTANCE. IF WE CAN IDENTIFY CHARITY STATUS AT TIME OF VISIT (BASED ON PATIENT) NO BILL IS SENT. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 23: THE ORGANIZATION DETERMINED THAT DURING FISCAL YEAR 2017, CERTAIN PATIENTS THAT RECEIVED PATIENT CARE AND WERE ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY WERE BILLED MORE THAN THE AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAD INSURANCE COVERING SUCH CARE. INDIVIDUAL REFUNDS ARE BEING CALCULATED AND WILL BE MADE ONCE CALCULATIONS ARE COMPLETE. THE ORGANIZATION EXPECTS THAT TOTAL REFUNDS WILL BE LESS THAN $50,000. PART V, SECTION B, LINE 7A WWW.WAYNEHEALTH.ORG/ABOUT/COMMUNITY-OUTREACH/REPORTS-ASSESSMENTS PART V, SECTION B, LINE 7B WWW.WAYNEGOV.COM/249/COMMUNITY-HEALTH-ASSESSMENT PART V, SECTION B, LINE 10A WWW.WAYNEHEALTH.ORG/ABOUT/COMMUNITY-OUTREACH/REPORTS-ASSESSMENTS PART V, SECTION B, LINES 16A-C RECENTLY, DURING AN INTERNAL COMPLIANCE REVIEW, THE ORGANIZATION DETERMINED THAT CERTAIN ASPECTS OF ITS WRITTEN FINANCIAL ASSISTANCE POLICY, BILLING/COLLECTIONS POLICY, AND BILLING STATEMENTS NEEDED TO BE ENHANCED AND/OR CLARIFIED. ADDITIONALLY, THE FOLLOWING ITEMS WERE ADDED: - CHANGE IN DISCOUNT GIVEN TO PATIENTS QUALIFYING FOR CHARITY CARE, BASED ON THE LOOKBACK METHOD TO CALCULATE AMOUNTS GENERALLY BILLED; - APPENDIX ADDED TO INCLUDE A LIST OF PROVIDERS NOT COVERED BY THE FAP; - FAP PLAIN LANGUAGE SUMMARY UPDATED AND POSTED ONLINE AND OFFERED TO PATIENTS AT DISCHARGE OR INTAKE; - FAP UPDATED AND POSTED ONLINE; - SPANISH TRANSLATIONS OF ALL FAP DOCUMENTS UPDATED AND POSTED ONLINE.THE ORGANIZATION BELIEVES THAT THESE CHANGES MEET THE REQUIREMENTS OF SECTION 501(R) AND WILL PROVIDE MORE CLARITY TO BOTH PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY AND THE ORGANIZATION'S BILLING STAFF. AS A RESULT, THE ORGANIZATION REVISED ITS FINANCIAL ASSISTANCE POLICY TO MAKE SURE THAT IT MEETS ALL THE REQUIREMENTS OF SECTION 501(R). PLEASE SEE THE UPDATED FAP AT HTTP://WWW.WAYNEHEALTH.ORG/PATIENTS/PATIENT-FINANCIAL-SERVICES/FINANCIAL-ASSISTANCE-POLICY. PART V, SECTION B, LINE 4 THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") FOR TAX YEAR 2015 (FISCAL YEAR JUNE 30, 2016) WAS COMPLETED BY JUNE 23, 2016 AND WAS ADOPTED BY THE WAYNE BOARD OF DIRECTORS ON AUGUST 10, 2016 (WITH THE ADOPTION REFLECTED IN THE BOARD MINUTES FOR THAT MEETING). AT THIS SAME BOARD MEETING, THE WAYNE BOARD APPROVED A CHNA PROGRESS REPORT THAT EVALUATED THE RESOURCES AND IMPACT OF STRATEGIES USED TO COMBAT THE NEEDS IDENTIFIED IN WAYNE'S 2012 CHNA. BECAUSE THE NEEDS IDENTIFIED IN THE 2012 CHNA PROGRESS REPORT ARE SUBSTANTIALLY SIMILAR TO THE NEEDS IDENTIFIED IN THE 2015 CHNA, APPROVAL OF THIS PROGRESS REPORT FUNCTIONED AS THE BOARD'S APPROVAL OF CONTINUATION OF THE STRATEGIES PUT IN PLACE AFTER THE 2012 CHNA. AFTER THE CHNA WAS CONDUCTED, THE BOARD ALSO ACTIVELY MONITORED IMPLEMENTATION STRATEGY PROGRESS BY RECEIVING QUARTERLY REPORTS ON ACTIONS TO IMPROVE ACCESS TO HEALTHCARE AND REDUCE OBESITY, WHICH WERE TOP PRIORITIES IN THE 2015 CHNA. THE 2015 TAX YEAR WAS A SHORT TAX YEAR BECAUSE THE ORGANIZATION ENTERED INTO AN AFFILIATION AND MANAGEMENT AGREEMENT WITH UNC HEALTH CARE SYSTEM ("UNCHCS") ON JANUARY 1, 2016, AND THE ORGANIZATION CHANGED ITS FISCAL YEAR END FROM SEPTEMBER 30 TO JUNE 30 TO BE CONSISTENT WITH UNC HEALTH CARE'S YEAR END. HAD THE ORGANIZATION OPERATED WITHIN A NORMAL 12-MONTH TAX YEAR LIKE IT HAD ALWAYS DONE, THE ORGANIZATION'S BOARD WOULD HAVE ACTED WELL WITHIN THE TAX YEAR. APPROVAL ONLY OCCURRED AFTER THE END OF THE 2015 TAX YEAR BECAUSE THE 2015 TAX YEAR WAS 3 MONTHS SHORTER THAN NORMAL.THE FINAL TREASURY REGULATIONS BECAME EFFECTIVE FOR TAX YEARS BEGINNING AFTER DECEMBER 29, 2015 AND, THEREFORE, WERE NOT IN EFFECT FOR THE 2015 TAX YEAR (WHICH BEGAN ON OCTOBER 1, 2015). FURTHER, TREAS. REG. 1.501(R)-7(B) PROVIDES, IN PART, THAT "[F]OR TAXABLE YEARS BEGINNING ON OR BEFORE DECEMBER 29, 2015, A HOSPITAL FACILITY MAY RELY ON A REASONABLE, GOOD FAITH INTERPRETATION OF SECTION 501(R)." EVEN IF THE FINAL TREASURY REGULATIONS HAD BEEN EFFECTIVE FOR THE 2015 TAX YEAR, THE ORGANIZATION CONSIDERS THE BOARD'S APPROVAL OF THE CHNA AFTER THE CLOSE OF THE SHORT TAX YEAR TO BE A MINOR ERROR PURSUANT TO REG. 1.501(R)-2(B) BECAUSE IT WAS DUE TO REASONABLE CAUSE. THE ORGANIZATION HAD NEVER HAD A SHORT NINE-MONTH TAX YEAR, AND THE BOARD CLEARLY WOULD HAVE ADOPTED THE CHNA PRIOR TO THE END OF A NORMAL 12-MONTH TAX YEAR. A MINOR ERROR IS NOT CONSIDERED TO BE A FAILURE TO MEET AN IRC 501(R)(3) REQUIREMENT. FINALLY, SUBSEQUENT TO ADOPTING THE MOST RECENT CHNA AND IMPLEMENTATION STRATEGY, THE ORGANIZATION, THROUGH MOVING THE CHNA PROCESS TO A ROLE NEW AT WAYNE, CALLED VICE PRESIDENT OF STRATEGY AND BUSINESS DEVELOPMENT, HAS CEMENTED THE STRATEGIC IMPORTANCE OF MEETING IDENTIFIED COMMUNITY NEEDS. WAYNE HAS ENTERED INTO A REGIONAL APPROACH WITH OTHER RURAL EASTERN NORTH CAROLINA COUNTIES TO SURVEY THE PUBLIC AND UPDATE DEMOGRAPHIC AND HEALTH DATA, LEADING TO IMPROVED LINKAGES BETWEEN COMMUNITY HEALTH DATA AND HOSPITAL AND COMMUNITY STRATEGIES TO IMPROVE HEALTH. THE NEW PROCESS WILL INCLUDE TRACKING ALL MILESTONES REQUIRED UNDER THE FINAL TREASURY REGULATIONS, WHICH THE ORGANIZATION IS COMMITTED TO MEETING. 5 1 - WAYNE MRI LLC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 MRI 2 - GOLDSBORO WOUND CARE CENTER 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 WOUND CARE 3 - KINSTON WOUND CARE CENTER 204 AIRPORT ROAD KINSTON NC 28504 WOUND CARE 4 - WAYNE MEMORIAL HOSPITAL PHYSICAL THERAPY 2808 MCLAMB PLACE GOLDSBORO NC 27534 PHYSICAL THERAPY 5 - CENTER FOR NUTRITION AND DIABETES HEALTH 208 COX BLVD STE 101 GOLDSBORO NC 27534 DIABETES CENTER PART I, LINE 3C: WAYNE MEMORIAL MANAGEMENT USES 200% OF FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PATIENTS WHO PROVIDES INFOMRATION TO US. WE ALSO USE A PROPRIETARY CREDIT SCORING TOOL TO FURTHER DETERMINE ELIGIBILITY AND FOR NON-COMPLIANT PATIENTS. THIS PROPRIETARY TOOL USES ALGORITHMS, CONSUMER DATA, AND OTHER INFORMATION TO ASSIST WITH UNDERSTANDING PATIENT'S ABILITY TO PAY. PART I, LINE 7: AMOUNTS SHOWN IN PART I, LINE 7, COLUMN C WERE COMPUTED USING THE COST-TO-CHARGE RATIO WORKSHEET (WORKSHEET 2) FROM THE IRS INSTRUCTIONS FOR SCHEDULE H. PART I, LN 7 COL(F): FOR PURPOSES OF CALCULATING THE COMMUNITY BENEFIT PERCENTAGE IN PART I, COLUMN (F), THE ORGANIZATION SUBTRACTED $22,750,114 (WHICH WAS REPORTED ON FORM 990, PART IX, LINE 25) AS BAD DEBT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL SURVEYS THE NEEDS OF THE MEDICAL COMMUNITY (PROVIDERS) TO ENABLE THE BOARD OF DIRECTORS TO ADOPT A MEDICAL STAFF DEVELOPMENT PLAN, FROM WHICH THEY DETERMINE RECRUITMENT TARGETS. IN THE CURRENT ENVIRONMENT, HOSPITALS ARE WORKING WITH MEDICAL STAFFS TO MEET THE NEED FOR PRIMARY CARE, AS WELL AS SPECIALTY CARE. THE HOSPITAL HAS PROVIDED SUPPORT IN THE FORM OF LOANS TO DOCTORS NEW TO THE AREA FOR THE FIRST YEAR OF PRACTICE, WHICH ARE FORGIVEN AS THESE PHYSICIANS STAY AND MEET COMMUNITY NEEDS.WAYNE MEMORIAL HOSPITAL EMPLOYS MORE THAN 700 REGISTERED NURSES, PLUS OTHER LICENSED HEALTH PROVIDERS (LAB TECHNOLOGISTS, IMAGING TECHNOLOGISTS, PHARMACISTS, PHARMACY TECHNOLOGISTS) TO CARE FOR RESIDENTS OF WAYNE COUNTY WHO NEED HOSPITAL SERVICES. IN SUPPORT OF THIS MISSION, THE HOSPITAL HAS CONTRIBUTED SCHOLARSHIP FUNDS TO ENABLE STUDENTS AT WAYNE COMMUNITY COLLEGE TO PURSUE DEGREES IN HEALTH SCIENCES. NURSES FROM WAYNE MEMORIAL ARE A VITAL PART OF SCHOOL-BASED HEALTH, AND ARE ALSO PART OF MANY LOCAL BUSINESSES WHICH SEE THE VALUE OF HAVING ON-SITE HEALTH EXPERTISE IN KEEPING THEIR EMPLOYEES PRODUCTIVE AND WELL. EDUCATING OUR LOCAL WORKFORCE IS A PRIORITY OF THIS HOSPITAL, IN TERMS OF CARE OF PATIENTS, AND CREATING A CULTURE OF WELLNESS WITHIN OUR COMMUNITY, BOTH AT SCHOOLS, IN BUSINESSES AND IN HOMES. PART III, LINE 2: BAD DEBT EXPENSES WAS CALCULATED BY APPLYING THE COST-TO-CHARGE RATIO DETERMINED BY THE HOSPITAL TO THE GROSS BAD DEBT CHARGES FOR THE YEAR, INCLUDING ANY UN-DISCOUNTED SELF-PAY BAD DEBT CHARGES. PART III, LINE 4: THE HOSPITAL USES HISTORICAL COLLECTION EXPERIENCE AND A REVIEW OF CURRENT RECEIVABLES TO PROVIDE AN ESTIMATE OF THE ALLOWANCE FOR UNCOLLECTIBLES AND THE BAD DEBT EXPENSE. ACCOUNTS PAST DUE FOR MORE THAN 90 DAYS ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IF DEEMED UNCOLLECTIBLE, ACCOUNTS ARE REFERRED TO ONE OF TWO OUTSIDE COLLECTION AGENCIES UNLESS THE ACCOUNT IS BEING REVIEWED UNDER THE HOSPITAL'S CHARITY POLICY. THE HOSPITAL PROVIDES SERVICES TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS A RESULT, THE HOSPITAL HAS INCURRED LOSSES FROM BAD DEBT EXPENSE. THESE UNREIMBURSED SERVICES ARE CONSIDERED A COMMUNITY BENEFIT SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE BE UNMET. NOTE 2 ON PAGE 19 OF THE AUDITED FINANCIAL STATEMENTS DISCUSSES BAD DEBTS.PART III, SECTION A, LINE 2:THE AMOUNT ON LINE 2 WAS DERIVED BY TAKING THE BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS AND MULTIPLYING IT BY THE RATIO OF PATIENT CARE COST TO CHARGES DERIVED USING WORKSHEET 2 OF THE IRS INSTRUCTIONS FOR SCHEDULE H.PART III, SECTION A, LINE 3:THE HOSPITAL DOES NOT HAVE A PROCESS IN PLACE THAT ESTIMATES THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER A FINANCIAL ASSISTANCE POLICY. PART III, LINE 8: THE HOSPITAL PROVIDES SERVICES TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS A RESULT, THE HOSPITAL HAS INCURRED LOSSES BY SERVING MEDICARE PATIENTS. THE UNREIMBURSED SERVICES THE HOSPITAL PROVIDES TO PATIENTS COVERED BY MEDICARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE BE UNMET.PART III, SECTION B, LINE 8:THE COST TO CHARGE RATIO AS CALCULATED BY THE MOST RECENTLY FILED COST REPORT WAS USED TO DETERMINE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: OUR COLLECTION POLICY INDICATES OUR USE OF A CREDIT SCORING TOOL WHICH ASSISTS OUR COLLECTION STAFF IN THE IDENTIFICATION OF PATIENTS THAT QUALIFY FOR UNCOMPENSATED CARE. PART VI, LINE 2: WAYNE MEMORIAL HOSPITAL ROUTINELY CONDUCTS A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE WAYNE COUNTY HEALTH DEPARTMENT. IN 2015, A JOINT CHNA WAS BEGUN, WHICH CONCLUDED IN THE FALL OF 2015, AND WAS REPORTED TO THE COMMUNITY IN SUMMER 2016, PART OF THE HOSPITAL'S FYE 9/30/2016. AS PART OF THIS CHNA, AN ELECTRONIC AND PAPER SURVEY WAS CONDUCTED, WITH MORE THAN 500 RESPONSES. FOCUS GROUPS WERE CONVENED IN 6 DIFFERENT SETTINGS (DIVERSE IN GEOGRAPHY AND CULTURE) TO ADD MORE UNDERSTANDING. ACTIONS ARE BEING COORDINATED AND TAKEN BY KEY CONSTITUENTS FROM WAYNE COUNTY, IN PARTNERSHIP WITH THE WAYNE COUNTY HEALTH DEPARTMENT, THE CITY OF GOLDSBORO, THE HOSPITAL AND OTHER AGENCIES TO ENCOURAGE GOOD HEALTH COUNTY-WIDE.FINDINGS FROM THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT SHOWED SIGNIFICANT OVERLAP WITH THOSE FROM THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT. OBESITY CONTINUES TO BE THE SINGLE MOST PERVASIVE HEALTH ISSUE IN WAYNE COUNTY, FOLLOWED BY CHRONIC DISEASES. TOGETHER, THESE ARE TAKING A HEAVY TOLL ON WAYNE COUNTYS HEALTH. MORE THAN 12% OF WAYNE COUNTY ADULTS ARE DIAGNOSED WITH DIABETES. OBESITY HAS BEEN SHOWN TO CONTRIBUTE TO THE LEADING CAUSES OF DEATH INCLUDING HEART DISEASE, SOME CANCERS, AND DIABETES. THE PERCENTAGE OF OVERWEIGHT AND OBESE ADULTS IN WAYNE COUNTY HAS INCREASED TO MORE THAN 70% - MORE THAN 65,000 PEOPLE. IN RESPONSE TO THIS ISSUE, COMMUNITY PARTNERS HAVE COME TOGETHER TO FORM THE "HEALTHY WAYNE TASK FORCE", WHICH HAS PLACE HEALTHY LIVING AT ITS CENTER. ITS FIRST INITIATIVE, BEGUN IN THE SUMMER OF 2013, IS CALLED GOWAYNEGO. INITIAL EFFORTS HAVE BEEN TO CENTRALIZE COMMUNICATIONS TO LOCAL CITIZENS ABOUT THE IMPORTANCE OF INCREASING DAILY MOVEMENT, AND EDUCATING CITIZENS ABOUT FREE AND LOW-COST WAYS TO GET MORE ACTIVE IN WAYNE COUNTY. MORE THAN 3,000 T-SHIRTS WITH THE GOWAYNEGO LOGO HAVE BEEN DISTRIBUTED TO WAYNE COUNTY RESIDENTS, AND A WEBSITE HAS BEEN SET UP TO ENCOURAGE GETTING ROUTINE EXERCISE. PARTNERS IN THE HEALTHY WAYNE TASK FORCE INCLUDE WAYNE COUNTY HEALTH DEPARTMENT, WAYNE HEALTH FOUNDATION (DBA WATCH), GOLDSBORO FAMILY YMCA, CITY OF GOLDSBORO PARKS & RECREATION DEPARTMENT, UNITED WAY OF WAYNE COUNTY, SEYMOUR JOHNSON AIR FORCE BASE, GOLDSBORO PEDIATRICS, PARTNERSHIP FOR CHILDREN OF WAYNE COUNTY, WAYNE INITIATIVE FOR SCHOOL HEALTH, AND OTHERS. HEALTH LITERACY AND MENTAL HEALTH WERE THE OTHER MOST SIGNIFICANT ISSUES COMING OUT OF THE 2015 COMMUNITY HEALTH ASSESSMENT. A SUMMARY OF ALL INITIATIVES SELECTED, RESOURCES, USED, AND EVALUATION OF RESULTS IS INCLUDED AT WWW.WAYNEHEALTH.ORG.HEALTH LITERACY IS AN ISSUE IN RURAL AREAS LIKE EASTERN NORTH CAROLINA. IN WAYNE COUNTY, 10% OF ADULTS ARE NON-READERS, AND 26% STRUGGLE WITH BASIC LITERACY. WAYNE MEMORIAL HOSPITAL HAS A TEAM OF NURSES AND TRAINERS WORKING TO IMPROVE DISCHARGE INSTRUCTIONS FOR PATIENTS AND FAMILIES, TO REDUCE THE NUMBERS OF PATIENTS WHO MUST RETURN TO THE HOSPITAL SOON AFTER DISCHARGE FOR PROBLEMS THAT MIGHT NOT HAVE ARISEN IF THERE WERE BETTER UNDERSTANDING OF FOLLOW UP CARE. THIS TEAM IS USING RESOURCES DEVELOPED FROM AROUND THE COUNTRY TO TRY TO GET IMPROVED RESULTS (LOWER READMISSIONS). WITH RESPECT TO TEACHING READING SKILLS, IN WAYNE COUNTY, LITERACY CONNECTIONS OF WAYNE COUNTY IS A NON-PROFIT AGENCY CREATED TO IMPROVE ADULT LITERACY. LITERACY CONNECTIONS PROVIDES FREE, CONFIDENTIAL, ONE-ON-ONE TUTORING FOR ADULTS TO IMPROVE THEIR READING SKILLS. IT IS SUPPORTED BY WAYNE COUNTY GOVERNMENT, AND UNITED WAY OF WAYNE COUNTY. MENTAL HEALTH IS AN ISSUE THAT CONTINUES TO IMPACT HEALTH CARE IN OUR COMMUNITY, OUR STATE AND THE ENTIRE COUNTRY. IN RECOGNITION OF THE SPECIAL NEEDS OF PATIENTS WITH BEHAVIORAL HEALTH ISSUES, THE HOSPITAL DESIGNED ITS NEW EMERGENCY DEPARTMENT (OPENED IN 2012) TO ENABLE SEPARATION OF PATIENTS WITH MENTAL ISSUES FROM PATIENTS WITH PHYSICAL HEALTH ISSUES. THE OBJECTIVE WAS TO GIVE THESE PATIENTS AN AREA WHERE THEY CAN BE CARED FOR IN A CALM CONTROLLED ENVIRONMENT, WHERE THEY AND THOSE THAT ARE CARING FOR THEM CAN BE SAFE. IN ADDITION, THE HOSPITAL'S PARENT ORGANIZATION, WAYNE HEALTH CORPORATION, RECOGNIZING THE NEED TO REPLACE PSYCHIATRISTS WHO WERE APPROACHING RETIREMENT, RECRUITED THREE ADDITIONAL PSYCHIATRISTS, EMPLOYED BY HOSPITAL'S SISTER ORGANIZATION, WAYNE HEALTH PHYSICIANS, TO SEE PATIENTS IN OFFICES AS OUTPATIENTS, PLUS TREAT PATIENTS ADMITTED TO THE INPATIENT UNIT. A SUMMARY OF ALL INITIATIVES SELECTED, RESOURCES USED, AND EVALUATION OF RESULTS IS INCLUDED AT WWW.WAYNEHEALTH.ORG. PART VI, LINE 3: WE HAVE FINANCIAL COUNSELORS THAT ASSIST WHILE THEY ARE PATIENTS. WE ALSO SEND FINANCIAL ASSISTANCE LETTERS TO PATIENTS THAT WE ARE UNABLE TO SEE WHILE THEY ARE IN-HOUSE. WE ALSO PROVIDE INFORMATIONAL PAMPHLETS AND HAVE INFORMATION AVAILABLE ON THE HOSPITAL WEBSITE. PART VI, LINE 4: WAYNE MEMORIAL HOSPITAL SERVES PRIMARILY WAYNE COUNTY,NORTH CAROLINA, WITH AN ESTIMATED POPULATION WAS 124,000 IN 2015, ACCORDING TO THE US CENSUS QUICKFACTS. THE POPULATION IS SLIGHTLY YOUNGER THAN THE AVERAGE IN NORTH CAROLINA, LIKELY DUE TO THE PRESENCE OF SEYMOUR JOHNSON AIR FORCE BASE, WITH ABOUT 6,000 ACTIVE DUTY AND RESERVISTS PLUS THEIR FAMILIES. AVERAGE HOUSEHOLD INCOME IN WAYNE COUNTY IS LOWER, AT $41,172, THAN NORTH CAROLINA'S AVERAGE OF $46,693. CHILDREN LIVING IN POVERTY IN WAYNE COUNTY, (AVERAGE 2010-2014) IS HIGHER, AT 35%, COMPARED TO NORTH CAROLINA'S AVERAGE OF 26%. WAYNE COUNTY'S POPULATION IS 51.1% WHITE, 32% BLACK, AND 11.2% HISPANIC. THE COUNTY IS LARGE, AT 553 SQUARE MILES, AND IT IS THE 4TH LARGEST AGRICULTURAL PRODUCER IN THE STATE. POVERTY IMPACTS ACCESS TO CARE, WITH EMERGENCY DEPARTMENT USE HIGHER IN AREAS WITH HIGHER PROVERTY, AND SHORTER LIVES ON AVERAGE. PART VI, LINE 5: WAYNE MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF, WHICH MEANS THAT ANY PHYSICIAN WHO MEETS QUALITY STANDARDS SET BY A COMMITTEE OF THE HOSPITAL (WHICH INCLUDES BOARD MEMBERS) IS WELCOME TO JOIN THE STAFF, IN RETURN FOR CERTAIN RESPONSIBILITIES RELATED TO PROVIDING CARE TO PATIENTS SEEN IN THE EMERGENCY DEPARTMENT WHO NEED INPATIENT CARE. THE BOARD OF DIRECTORS IS COMPRISED ON 12 CITIZENS OF WAYNE COUNTY, INCLUDING THE CEO, WHO ARE CHARGED WITH ENSURING THAT QUALITY, EFFICIENT CARE IS PROVIDED AT THE HOSPITAL, AND FOR ENSURING PLANNING, WITH COMMUNITY PARTNERS, FOR FUTURE HEALTH NEEDS. PART VI, LINE 6: AS THE PROVIDER OF CARE WITHIN THE COMMUNITY WITH THE MOST DIVERSE AND SOPHISTICATED EQUIPMENT, THE BOARD, MANAGEMENT AND STAFF OF WAYNE MEMORIAL HOSPITAL SEES ITS ROLE AS BOTH COORDINATOR OF CARE FOR THOSE WHO ARE THE SICKEST IN OUR COMMUNITY AS WELL AS PROMOTER OF HEALTHY LIVING FOR ALL RESIDENTS, IN COORDINATION WITH OUR PARTNERS IN HEALTH THROUGHOUT WAYNE COUNTY. THE HOSPITAL HAS TWO PRIMARY AFFILIATES THAT ARE INTEGRAL TO COMMUNITY HEALTH. ONE IS WAYNE HEALTH FOUNDATION,DBA "WATCH", WHICH HAS OPERATED A MOBILE VAN FOR UNINSURED SINCE THE 1990'S, ADDED TWO FIXED CLINICS SINCE 2009, AND WHOSE OTHER PRIMARY FOCUS HAS BEEN ADDRESSING COMMUNITY NEEDS IDENTIFIED IN FREQUENT HEALTH NEEDS ASSESSMENTS SINCE THAT TIME. THE SECOND SISTER CORPORATION, WAYNE HEALTH PHYSICIANS, WAS ORGANIZED IN 2009 TO HELP MEET THE NEEDS FOR PRIMARY AND SPECIALTY PHYSICIAN CARE IN WAYNE COUNTY. THIS WAS IN RESPONSE TO NATIONAL TRENDS THAT SHOWED PHYSICIANS SEEKING EMPLOYMENT IN SYSTEM ENVIRONMENTS TO ALLOW THEM MORE FOCUS ON PATIENT CARE, AND LESS ON THE BUSINESS ASPECTS OF MEDICAL PRACTICES. THIS COMPANY IS PROVIDING AN AVENUE TO WORK TOWARD LOWER OVERALL HEALTH CARE COSTS THROUGH BETTER COORDINATION OF CARE, WITH THE OBJECTIVE OF PROVIDING SERVICES TO PATIENTS IN THE LOWEST COST SETTING. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 THE FOUNDATION OF WAYNE COMMUNITY COLLEGE PO BOX 8002 GOLDSBORO NC 27533 561556512 501(C)(3) 100000 NURSING SCHOLARSHIPS UNIVERSITY OF MOUNT OLIVE 634 HENDERSON ST MOUNT OLIVE NC 28365 560623936 501(C)(3) 50000 BOOK SCHOLARSHIP EDUCATIONAL ASSISTANCE 61 99274 BOOK ADDITIONAL COURSE STUDY SCHOLARSHIPS 47 168341 PART I, LINE 2: WAYNE MEMORIAL HOSPITAL, INC. MAKES GRANTS TO SUPPORT THE ACTIVITIES OF ITS RELATED ORGANIZATIONS AND TO PROMOTE GOOD COMMUNITY RELATIONS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 SHIRLEY HARKEY CHIEF OPERATIONS OFFICER 220032 0 91918 0 32007 0 26130 0 27234 0 397321 0 28461 0 DONNA WIMBERLY CHIEF NURSING OFFICER 176417 0 72165 0 1145 0 15073 0 27653 0 292453 0 0 0 RICHARD ROGERS VICE-PRESIDENT HUMAN RESOURCES 193333 0 49098 0 20309 0 24707 0 22576 0 310023 0 0 0 REBECCA W CRAIG CHIEF FINANCIAL OFFICER 258611 0 28983 0 30989 0 39136 0 25119 0 382838 0 26898 0 DANIEL BROCK CRNA 165364 0 23271 0 65365 0 13324 0 586 0 267910 0 0 0 RICHARD MIDDLETON CRNA 161586 0 22399 0 45215 0 9416 0 28130 0 266746 0 0 0 BETTY ROUSE CRNA 171681 0 12180 0 43406 0 14796 0 9471 0 251534 0 0 0 JAMIE RICHARDS CRNA 149513 0 29660 0 42828 0 14770 0 28266 0 265037 0 0 0 AMY WILLOUGHBY CRNA 171211 0 8380 0 40379 0 23267 0 9246 0 252483 0 0 0 J WILLIAM PAUGH CEO (RETIRED) 266927 0 149974 0 233874 0 1505 0 9151 0 661431 0 227166 0 THOMAS W BRADSHAW COO (RETIRED) 96569 0 0 0 342487 0 11666 0 25599 0 476321 0 82343 0 PART I, LINE 1A LESS THAN $300 PAID ANNUALLY. PART I, LINE 1B CERTAIN DUES AND FEES AND COMPANION TRAVEL ARE REIMBURSED BY THE ORGANIZATION. PART I, LINE 4B REBECCA CRAIG PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED $26,898 IN PAYMENTS FROM THE PLAN DURING THE YEAR. WILLIAM PAUGH, A FORMER OFFICER, RECEIVED $227,166 IN PAYMENTS FROM THE SUPPLEMENTAL NON-QUALIFED RETIREMENT PLAN DURING THE YEAR. THOMAS BRADSHAW, A FORMER KEY EMPLOYEE, RECEIVED $82,343 IN PAYMENTS FROM THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DURING THE YEAR. HE ALSO RECEIVED SEVERANCE PAYMENTS TOTALING $258,488 DURING THE YEAR. SHIRLEY HARKEY PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED $28,461 IN PAYMENTS FROM THE PLAN DURING THE YEAR. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2015-07-21 17455000 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2017-05-25 77245000 SURGICAL CENTER/AIR HANDLER UNITS/REFUND PRIOR BONDS 0 0 0 A 4400000 17455000 17455000 1 0 1 1 B 77245000 482133 33956989 42805878 1 0 0 1 A 0 1 1 1 0 0.02590 0.02590 0 0 1 B 0 0 1 1 0 0.01100 0.01100 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 0 B 1 FORM 990, PART VI, SECTION A, LINE 3 IN DECEMBER 2015, IN CONJUNCTION WITH THE HOSPITAL'S AFFILIATION WITH UNC HEALTH CARE SYSTEM ("UNCHCS"), THE HOSPITAL ENTERED INTO A TEN-YEAR MANAGEMENT AGREEMENT WITH UNCHCS, EFFECTIVE JANUARY 1, 2016. THE CONTRACT GIVES UNCHCS THE RESPONSIBILITY FOR THE DAY-TO-DAY OPERATIONS OF THE HOSPITAL. UNDER THIS AGREEMENT, UNCHCS EMPLOYS AND PROVIDES THE HOSPITAL WITH A CHIEF EXECUTIVE OFFICER (CEO). FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF FORM 990 IS MADE AVAILABLE TO THE GOVERNING BODY FOR REVIEW BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL PERSONNEL ARE RESPONSIBLE FOR ADHERING TO THE CORPORATE COMPLIANCE PLAN. THIS PLAN REQUIRES PERSONNEL TO DISCLOSE CONFLICTS AS THEY ARISE. VOTING MEMBERS OF THE GOVERNING BODY ARE RECUSED FROM VOTING WHEN A CONFLICT ARISES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS REVIEWED AGAINST COMPARABILITY DATA AND APPROVED BY THE BOARD. WRITTEN COMPENSATION AGREEMENTS ARE KEPT UP-TO-DATE. OFFICER AND KEY EMPLOYEE COMPENSATION IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE CORPORATE COMPLIANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE. ADDITIONALLY, THE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE ON WWW.DACBOND.COM AND WWW.GUIDESTAR.ORG. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -902,458. CHANGE IN MINIMUM PENSION LIABILITY 23,862,449. CHANGE IN VALUE OF DERIVATIVE FINANCIAL INSTRUMENT 3,817,453. DISTRIBUTIONS FROM MEMBERS 1,740,233. AMERICAN MANAGEMENT ASSOCIATES LLC 2719 GRAVES DRIVE GOLDSBORO NC 27534 561622637 COLLECTIONS NC N/A WAYNE HEALTH FOUNDATION INC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 581881912 SUPPORT NC 501(C)(3) LINE 10 N/A 0 WAYNE HEALTH CORPORATION PO BOX 8001 GOLDSBORO NC 27534 561479733 HEALTHCARE NC 501(C)(3) LINE 12A, I N/A 0 WAYNE HEALTH PHYSICIANS 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 264291056 HEALTHCARE NC 501(C)(3) LINE 10 N/A 0 WAYNE MEMORIAL HOSPITAL FOUNDATION 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 814132398 SUPPORT NC 501(C)(3) LINE 10 N/A 0 WAYNE MRI LLC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 342043934 MRI SERVICES NC N/A RELATED 0 1 0.66670 WAYNE HEALTH ENTERPRISES INC PO BOX 8001 GOLDSBORO NC 27533 561622624 NC WAYNE HEALTH CORPORATION C 1 WAYNE HEALTH PROPERTIES PO BOX 8001 GOLDSBORO NC 27533 561756076 NC WAYNE HEALTH ENTERPRISES C 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 1 WAYNE HEALTH CORPORATION K ACTUAL CASH TRANSFER WAYNE HEALTH PHYSICIANS D ACTUAL CASH TRANSFER