2018-11-13T08:49:31-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2017-01-01 560603900 ASHE MEMORIAL HOSPITAL INC ASHE 3368467101 200 HOSPITAL AVENUE JEFFERSON NC 28640 CHARLES WRIGHT CFO 3368467101 2018-11-12 1 JOHN NORMAN P01506766 7049985200 2018-11-12 67.137.57.251 2018-11-12 09:55:19 ES P 967DCA4FABF3D6C7AE4D014617AEEE9CE601AE20 625448C0F55D99FA31EEB930CD4AF0F24507C48B 2017 2019-02-21 02:37:17Z LAURA LAMBETH 200 HOSPITAL AVE JEFFERSON NC 28640 35868644 0 X WWW.ASHEMEMORIAL.ORG X 1939 NC ACUTE HOSPITAL CARE SERVICES PROVIDED TO THE RESIDENTS OF ASHE COUNTY, NC AND SURROUNDING AREAS. 16 16 396 26 0 0 2041959 1044314 31287666 34597538 38209 32388 261702 194404 33629536 35868644 966516 800335 0 0 16014265 17184427 0 0 373120 15962398 17504644 32943179 35489406 686357 379238 16634016 17298384 6493154 6525156 10140862 10773228 THE HOSPITAL'S MISSION STATEMENT IS ICARE, WHICH STANDS FOR INVESTMENT IN THE DEVELOPMENT OF PEOPLE, COMMITMENT TO CONTINUOUS IMPROVEMENT, ACCOUNTABILITY TO THOSE WE SERVE, RESPONSIVENESS TO THE HEALTH CARE NEEDS OF THE COMMUNITY, AND EXCELLENCE IN PRIMARY HEALTHCARE. 0 0 32778522 800335 34605634 ASHE MEMORIAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF ASHE COUNTY AND THE SURROUNDING AREAS. THE HOSPITAL PROVIDED A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT AND OUTREACH TO THE COUNTY AND SURROUNDING AREAS. BENEFIT AND OUTREACH PROGRAMS ARE PROVIDED IN CONJUNCTION WITH THE ASHE COUNTY HEALTH COUNCIL AND INDEPENDENTLY THROUGH VARIOUS DEPARTMENTS AND SERVICES. 32778522 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 1 36 0 1 396 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X CHARLES WRIGHT CFO 3368460798 200 HOSPITAL AVENUE JEFFERSON NC 28640 X TOM EFFORD PRESIDENT 1.00 X X 0 0 0 HOBART DAVIS VICE PRESIDENT 1.00 X X 0 0 0 DONNIE JOHNSON VICE PRESIDENT 1.00 X X 0 0 0 JAN CADDELL TREASURER 1.00 X X 0 0 0 JANE LONON SECRETARY 1.00 X X 0 0 0 WALTER E DAVIS MD BOARD MEMBER 1.00 X 0 0 0 DENNIS E HOUCK BOARD MEMBER 1.00 X 0 0 0 EDWARD J MILLER MD BOARD MEMBER 1.00 X 0 0 0 STEPHEN SHOEMAKER BOARD MEMBER 1.00 X 0 0 0 DR CHARLES JONES BOARD MEMBER 1.00 X 0 0 0 SUE HAMPTON BOARD MEMBER 1.00 X 0 0 0 BRETT T SUMMEY DDS BOARD MEMBER 1.00 X 0 0 0 JAMES G GAMBILL JR BOARD MEMBER 1.00 X 0 0 0 GREG BOWER RPH BOARD MEMBER 1.00 X 0 0 0 HORACE THOMPSON BOARD MEMBER 1.00 X 0 0 0 NANCY KAUTZ MEMBER AT LARGE 1.00 X 0 0 0 OKSANENOWEN D PHYSICIAN 40.00 X 390545 0 0 BROWN JRFORREST MATTHEW PHYSICIAN 40.00 X 374431 0 0 WONSICKMELINDA PHYSICIAN 40.00 X 340908 0 0 LUOMADAVID C PHYSICIAN 40.00 X 287670 0 0 CALLAHANTYLER PHYSICIAN 40.00 X 269712 0 0 1663266 0 0 6 0 1 0 JEFFERSON EMERGENCY SERVICES 5665 NEW NORTHSIDE DR ST ATLANTA GA 30328 ED PROVIDERS 1026404 RESTORE RESPIRATORY CARE INC 200 GALLERIA PARKWAY ATLANTA GA 30339 RESPIRATORY THERAPY 793234 MORRISON MANAGEMENT SPECIALISTS INC A1 5801 PEACHTREE DUNWOODY R ATLANTA GA 30342 FOOD SERVICE 734527 CROTHALL HEALTHCARE A1516 1500 LIBERTY RIDGE DRIVE SUITE 210 WAYNE PA 19087 HOUSEKEEPING SERVICES 371774 ALLIANCE HEALTHCARE SERVICES INC PO BOX 96485 CHICAGO IL 60693 MRI EQUIP RENTAL 312000 12 140694 675687 227933 1044314 PATIENT SERVICE REVENUE 623000 33999311 33999311 PHARMACY 446110 302680 302680 OTHER OPERATING REVENUE 623000 295547 295547 34597538 32388 32388 186308 0 186308 186308 186308 MISCELLANEOUS 900099 8096 8096 8096 35868644 34605634 0 218696 800335 800335 1863266 1807368 55898 12880574 12494157 386417 1530461 1484546 45915 910126 882822 27304 244269 244269 58037 58037 46754 46754 2314970 1914418 400552 56747 11349 44830 568 7055049 6596470 423304 35275 354457 38990 315467 683231 683231 54723 44873 9850 120127 120127 1285362 1285362 257195 257195 BAD DEBT EXPENSE 4049358 4049358 MISCELLANEOUS 899952 283508 279167 337277 RECRUITMENT 24413 24413 35489406 32778522 2337764 373120 2131181 2570666 880620 1008361 3099616 3414474 12769 901614 910067 143585 182736 34506825 26061932 8922939 8444893 507947 522505 33745 244682 16634016 17298384 2954677 3245546 244894 180666 3106788 3098944 186795 0 6493154 6525156 X 9849305 10229256 291557 543972 10140862 10773228 16634016 17298384 X 379238 713 252415 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 6051 6051 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING EXPENDITURES ON BEHALF OF ITS MEMBERSHIP BODY. THE AMOUNT LISTED ABOVE IS AN ESTIMATE OF THE AMOUNT OF DUES ATTRIBUTABLE TO LOBBYING FOR THE 12 MONTH PERIOD ENDING DECEMBER 31, 2017. 212253 212253 18130804 11543259 6587545 109022 45426 63596 14745696 13430862 1314834 1309050 1042385 266665 8444893 X PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AWC AND AFS ARE SINGLE MEMBER LIMITED LIABILITY COMPANIES AND ARE CONSIDERED DISREGARDED ENTITIES FOR INCOME TAX PURPOSES. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S CONSOLIDATED FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLE FOR THE CONSOLIDATED FINANCIAL STATEMENTS RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2017 AND 2016. 1 1 X 1 X 1 X 1 1 0 1 1 319471 319471 0.01020 2919330 2544308 375022 0.01190 545455 552159 0 0.00000 3784256 3096467 694493 0.02210 3784256 3096467 694493 0.02210 1 4042134 1662334 16281220 16975472 -694252 X 1 0 1 1 ASHE MEMORIAL HOSPITAL 200 HOSPITAL AVENUE JEFFERSON NC 28640 X X X X CRITICAL ACCESS HOSPITAL ASHE MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 14 1 1 1 1 X WWW.ASHEMEMORIAL.ORG X 1 14 1 WWW.ASHEMEMORIAL.ORG 0 1 X 150.000000000000 250.000000000000 X X X X X X 1 1 X X X 1 X WWW.ASHEMEMORIAL.ORG X WWW.ASHEMEMORIAL.ORG X WWW.ASHEMEMORIAL.ORG X X X X X 1 0 X X X 1 X 0 0 ASHE MEMORIAL HOSPITAL INC. PART V, SECTION B, LINE 5: THE HOSPITAL CONDUCTED TWO SURVEYS TO SOLICIT FEEDBACK FROM PERSONS WHO REPRESENT THE COMMUNITY. FIRST, THE HOSPITAL CONDUCTED A YOUTH RISK BEHAVIOR SURVEY BY SURVEYING MIDDLE SCHOOL STUDENTS IN THE AREA ABOUT BEHAVIORS THAT AFFECT THEIR HEALTH. SECOND, THE HOSPITAL CONDUCTED THE COMMUNITY OPINION SURVEY IN EACH APPALACHIAN DISTRICT COUNTY (ALLEGHANY, ASHE AND WATAUGA) THROUGH THE COLLECTION OF PAPER SURVEYS AND DISTRIBUTION OF A LINK ON AREA WEBSITES THROUGH SURVEY MONKEY. ADDITIONALLY, LOCAL MEDIA OUTLETS SUPPORTED THE PROMOTION OF THE SURVEY THROUGH ON-AIR INTERVIEWS, PRESS RELEASE STORIES, AND PAID ADVERTISING ON THE RADIO. ASHE MEMORIAL HOSPITAL INC. PART V, SECTION B, LINE 6A: ALLEGHANY MEMORIAL HOSPITALAPPALACHIAN REGIONAL HEALTHCARE SYSTEMS ASHE MEMORIAL HOSPITAL INC. PART V, SECTION B, LINE 6B: APPALACHIAN DISTRICT HEALTH DEPARTMENT ASHE MEMORIAL HOSPITAL INC. PART V, SECTION B, LINE 11: THE HOSPITAL, IN CONJUNCTION WITH THE ASHE HEALTH ALLIANCE, IDENTIFIED THE FOLLOWING PRIORITIES:1. SUBSTANCE USE AND ABUSE2. PHYSICAL ACTIVITY AND NUTRITION3. CHRONIC DISEASE MANAGEMENT AND AWARENESSIN ADDITION TO SUPPORTING THE WORK OF THE ASHE HEALTH ALLIANCE, THE HOSPITAL IS DEDICATED TO IMPROVING MEDICAL SERVICES AND ACCESS TO CARE IN ASHE COUNTY THROUGH THE ADDITION OF SERVICES IN THE FOLLOWING AREAS:1. ADDITION OF A CANCER UNIT WITH CHEMOTHERAPY AVAILABLE2. RECRUITMENT OF ADDITIONAL PROVIDERS3. ADDITION OF BEHAVIORAL HEALTH STAFF AND SERVICES4. EXPANSION AND UPDATE OF THE EMERGENCY DEPARTMENT5. ONGOING OUTREACH FOR DISEASE DETECTION AND ACCESS TO CARE 3 1 - MOUNTAIN FAMILY CARE CENTER 200 HOSPITAL AVENUE JEFFERSON NC 28640 RURAL HEALTH CLINIC 2 - AMH ASHE WOMEN'S CENTER 420 E 2ND STREET WEST JEFFERSON NC 28694 PHYSICIANS OFFICES 3 - MOUNT JEFFERSON FAMILY MEDICINE 200 HOSPITAL AVENUE JEFFERSON NC 28640 FAMILY MEDICINE PART I, LINE 6A: NCHA PART I, LN 7 COL(F): THE ORGANIZATION RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE ORGANIZATION RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE ORGANIZATION'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 2: THE ORGANIZATION APPLIED THE COST-TO-CHARGE RATIO TO ITS BAD DEBT GROSS CHARGES TO DETERMINE THE AMOUNT REPORTED AS BAD DEBT EXPENSE IN SCHEDULE H. PART III, LINE 3: THE ORGANIZATION ISOLATED BAD DEBT CHARGES ATTRIBUTABLE TO UNINSURED PATIENTS AND MULTIPLIED THOSE CHARGES BY ITS COST-TO-CHARGE RATIO TO ESTIMATE THE ORGANIZATIONS' BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBILE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 9B: THE POLICY DOES NOT SPECIFICALLY ADDRESS THIS ISSUE BUT WE NORMALLY PROVIDE THE CHARITY CARE DISCOUNT PRIOR TO SENDING TO BAD DEBT IF THE PATIENT QUALIFIES FOR CHARITY IN PART BUT FAILS TO PAY THEIR PORTION DUE. PART VI, LINE 2: ON NOVEMBER 7, 2014, THE ASHE HEALTH ALLIANCE MET IN JEFFERSON, NC TO REVIEW THE TIMELINE, KEY COMPONENTS, AND ACTIONS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT. PRIOR TO THIS MEETING, SOME COMMITTEE MEMBERS, INCLUDING STAFF FROM ASHE MEMORIAL HOSPITAL, PROVIDED FEEDBACK TO THE APPALACHIAN DISTRICT HEALTH DEPARTMENT STAFF IN THE DEVELOPMENT OF THE COMMUNITY OPINION SURVEY.METHODS USED FOR THIS REPORT INCLUDE:COMMUNITY HEALTH OPINION SURVEY -- THIS SURVEY WAS DEVELOPED TO MIRROR QUESTIONS THAT IDENTIFIED COMMUNITY STRENGTHS, IMPORTANT HEALTH PROBLEMS, AND HEALTH BEHAVIORS OF COMMUNITY RESIDENTS. QUESTIONS WERE MODELED AFTER THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS AND PAST SURVEY INSTRUMENTS USED. A TOTAL OF 600 ENGLISH AND 100 SPANISH SURVEY INSTRUMENTS WERE PRINTED AND DISTRIBUTED IN MULTIPLE COMMUNITY VENUES WITH THE SUPPORT OF ASHE HEALTH ALLIANCE MEMBERS. LOCATIONS FOR DISTRIBUTION INCLUDED THE ASHE COUNTY LIBRARY, ASHE MEMORIAL HOSPITAL, ASHE COUNTY HEALTH DEPARTMENT AND WIC CLINIC, ASHE PARTNERSHIP FOR CHILDREN, AND MANY COMMUNITY LOCATIONS THROUGH SPECIAL VOLUNTEER EFFORTS. IN ADDITION, AN ELECTRONIC VERSION OF THE SURVEY INSTRUMENT WAS DEVELOPED USING SURVEY MONKEY, A SURVEY SUBSCRIPTION SERVICE HELD BY THE APPALACHIAN DISTRICT HEALTH DEPARTMENT. THE SURVEY INSTRUMENT LINK WAS EMAILED TO ASHE HEALTH ALLIANCE MEMBERS IN NOVEMBER, 2014, AND ALL WERE ASKED TO DISTRIBUTE AND POST THE LINK ACCORDINGLY. IN ADDITION, THE LOCAL MEDIA HIGHLIGHTED THE COMMUNITY HEALTH ASSESSMENT PROCESS AND ASKED FOR INPUT BY COMPLE5NG THE SURVEY ELECTRONICALLY OR AT A COMMUNITY LOCATION.COMMUNITY HEALTH LEADERSHIP SURVEY -- THIS SURVEY WAS INTENDED TO COMPLEMENT THE COMMUNITY HEALTH OPINIONS AND UNDERSTAND HOW COMMUNITYLEADERS SEE COMMUNITY HEALTH PROBLEMS AND STRENGTHS. THE APPALACHIAN DISTRICT BOARD OF HEALTH PROVIDED FEEDBACK ON DISTRIBUTION OF THIS SURVEY. UNLIKE THE COMMUNITY OPINION SURVEY, THIS SURVEY WAS ONLY DISTRIBUTED ELECTRONICALLY USING SURVEY MONKEY, AND FURTHER RESULTS MAY BE WARRANTED TO GET A FULL PICTURE OF COMMUNITY HEALTH LEADER INPUT. GIVEN THE TIME CONSTRAINTS TO MEET THE REPORT SUBMISSION DEADLINES, THIS MAY BE AN AVENUE THE COALITION WILL EXPLORE WITH COMMUNITY LISTENING SESSIONS PLANNED NEXT.SECONDARY DATA -- THIS IS AN IMPORTANT PART OF THE OVERALL REPORT SINCE MUCH OF THE DESCRIBED CONDITION OF THE COMMUNITY UTILIZES DATA COLLECTED FROM TRUSTED SOURCES SUCH AS THE US CENSUS BUREAU AND THE NC STATE CENTER FOR HEALTH STATISTICS. THIS DATA PROVIDES US WITH INFORMATION ABOUT THE DEMOGRAPHIC PROFILE OF THE COMMUNITY,POPULATION GROWTH TRENDS, AND TREND ANALYSES OF KEY ISSUES LIKE INCOME AND POVERTY, HEALTH BEHAVIORS, AND LEADING CAUSES OF ILLNESS AND DEATH.INCLUDED IN THIS REPORT ARE COMPARISONS BETWEEN THE COUNTY, A PEER COUNTY, AND THE STATE OF NC OVERALL. WE USE THESE COMPARISONS TO BETTER UNDERSTAND HOW THIS COUNTY'S STATISTICS DIFFER FROM A SIMILAR COUNTY OR THE STATE. SOME DATA IS REPORTED IN RATES PER A CERTAIN NUMBER IN THE POPULATION (E.G., 100,000) WHILE OTHER IS REPORTED AS A PERCENT. NEW CASES OF A DISEASE ARE OFTEN REPORTED AS A RATE WHILE HEALTH BEHAVIORS AND PREVALENCE OF A DISEASE EXISTING IN THE POPULATION IS REPORTED AS APERCENTAGE. PART VI, LINE 3: PATIENTS AND/OR GUARANTORS ARE EVALUATED FOR CHARITY CARE APPROVAL PRIOR TO SERVICES BEING RENDERED, AT THE TIME OF SERVICE, OR AS SOON AS PRACTICAL AFTER SERVICE HAS BEEN PROVIDED TO THE PATIENT. AMH POSTS NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE TO LOW-INCOME UNINSURED PATIENTS. THESE NOTICES ARE POSTED IN VISIBLE LOCATIONS THROUGHOUT THE HOSPITAL SUCH AS ADMITTING/REGISTRATION, FINANCIAL COUNSELING OFFICE, AND OTHER OUTPATIENT AND/OR EMERGENCY SETTINGS. NOTICES OR BROCHURES ARE ALSO PROVIDED TO UNINSURED PATIENTS AT TIME OF REGISTRATION AND INCLUDE BRIEF INSTRUCTIONS ON HOW TO APPLY FOR FINANCIAL ASSISTANCE OR A DISCOUNTED PAYMENT AND A CONTACT TELEPHONE NUMBER THAT A PATIENT OR FAMILY MEMBER CAN CALL TO OBTAIN MORE INFORMATION. INFORMATION REGARDING FINANCIAL ASSISTANCE IS INCLUDED WITH THE PATIENT'S BILLS AND STATEMENTS. BUSINESS CARDS NOTIFYING PATIENTS OF FINANCIAL ASSISTANCE PROGRAMS AND WHERE TO TELEPHONE FOR ASSISTANCE ARE LOCATED THROUGHOUT THE HOSPITAL.OUR CHARITY POLICY AND CHARITY APPLICATION IS AVAILABLE ON THE HOSPITAL'S WEBSITE. INFORMATION REGARDING CHARITY APPLICATION IS PROVIDED IN ENGLISH AND IN SPANISH. AMH ALSO SHARES ITS CHARITY CARE POLICIES WITH APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHERORGANIZATIONS THAT ASSIST SUCH PATIENTS. PART VI, LINE 4: ASHE COUNTY, NC SITS IN THE NORTHWESTERN CORNER OF NORTH CAROLINA BORDERING TENNESSEE, WATAUGA, WILKES, AND ALLEGHANY COUNTY IN NC. THE TWO LARGEST TOWNSHIPS ARE WEST JEFFERSON AND JEFFERSON, NC, LOCATED IN THE HEART OF THE COUNTY. OVERALL, THE ASHE COUNTY POPULATION IS 27,151 (2013 ESTIMATE) WITH EVEN DISTRIBUTION OF MALES AND FEMALES IN THEPOPULATION. THE MEDIAN AGE FOR THE COUNTY IS 45.5 YEARS COMPARED TO 37.6 YEARS FOR NC OVERALL (US CENSUS BUREAU,2013). THIS DATA POINTS OUT THAT THE COUNTY HAS A POPULATION ABOUT 7.9 YEARS "OLDER" THAN NC. THE POPULATION IS EXPECTED TO GROW TO 28,933 IN 2020 AND UP TO 30,548 IN 2030 (NC OFFICE OF STATE BUDGET AND MANAGEMENT, 2014). THE MAJORITY OF RESIDENTS IN THE COUNTY, OR 97.2%, IDENTIFY THEMSELVES AS WHITE COMPARED TO THAT OF NC AT 69.7% WHITE. IN ASHE COUNTY THERE IS A MUCH LOWER PERCENTAGE OF AFRICAN AMERICAN RESIDENTS WHEN COMPARED TO NC. OVERALL, THECOUNTY HAS A SLIGHTLY LOWER PERCENTAGE OF HISPANIC OR LATINO PERSONS AT 5% COMPARED TO 8.5% IN NC AND 9.3% IN NEIGHBORING ALLEGHANY COUNTY (US CENSUS BUREAU, 2013). THIS DIFFERENCE COULD BE INFLUENCED BY THE AGRICULTURE HISTORY OF THE COUNTY SINCE IT IS A LARGE PRODUCER OF NC CHRISTMAS TREES AND MAY EMPLOY SOME RESIDENTS IN THAT INDUSTRY. NEARLY 53% OF ASHE COUNTY RESIDENTS ARE 55 OR OLDER. OTHER IMPORTANT DEMOGRAPHICS THAT IMPACT THE HEALTH NEEDS OF ASHE COUNTY RESIDENTS:* NEARLY 75% OF ALL CHILDREN PARTICIPATE IN THE FREE OR REDUCED LUNCH PROGRAM.* ASHE COUNTY HAS AN UNEMPLOYMENT RATE OF APPROXIMATELY 7.6%.* APPROXIMATELY 20% OF ASHE COUNTY RESIDENTS ARE AT OR BELOW THE POVERTY LEVEL. 1 FINANCIAL ASSISTANCE 344 800335 PART I, LINE 2: FINANCIAL ASSISTANCE IS TRACKED THROUGH THE HOSPITAL'S FAP WHICH IS DESCRIBED IN SCHEDULE H. X X X X 0 0 0 0 0 0 0 0 0 OKSANENOWEN D PHYSICIAN 390545 0 0 0 0 0 0 0 0 0 390545 0 0 0 BROWN JRFORREST MATTHEW PHYSICIAN 374431 0 0 0 0 0 0 0 0 0 374431 0 0 0 WONSICKMELINDA PHYSICIAN 340908 0 0 0 0 0 0 0 0 0 340908 0 0 0 LUOMADAVID C PHYSICIAN 287670 0 0 0 0 0 0 0 0 0 287670 0 0 0 CALLAHANTYLER PHYSICIAN 269712 0 0 0 0 0 0 0 0 0 269712 0 0 0 PART I, LINE 3 COMPENSATION FOR THE CEO IS PROVIDED BY AN UNRELATED ORGANIZATION. PLEASE SEE THE RESPONSE TO FORM 990, PART VI, LINE 15A FOR MORE DETAILS. DR CHARLES JONES BOARD MEMBER 418305 CALL PAY, RENTAL OFFICE SPACE, & LEASED ROOM 0 FORM 990, PART VI, SECTION A, LINE 3 SEE NOTE FOR PART VI, LINE 15. FORM 990, PART VI, SECTION A, LINE 6 THE HOSPITAL IS ORGANIZED AS A STOCK CORPORATION, AND SHARES OF STOCK ARE SOLD TO MEMBERS OF THE COMMUNITY AND ARE FREELY TRANSFERABLE, BUT HAVE NO CAPITAL VALUE. SHAREHOLDERS DO NOT RECEIVE DIVIDENDS. FORM 990, PART VI, SECTION A, LINE 7A TRUSTEES SHALL BE ELECTED BY THE SHAREHOLDERS OF THE CORPORATION AT THE ANNUAL MEETING OF THE MEMBERSHIP. EACH SELECTED TRUSTEE SHALL HOLD OFFICE FOR A TERM OF THREE YEARS AND UNTIL HIS SUCCESSOR IS ELECTED AND QUALIFIED. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION CANNOT SELL REAL PROPERTY WITHOUT APPROVAL BY THE SHAREHOLDERS. PLEASE SEE THE RESPONSE TO LINE 6 ABOVE. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. THE BOARD IS INFORMED OF THE FILING OF THE RETURN AND THE 990 IS MADE AVAILABLE TO THEM FOR REVIEW AFTER THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL VOTING MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST SURVEY AND RETURN TO THE BOARD CHAIRMAN. THE SURVEY INCLUDES A DISCLOSURE STATEMENT AND A REVIEW OF THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL HAS BEEN MANAGED BY HCA AND/OR QUORUM HEALTH RESOURCES, LLC (QHR) SINCE 1982. THE CONTRACT EXPIRED IN AUGUST 2013 AND WAS NOT RENEWED BY THE BOARD OF TRUSTEES. SUBSEQUENTLY, THE BOARD OF TRUSTEES OF THE HOSPITAL CONTRACTED WITH NOVANT HEALTH SHARED SERVICES WITH THE EFFECTIVE DATE OF AUGUST 2013. NOVANT WAS TO EMPLOY THE CEO. AS THE EMPLOYER OF THE CEO, NOVANT SETS COMPENSATION UTILIZING THE APPROPRIATE COMPARABILITY DATA TO ESTABLISH FAIR MARKET VALUE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PLEASE CONTACT THE ADMINISTRATIVE OFFICE FOR FURTHER DETAILS. SEE FORM 990, PART VI, LINE 20. FORM 990, PART XI, LINE 9: TEMPORARILY RESTRICTED CONTRIBUTIONS 970,414. FOUNDATION CONTRIBUTIONS RELEASED FOR OPERATIONS GOLDEN LEAF CONTRIBUTIONS RELEASED FOR OPERATIONS CONTRIBUTIONS RELEASED FOR OPERATIONS -717,999. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. AMH ASHE WOMEN'S CENTER LLC 420 E 2ND STREET WEST JEFFERSON NC 28694 451482188 PHYSICIANS PRACTICE NC 90 395469 ASHE MEMORIAL HOSPITAL ASHE FINANCIAL SERVICES LLC 200 HOSPITAL AVENUE JEFFERSON NC 28640 810919041 HEALTHCARE NC 2814374 67208 ASHE MEMORIAL HOSPITAL ASHE MEMORIAL HOSPITAL FOUNDATION INC 200 HOSPITAL AVE JEFFERSON NC 28640 582078244 FUNDRAISING NC 501(C)(3) 11A ASHE MEMORIAL HOSPITAL 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 ASHE MEMORIAL HOSPITAL FOUNDATION C 140694