2018-04-30T10:39:40-04:00 2017-06-30 990 2016-07-01 540566029 NORTON COMMUNITY HOSPITAL INC NORT 2766799600 1106 W MARKET STREET JOHNSON CITY TN 37604 MARK LEONARD NCH/DCH CEO 2766799600 2018-04-26 EBA7F521928E27B6E9DB4326061FED7B51503225 EBA7F521928E27B6E9DB4326061FED7B51503225 2016 2021-01-29 14:40:06Z MARK LEONARD 100 15TH STREET NW NORTON VA 24273 65005591 false X WWW.BALLADHEALTH.ORG/NCH X 1949 VA NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. 13 4 599 46 138028 39839 123976 98297 64684469 63392952 879993 983073 433267 494900 66121705 64969222 32811 64675 0 35997567 35591617 0 1139 26098553 26493911 62128931 62150203 3992774 2819019 95001591 96531232 40777394 38253781 54224197 58277451 X NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. false false 52982115 64675 63529273 NORTON COMMUNITY HOSPITAL (NCH) IS LOCATED IN NORTON, VIRGINIA. OUR 129-BED ACUTE-CARE FACILITY HAS SERVED SOUTHWEST VIRGINIA AND SOUTHEASTERN KENTUCKY SINCE 1949. AS THE LARGEST HEALTHCARE FACILITY IN THE COALFIELD REGION, NCH PROVIDES A WIDE ARRAY OF SERVICES THROUGH HIGHLY TRAINED PHYSICIANS AND SUPPORT STAFF. NCH IS THE SOLE OWNER OF DICKENSON COMMUNITY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN CLINTWOOD, VIRGINIA. NCH IS A SUBSIDIARY OF MOUNTAIN STATES HEALTH ALLIANCE. (CONT'D ON SCHEDULE O) (CONT'D) NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 170,800 TOWARDS EFFORTS TO RECRUIT PHYSICIANS TO OUR COMMUNITY AND RETAIN THEM. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S. ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. IN MANY CASES, RECRUITMENT IS DUE TO PHYSICIAN RETIREMENT. FY17 RECRUITMENT EXPENSE AT NCH IS COMPRISED OF PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A TEMPORARY LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. LOAN FORGIVENESS IS AN INCENTIVE FOR PHYSICIANS TO STAY IN OUR AREA PROVIDING HEALTH SERVICES TO THE COMMUNITY. PHYSICIAN LOANS ARE FORGIVEN OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY. DURING FY17, OUR RECRUITMENT ACTIVITIES WERE DIRECTED TOWARD SPECIALTY AREAS SUCH AS CARDIOLOGY, GENERAL SURGERY, OB, ORTHOPEDIC SURGERY, UROLOGY, FAMILY PRACTICE, HOSPITALISTS, AND A NURSE PRACTITIONER. MSHA'S RECRUITMENT DEPARTMENT RECRUITS ON BEHALF OF ALL ITS HOSPITALS AND THE COSTS ASSOCIATED WITH RECRUITMENT FOR A PARTICULAR HOSPITAL ARE EXPENSED TO THE RECRUITING HOSPITAL. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED NEARLY 12,000 BLACK LUNG PROCEDURES THIS YEAR. WITH FINANCIAL ASSISTANCE FROM A USDA RURAL DEVELOPMENT GRANT, MOUNTAIN STATES HEALTH ALLIANCE (MSHA) ESTABLISHED A TELEMEDICINE NETWORK CONNECTING ICU DOCTORS AT JOHNSON CITY MEDICAL CENTER (MSHA'S FLAGSHIP HOSPITAL) WITH THE SYSTEM'S SIX RURAL HOSPITALS, INCLUDING NORTON COMMUNITY HOSPITAL. MOUNTAIN STATES ALREADY PRACTICES TELEMEDICINE FOR PEDIATRICS, EMERGENCY ROOM AND PSYCHIATRICS, PROVIDING A HIGH-QUALITY, LIVE VIDEO AND AUDIO LINK BETWEEN A PROVIDER AT ONE FACILITY AND A PATIENT AND PROVIDER AT ANOTHER FACILITY. THE NEW USDA GRANT IS SPECIFICALLY FOR THE INTENSIVE CARE UNIT, ALLOWING SPECIALISTS AT JCMC TO CONDUCT REAL-TIME CONSULTATIONS WITH PATIENTS AND CAREGIVERS IN THE ICU AT OUR RURAL HOSPITALS. MANY PATIENTS IN RURAL TOWNS DO NOT HAVE CARS OR DISPOSABLE INCOME TO SPEND ON GAS, MEALS OR LODGING TO COME TO JCMC FOR CARE, SO TELEMEDICINE BRINGS THE CARE TO THEM. THIS NEW SERVICE IS PROJECTED TO SERVE ABOUT 5,000 PATIENTS PER YEAR. THE USDA GRANT IS ONE OF THE USDA'S DISTANCE LEARNING AND TELEMEDICINE PROJECTS. MSHA'S TRIUMPH CANCER NAVIGATOR PROGRAM CELEBRATED ITS ONE-YEAR ANNIVERSARY DURING FY17. THE PROGRAM HAS EXPANDED ITS SCOPE TO INCLUDE MORE MSHA HOSPITALS AND NOW INCLUDES NORTON COMMUNITY HOSPITAL. IN ADDITION, THE NAVIGATION PROGRAM EXPANDED TO COVER ALL TYPES OF CANCER. THE PROGRAM IS DESIGNED TO SUPPORT CANCER PATIENTS AND THEIR FAMILIES, ADVOCATE FOR THE PATIENT, AND TO HELP COORDINATE THE PATIENT'S CARE THROUGHOUT THE CONTINUUM OF TREATMENT - FROM DIAGNOSIS TO SURVIVORSHIP. THERE IS NO CHARGE FOR THESE SERVICES REGARDLESS OF WHETHER A PATIENT CHOOSES TO RECEIVE THEIR TREATMENT AT A MSHA FACILITY OR A DIFFERENT PROVIDER. THOSE THAT JOIN THE PROGRAM RECEIVE ONE-ON-ONE ASSISTANCE FROM SPECIALLY TRAINED ONCOLOGY PROFESSIONALS. OUR CANCER NAVIGATORS COMMUNICATE WITH THE PATIENT'S DOCTOR, WILL COORDINATE TRANSPORTATION, SET UP APPOINTMENT REMINDERS AND PROVIDE EMOTIONAL SUPPORT FOR BOTH THE PATIENT AND THE PATIENT'S FAMILY. OUR NAVIGATORS WILL ALSO COORDINATE SUPPORT SERVICES SUCH AS TREATMENT PLANNING, PROSTHESIS SELECTION, NUTRITION COUNSELING, AND IDENTIFICATION OF RESOURCES FOR SPIRITUAL CARE, FINANCIAL ASSISTANCE AND OTHER NEEDS. OUR NAVIGATORS PARTICIPATE IN COMMUNITY EVENTS SUCH AS HEALTH FAIRS, CANCER EDUCATION EVENTS, AND CANCER SUPPORT GROUPS. THEY VISIT PHYSICIAN OFFICES, SENIORS' GROUPS, ATTEND MEETINGS WITH LOCAL BUSINESS ORGANIZATIONS, AND THEY WORK WITH MANY OTHER ORGANIZATIONS TO EXPLAIN THE NAVIGATION PROGRAM AND PROVIDE CANCER AWARENESS/EDUCATION THROUGHOUT THE COMMUNITY. THE PROGRAM HAS MADE AN IMPACT, WITH THE TRIUMPH PROGRAM RECEIVING A PATIENT SATISFACTION SCORE OF 93. OUR HOSPITAL'S TRIUMPH CANCER NAVIGATOR RECOGNIZED A NEED IN OUR COMMUNITY FOR SOME CANCER PATIENTS STRUGGLING WITH THEIR ILLNESS, WHILE ALSO DEALING WITH FINANCIAL WORRIES SO OUR NAVIGATOR CAME UP WITH THE IDEA FOR A FUNDRAISER. WORKING WITH MOUNTAIN STATES FOUNDATION, TWO "SOUP AND PAINT" EVENTS BROUGHT TEAM MEMBERS AND COMMUNITY MEMBERS TOGETHER TO ENJOY WARM SOUP AND A CRAFT PROJECT FOR A GOOD CAUSE. A LOCAL PAINTING INSTRUCTOR DONATED HER TIME FOR THE TWO EVENTS. MONEY RAISED PROVIDED FINANCIAL ASSISTANCE TO CANCER PATIENTS FOR THINGS LIKE GAS VOUCHERS, TAXI FARES, NON-COVERED MEDICATIONS, NUTRITIONAL EXPENSES, AND PERSONAL CARE ITEMS. DEPENDING ON PATIENTS' GREATEST NEEDS, IMPORTANT BILLS SUCH AS UTILITIES HAVE BEEN COVERED. THE UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE HOSTED AN INAUGURAL GIRLS DAY IN STEM-H FOR SIXTH-GRADE GIRLS IN THE REGION TO SHOW THE YOUNG GIRLS THAT CAREERS IN SCIENCE, TECHNOLOGY, ENGINEERING, MATHEMATICS AND HEALTH (S-T- E-M-H) ARE NOT JUST FOR MEN. DURING THE EVENT, NORTON COMMUNITY HOSPITAL PROVIDED DEMONSTRATIONS AND ACTIVITIES DESIGNED TO SPARK AN INTEREST IN MATH AND SCIENCE AND PERHAPS INTRODUCE THE GIRLS TO THE POSSIBILITY OF PURSUING CAREERS IN THE HEALTH CARE FIELD. OUR TEAM MEMBER ACTIVITIES AND PRESENTATIONS COVERED THE AREAS OF PHARMACY, OCCUPATIONAL AND PHYSICAL THERAPY, LABORATORY TECHNOLOGY, AND EMERGENCY SERVICES. STUDIES SHOW THAT YOUNG GIRLS BEGIN TO LOSE INTEREST IN STEM-H FIELDS OF STUDY JUST BEFORE THEY REACH HIGH SCHOOL. THE NUMBERS DROP AGAIN IN HIGH SCHOOL AND IN COLLEGE. ACCORDING TO THE UNITED STATES DEPARTMENT OF COMMERCE, WOMEN CONSTITUTE SLIGHTLY MORE THAN HALF OF COLLEGE EDUCATED WORKERS BUT MAKE UP ONLY 25 PERCENT OF COLLEGE EDUCATED STEM WORKERS. IN AN EFFORT TO RECRUIT MORE STUDENTS INTO THE HEALTH CARE FIELD, TEAM MEMBERS FROM NORTON COMMUNITY HOSPITAL PARTICIPATED IN A HEALTH CARE CAREER EXPO FOR EIGHTH-GRADE STUDENTS WHO HAD EXPRESSED AN INTEREST IN HEALTH CARE CAREERS. THE STUDENTS WERE ABLE TO ROTATE THROUGH THREE HEALTH CAREER SCENARIOS TO GET A TASTE OF A JOB IN HEALTH CARE. THE FIRST SCENARIO GAVE THE STUDENTS THE OPPORTUNITY TO "GOWN UP" FOR SURGERY, WITH INSTRUCTIONS ON SURGICAL INSTRUMENTS AND THE IMPORTANCE OF A STERILE ENVIRONMENT. THE STUDENTS WITNESSED THE REPAIR OF A "BANANAPLASTY", WITH OUR CNO SURGICALLY REPAIRING A PARTIALLY PEELED BANANA. THE STUDENTS GOT TO WITNESS TYPES OF STITCHES USED IN SURGICAL CASES AND THE TYPES OF INSTRUMENTS INVOLVED. THE SECOND SCENARIO PROVIDED INFORMATION RELATED TO A CAREER IN PHARMACY WITH OUR PHARMACY DIRECTOR WALKING THE STUDENTS THROUGH THE EDUCATIONAL REQUIREMENTS AND PROCESSES INVOLVED WITH PURSUING PHARMACY DEGREES AND FACILITATED A VERY COMPETITIVE ROUND OF PHARMACY BINGO WHICH INTRODUCED STUDENTS TO MEDICAL TERMINOLOGY RELATED TO PHARMACY. IN THE THIRD SCENARIO, STUDENTS WERE TAUGHT ABOUT HEART AND LUNG FUNCTIONS. STUDENTS VIEWED THEIR OWN HEART RHYTHMS WHILE LEARNING ABOUT EKG PATTERNS. THEY LISTENED TO BREATH SOUNDS AND RESPIRATIONS ON A PEDIATRIC MANIKIN AND HOW TO USE A DINAMAP FOR MONITORING BLOOD PRESSURE AND CHECKING PULSE OXIMETRY READINGS. THE STUDENTS WERE ALSO TAUGHT HOW TO MANUALLY CHECK BLOOD PRESSURE READINGS. NORTON COMMUNITY HOSPITAL PARTNERED WITH DICKENSON COMMUNITY HOSPITAL, RIDGEVIEW MIDDLE SCHOOL AND SOUTHWEST VIRGINIA AREA HEALTH EDUCATION CENTER TO PUT THE PROGRAM TOGETHER. FUTURE PROGRAMS ARE BEING PLANNED FOR DIFFERENT AGE GROUPS. NCH OPERATES A PHYSICIAN CLINIC THAT IS LOCATED IN A RURAL, LOW-INCOME AREA. THE CLINIC IS STAFFED PRIMARILY WITH MEDICAL RESIDENTS. WITHOUT THE CLINIC, COMMUNITY MEMBERS WOULD NOT HAVE ACCESS TO PRIMARY CARE. NCH'S SUBSIDY OF THE CLINIC THIS YEAR EXCEEDED 626,000. AFTER COMPLETING AN EXT 52982115 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false true false false false false false true true true true false false true 124 0 true 599 true true true false false false false false false false false false X 13 4 false false false false true true true true true false false true true true true true true false false false VA X ROWENA BLACK 2764391031 100 15TH STREET NW NORTON VA 24273 MARVIN EICHORN MSHA EVPCOO DIRECTOR 0.50 54.50 X 0 590395 39746 MONTY MCLAURIN VPCEO NW MKT VICE-CHAIR 9.00 36.00 X X 0 565441 54906 MATTHEW CUSANO MD PHYSICIAN & 41.00 0.50 X 351087 0 30123 SHANE HILTON VPCFO MKT OPER DIRECTOR 2.00 43.00 X 0 339387 58849 TOM TULL MSHA VP DIRECTOR 1.00 44.00 X 0 170651 24339 CHARLES WARD CHAIR 1.00 0.50 X X 21445 0 0 ROBERT LEONARD SECRETARY/TR 1.00 1.00 X X 12560 0 0 JAMES MANICURE DIRECTOR 0.50 1.10 X 8172 0 0 BUFORD STURGILL DIRECTOR 0.50 0.50 X 6833 0 0 BILL WAMPLER DIRECTOR 1.00 0.50 X 3765 0 0 CHARLES SLEMP DIRECTOR 0.50 0.50 X 1260 0 0 ERNIE WARD DIRECTOR 1.00 1.00 X 1260 0 0 VALERIE LAWSON DIRECTOR 1.00 0.50 X 840 0 0 MARK LEONARD NCH/DCH CEO 39.00 6.00 X 0 256280 46006 KEVIN MORRISON NCH/DCH CFO 39.00 6.00 X 0 117853 14896 VISHAL RAJ MD PHYSICIAN 40.00 X 503584 0 17950 DARYL PIERCE MD PHYSICIAN 40.00 X 419554 0 15545 MICHAEL GREEN MD PHYSICIAN 40.00 X 380309 0 6497 RUBYE WASHINGTON-MOORE MD PHYSICIAN 40.00 X 313874 0 30681 BERNIE SERGENT MD PHYSICIAN 40.00 X 292489 0 29107 STEPHEN SAWYER AVPCFO NW MKT IPMC CFO/FMR 0.00 45.00 X 0 189714 30666 2317032 2229721 399311 32 true true false VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON VA 24212 ANESTHESIA SERV 846819 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN FEES 606315 ARAMARK SERVICES INC 615 MCCALLIE AVENUE CHATTANOOGA TN 37403 DIETARY SERV 558428 DAVIS BROTHERS NURSERY INC 122 BASSWOOD ROAD ROSE HILL VA 24281 LANDSCAPING 242238 GRC CONSTRUCTION SERVICES 130 REGIONAL PARK DRIVE KINGSPORT TN 37660 CONSTRUCTION 209224 9 81053 6500 10744 98297 PATIENT REVENUE 621110 62394052 62394052 WELLNESS PROGRAMS 621110 981061 981061 LABORATORY REVENUE 621511 17839 17839 63392952 643994 643994 221663 36369 185294 185294 22823 162471 332643 6436 332643 6436 339079 6436 332643 WELLNESS CENTER 713940 97366 97366 PRECEPTOR PAYMENTS 900099 82925 82925 REVENUE FROM PARENT 900099 49960 49960 79355 79355 309606 64969222 63514434 138028 1218463 X 64675 64675 1016328 423492 592836 27036017 24976165 2059852 1124787 1046274 78513 4713173 4102778 610395 1701312 1655327 45985 262129 248537 13592 277635 277635 50004 50004 86131 86131 7390506 6277609 1112897 231108 32848 198260 652685 571550 81135 1407628 1380655 26973 1024632 870432 154200 327668 311462 15067 1139 292370 292370 4418812 2741383 1677429 512922 122645 390277 MEDICAL SUPPLIES 5867711 5867711 MANAGEMENT FEES TO PARENT 1778643 758646 1019997 REPAIRS & MAINTENANCE 1185772 1146810 38962 UBI TAXES 6381 6381 721174 383116 338058 62150203 52982115 9166949 1139 X 7369839 2714701 9496254 9843893 62692 1436665 1317625 485218 253685 102948111 55825056 49861960 47123055 26107697 35086412 181266 191861 95001591 96531232 7118549 6101019 20985500 20708048 12673345 11444714 40777394 38253781 X 54096792 58203041 127405 74410 54224197 58277451 95001591 96531232 X 2819019 1883372 -649137 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2811 false false false 2811 false SCHEDULE C, PART II-B, LINE 1 NCH HAD LOBBYING EXPENSES OF 2,811 WHICH REPRESENTS THE PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION AND TO NATIONAL RURAL HEALTH ASSOCIATION ATTRIBUTABLE TO DIRECT LOBBYING. 2111034 2111034 52150123 21866468 30283655 282116 209193 72923 47112123 33292178 13819945 1292715 457217 835498 47123055 PENSION BENEFITS 9202152 DUE TO AFFILIATES 1256919 RESERVE-PROF. LIABILITY SELF-INSUR 985643 11444714 X SCHEDULE D, PAGE 3, PART X "THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2017 AND 2016. AT JUNE 30, 2017, TAX RETURNS FOR 2014 THROUGH 2016 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE." true true X true X true X true true false true true 790535 790535 0.01270 14351717 9807888 4543829 0.07310 15142252 9807888 5334364 0.08580 255841 255841 0.00410 3496731 1601495 1895236 0.03050 1951007 620646 1330361 0.02140 39175 39175 0.00060 5742754 2222141 3520613 0.05660 20885006 12030029 8854977 0.14250 true 8007203 6005402 16875422 16028859 846563 X true true 1 1 NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON VA 24273 BALLADHEALTH.ORG/NCH H 1879 X X X X NORTON COMMUNITY HOSPITAL 1 false false true X X X X X X X X 15 true true false true X BALLADHEALTH.ORG/NCH X true 16 false true false true X 200.000000000000 400.000000000000 X X true true X X X true X BALLADHEALTH.ORG X BALLADHEALTH.ORG X BALLADHEALTH.ORG X X X X X true X false X X X true X false false FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES, INCLUDING NCH. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 5 TO 18 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S PERCEIVED HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS, AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE FACILITY COMMUNITY BOARDS (SUCH AS NCH'S BOARD) WERE PRESENTED THIS INFORMATION AND SHARED THEIR THOUGHTS AS WELL ON THE HEALTH NEEDS TO PRIORITIZE. THE SPECIFIC NEEDS FOR EACH COUNTY WERE THEN ADDRESSED IN THE RESPECTIVE FACILITY IMPLEMENTATION PLAN WHICH WAS ADOPTED SEVERAL MONTHS LATER. FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. NCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 11 MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2015. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2014 AND 2015. DUE TO LIMITED RESOURCES, EACH FACILITY PRIORITIZED FOUR TO FIVE HEALTH PRIORITIES ON WHICH TO FOCUS AND DEVELOP IMPLEMENTATION PLANS TO IMPACT. THERE WERE SEVEN COMMON HEALTH PRIORITIES SELECTED BY THE VARIOUS 11 FACILITIES, BUT NOT ALL FACILITIES SELECTED THE SAME AREAS. THE SEVEN ARE OBESITY, SUBSTANCE/PRESCRIPTION DRUG ABUSE, DIABETES, CANCER, HEART DISEASE, SMOKING AND MENTAL HEALTH. ALL OF THESE ARE SIGNIFICANT ISSUES FOR ALL 11 FACILITIES, BUT EACH CHOSE TO PRIORITIZE ON A DIFFERENT SET SO THEY COULD TARGET THEIR EFFORTS AND BE MORE EFFECTIVE WITH LIMITED RESOURCES. FOR EXAMPLE, WHILE NEARLY ALL THE FACILITIES IDENTIFIED OBESITY (11 OF 11) AND SUBSTANCE/PRESCRIPTION DRUG ABUSE (10 OF 11), ONLY CERTAIN FACILITIES ELECTED TO FOCUS ON SOME NUMBER OF THE OTHER FIVE COMMON HEALTH PRIORITIES. WHILE MENTAL HEALTH IS CLEARLY A SIGNIFICANT ISSUE FOR ALL 11 FACILITIES, ONLY THREE ARE FOCUSED ON IT DUE TO LIMITED RESOURCES. THE SAME IS TRUE WITH SMOKING WHERE ONLY 5 OF THE 11 FACILITIES ARE FOCUSED ON IT, BUT IT IS AN ISSUE FOR ALL FACILITIES. SIX OF THE 11 FACILITIES SELECTED CANCER; 6 OF THE 11 SELECTED HEART DISEASE; AND 9 OF THE 11 CHOSE DIABETES. ANOTHER WAY TO STATE THIS IS BY FACILITY. FOR EXAMPLE, WHILE CANCER AND MENTAL HEALTH ARE PREVALENT CHALLENGES FOR JCMC'S PRIMARY SERVICE AREA, THE HOSPITAL ELECTED NOT TO FOCUS ON THOSE DUE TO LIMITED TIME, FUNDING, PERSONNEL AND OTHER RESOURCES NEEDED TO EFFECTUATE CHANGE. UCMH FELT IT WAS UNABLE TO ADDRESS HEART DISEASE, SMOKING, AND MENTAL HEALTH ISSUES IN ITS PRIMARY SERVICE AREA. SOME FACILITIES IDENTIFIED ISSUES SUCH AS TRANSPORTATION AND EDUCATION AS BARRIERS TO GOOD HEALTH, BUT WERE ALSO UNABLE TO SET ASIDE SUFFICIENT RESOURCES TO MEANINGFULLY IMPACT THOSE CHALLENGES. AFTER THE FACILITIES SELECTED A REASONABLE NUMBER OF HEALTH PRIORITIES THEY FELT THEY COULD ADEQUATELY IMPACT, AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF NOVEMBER AND DECEMBER 2015. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. THE FACILITIES CONTINUE TO CONDUCT ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, NCH WORKS WITH LOCAL PHYSICIANS TO PROVIDE A SUPPORT PROGRAM FOR PREGNANT WOMEN WITH SUBSTANCE ABUSE ISSUES. IN COLLABORATION WITH ANOTHER NONPROFIT, WE PROVIDED FREE COLONOSCOPIES TO LOW INCOME COMMUNITY MEMBERS. WE ALSO PROVIDED NUMEROUS PUBLIC HEALTH EDUCATIONAL INFORMATION BY PARTNERING WITH LOCAL MEDIA OUTLETS TO COVER TOPICS SUCH AS WOMEN'S HEALTH, LUNG CANCER, AND A MEDICATION ASSISTANCE PROGRAM. SEVERAL MSHA FACILITIES, INCLUDING NCH, PARTICIPATE IN THE MSHA TRIUMPH CANCER NAVIGATOR PROGRAM WHICH HELPS COORDINATE CARE FOR CANCER PATIENTS FREE OF CHARGE TO ALL PATIENTS, REGARDLESS OF WHETHER THEY CHOOSE TO RECEIVE THEIR TREATMENT AT A MSHA FACILITY. PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE FINANCIAL ASSISTANCE APPROVAL CAN APPLY TO AN ASSORTMENT OF PATIENTS SUCH AS THOSE WHO HAVE EXHAUSTED THEIR MEDICAID BENEFITS, THOSE WHO QUALIFIED FOR MEDICAID AFTER THE DATE OF SERVICE, DECEASED PATIENTS WITH NO ESTATE OR ASSETS, UNINSURED PATIENTS, AND UNDERINSURED PATIENTS. MSHA/NCH CHARITY QUALIFICATION IS BASED ON FEDERAL POVERTY GUIDELINES BUT ALSO USES ASSET VALUES TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. CHARITY APPROVAL COVERS ALL DATES OF SERVICE FOR THE PATIENT WHEN THEY ARE APPROVED AND THERE IS NO LIMITATION OR CAP ON THE AMOUNT OF CHARITY THAT THEY CAN RECEIVE. MSHA ALWAYS ATTEMPTS TO FULFILL ITS OBLIGATION TO PROVIDE FINANCIAL ASSISTANCE TO THOSE PATIENTS WITHOUT THE ABILITY TO PAY. THE MAJORITY OF MSHA HOSPITALS ARE LOCATED IN TENNESSEE AND PURSUANT TO TENNESSEE LAW ALL PATIENTS WITHOUT THIRD-PARTY PAYER COVERAGE RECEIVE A DISCOUNT OF 70%, WITH THE EXCEPTION OF CRITICAL ACCESS HOSPITALS THAT RECEIVE 58%. THIS IS A CALCULATED DISCOUNT THAT IS UPDATED ON AN ANNUAL BASIS. ALTHOUGH VIRGINIA DOES NOT HAVE A LAW THAT REQUIRES HOSPITALS TO PROVIDE DISCOUNTS TO UNINSURED PATIENTS, MSHA EXTENDS THESE UNINSURED DISCOUNTS TO ITS VIRGINIA HOSPITALS AS WELL, INCLUDING NCH. PART I, LINE 6A - RELATED ORGANIZATION INFORMATION MOUNTAIN STATES HEALTH ALLIANCE, NCH'S MAJORITY OWNER, PREPARED A COMMUNITY BENEFIT REPORT THAT INCLUDED NCH DURING THE TAX YEAR. THE REPORT WAS MADE AVAILABLE TO THE PUBLIC. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE COST TO CHARGE RATIO (WORKSHEET 2 "RATIO OF PATIENT CARE COST TO CHARGES") WAS USED TO CALCULATE LINE 7A FINANCIAL ASSISTANCE COST. OUR COST ACCOUNTING SYSTEM PROVIDED MEDICAID/TENNCARE LOSSES REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH AND OUR PHYSICIAN CLINIC. WE USED COST TO CHARGE RATIOS FOR HOME HEALTH AND OUR PHYSICIAN CLINIC BECAUSE THEIR DATA ARE NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS OR EXPENSES SPECIFIC TO A COMMUNITY HEALTH EVENT, WITH NO ADDITIONAL OVERHEAD INCLUDED IN THE COST. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF INTERNSHIPS (NURSING, PHARMACY, EMT, RESPIRATORY THERAPY, PUBLIC HEALTH, PHYSICAL/OCCUPATIONAL THERAPY, AND STUDENTS FROM OTHER ALLIED HEALTH PROGRAMS) WITH SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING AT A HOSPITAL AS PART OF THEIR EDUCATION AND TRAINING. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT KEEPS DETAILED RECORDS OF HOURS SPENT ON THESE STUDENT ACTIVITIES, THE NUMBER OF STUDENTS THAT ROTATE THROUGH OUR HOSPITAL, ETC. INFORMATION IS MAINTAINED FOR EACH HOSPITAL UNIT THAT PARTICIPATES. WE ONLY INCLUDE LABOR RELATED COSTS AND WE ONLY ASSUME A PERCENTAGE OF OUR INVOLVED TEAM MEMBERS' TIME ARE DEVOTED TO THESE STUDENTS. NCH PARTICIPATES IN A MEDICARE-APPROVED INTERNAL MEDICINE RESIDENT PROGRAM. COSTS AND REIMBURSEMENT FOR THE MEDICAL RESIDENT PROGRAM ARE TAKEN FROM THE HOSPITAL'S FILED MEDICARE COST REPORT. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USED OUR COST ACCOUNTING SYSTEM TO DETERMINE COMMUNITY BENEFIT EXPENSE. THERE ARE TWO EXCEPTIONS WHERE WE DO NOT USE OUR COST ACCOUNTING SYSTEM. WE HAVE A PHYSICIAN CLINIC IN A RURAL, LOW INCOME AREA THAT IS SUBSIDIZED BY THE HOSPITAL. NCH OWNS AND OPERATES THE CLINIC AND SUBSIDIZES THE CLINIC'S LOSSES (626,926). THE OTHER EXCEPTION RELATES TO CLINICAL SERVICES WE PROVIDE TO LOCAL NONPROFITS (73,177). FOR THESE, WE APPLIED THE 990 COMPUTED COST TO CHARGE RATIO. FOR MANY YEARS, NCH HAS PROVIDED FREE CLINICAL SERVICES TO ORGANIZATIONS THAT WORK WITH HOMELESS OR LOW INCOME INDIVIDUALS. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND MEDICAID/TENNCARE ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITAL THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE OR SERVICES THAT ARE READILY AVAILABLE FROM OTHER FOR-PROFIT PROVIDERS IN OUR SERVICE AREA. PART II - COMMUNITY BUILDING ACTIVITIES NCH LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. WE DO NOT CAPTURE COSTS ASSOCIATED WITH TEAM MEMBERS THAT SERVE ON OTHER NON PROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. NCH, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. MOST OF THESE ORGANIZATIONS WORK TO IMPROVE THE LIVES OF COMMUNITY MEMBERS THAT HAVE LIMITED, OR NO, FINANCIAL RESOURCES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY SELF-PAY BALANCES INCLUDE ACCOUNTS AFTER PAYMENTS AND CONTRACTUAL ADJUSTMENTS (DISCOUNTS) HAVE BEEN POSTED FROM ALL THIRD-PARTY PAYERS- GENERALLY LEAVING THE PATIENT RESPONSIBLE FOR ANY REMAINING DEDUCTIBLE AND/OR CO-PAYMENT. OTHER SELF-PAY ACCOUNTS ARE FROM PATIENTS WITH NO INSURANCE OR OTHER THIRD-PARTY COVERAGE. ALL UNINSURED PATIENTS RECEIVE A 70% UNINSURED DISCOUNT AND MANY SELF-PAY PATIENTS WILL QUALIFY FOR CHARITY CARE IF THEY PROVIDE THE FINANCIAL INFORMATION WE NEED TO DEEM THEM ELIGIBLE. AFTER THE NORMAL COLLECTION PROCESS HAS INDICATED AN ACCOUNT IS UNCOLLECTIBLE, NCH WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO GATHER HISTORICAL INFORMATION TO APPLY TO THE CURRENT RECEIVABLE BALANCE. ANOTHER CONSIDERATION WHEN ESTIMATING BAD DEBT EXPENSE IS UNUSUAL CIRCUMSTANCES (SUCH AS LOCAL, REGIONAL OR NATIONAL ECONOMIC CONDITIONS) WHICH AFFECT THE COLLECTABILITY OF RECEIVABLES. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE OUR REIMBURSEMENT DEPARTMENT ESTIMATES THAT 75% OF BAD DEBT EXPENSE AT NCH IS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE, EITHER A FULL OR PARTIAL WRITE-OFF OF CHARGES. THIS ESTIMATE IS BASED ON THE COMPOSITION OF BAD DEBTS ATTRIBUTABLE TO PEOPLE WITH NO FORM OF INSURANCE OR OTHER THIRD-PARTY COVERAGE, WHICH REPRESENTS THE MAJORITY OF BAD DEBT ACCOUNTS. WE ALSO ESTIMATE A MUCH SMALLER PERCENTAGE OF LIKELY CHARITY-ELIGIBLE ACCOUNTS TO PEOPLE WITH BALANCES AFTER INSURANCE/THIRD- PARTY COVERAGE HAS PAID (E.G. DEDUCTIBLES AND CO-PAYMENT BALANCES). IT IS IMPLAUSIBLE TO DETERMINE WITH EXACTITUDE THE AMOUNT OF NCH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETED FINANCIAL ASSESSMENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSISTANCE FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT 84.6% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS PROCESSED DURING FY17 RECEIVED A FULL DISCOUNT (COMPLETE WRITE-OFF). AN ADDITIONAL 11.2% RECEIVED A PARTIAL DISCOUNT, RESULTING IN AN OVERALL APPROVAL RATE OF 95.8% FOR COMPLETED APPLICATIONS. DURING FY17, ONLY 4.2% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS WERE DENIED. UNFORTUNATELY, MANY PATIENTS EITHER DO NOT SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE OR DO NOT PROVIDE A COMPLETE APPLICATION. INCOMPLETE APPLICATIONS ARE RETURNED TO PATIENTS ALONG WITH A NOTICE OF MISSING INFORMATION. THE NOTICE ALSO PROVIDES A CONTACT PHONE NUMBER PATIENTS MAY CALL FOR ASSISTANCE IN COMPLETING THE APPLICATION. ALL SELF-PAY PATIENTS RECEIVE FOLLOW UP CALLS EVERY 7 DAYS FROM A COMPANY NCH PAYS TO PROCESS CHARITY CARE APPLICATIONS FOR UNINSURED PATIENTS AND TO OFFER PATIENTS ENROLLMENT ASSISTANCE IN MEDICAID. OUR FINANCIAL COUNSELORS FOLLOW UP WITH PATIENTS THAT HAVE A BALANCE AFTER INSURANCE HAS PAID. WE HAVE MANY INSTANCES OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE ARE SURE WOULD QUALIFY FOR FINANCIAL ASSISTANCE. ALTHOUGH PATIENTS ARE ENCOURAGED TO APPLY FOR ASSISTANCE, MANY WILL NOT DO SO. MSHA WOULD PREFER FOR PATIENTS TO SUBMIT COMPLETED FINANCIAL ASSISTANCE APPLICATIONS GIVEN HISTORICAL DATA CLEARLY INDICATES THAT MOST UNINSURED PATIENTS WILL QUALIFY FOR FINANCIAL ASSISTANCE UNDER OUR PROGRAM. WITHOUT A COMPLETED APPLICATION, WE HAVE NO CHOICE OTHER THAN TO REPORT AN UNPAID ACCOUNT AS BAD DEBT INSTEAD OF CHARITY CARE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE TEXT OF NCH'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE APPEARS ON PAGES 13 AND 14 IN OUR MOST RECENT AUDITED FINANCIAL STATEMENTS (ATTACHED). PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE REPORTED USING NCH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS TRANSPORTATION OF A PATIENT AND COMFORT ITEMS TO INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS AND PHYSICIAN GUARANTEES ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED. ALSO, A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS SUCH AS THOSE NOTED ABOVE, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. WHILE WE AGREE THAT COSTS SUCH AS MARKETING TO ATTRACT PATIENTS AND LOBBYING ARE REASONABLE TO EXCLUDE, IT DOES NOT SEEM REASONABLE TO EXCLUDE RECRUITMENT OF PHYSICIANS AND BASIC ITEMS SUCH AS TELEVISIONS IN PATIENT ROOMS. ALTHOUGH NCH DID NOT SUSTAIN A MEDICARE LOSS THIS YEAR, WE STRONGLY FEEL HOSPITALS THAT DO SUSTAIN OVERALL MEDICARE LOSSES SHOULD BE ALLOWED TO REPORT LOSSES IN PART I AS A COMMUNITY BENEFIT, SIMILAR TO OTHER GOVERNMENTAL PROGRAMS SUCH AS MEDICAID. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, HOSPITALS ARE REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR THE MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW COST. THEREFORE, IT IS ONLY LOGICAL TO ALLOW HOSPITALS TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT. BY MAKING THIS CHANGE, NON-PROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES ECONOMICALLY INJURIOUS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION: NCH HAS ESTABLISHED A STRONG COMMITMENT TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES WE SERVE. ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GENERAL GUIDELINES, WHILE ALLOWING FOR UNIQUE FINANCIAL CIRCUMSTANCES - FOR EXAMPLE, MEDICALLY INDIGENT PATIENTS WITH CATASTROPHIC MEDICAL COSTS THAT WOULD THREATEN THE PATIENT'S HOUSEHOLD FINANCIAL VIABILITY. NORTON COMMUNITY HOSPITAL RECOGNIZES ITS OBLIGATION TO PROVIDE QUALITY HEALTHCARE TO THOSE WHO ARE UNABLE TO PAY. NCH CHARITY GUIDELINES ARE BASED ON THE NATIONAL POVERTY GUIDELINES. HOWEVER, FINANCIAL ASSISTANCE IS NOT BASED SOLELY ON INCOME. UNIQUE FINANCIAL CIRCUMSTANCES ARE CONSIDERED, WHICH CAN CHANGE THE CATEGORY OF ELIGIBILITY. IN ADDITION, CHARITY DETERMINATION MAY BE RETROACTIVE FOR ALL DATES OF SERVICE. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED. ALL MSHA HOSPITALS ADHERE TO IRS REGULATORY GUIDELINES SET FORTH IN 501(R). A COPY OF OUR CREDIT AND COLLECTION POLICY MAY BE FOUND ONLINE OR OBTAINED IN PRINT VERSION FREE OF CHARGE. PART VI, LINE 2 - NEEDS ASSESSMENT MSHA INCLUDED AMERICA'S HEALTH RANKINGS (AHR) IN ITS ASSESSMENT IN ORDER TO BETTER DEFINE THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. IN 2017, VIRGINIA'S OVERALL HEALTH RANKING REMAINED AT 19TH, WHILE TENNESSEE MOVED FROM 44TH TO 45TH. HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE NCH IS LOCATED) CLOSELY RESEMBLES THE HEALTH RANKINGS FOR TENNESSEE. AMERICA'S HEALTH RANKINGS ARE BASED ON A SERIES OF MEASURES INCLUDING SEVERAL HEALTH OUTCOMES AND HEALTH FACTORS. A SURVEY WAS GIVEN TO 106 INDIVIDUALS REPRESENTING THE TEN COUNTIES IN WHICH MSHA OWNS A FACILITY. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH LEADERS, NONPROFIT DIRECTORS, SCHOOL NURSES AND OFFICIALS, AND BUSINESS LEADERS. A SURVEY WAS GIVEN TO EACH INDIVIDUAL SEEKING FEEDBACK REGARDING AVAILABLE RESOURCES IN EACH AREA, THE PERCEIVED HEALTH STATUS, HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. THE MAJORITY OF RESPONSES SUGGESTED FOCUSING ON EDUCATION IN ORDER TO PROMOTE HEALTHY HABITS AND INCREASED ACCESS TO RESOURCES. OTHER RESPONSES INCLUDED: MAKE PHYSICAL EDUCATION A REQUIREMENT AS PART OF SCHOOL CURRICULUM, IMPROVE NATURAL TRAILS AND WALKWAYS, INCREASE COMMUNITY SUPPORT FOR SMOKE-FREE AREAS, PARTNER WITH LOCAL FARMER'S MARKETS, SHARE HEALTH INFORMATION BETWEEN PHARMACIES, NETWORK WITH SMALL BUSINESSES AND NONPROFITS IN ORDER TO AVOID DUPLICATING RESOURCES, AND PROVIDE EARLY SCREENINGS FOR THE UNINSURED OR UNDERINSURED. OVERALL, THE COMMUNITY MEMBERS GAVE MSHA'S CORE SERVICE AREA A HEALTH STATUS RANKING OF 4.55 OUT OF 10 (1 BEING THE LOWEST, 10 BEING THE HIGHEST). NCH WAS GIVEN A HEALTH STATUS RANKING OF 3.6. AMONG THE 106 PARTICIPANTS, THE AREAS OF OBESITY, CANCER, HEART DISEASE, SMOKING, SUBSTANCE/PRESCRIPTION DRUG ABUSE, AND DIABETES WERE THE TOP HEALTH PRIORITIES IN OUR REGION. ACCORDING TO THE MOST RECENT AHR REPORTS, VIRGINIA AND TENNESSEE BOTH SAW AN INCREASE IN DIABETES AND OBESITY WITHIN THE PAST TEN YEARS. VIRGINIA RANKS 25TH FOR CARDIOVASCULAR DEATHS, 24TH FOR CANCER DEATHS AND 23RD FOR DIABETES. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE MOUNTAIN STATES HEALTH ALLIANCE COMMUNICATES WITH AND EDUCATES OUR PATIENTS THROUGH VARIOUS AVENUES FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND HOSPITAL FINANCIAL ASSISTANCE. EDUCATION IS PROVIDED TO PATIENTS THROUGH SIGNAGE AND FINANCIAL ASSISTANCE BROCHURES AT ALL HOSPITAL AND AMBULATORY ADMISSION LOCATIONS. FINANCIAL ASSISTANCE APPLICATIONS AND PLAIN LANGUAGE SUMMARIES ARE PROVIDED TO PATIENTS SHOULD THEY REQUEST ONE DURING THEIR PRE- REGISTRATION, REGISTRATION OR FINANCIAL COUNSELING PROCESS. OUR GOVERNMENTAL PROGRAM ELIGIBILITY REPRESENTATIVES ASSIST PATIENTS IN SECURING ELIGIBILITY FOR MEDICAID, FEDERAL DISABILITY AND OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. ADDITIONALLY, IF A PATIENT OR COMMUNITY RESIDENT EXPRESSES AN INTEREST IN THE ACA HEALTHCARE EXCHANGE, OUR REPRESENTATIVES HAVE THE QUALIFICATIONS AND EXPERIENCE TO ASSIST THEM THROUGH THE ENTIRE PROCESS. FINANCIAL COUNSELORS OFFER FINANCIAL ASSISTANCE APPLICATIONS TO PATIENTS WHO DO NOT QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND ARE UNABLE TO PAY FOR THE COST OF THEIR HEALTHCARE. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE ON OUR WEBSITE TO INCLUDE THE FINANCIAL ASSISTANCE APPLICATION, POLICY AND PLAIN LANGUAGE SUMMARY IN BOTH ENGLISH AND SPANISH. ALL PATIENT STATEMENTS HAVE VERBIAGE DISCUSSING FINANCIAL ASSISTANCE ALONG WITH THE CONTACT INFORMATION. OUR LAST LETTER TO THE PATIENT DISPLAYS THE PLAIN LANGUAGE SUMMARY. IN ALL ORAL CORRESPONDENCES WITH THE PATIENT, IF IT IS IDENTIFIED THEY CANNOT MEET THE PAYMENT REQUIREMENTS ON THEIR ACCOUNT, FINANCIAL ASSISTANCE IS DISCUSSED AS AN OPTION. PART VI, LINE 4 - COMMUNITY INFORMATION NCH IS LOCATED IN NORTON, WISE COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. SOUTHWEST VIRGINIA (SWVA) IS LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION AND HAS A HIGH RATE OF UNINSURED ADULTS. ACCORDING TO U.S. CENSUS BUREAU ESTIMATES, NORTON HAS A POPULATION OF APPROXIMATELY 3,978, WHILE WISE COUNTY'S POPULATION IS 40,074. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF WISE COUNTY IS 40.0 WHICH IS OLDER THAN THE MEDIAN AGE OF 37.8 IN VIRGINIA. 16.2% OF WISE COUNTY'S RESIDENTS ARE 65 OR OLDER COMPARED TO 14.2% FOR THE STATE. THE BUREAU ESTIMATES WISE COUNTY MEDIAN HOUSEHOLD INCOME AT 36,352 COMPARED TO 66,149 FOR THE STATE OF VIRGINIA. 31% OF WISE COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 15% STATEWIDE. WISE COUNTY'S HEALTH OUTCOMES RANK 124 OUT OF 134 IN THE STATE. WISE COUNTY IS ALMOST 57% RURAL COMPARED WITH THE STATEWIDE RURAL RATE OF 24.5%. THIS FACTOR IS A SIGNIFICANT CONTRIBUTING FACTOR IN INFLUENCING HEALTH OUTCOMES IN A POPULATION. MANY RURAL RESIDENTS MUST TRAVEL A GREATER DISTANCE TO ACCESS DIFFERENT POINTS OF THE HEALTH CARE DELIVERY SYSTEM; HOWEVER, DUE TO GEOGRAPHIC DISTANCE, SOMETIMES EXTREME WEATHER CONDITIONS, LACK OF PUBLIC TRANSPORTATION AND CHALLENGING ROADS, RURAL RESIDENTS MAY BE LIMITED, AND IN SOME INSTANCES, EVEN PROHIBITED FROM ACCESSING HEALTH CARE SERVICES. MORE THAN 50% OF VEHICLE CRASH-RELATED FATALITIES OCCUR IN RURAL AREAS, EVEN THOUGH LESS THAN ONE-THIRD OF MILES TRAVELED IN A VEHICLE OCCUR THERE AND THERE IS AN ADDITIONAL 22% RISK OF INJURY-RELATED DEATHS IN RURAL COMMUNITIES. WITHIN OUR OWN COUNTY, INJURY DEATHS ARE ALMOST DOUBLE THE STATEWIDE RATE. AND, WHILE OUR AREA HAS GENERALLY UNFAVORABLE HEALTH STATISTICS, THERE ARE FAR FEWER PRIMARY CARE PHYSICIANS PER RESIDENT IN OUR COUNTY THAN THE STATE'S AVERAGE. OUR COUNTY'S RATIO OF POPULATION TO PRIMARY CARE PHYSICIANS IS 2,100:1 COMPARED TO THE STATE'S AVERAGE OF 1,320:1. IN OTHER WORDS, WE HAVE 40% MORE RESIDENTS PER PHYSICIAN THAN THE STATE'S AVERAGE. IT IS DIFFICULT TO RECRUIT PHYSICIANS TO A RURAL AREA SUCH AS OURS. A NUMBER OF FACTORS CONTRIBUTE TO A UNIQUE AND CHALLENGING ENVIRONMENT THAT INFLUENCE OVERALL HEALTH STANDING IN OUR COUNTY. ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S COUNTY HEALTH RANKINGS, 31% OF THE ADULTS IN NCH'S HOME COUNTY ARE OBESE. OBESITY INCREASES THE RISK FOR MANY HEALTH CONDITIONS SUCH AS CORONARY HEART DISEASE, TYPE 2 DIABETES, HYPERTENSION, STROKE, CANCER, SLEEP APNEA AND RESPIRATORY PROBLEMS, AND OSTEOARTHRITIS. EVIDENCE INDICATES PHYSICAL ACTIVITY, INDEPENDENT OF ITS EFFECT ON WEIGHT, HAS SUBSTANTIAL BENEFITS FOR HEALTH. OUR COUNTY'S INACTIVITY RATE OF 35% IS ALMOST 67% HIGHER THAN THE STATEWIDE RATE. WISE COUNTY'S ADULT SMOKING RATE IS ALMOST 24% HIGHER THAN THAT OF VIRGINIA'S AVERAGE. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH NCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. NCH'S LEADERSHIP REMAINS MINDFUL OF MANAGING THE ALLIANCE'S LIMITED RESOURCES SO THAT ADEQUATE FACILITIES AND EQUIPMENT ARE AVAILABLE FOR THE CARE OF OUR PATIENTS. SURPLUS FUNDS ARE INVESTED INTO IMPROVING TREATMENT OPTIONS FOR OUR PATIENTS THROUGH NEW TECHNOLOGIES, RECRUITING PHYSICIANS AND TRAINED STAFF IN SHORTAGE AREAS, AND IMPROVING OUR FACILITIES. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. NCH HAS A MEDICARE-APPROVED INTERNAL MEDICINE RESIDENCY EDUCATION PROGRAM. IN ADDITION, OUR HOSPITAL SERVES AS A TRAINING SITE FOR MANY OTHER TYPES OF HEALTH PROFESSIONS SUCH AS NURSING, PHARMACY, RESPIRATORY THERAPY, AND OTHER ALLIED HEALTH PROGRAMS. WE PROVIDE FOR MEDIA COVERAGE TO EDUCATE OUR COMMUNITY ON HEALTH ISSUES, PROVIDE FREE CLINICAL CARE TO LOW INCOME INDIVIDUALS IN COLLABORATION WITH OTHER NONPROFIT ORGANIZATIONS, AND PROVIDE FREE DRUGS AND SUPPLIES TO LOCAL NONPROFIT EMERGENCY RESPONSE ORGANIZATIONS. WE ALSO PROVIDED FUNDING TO A LOCAL UNIVERSITY FOR NURSING STUDENT SCHOLARSHIPS THIS YEAR. NCH OWNS DICKENSON COUNTY HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED IN THE APPALACHIAN MOUNTAINS. DICKENSON IS 100% RURAL ACCORDING TO THE ROBERT WOOD JOHNSON FOUNDATION'S 2017 COUNTY HEALTH RANKINGS REPORT. DICKENSON COUNTY'S MEDIAN HOUSEHOLD INCOME IS ONLY 47% OF THE MEDIAN STATEWIDE INCOME AND THE COUNTY'S HEALTH OUTCOMES RANK 122 OUT OF 134 IN THE STATE. DCH OPERATES AT A SUBSTANTIAL FINANCIAL LOSS AND RELIES ON NCH TO SUBSIDIZE ITS OPERATIONS. NCH'S CAPITAL CONTRIBUTION TO DCH WAS JUST UNDER 2.9 MILLION. THE MAJORITY OF NCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. MANY OF OUR BOARD MEMBERS ARE NOT CONSIDERED INDEPENDENT, PER IRS FORM 990 INSTRUCTIONS. FOUR WERE EMPLOYED BY NCH'S MAJORITY OWNER, MOUNTAIN STATES HEALTH ALLIANCE. TWO MEMBERS ARE NOT CONSIDERED INDEPENDENT BECAUSE THEY HAD A FAMILY MEMBER EMPLOYED BY NCH DURING THE YEAR (IN NON-MANAGERIAL POSITIONS). TWO LACK INDEPENDENCE BECAUSE THEY RECEIVED 1099 REPORTABLE COMPENSATION EXCEEDING 10,000 FOR HEALTH INSURANCE PAID BY NCH. ANOTHER BOARD MEMBER IS NOT INDEPENDENT BECAUSE HE WAS EMPLOYED BY NCH. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY NCH. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM NCH IS A 129-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 13- MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. NCH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE, THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. NCH SERVES AS THE COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM NCH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. IF NEED BE, PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT VIRGINIA false UNIVERSITY OF VIRGINIA AT WISE 1 COLLEGE AVE WISE VA 24293 541638774 501C3 56000 NRSG. & ATHL. PROGMS 1 SCHEDULE I, PAGE 1, PART I, LINE 2 NCH CHARITABLE DONATIONS REQUIRE FINAL APPROVAL BY THE CEO. IN ORDER TO IMPROVE THE OVERALL EFFICIENCY OF CONTRIBUTION REQUEST EVALUATION, ALL REQUESTS ARE NOW REQUIRED TO BE COMPLETED USING THE ONLINE APPLICATION FORM. THE ONLINE FORM PROVIDES CONSISTENCY AMONG APPLICANTS AND GIVES US THE INFORMATION WE NEED IN ORDER TO MAKE A FULLY VETTED FUNDING DECISION. SOME OF THE INFORMATION WE REQUIRE FROM APPLICANTS INCLUDES: IF THE APPLICANT IS REQUESTING FUNDING FOR A SPECIFIC EVENT OR PROGRAM, THE DATE, LOCATION, AND TIME ARE REQUIRED DESCRIPTION OF THE EVENT/PROGRAM APPLICANT'S OTHER SOURCES OF INCOME EVENT/PROGRAM BUDGET HOW THE EVENT/PROGRAM SUPPORTS NCH'S MISSION WHO WILL BENEFIT FROM OUR CONTRIBUTION WHAT WILL THE EVENT/PROGRAM ACCOMPLISH APPLICANT ORGANIZATION'S MISSION STATEMENT YEAR THE APPLICANT ORGANIZATION WAS FOUNDED NUMBER OF PEOPLE SERVED ANNUALLY BY THE APPLICANT APPLICANT'S WEBSITE TAX STATUS OF THE APPLICANT AND FEDERAL TAXPAYER ID NUMBER WITH FEW EXCEPTIONS, DONATIONS TO NATIONAL ORGANIZATIONS ARE HANDLED AT MSHA'S CORPORATE LEVEL, WHICH PREVENTS MULTIPLE CONTRIBUTIONS BEING MADE TO THE SAME NATIONAL ORGANIZATION AND ALLOWS ADDITIONAL CONTRIBUTION DOLLARS TO BE USED FOR REGION-SPECIFIC REQUESTS. DONATIONS FROM MSHA HOSPITALS, INCLUDING NCH, ARE ALMOST ENTIRELY DIRECTED TO LOCAL NONPROFIT ORGANIZATIONS. MSHA'S SOCIAL RESPONSIBILITY COMMITTEE, WHICH PROVIDES SYSTEM-WIDE GUIDANCE, IS COMPRISED OF COMMUNITY LEADERS INCLUDING THE DEAN OF A LOCAL UNIVERSITY, THE PRESIDENT OF A LOCAL COLLEGE, UNITED WAY OF WASHINGTON COUNTY'S PRESIDENT, COMMUNITY VOLUNTEERS, BUSINESS LEADERS, MOUNTAIN STATES FOUNDATION'S PRESIDENT, AND OTHERS. COMMITTEE MEMBERS WERE SELECTED SO THAT MEMBERSHIP EXPERTISE INCLUDES PUBLIC HEALTH, HEALTH PROFESSIONS EDUCATION, KNOWLEDGE OF OTHER RESOURCES AVAILABLE TO CHARITABLE ORGANIZATIONS, AND INDIVIDUALS WITH HANDS-ON COMMUNITY VOLUNTEER EXPERIENCE. SOME OF THE ROUTINE ACTIVITIES OF THE COMMITTEE DURING QUARTERLY MEETINGS INCLUDE: QUARTERLY REVIEW OF THE SOCIAL RESPONSIBILITY SCORECARD; A MEASUREMENT OF ACTUAL ACCOMPLISHMENTS IN THE YEAR COMPARED TO TARGETS SET AT THE BEGINNING OF THE YEAR REVIEW OF CHARITABLE CONTRIBUTION GIVING FOR THE PREVIOUS QUARTER OPPORTUNITY FOR LOCAL TAX EXEMPT ORGANIZATIONS TO PRESENT TO THE COMMITTEE PROGRAMS THEY OFFER, ACHIEVEMENTS, AND FUNDING NEEDS THE COMMITTEE MAY OR MAY NOT RECOMMEND MSHA CORPORATE/HOSPITAL FUNDING OF PROGRAMS SOMETIMES, MSHA DEPARTMENTS WILL BRING PROPOSALS FOR NEW PROGRAMS TO BENEFIT A SPECIFIC POPULATION, SUCH AS CHILDREN X X false true false false false false false false false MARVIN EICHORN MSHA EVPCOO DIRECTOR 558459 31936 18200 24493 630141 MONTY MCLAURIN VPCEO NW MKT VICE-CHAIR 296329 269112 32670 24986 620347 108669 MATTHEW CUSANO MD PHYSICIAN & DIRECTOR 261135 41364 48588 8171 22881 381210 SHANE HILTON VPCFO MKT OPER DIRECTOR 322719 12565 4103 36871 24815 398236 TOM TULL MSHA VP DIRECTOR 159956 10695 13784 12214 194990 MARK LEONARD NCH/DCH CEO 247334 8946 26216 22333 302286 VISHAL RAJ MD PHYSICIAN 455901 20812 26871 19053 521534 DARYL PIERCE MD PHYSICIAN 417374 2180 16667 435099 MICHAEL GREEN MD PHYSICIAN 364749 15560 5653 1880 386806 RUBYE WASHINGTON-MOORE MD PHYSICIAN 273951 18500 21423 7962 23706 344555 BERNIE SERGENT MD PHYSICIAN 177971 67560 46958 7802 22215 321596 STEPHEN SAWYER AVPCFO NW MKT IPMC CFO/FMR NCH CFO 174936 14778 9539 22803 220380 SCHEDULE J, PAGE 1, PART I, LINE 4 MONTY MCLAURIN, VP/CEO NW MKT 0 15,920 0 SHANE HILTON, VP/CFO MKT OPER. 0 17,247 0 MARK LEONARD 0 13,214 0 SCHEDULE J, PART III PART I, LINE 4B MONTY MCLAURIN, SHANE HILTON, AND MARK LEONARD PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE(MSHA). THE 457(F)PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON- COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON- OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24-MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. JAMIE FLEMING FAMILY MEMBER 37881 FAMILY MBR OF BD MBR false DEBBIE WARD FAMILY MEMBER 72050 FAMILY MBR OF BD MBR false SCHEDULE L, PART V BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: 1(A) NAME OF PERSON: JAMIE FLEMING 1(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JAMES MANICURE, NORTON COMMUNITY HOSPITAL (NCH)BOARD MEMBER 1(D) DESCRIPTION OF TRANSACTION: JAMES MANICURE, BOARD MEMBER OF NCH, IS A FAMILY MEMBER OF JAMIE FLEMING, AN EMPLOYEE OF NCH. 2(A) NAME OF PERSON: DEBBIE WARD 2(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF ERNIE WARD, NORTON COMMUNITY HOSPITAL (NCH)BOARD MEMBER 2(D) DESCRIPTION OF TRANSACTION: ERNIE WARD, BOARD MEMBER OF NCH, IS A FAMILY MEMBER OF DEBBIE WARD, AN EMPLOYEE OF NCH. FORM 990 - ORGANIZATION'S MISSION NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. FORM 990, PAGE 2, PART III, LINE 4A (CONT'D) NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. BASED ON COMMUNITY NEED, NCH INCURRED EXPENSE OF 170,800 TOWARDS EFFORTS TO RECRUIT PHYSICIANS TO OUR COMMUNITY AND RETAIN THEM. ACCORDING TO THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES, PHYSICIAN RETIREMENT IS THE PRIMARY FACTOR BEHIND THE PHYSICIAN SHORTAGE IN THE U.S. ABOUT ONE-THIRD OF CURRENTLY PRACTICING PHYSICIANS WILL BE AT LEAST 65 YEARS OLD WITHIN THE NEXT DECADE. IN MANY CASES, RECRUITMENT IS DUE TO PHYSICIAN RETIREMENT. FY17 RECRUITMENT EXPENSE AT NCH IS COMPRISED OF PHYSICIAN LOAN FORGIVENESS, RECRUITMENT OF A TEMPORARY LOCUMS POSITION FOR OUR BLACK LUNG PROGRAM, AND COSTS ASSOCIATED WITH RECRUITMENT EFFORTS FOR A NUMBER OF SPECIALTIES. LOAN FORGIVENESS IS AN INCENTIVE FOR PHYSICIANS TO STAY IN OUR AREA PROVIDING HEALTH SERVICES TO THE COMMUNITY. PHYSICIAN LOANS ARE FORGIVEN OVER A PERIOD OF YEARS AS A PHYSICIAN REMAINS IN OUR COMMUNITY. DURING FY17, OUR RECRUITMENT ACTIVITIES WERE DIRECTED TOWARD SPECIALTY AREAS SUCH AS CARDIOLOGY, GENERAL SURGERY, OB, ORTHOPEDIC SURGERY, UROLOGY, FAMILY PRACTICE, HOSPITALISTS, AND A NURSE PRACTITIONER. MSHA'S RECRUITMENT DEPARTMENT RECRUITS ON BEHALF OF ALL ITS HOSPITALS AND THE COSTS ASSOCIATED WITH RECRUITMENT FOR A PARTICULAR HOSPITAL ARE EXPENSED TO THE RECRUITING HOSPITAL. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. NCH'S BLACK LUNG CLINIC OFFERS THE REGION'S ONLY PROGRAM APPROVED AND FEDERALLY CERTIFIED BY THE U.S. DEPARTMENT OF LABOR FOR THE FEDERAL BLACK LUNG PROGRAM. WE HAVE ELEVEN APPROVED PROVIDERS FOR OUR BLACK LUNG PROGRAM. OUR BLACK LUNG CLINIC OFFERS DISEASE SCREENING/DIAGNOSTIC TESTING AND PULMONARY REHABILITATION SERVICES. BLACK LUNG DISEASE, OR COAL WORKER'S PNEUMOCONIOSIS, IS A LUNG DISEASE THAT RESULTS FROM BREATHING IN DUST FROM COAL GRAPHITE, OR MAN-MADE CARBON OVER A LONG PERIOD OF TIME. WE PROVIDED NEARLY 12,000 BLACK LUNG PROCEDURES THIS YEAR. WITH FINANCIAL ASSISTANCE FROM A USDA RURAL DEVELOPMENT GRANT, MOUNTAIN STATES HEALTH ALLIANCE (MSHA) ESTABLISHED A TELEMEDICINE NETWORK CONNECTING ICU DOCTORS AT JOHNSON CITY MEDICAL CENTER (MSHA'S FLAGSHIP HOSPITAL) WITH THE SYSTEM'S SIX RURAL HOSPITALS, INCLUDING NORTON COMMUNITY HOSPITAL. MOUNTAIN STATES ALREADY PRACTICES TELEMEDICINE FOR PEDIATRICS, EMERGENCY ROOM AND PSYCHIATRICS, PROVIDING A HIGH-QUALITY, LIVE VIDEO AND AUDIO LINK BETWEEN A PROVIDER AT ONE FACILITY AND A PATIENT AND PROVIDER AT ANOTHER FACILITY. THE NEW USDA GRANT IS SPECIFICALLY FOR THE INTENSIVE CARE UNIT, ALLOWING SPECIALISTS AT JCMC TO CONDUCT REAL-TIME CONSULTATIONS WITH PATIENTS AND CAREGIVERS IN THE ICU AT OUR RURAL HOSPITALS. MANY PATIENTS IN RURAL TOWNS DO NOT HAVE CARS OR DISPOSABLE INCOME TO SPEND ON GAS, MEALS OR LODGING TO COME TO JCMC FOR CARE, SO TELEMEDICINE BRINGS THE CARE TO THEM. THIS NEW SERVICE IS PROJECTED TO SERVE ABOUT 5,000 PATIENTS PER YEAR. THE USDA GRANT IS ONE OF THE USDA'S DISTANCE LEARNING AND TELEMEDICINE PROJECTS. MSHA'S TRIUMPH CANCER NAVIGATOR PROGRAM CELEBRATED ITS ONE-YEAR ANNIVERSARY DURING FY17. THE PROGRAM HAS EXPANDED ITS SCOPE TO INCLUDE MORE MSHA HOSPITALS AND NOW INCLUDES NORTON COMMUNITY HOSPITAL. IN ADDITION, THE NAVIGATION PROGRAM EXPANDED TO COVER ALL TYPES OF CANCER. THE PROGRAM IS DESIGNED TO SUPPORT CANCER PATIENTS AND THEIR FAMILIES, ADVOCATE FOR THE PATIENT, AND TO HELP COORDINATE THE PATIENT'S CARE THROUGHOUT THE CONTINUUM OF TREATMENT - FROM DIAGNOSIS TO SURVIVORSHIP. THERE IS NO CHARGE FOR THESE SERVICES REGARDLESS OF WHETHER A PATIENT CHOOSES TO RECEIVE THEIR TREATMENT AT A MSHA FACILITY OR A DIFFERENT PROVIDER. THOSE THAT JOIN THE PROGRAM RECEIVE ONE-ON-ONE ASSISTANCE FROM SPECIALLY TRAINED ONCOLOGY PROFESSIONALS. OUR CANCER NAVIGATORS COMMUNICATE WITH THE PATIENT'S DOCTOR, WILL COORDINATE TRANSPORTATION, SET UP APPOINTMENT REMINDERS AND PROVIDE EMOTIONAL SUPPORT FOR BOTH THE PATIENT AND THE PATIENT'S FAMILY. OUR NAVIGATORS WILL ALSO COORDINATE SUPPORT SERVICES SUCH AS TREATMENT PLANNING, PROSTHESIS SELECTION, NUTRITION COUNSELING, AND IDENTIFICATION OF RESOURCES FOR SPIRITUAL CARE, FINANCIAL ASSISTANCE AND OTHER NEEDS. OUR NAVIGATORS PARTICIPATE IN COMMUNITY EVENTS SUCH AS HEALTH FAIRS, CANCER EDUCATION EVENTS, AND CANCER SUPPORT GROUPS. THEY VISIT PHYSICIAN OFFICES, SENIORS' GROUPS, ATTEND MEETINGS WITH LOCAL BUSINESS ORGANIZATIONS, AND THEY WORK WITH MANY OTHER ORGANIZATIONS TO EXPLAIN THE NAVIGATION PROGRAM AND PROVIDE CANCER AWARENESS/EDUCATION THROUGHOUT THE COMMUNITY. THE PROGRAM HAS MADE AN IMPACT, WITH THE TRIUMPH PROGRAM RECEIVING A PATIENT SATISFACTION SCORE OF 93. OUR HOSPITAL'S TRIUMPH CANCER NAVIGATOR RECOGNIZED A NEED IN OUR COMMUNITY FOR SOME CANCER PATIENTS STRUGGLING WITH THEIR ILLNESS, WHILE ALSO DEALING WITH FINANCIAL WORRIES SO OUR NAVIGATOR CAME UP WITH THE IDEA FOR A FUNDRAISER. WORKING WITH MOUNTAIN STATES FOUNDATION, TWO "SOUP AND PAINT" EVENTS BROUGHT TEAM MEMBERS AND COMMUNITY MEMBERS TOGETHER TO ENJOY WARM SOUP AND A CRAFT PROJECT FOR A GOOD CAUSE. A LOCAL PAINTING INSTRUCTOR DONATED HER TIME FOR THE TWO EVENTS. MONEY RAISED PROVIDED FINANCIAL ASSISTANCE TO CANCER PATIENTS FOR THINGS LIKE GAS VOUCHERS, TAXI FARES, NON-COVERED MEDICATIONS, NUTRITIONAL EXPENSES, AND PERSONAL CARE ITEMS. DEPENDING ON PATIENTS' GREATEST NEEDS, IMPORTANT BILLS SUCH AS UTILITIES HAVE BEEN COVERED. THE UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE HOSTED AN INAUGURAL GIRLS DAY IN STEM-H FOR SIXTH-GRADE GIRLS IN THE REGION TO SHOW THE YOUNG GIRLS THAT CAREERS IN SCIENCE, TECHNOLOGY, ENGINEERING, MATHEMATICS AND HEALTH (S-T- E-M-H) ARE NOT JUST FOR MEN. DURING THE EVENT, NORTON COMMUNITY HOSPITAL PROVIDED DEMONSTRATIONS AND ACTIVITIES DESIGNED TO SPARK AN INTEREST IN MATH AND SCIENCE AND PERHAPS INTRODUCE THE GIRLS TO THE POSSIBILITY OF PURSUING CAREERS IN THE HEALTH CARE FIELD. OUR TEAM MEMBER ACTIVITIES AND PRESENTATIONS COVERED THE AREAS OF PHARMACY, OCCUPATIONAL AND PHYSICAL THERAPY, LABORATORY TECHNOLOGY, AND EMERGENCY SERVICES. STUDIES SHOW THAT YOUNG GIRLS BEGIN TO LOSE INTEREST IN STEM-H FIELDS OF STUDY JUST BEFORE THEY REACH HIGH SCHOOL. THE NUMBERS DROP AGAIN IN HIGH SCHOOL AND IN COLLEGE. ACCORDING TO THE UNITED STATES DEPARTMENT OF COMMERCE, WOMEN CONSTITUTE SLIGHTLY MORE THAN HALF OF COLLEGE EDUCATED WORKERS BUT MAKE UP ONLY 25 PERCENT OF COLLEGE EDUCATED STEM WORKERS. IN AN EFFORT TO RECRUIT MORE STUDENTS INTO THE HEALTH CARE FIELD, TEAM MEMBERS FROM NORTON COMMUNITY HOSPITAL PARTICIPATED IN A HEALTH CARE CAREER EXPO FOR EIGHTH-GRADE STUDENTS WHO HAD EXPRESSED AN INTEREST IN HEALTH CARE CAREERS. THE STUDENTS WERE ABLE TO ROTATE THROUGH THREE HEALTH CAREER SCENARIOS TO GET A TASTE OF A JOB IN HEALTH CARE. THE FIRST SCENARIO GAVE THE STUDENTS THE OPPORTUNITY TO "GOWN UP" FOR SURGERY, WITH INSTRUCTIONS ON SURGICAL INSTRUMENTS AND THE IMPORTANCE OF A STERILE ENVIRONMENT. THE STUDENTS WITNESSED THE REPAIR OF A "BANANAPLASTY", WITH OUR CNO SURGICALLY REPAIRING A PARTIALLY PEELED BANANA. THE STUDENTS GOT TO WITNESS TYPES OF STITCHES USED IN SURGICAL CASES AND THE TYPES OF INSTRUMENTS INVOLVED. THE SECOND SCENARIO PROVIDED INFORMATION RELATED TO A CAREER IN PHARMACY WITH OUR PHARMACY DIRECTOR WALKING THE STUDENTS THROUGH THE EDUCATIONAL REQUIREMENTS AND PROCESSES INVOLVED WITH PURSUING PHARMACY DEGREES AND FACILITATED A VERY COMPETITIVE ROUND OF PHARMACY BINGO WHICH INTRODUCED STUDENTS TO MEDICAL TERMINOLOGY RELATED TO PHARMACY. IN THE THIRD SCENARIO, STUDENTS WERE TAUGHT ABOUT HEART AND LUNG FUNCTIONS. STUDENTS VIEWED THEIR OWN HEART RHYTHMS WHILE LEARNING ABOUT EKG PATTERNS. THEY LISTENED TO BREATH SOUNDS AND RESPIRATIONS ON A PEDIATRIC MANIKIN AND HOW TO USE A DINAMAP FOR MONITORING BLOOD PRESSURE AND CHECKING PULSE OXIMETRY READINGS. THE STUDENTS WERE ALSO TAUGHT HOW TO MANUALLY CHECK BLOOD PRESSURE READINGS. NORTON COMMUNITY HOSPITAL PARTNERED WITH DICKENSON COMMUNITY HOSPITAL, RIDGEVIEW MIDDLE SCHOOL AND SOUTHWEST VIRGINIA AREA HEALTH EDUCATION CENTER TO PUT THE PROGRAM TOGETHER. FUTURE PROGRAMS ARE BEING PLANNED FOR DIFFERENT AGE GROUPS. NCH OPERATES A PHYSICIAN CLINIC THAT IS LOCATED IN A RURAL, LOW-INCOME AREA. THE CLINIC IS STAFFED PRIMARILY WITH MEDICAL RESIDENTS. WITHOUT THE CLINIC, COMMUNITY MEMBERS WOULD NOT HAVE ACCESS TO PRIMARY CARE. NCH'S SUBSIDY OF THE CLINIC THIS YEAR EXCEEDED 626,000. AFTER COMPLETING AN EXTENSIVE APPLICATION PROCESS, NORTON COMMUNITY HOSPITAL'S INTERNAL MEDICINE RESIDENCY PROGRAM ACHIEVED ACCREDITATION BY THE ACCREDITATION COUNCIL FOR GRADUATE MEDICAL EDUCATION (ACGME). ACGME SETS STANDARDS FOR U.S. MEDICAL EDUCATION (RESIDENCY AND FELLOWSHIP) PROGRAMS AND THE INSTITUTIONS THAT SPONSOR THEM. ACCREDITATION DECISIONS ARE BASED ON EVALUATION AND REVIEW OF PUBLISHED ACCREDITATION QUALITY STANDARDS. NCH TAKES GREAT PRIDE IN TRAINING YOUNG PHYSICIANS FOR OUR RURAL, PREDOMINANTLY LOW-INCOME AND FORM 990, PAGE 6, PART VI, LINE 6 THE CORPORATION IS ORGANIZED AS A VIRGINIA, NON-STOCK, NONPROFIT CORPORATION. MOUNTAIN STATES HEALTH ALLIANCE IS THE 50.1% MEMBER OF NORTON COMMUNITY HOSPITAL,INC. COMMUNITY HEALTHCARE FOUNDATION, INC. IS THE 49.9% MEMBER OF NORTON COMMUNITY HOSPITAL, INC. FORM 990, PAGE 6, PART VI, LINE 7A THERE ARE TWO CLASSES OF MEMBERS AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE NORTON COMMUNITY HOSPITAL CLASS IS ELECTED BY THE COMMUNITY HEALTHCARE FOUNDATION BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT. FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY, DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL. FORM 990, PAGE 6, PART VI, LINE 11B THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS. THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW. FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY, THE CORPORATE AUDIT AND COMPLIANCE DEPARTMENT OF MSHA FORWARDS THE CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO ALL MSHA MANAGEMENT TEAM MEMBERS AND BOARD MEMBERS INCLUDING THOSE AT NCH. EMPLOYEES AND BOARD MEMBERS MUST NOTE ANY CONFLICTS OR ATTEST THEY HAVE "NONE", AND RETURN THE FORM TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION. FORM 990, PAGE 6, PART VI, LINE 15A ON AN ANNUAL BASIS, MOUNTAIN STATE HEALTH ALLIANCE'S HUMAN RESOURCE (H/R) DEPARTMENT EVALUATES COMPENSATION FOR ALL EXECUTIVES AT A POSITION LEVEL OF ASSISTANT VICE PRESIDENT AND ABOVE. THE REVIEW INCLUDES NCH/DCH'S CEO. H/R'S EVALUATION IS BASED ON MARKET DATA OBTAINED FROM INDEPENDENT THIRD- PARTY CONSULTANTS FOR POSITIONS WITH SIMILAR RESPONSIBILITIES AT SIMILARLY SITUATED ORGANIZATIONS. BASED ON THIS COMPARABLE DATA, MOUNTAIN STATE'S PRESIDENT & CEO EVALUATES THE DATA AND SUBMITS HIS RECOMMENDATIONS TO MOUNTAIN STATE'S BOARD OF DIRECTORS FOR THEIR FINAL REVIEW AND APPROVAL. IN ADDITION, MOUNTAIN STATES OFFERS AN INCENTIVE PLAN TO EXECUTIVES BASED ON TARGETED ACHIEVEMENT METRICS SET IN ADVANCE OF THE PAY YEAR. ESTABLISHED METRICS INCLUDE: COMMUNICATION WITH PATIENTS, PATIENT EVIDENCE-BASED CARE SCORES AND PATIENT SAFETY, VALUE-BASED PURCHASING, ETC. THESE SAME METRICS ARE USED FOR ALL EMPLOYEES THROUGHOUT MSHA, WITH ONLY A SMALL NUMBER OF EXCEPTIONS FOR OUR COMPANIES THAT DO NOT PROVIDE DIRECT PATIENT CARE. FORM 990, PAGE 6, PART VI, LINE 15B SIMILAR TO NCH/DCH'S CEO, NCH'S CFO RECEIVES COMPENSATION THAT COMPLIES WITH MOUNTAIN STATE'S SALARY POLICY AND UNDERGOES THE SAME REVIEW AND APPROVAL PROCESS BY MOUNTAIN STATE'S BOARD OF DIRECTORS AS THE CEO, AS DESCRIBED IN 15A. ONE PHYSICIAN SERVES ON NCH'S BOARD. HIS COMPENSATION RELATES TO MEDICAL SERVICES HE PROVIDES TO NCH. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY BASIS. FORM 990, PART VII - RELATED ORGANIZATIONS DIRECTOR COMPENSATION: NORTON COMMUNITY HOSPITAL'S BOARD OF DIRECTORS, MARVIN EICHORN, SHANE HILTON, MONTY MCLAURIN, AND TOM TULL RECEIVE COMPENSATION FOR SERVICES PROVIDED TO RELATED ORGANIZATIONS AND DO NOT RECEIVE COMPENSATION FOR SERVICES AS A NCH BOARD MEMBER. FORM 990, PART IX, LINE 11G HOSPITAL SUPPORTED CLINICS 1,227,335 0 0 HOSPITAL BASED PROVIDERS 2,244,244 0 0 PHYSICIAN FEES 1,694,780 0 0 LINEN & ENVIRONMENTAL SERV. 721,878 0 0 CONTRACT LABOR 138,248 68,039 0 COLLECTION FEES 0 384,334 0 CONSULTING FEES 0 224,294 0 TRANSCRIPTION 0 92,640 0 ENGINEERING SERVICES 0 194,001 0 VARIOUS EXPENSES 251,124 149,589 0 TOTAL 6,277,609 1,112,897 0 FORM 990, PART X PART IV, LINE 24A AND PART X, LINE 20 - TAX EXEMPT BOND LIABILITY THE TAX EXEMPT BOND LIABILITY REFLECTS THE PORTION OF BONDS ISSUED BY MOUNTAIN STATES HEALTH ALLIANCE, NCH'S MAJORITY OWNER, ON BEHALF OF NCH FOR CAPITAL NEEDS. NCH PAYS ALL COSTS RELATED TO THIS PORTION OF THE BOND ISSUE. FORM 990, PART XI, LINE 9 CHANGE IN TEMP. RESTRICTED GRANTS -52,994 ELIMINATION OF INTERCOMPANY REC/PAY -2,889,117 PENSION PLAN ADJUSTMENT 2,292,974 TOTAL -649,137 NORTON COMMUNITY PHYSICIAN SVCS LLC 96 15TH ST NW NORTON VA 24273 260868690 MED. SERV. 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