2017-11-15T06:49:29-06:00 2016-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-01-01 541453954 AUGUSTA HEALTH CARE INC D/B/A AUGUSTA HEALTH AUGU 5409324685 PO BOX 1000 FISHERSVILLE VA 22939 MARY N MANNIX FACHE CEO 5409324685 2017-11-15 1 Amy Bibby P00445891 8282542254 12.25.12.224 2017-11-15 06:40:40 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 ADBFC64F84809A3D359AE279AE52D225AAF16287 2016 2021-01-29 14:40:06Z AUGUSTA HEALTH MARY N MANNIX FACHE PO BOX 1000 FISHERSVILLE VA 22939 311648928 0 X WWW.AUGUSTAHEALTH.COM X 1988 VA PROVISION OF FULL SERVICE HEALTHCARE. 15 13 2111 291 4611477 -440026 344459 239415 300740641 296376664 20199185 10750924 3541960 3591514 324826245 310958517 532629 455931 0 0 122038991 114740842 0 0 0 186689447 154145051 309261067 269341824 15565178 41616693 573083550 614368744 52844656 46444319 520238894 567924425 X THE MISSION OF AUGUSTA HEALTH IS TO PROMOTE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH ACCESS TO EXCELLENT CARE. 0 0 233145243 455931 291835561 AUGUSTA HEALTH CARE, INC. IS A 501(C)(3) ORGANIZATION DOING BUSINESS AS AUGUSTA HEALTH. THE ORGANIZATION INCLUDES A MEDICAL CENTER WITH 255 LICENSED INPATIENT BEDS; AN EMERGENCY DEPARTMENT TREATING APPROXIMATELY 61,000 COMMUNITY MEMBERS PER YEAR; A STATE OF THE ART CANCER CENTER PROVIDING TAILOR-MADE COMPREHENSIVE CARE INCLUDING MEDICAL ONCOLOGY AND RADIATION ONCOLOGY; A HOME HEALTH AND HOSPICE PROGRAM SERVING PATIENTS WHO WISH TO REMAIN AT HOME DURING THEIR TREATMENT OR FINAL DAYS; A WOUND HEALING CLINIC PROVIDING A COMPREHENSIVE TREATMENT REGIMEN FOR CHRONIC NON-HEALING WOUNDS; AND A SKILLED NURSING UNIT PROVIDING COMPREHENSIVE REHABILITATION FOR PATIENTS RECOVERING FROM ORTHOPEDIC SURGERY.THE CAMPUS OF AUGUSTA HEALTH IS DESIGNED TO PROVIDE NOT ONLY HOSPITAL SERVICES BUT COMMUNITY ORIENTED SERVICES. THE CAMPUS INCLUDES THE HOSPITAL PROPER; A MAJOR FITNESS CENTER; AN EDUCATIONAL BUILDING THAT HOUSES AUGUSTA HEALTH EDUCATIONAL SERVICES, A BRANCH OF A LOCAL COMMUNITY COLLEGE; A COMMUNITY BUILDING WITH LARGE CONFERENCE ROOMS AVAILABLE TO OTHER COMMUNITY ORGANIZATIONS; AND A BEHAVIORAL HEALTH BUILDING FOR THE PROVISION OF OUTPATIENT PSYCHIATRIC AND SUBSTANCE ABUSE SERVICES. THIS WIDE RANGE OF FACILITIES HELPS TO SUPPORT AUGUSTA HEALTH'S VISION OF PROVIDING THE COMMUNITY WITH A FULL CONTINUUM OF HEALTH AND COMMUNITY SERVICES. In 2016 Augusta Health received the following Honors, Awards, and Accreditations: 2016 Heatlhgrades America's 50 Best Hospitals, 2016 Healthgrades America's 100 Best Orthopedic Surgery, 2016 Healthgrades Joint Replacement Excellence Award, 2016 Healthgrades Pulmonary Care Excellence Award, 2016- Get With The Guidelins- Silver Plus Award with Target Stroke Honor Roll, Becker's Hospital Review 100 Great Community Hospitals, Joint Commission Reaccreditation 2016, Joint Commission Primary Stroke Center Certification, Breast Imaging Center of Excellence by the American College of Radiology, and Mammography Accredited Facility by the American College of Radiology.AUGUSTA HEALTH'S NET COMMUNITY BENEFIT FOR 2016 IS ESTIMATED TO BE $17,149,570. THIS BENEFIT CAN BE CATEGORIZED AS FOLLOWS: CHARITY - $ 8,726,614 MEDICAID - 4,502,410 COMMUNITY HEALTH SERVICES - 1,343,507 HEALTH PROFESSIONAL EDUCATION - 106,088 SUBSIDIZED HEALTH SERVICES - 2,063,857 CASH & IN-KIND CONTRIBUTIONS - 407,094 233145243 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 2111 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 15 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X X SARAH HASH-RODGERS 5403324685 189 MEDICAL CENTER DRIVE FISHERSVILLE VA 22939 REV JOHN C PETERSON CHAIRMAN 1.00 1.00 X X 0 0 0 VICTOR M SANTOS VICE CHAIRMAN 1.00 X X 0 0 0 LAUREL L LANDES SECRETARY/TREASURER 1.00 1.00 X 0 0 0 CHARLES ANDERSEN MD BOARD MEMBER 1.00 1.00 X 0 0 0 DEBRA S CALLISON BOARD MEMBER 1.00 X 0 0 0 JOHN B DAVIS BOARD MEMBER 1.00 X 0 0 0 RONALD W DENNY BOARD MEMBER 1.00 X 0 0 0 DAVID W FOSNOCHT MD BOARD MEMBER 1.00 X 0 0 0 BEVERLY CHERI S MORAN BOARD MEMBER 1.00 1.00 X 0 0 0 A WHIT MORRISS MD BOARD MEMBER 1.00 1.00 X 0 0 0 BURNIE POWERS BOARD MEMBER 1.00 X 0 0 0 JOSEPH L RANZINI MD BOARD MEMBER 40.00 X 221202 0 18530 ARONA E RICHARD BOARD MEMBER 1.00 1.00 X 0 0 0 WILLIAM L VAUHGN BOARD MEMBER 1.00 X 0 0 0 MARY N MANNIX PRESIDENT & CEO 38.00 2.00 X X 703362 0 110740 ROBERT W RILEY former CFO (THRU oct) 39.00 1.00 X 397318 0 13295 JIM GRAVELL INTERIM CFO (FROM NOV) 39.00 1.00 X 0 0 0 RICH EMBREY MD CMO & VP Population Health 40.00 X 299432 0 41642 MARVELLA REA CNO 40.00 X 229544 0 33005 KATHLEEN HEATWOLE VP OF PLANNING & DEVELOP (THRU jul) 40.00 X 177922 0 14658 DAN O'CONNOR VP OF HUMAN RESOURCES 40.00 X 306619 0 42017 LISA CLINE COO 40.00 X 399972 0 57592 MIKE CANFIELD CIO 40.00 X 279772 0 37826 GEORGE SEMKO ADMIN DIRECTOR REVENUE CYCLE 40.00 X 206407 0 15570 ALEXANDER BROWN VP OF LEGAL AFFAIRS 40.00 X 174589 0 21860 FRANCIS CARRUCIO ADMIN DIRECTOR FACILITIES, ENGINEERING, PLANT OPER 40.00 X 216767 0 6552 SCOTT CRABTREE ADMIN DIRECTOR OF PROFESSIO 40.00 X 178704 0 12480 ANDREW WEST CMIO 40.00 X 161585 0 4489 STEVEN YUKNEIWICZ PHARMACIST 40.00 X 158025 0 8047 VICKIE TAYLOR SURGICAL DIRECTOR 40.00 X 152339 0 15646 4263559 0 453949 69 0 1 0 DEARBORN ADVISORS LLC PO BOX 6686 CAROL STREAM IL 60197 IT MANAGEMENT AND STAFF 3308538 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 FOOD SERVICES MANAGEMENT 2901022 XTEND HEALTHCARE 500 W MAIN ST STE 14 HENDERSONVILLE TN 37075 BUSINESS OFFICE CONSULTANT 1179735 BLUE RIDGE PAHOLOGISTS 70 Medical Center Circle FISHERVILLE VA 22939 PATHOLOGY READINGS 1036779 OLD DOMINION SECURITY CO INC 2140 Tomlynn St RICHMOND VA 23230 Hospital Security Service 854512 51 239415 239415 NET PATIENT SERVICE REVENUE 621400 281639955 281095742 544213 RETAIL PHARMACY 446110 6403670 3949843 2453827 DME 621400 5461115 5260588 200527 FITNESS CENTER 713940 2147990 931349 1216641 EHR INCENTIVE PAYMENT 900099 598039 598039 125895 125895 296376664 10942513 10942513 1192277 498822 693455 693455 693455 191589 -191589 -191589 -191589 CAFETERIA/VENDING 722210 1453588 1453588 AFFILIATED REVENUES 900099 1374097 1374097 TELEPHONE ANSWERING 900099 70374 70374 2898059 310958517 291835561 4611477 14272064 X 455931 455931 3396139 3396139 88310215 78591504 9718711 1948694 1670013 278681 14672937 12570860 2102077 6412857 5495760 917097 904763 904763 240506 240506 137911 137911 23259 23259 37125198 25485767 11639431 1327055 899427 427628 10991739 5659642 5332097 1745269 1678871 66398 5305922 5305922 354778 345908 8870 225661 95098 130563 884933 884933 15937486 15937486 1513732 1513732 MEDICAL SUPPLIES 31017117 31017117 BAD DEBTS 22071647 22071647 COST OF DRUGS SOLD 21545225 21545225 COST OF FOOD 1841457 1841457 951393 78943 872450 269341824 233145243 36196581 0 10138246 20848886 43176162 44308491 34704 27204 6416197 6235053 2049513 2347918 354532667 217554757 137665652 136977910 264121349 295073981 23907502 6679968 73576200 90159686 326970 280577 11671055 11429070 573083550 614368744 22407451 22888479 162308 104779 21400000 17867406 418576 271554 8456321 5312101 52844656 46444319 X 519798951 566391326 439943 1533099 520238894 567924425 573083550 614368744 X 41616693 5540612 528226 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23259 23259 0 Part II-B, Line 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION (VHHA). THESE ORGANIZATIONS ROUTINELY ENGAGE IN LOBBYING EFFORTS ON BEHALF OF ITS MEMBERSHIP BODY, AND A PORTION OF EACH MEMBER'S DUES ARE ALLOCATED TO THOSE LOBBYING EXPENDITURES. THE PORTION OF THE HOSPITAL'S DUES ALLOCATED TO LOBBYING WAS $ 23,259. 1511837 4208600 5720437 116904289 48411041 68493248 10813457 9076936 1736521 214190704 160066780 54123924 6903780 6903780 136977910 INVESTMENT IN AMG 90159686 C 90159686 OTHER LIABILITIES 5248445 UNAMORTIZED BOND DISCOUNTS 63656 5312101 X 294619402 5540612 1217014 6757626 287861776 23096741 23096741 310958517 246814246 0 246814246 22527578 22527578 269341824 Part X, Line 2: THE HOSPITAL, MEDICAL GROUP, AND FOUNDATION ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON INCOME DERIVED FROM ITS EXEMPT PURPOSE AS A NONPROFIT ORGANIZATION UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAX. THE COMPANY HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2016. Part XI, Line 2d - Other Adjustments: CHANGE IN FUNDING OF PENSION PLAN -100,371. CHANGE IN TEMPORARILY RESTRICTED ASSETS 1,093,156. NET ASSETS RELEASED FROM RESTRICTIONS 224,229. Part XI, Line 4b - Other Adjustments: BAD DEBT NET WITH REVENUE 22,071,647. CONTRIBUTIONS EXPENSE NET WITH REVENUE 455,931. EQUITY TRANSFERS BETWEEN AFFILIATES 569,163. Part XII, Line 4b - Other Adjustments: BAD DEBT NET WITH REVENUE 22,071,647. CONTRIBUTIONS EXPENSE NET WITH REVENUE 455,931. Central America and the Caribbean - 0 0 INVESTMENT IN CAPTIVE INSURANCE 3973601 Central America and the Caribbean - 0 0 SELF INSURANCE PREMIUMS 3863961 0 0 0 0 0 0 7837562 0 7837562 1 0 1 0 0 0 1 1 1 X 1 X 1 1 0 1 0 8726614 8726614 0.03530 17575861 13073451 4502410 0.01820 26302475 13073451 13229024 0.05350 1343507 1343507 0.00540 106088 106088 0.00040 8258631 6194774 2063857 0.00830 407094 407094 0.00160 10115320 6194774 3920546 0.01570 36417795 19268225 17149570 0.06920 1695 42607 42607 0.00020 1 55 2751 2751 0.00000 1 1750 45358 45358 0.00020 1 22071647 3429401 86324787 83276509 3048278 X 1 1 1 1 AUGUSTA HEALTH 78 MEDICAL CENTER DR FISHERSVILLE VA 22939 X X X HOME HEALTH; SNF; PSYCH, DME; HOSPICE AUGUSTA HEALTH 1 0 0 1 X X X X X X X X 16 1 0 0 1 X SEE DISCLOSURE X 1 16 1 https://www.augustahealth.com/sites/default/files/documents/community-outre 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X www.augustahealth.com X SEE PART VI X www.augustahealth.com/billing-insurance/assistance-programs X X X X X X X 1 X 0 X X X X 1 X 0 0 AUGUSTA HEALTH Part V, Section B, Line 5: To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was implemented for this process. A list of recommended participants was provided by Augusta Health; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall.FOR ADDITIONAL INFORMATION GO TO:www.augustahealth.com/community-outreach/community-health-needs-assessment AUGUSTA HEALTH Part V, Section B, Line 11: During the CHNA process, the data revealed a total of 13 distinct areas of opportunity. Augusta Health's 2017-2019 implementation strategies are designed to address the top three highest priority areas. In response to the identified top priority community needs, Augusta Health has developed three overarching goals and identified specific implementation strategies and programs to address the needs in the three highest priority need areas. Augusta Health has also committed to supporting intervention strategies in other key need areas. The goals and implementation strategies are as follows:Goal 1: To improve the wellbeing of Staunton, Augusta County and Waynesboro residents through increased knowledge about and access to healthy foods and participation in physical activity programs.Goal 2: To decrease prevalence of prediabetes and improve diabetes management by expanding education offerings and access to services.Goal 3: To increase the number of residents who are connected to the appropriate mental health service at the correct level of care by expanding screenings, improving access and working with community partners to determine additional mental health services needed in Staunton, Augusta County and Waynesboro.Augusta Health has selected these three priorities because of its ability to work in partnership with other organizations and agencies to make the greatest impact. Other needs that were identified have the potential to be addressed through collaborative programming that may or may not involve Augusta Health as a facilitator, partner or funder. AUGUSTA HEALTH Part V, Section B, Line 13h: Individuals eligible for financial assistance under this policy shall not be charged more than the amounts generally billed (AGB) to individuals who have insurance. This value shall be calculated using the "look-back" method based on actual paid claims from Medicare fee-for-service and private health insurers. The current AGB is 35% and is updated annually. AUGUSTA HEALTH Part V, Section B, Line 16j: Notice contained in all patient statements. PART V, SECTION B, LINE 7A: https://www.augustahealth.com/sites/default/files/documents/community-outreach/health_needs_prioritization_session_slides_2016.pdf Part I, Line 7: FOR PURPOSES OF PART I, LINE 7(A) THE ORGANIZATION USED THE METHODS PROVIDED IN THE 2016 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO TO CONVERT CHARITY CARE WRITE-OFFS TO COST. AMOUNTS REPORTED ON LINES 7(B) AND 7(G) WERE DERIVED FROM THE ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM. Part I, Line 7g: INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES ACCOUNT FOR $1,535,821 OF THE NET COMMUNITY BENEFIT OF SUBSIDIZED SERVICES. THESE SERVICES PROVIDE SHORT-TERM PSYCHIATRIC CARE FOR ADULTS AND GERIATRIC PATIENTS IN A SUPPORTIVE ENVIRONMENT WITH 24-HOUR NURSING CARE. HOME HEALTH SERVICES PROVIDED BY THE ORGANIZATION CONTRIBUTED $528,036 IN NET COMMUNITY BENEFIT. AUGUSTA HEALTH'S HOME HEALTH PROGRAM OFFERS SKILLED NURSING CARE, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, AND MEDICAL SOCIAL WORKERS. Part I, Ln 7 Col(f): TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25 INCLUDES BAD DEBT IN THE AMOUNT OF $22,071,647. THIS AMOUNT FOR BAD DEBT HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENTAGE OF TOTAL EXPENSE ON SCHEDULE H, PART I, LINE 7, COL (F). Part II, Community Building Activities: THE HOSPITAL BOARD AND THE COMMUNITY BENEFIT COMMITTEE HAVE TAKEN A LEADERSHIP ROLE IN COORDINATING AND ORGANIZING COMMUNITY PARTNERSHIPS TO ADDRESS SYSTEMS THAT WILL LEAD TO A HEALTHIER COMMUNITY. THE COMMUNITY HEALTH FORUM, THE AUGUSTA REGIONAL DENTAL CLINIC AND AUGUSTA REGIONAL FREE CLINIC, GO GIRLS, STEP IT UP!, AND WALK WITH A DOC ARE ALL PROGRAMS THAT THE HOSPITAL HAS SUPPORTED OR INITIATED TO HELP CREATE AND SUSTAIN A HEALTHY COMMUNITY. Part III, Line 2: Accounts are written off to bad debt when management determines that recovery is unlikely and the company ceases collection efforts. Part III, Line 4: EXCERPT FROM 2016 FINANCIAL AUDIT, PATIENT ACCOUNTS RECEIVABLE:"PATIENT RECEIVABLES ARE RECORDED AT ESTABLISHED BILLING RATES WHEN PATIENT SERVICES ARE RENDERED. ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE RECORDED AS DEDUCTIONS FROM PATIENT ACCOUNTS RECEIVABLE TO REDUCE RECORDED AMOUNTS TO THEIR NET REALIZABLE VALUE. CONTRACTUAL ADJUSTMENTS REPRESENT THE DIFFERENCE BETWEEN ESTABLISHED BILLING RATES AND AMOUNTS REIMBURSED. THE COMPANY PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM THE UNWILLINGNESS OR INABILITY OF PATIENTS TO MAKE PAYMENTS FOR SERVICES. THE ALLOWANCE IS DETERMINED BY ANALYZING HISTORICAL DATA AND TRENDS. PATIENT ACCOUNTS RECEIVABLE ARE CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHEN MANAGEMENT DETERMINES THAT RECOVERY IS UNLIKELY AND THE COMPANY CEASES COLLECTION EFFORTS."THE BAD DEBT AMOUNT LISTED IN PART III SECTION A, NUMBER 2 WAS CALCULATED USING WORKSHEET A ON PAGE 4 OF THE 2016 SCHEDULE H INSTRUCTIONS.THE PORTION OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS BASED ON DISCHARGES IN 2016. PATIENTS THAT WERE CLASSIFIED AS "SP" WERE UN-INSURED AND THEREFORE CONSIDERED WITHOUT RESOURCES. THEIR ACCOUNT STATUS WAS "BD" MEANING THAT THE ACCOUNT WAS CONSIDERED UNCOLLECTABLE AT THE TIME OF THE REPORT. Part III, Line 9b: ONCE A PATIENT HAS BEEN DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ALL COLLECTION EFFORTS CEASE FOR CURRENT AND PAST DUE BALANCES AND THE NECESSARY ADJUSTMENTS ARE TAKEN TO THE ACCOUNTS RECEIVABLE. SHOULD THE PATIENT ONLY BE ELIGIBLE FOR A PORTION OF FINANCIAL ASSISTANCE (THROUGH OUR SLIDING SCALE), NO-INTEREST, LOW-PAYMENT, AND LONG TERM PAYMENT PLANS ARE AVAILABLE. PART V, LINE 16B https://www.augustahealth.com/sites/default/files/documents/business-office/financial_assistance_application_2015-forms.pdf Part VI, Line 2: The Augusta Health Board of Directors recognizes that the health of the community is multi-faceted. Augusta Health participates with over 110 agencies and organizations in the community health forum by donating staff support and resources to coordinate meetings. The goals of the forum are to determine the needs of the community, identify gaps and duplication of services and coordinate efforts as well as to facilitate communication and education among all forum participants about community health needs. In 2016, Augusta Health conducted their second Needs Assessment which identified community prioroties for improvements in the health of the population. Part VI, Line 3: Augusta Health has a Medicaid Eligibility team onsite to screen its patients for Medicaid eligibility, including disability. As for the organization's financial assistance program, Augusta Health informs its patients about it in the following ways:1. Detailed information about financial assistance is sent along with the statements.2. Financial assistance policy and application are available on the hospital's website www.augustahealth.com. 3. Copies of the financial assistance guidelines and application form are available at the points of service (Emergency Room, Outpatient and Inpatient areas, doctor's offices, etc.). Part VI, Line 4: Augusta Health serves a large rural area. The combined area of Staunton, Waynesboro and Augusta County , encompasses 1002.02 square miles and houses a total population of 119,016 residents, according to latest census estimates. Between the 2000 and 2010 US Censuses, the total area population increased by 9,514 persons, or 8.7%. While Augusta County is predominantly rural, the cities of Staunton and Waynesboro are nearly entirely urban. In the total area, 20.7% of the population are infants, children or adolescents age 17 and under, another 61.3% are age 18 to 64, while 18% are age 65 or older. The percentage of older adults is much higher than the state and US figuresIn looking at race independent of ethnicity, 88.9% of residents of the total are White and 7.1% are Black. The cities of Staunton and Waynesboro are more racially diverse than Augusta County. A total of 3.1% of total area residents are Hispanic or Latino, with the proportion the largest in Waynesboro. Between 2000 and 2010, the Hispanic population in the total area increased by 1,846 people, or 120.7% Less than one percent of the total area population and 5 and older live in a home in which no persons age 14 or older is proficient in English. Part VI, Line 5: As a community owned hospital, 100% of the surplus goes back into the community through facility upgrades, state of the art equipment purchases, increased patient care services, and patient care access points throughout the service area, as well as providing support to other local non-profit agencies that compliment and/or support the mission of Augusta Health. Part VI, Line 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 Central Shenandoah Planning (CATS) 112 MACTANLEY PLACE STAUNTON VA 24401 540857625 501(C)(3) 87360 OPERATIONAL SUPPORT Mary Baldwin College PO BOX 1500 STAUNTON VA 24402 540506319 501(C)(3) 60000 OPERATIONAL SUPPORT Augusta Regional Dental Clinic PO BOX 153 FISHERSVILLE VA 22939 202922988 501(C)(3) 40000 OPERATIONAL SUPPORT - MULTI-YEAR GRANT Blue Ridge Court Services 125 SOUTH NEW ST STAUNTON VA 24401 546001631 501(C)(3) 33500 FUNDS TO BE ALLOCATED TO THE NURSING PROGRAM Valley Hope Counseling Center 20 STONERIDGE DR STE 202 WAYNESBORO VA 22980 541956722 501(C)(3) 22500 OPERATIONAL SUPPORT Blue Ridge Community College PO BOX 80 WEYERS CAVE VA 24486 541268283 501(C)(3) 7500 OPERATIONAL SUPPORT Central Shenandoah EMS Council PO BOX 256 FISHERSVILLE VA 22939 541906904 501(C)(3) 10000 FUNDING FOR COMMUNITY TRAINING Crossraods to Brain Injury 601 UNIVERSITY BLVD STE 317 HARRISONBURG VA 22807 204795567 501(C)(3) 10000 OPERATIONAL SUPPORT Valley Area Community Support 85 SANGERS LN STAUNTON VA 24401 270132429 501(C)(3) 20000 OPERATIONAL SUPPORT Valley Mission 1513 WEST BEVERLY ST STAUNTON VA 24401 540930419 501(C)(3) 20000 OPERATIONAL SUPPORT Greater Augusta Wellness 900 NELSON ST STAUNTON VA 24401 546001673 501(C)(3) 11205 OPERATIONAL SUPPORT 11 Part I, Line 2: AUGUSTA HEALTH MADE GRANTS THROUGHOUT THE YEAR TO NON-PROFIT AND GOVERNMENTAL COMMUNITY PARTNERS WHO DEVELOPED PROJECTS OR PROVIDED SERVICES TO ADDRESS THE COMMUNITY'S HEALTH PRIORITIES IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. X X X X X 1 1 0 0 0 1 0 0 0 JOSEPH L RANZINI MD BOARD MEMBER 221202 0 0 0 0 0 6635 0 11895 0 239732 0 0 0 MARY N MANNIX PRESIDENT & CEO 555471 0 130391 0 17500 0 101776 0 8964 0 814102 0 147891 0 ROBERT W RILEY former CFO (THRU oct) 287137 0 51912 0 58269 0 7950 0 5345 0 410613 0 69892 0 RICH EMBREY MD CMO & VP Population Health 299432 0 0 0 0 0 36831 0 4811 0 341074 0 0 0 MARVELLA REA CNO 185515 0 29925 0 14104 0 24590 0 8415 0 262549 0 44029 0 KATHLEEN HEATWOLE VP OF PLANNING & DEVELOP (THRU jul) 115354 0 32301 0 30267 0 14658 0 0 0 192580 0 50051 0 DAN O'CONNOR VP OF HUMAN RESOURCES 246564 0 38648 0 21407 0 33293 0 8724 0 348636 0 60555 0 LISA CLINE COO 317449 0 51482 0 31041 0 40637 0 16955 0 457564 0 69950 0 MIKE CANFIELD CIO 279772 0 0 0 0 0 31946 0 5880 0 317598 0 0 0 GEORGE SEMKO ADMIN DIRECTOR REVENUE CYCLE 190312 0 16095 0 0 0 6414 0 9156 0 221977 0 16095 0 ALEXANDER BROWN VP OF LEGAL AFFAIRS 174589 0 0 0 0 0 21860 0 0 0 196449 0 0 0 FRANCIS CARRUCIO ADMIN DIRECTOR FACILITIES, ENGINEERI 199330 0 17437 0 0 0 5178 0 1374 0 223319 0 17437 0 SCOTT CRABTREE ADMIN DIRECTOR OF PROFESSIO 165130 0 13574 0 0 0 2948 0 9532 0 191184 0 13574 0 ANDREW WEST CMIO 161585 0 0 0 0 0 3531 0 958 0 166074 0 0 0 STEVEN YUKNEIWICZ PHARMACIST 158025 0 0 0 0 0 4817 0 3230 0 166072 0 0 0 VICKIE TAYLOR SURGICAL DIRECTOR 142528 0 9811 0 0 0 4478 0 11168 0 167985 0 9811 0 Part I, Lines 4a-b ROBERT RILEY RECEIVED A SEVERANCE PAYMENT OF $40,289. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENT FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS ARE REPRESENTED IN PART II, COLUMN (C): KATHLEEN HEATWOLE: 12,517 LISA CLINE: 12,573 Part I, Line 6 THE TOP EXECUTIVES OF AUGUSTA HEALTH WERE REQUIRED TO SET ANNUAL PERFORMANCE GOALS THAT ALIGNED WITH THE ORGANIZATION'S COMMITMENT TO PERFORMANCE EXCELLENCE. THE GOALS WERE ESTABLISHED WITH FOCUS ON THE FOLLOWING SIX AREAS: QUALITY, SERVICE, PEOPLE, COMMUNITY, GROWTH, AND FINANCE. EACH GOAL WAS REQUIRED TO HAVE MEASURABLE OUTCOMES AND WAS REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD TO ENSURE THAT IT SUPPORTED THE ORGANIZATION'S QUEST FOR SERVICE AND OPERATIONAL EXCELLENCE. WHILE NET EARNINGS WERE A CONSIDERATION IN THE AREA OF FINANCE, THE GOALS WERE ALSO CENTERED AROUND QUALITY, SERVICE, PEOPLE, COMMUNITY, AND GROWTH. EACH EXECUTIVE'S GOALS WERE WEIGHTED ACROSS THE PILLAR GOALS BASED ON THEIR AREA OF RESPONBILITY. WHEN AWARDING INCENTIVE COMPENSATION, THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD REVIEWED THE YEAR-END ACCOMPLISHMENTS OF THE TOP EXECUTIVES AND AWARDED INCENTIVE COMPENSATION BASED ON THEIR ACTUAL PERFORMANCE AS COMPARED TO THE ESTABLISHED PERFORMANCE BENCHMARKS. A INDUSTRIAL DEVELOPMENT AUTHORITY OF THE COUNTY OF AUGUSTA VA 541311681 05112mcp8 2003-12-17 33510000 CURRENT REFUNDING 0 0 0 A 15275000 38637362 5267469 374087 33483180 1994 1 0 1 1 A 0 0 0 1 0 0 0 0 1 A 0 Date Rebate Computation Performed Issuer Name: INDUSTRIAL DEVELOPMENT AUTHORITY OF THE COUNTY OF AUGUSTA, VA Date the Rebate Computation was Performed: 08/31/2010 SCHEDULE K, PART I, DESCRIPTION OF PURPOSE: THE SERIES 2003 BONDS WERE ISSUED FOR THE PURPOSE OF: 1) REFUNDING THE ISSUER'S PRIOR SERIES 1993 BONDS, 2) FUNDING A DEBT SERVICE RESERVE FUND FOR THE SERIES 2003 BONDS, AND 3) PAYING COST OF ISSUANCE EXPENSES. SCHEDULE K, PART II, LINE 11, OTHER SPENT PROCEEDS: THE AMOUNTS PRESENT ON PART II, LINE 11 REPRESENT AMOUNTS USED TO CURRENTLY REFUND BONDS ISSUED IN 1993. SCHEDULE K, PART III: THE SERIES 2003 BONDS WERE ISSUED ENTIRELY TO REFUND A PRIOR ISSUE DATED BEFORE JANUARY 1, 2003 AND WERE NOT USED TO ACQUIRE NEW PROPERTY; THEREFORE, SCHEDULE K, PART III IS NOT REQUIRED TO BE COMPLETED FOR THIS ISSUE. Form 990, Part VI, Section A, line 1 Executive compensation program is administered by the Executive Committee of the Board, based on a compensation philosophy approved by the Board at large. Qualified third party consultants are engaged to provide appropriate market comparability, survey data, and to assist the committee with reviews. The base salary benchmarks are targeted at the 50th percentile with flexibility to pay above or below the 50th percentile using salary ranges with a 50% range spread to recognize an incumbent's individual experience, skill, performance, or other relevant recruitment or retention factors. Incentive opportunities are established at levels that when combined with salaries positioned at the 50th percentile, are sufficient to provide total cash compensation that targets up to the approximately market 75th percentile of total cash compensation levels. Total compensation shall not exceed the 90th percentile for any individual without full board approval and documentation of the Board's reasons for such compensation. The Board of Directors receives a full report from the Executive Committee on the full compensation program at Augusta Health in an executive session of the Board. Conflicted members are excused from the meeting. Material covered includes the design of the compensation program, as well as a disclosure on range of base salaries, market benchmark data, and earned incentive compensation levels. Additionally, prerequisites such as the senior executive retirement plan (SERP) program and other related benefits are periodically reviewed with the Board. For those members who are not present for this annual report and remain free of conflict of interest, the chairman of the board presents the same material in a separate session. Form 990, Part VI, Section A, line 3 THE ORGANIZATION DELEGATES CFO DUTIES TO WARBIRD. THE MANAGEMENT COMPANY PROVIDES JIM GRAVELL AS AN INTERIM CFO. THE ORGANIZATION PAID WARBIRD $130,617 FOR SERVICES. Form 990, Part VI, Section B, line 11b The Accounting department will make copies of the Form 990 available to the CFO and CEO for review. All questions will be resolved and answered before presentation to the Executive Committee of the Board. The final draft of the return will be posted on the organization's internal website with access restricted to the Board and Key Administrative personnel for review. All questions will be resolved and answered by the CEO, CFO or Corporate Controller. Any revisions as a result of the Board review will be sent to the tax preparer and subsequent review by the Board will be scheduled accordingly. Form 990, Part VI, Section B, line 12c THE GOVERNANCE COMMITTEE IS CHARGED WITH REVIEWING THE CONFLICT OF INTEREST STATEMENTS EACH YEAR. THE REVIEW IS CONDUCTED AFTER THE ANNUAL BOARD MEETING IN APRIL. CONFLICT OF INTEREST REVIEWS OCCUR AT THE BEGINNING OF EACH BOARD AND COMMITTEE MEETING. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THOSE FOUND TO BE IN A CONFLICT OF INTEREST MUST ABSTAIN FROM VOTING AND MAY BE ASKED TO LEAVE THE MEETING DEPENDING ON THE TOPIC AND THEIR DEGREE OF CONFLICT. Form 990, Part VI, Section B, line 15 AUGUSTA HEALTH UTILIZES THE SERVICES OF INTEGRATED HEALTHCARE STRATEGIES, 901 MARQUETTE AVENUE SOUTH SUITE 2100 MINNEAPOLIS, MINNESOTA TO DETERMINE COMPETITIVE WAGE RANGES, VARIABLE COMPENSATION AND PREQUISITES FOR EXECUTIVE POSITIONS. IT IS THE GOAL OF THE AUGUSTA HEALTH BOARD TO SATISFY THE FOLLOWING OBJECTIVES: 1.) COMPETITIVENESS: THE PROCESS MUST PRODUCE COMPENSATION AND BENEFIT LEVELS THAT ENABLE THE BOARD TO ATTRACT AND RETAIN THE MANAGEMENT LEADERSHIP ESSENTIAL TO CARRYING OUT ITS MISSION. 2.) STRATEGIC ALIGNMENT: THE PROCESS MUST ALIGN EXECUTIVE COMPENSATION WITH THE INSTITUTION'S STRATEGIC GOALS. IT MUST REWARD MANAGEMENT FOR ACCOMPLISHING THESE GOALS. 3.) REGULATORY COMPLIANCE: THE PROCESS MUST ASSURE THAT THE INSTITUTION MEETS ITS CHARITABLE PURPOSE OBLIGATIONS TO REMAIN TAX-EXEMPT AND THEREFORE WILL REVIEW AND APPROVE ALL FORMS OF EXECUTIVE COMPENSATION AND BENEFITS IN A MANNER NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTIONS RULES OF SECTION 4958 OF THE IRC SO AS TO AVOID THE IMPOSITION OF INTERMEDIATE SANCTIONS IN THE FORM OF EXCISE TAXES PENALTIES ON ITS TRUSTEES AND EXECUTIVES. 4.) PUBLIC TRUST: BOARD MEMBERS ARE INVESTED WITH A PUBLIC TRUST TO SHEPHERD INSTITUTIONAL ASSETS AS RESPONSIBLE FIDUCIARIES AND REPRESENTATIVES. THEREFORE, THE PROCESS MUST ASSURE THAT COMPENSATION AND BENEFIT LEVELS ARE REASONABLE, NOT EXCESSIVE, AND DEFENSIBLE IF AND WHEN SUBJECTED TO PUBLIC SCRUTINY. Base salaries targeted at the 50th percentile, with flexibility to pay above or below the 50th percentile using salary ranges with a 50% range spread to recognize an incumbent's individual experience, skill, performance or other relevant recruitment or retention factors. Incentive opportunity levels that, when combined with salaries positioned at the 50th percentile, are sufficient to provide total cash compensation that targets up to the approximate market 75th percentile of total cash compensation levels. Total compensation shall not exceed the 90th percentile for any individual without full Board approval and documentation of the Board's reasons for such compensation. COMPENSATION, INDIVIDUAL PERFORMANCE AND COMPETITIVE DATA ARE REVIEWED ANNUALLY FOR ALL EXECUTIVE POSITIONS AS FOLLOWS: CEO CFO COO CNO CMO CIO VP OF HUMAN RESOURCES VP OF PLANNING AND DEVELOPMENT THE BOARD OF DIRECTORS RECEIVED A FULL REPORT FROM THE EXECUTIVE COMMITTEE ON THE FULL COMPENSATION PROGRAM AT AUGUSTA HEALTH IN AN EXECUTIVE SESSION OF THE BOARD. CONFLICTED MEMBERS WERE EXCUSED FROM THE MEETING. MATERIAL COVERED INCLUDED THE DESIGN OF THE COMPENSATION PROGRAM, AS WELL AS ACTUAL BASE SALARIES, MARKET BENCHMARK DATA, AND INCENTIVE COMPENSATION EARNED BY EACH EXECUTIVE. ADDITIONALLY, PREREQUISITES SUCH AS THE SERP PROGRAM AND OTHER RELATED BENEFITS WERE REVIEWED WITH THE BOARD. FOR THOSE MEMBERS WHO WERE NOT PRESENT FOR THIS MEETING AND REMAINED FREE OF CONFLICT OF INTEREST, THE CHAIRMAN OF THE BOARD PRESENTED THE SAME MATERIAL IN A SEPARATE SESSION. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ACCOUNTING OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. Form 990, Part VI, Section C, line 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ACCOUNTING OFFICE. PLEASE DIRECT ALL REQUESTS TO: AUGUSTA HEALTH CARE, INC. ATTN: CORPORATE CONTROLLER P.O. BOX 1000 FISHERSVILLE, VA 22939-1000 Form 990, Part IX, line 11g PHYSICIAN FEES: Program service expenses 11,488,861. Management and general expenses 0. Fundraising expenses 0. Total expenses 11,488,861. PURCHASED SERVICES: Program service expenses 7,120,269. Management and general expenses 3,670,783. Fundraising expenses 0. Total expenses 10,791,052. MAINTENANCE CONTRACTS: Program service expenses 4,923,025. Management and general expenses 2,653,667. Fundraising expenses 0. Total expenses 7,576,692. CONSULTANTS: Program service expenses 1,953,612. Management and general expenses 3,266,400. Fundraising expenses 0. Total expenses 5,220,012. OTHER FEES: Program service expenses 0. Management and general expenses 2,048,581. Fundraising expenses 0. Total expenses 2,048,581. Form 990, Part XI, line 9: CHANGE IN FUNDED STATUS OF PENSION PLAN -100,371. TEMPORARILY RESTRICTED CONTRIBUTIONS 1,093,156. NET ASSETS RELEASED FROM RESTRICTIONS 224,229. EQUITY TRANSFERS BETWEEN AFFILIATES -569,163. CHANGE IN NET ASSETS OF SHENANDOAH HOUSE -119,625. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VII BOARD MEMBER JOSEPH RANZINI IS PAID AS AN EMPLOYEE OF AUGUSTA MEDICAL GROUP, A RELATED ORGANIZATION AND NOT COMPENSATED FOR HIS BOARD MEMBER SERVICE. AUGUSTA CARE PARTNERS LLC 78 MEDICAL CENTER DR FISHERSVILLE VA 22939 462840076 HEALTHCARE VA 0 0 AHC COMMUNITY HEALTH FOUNDATION PO BOX 1000 FISHERSVILLE VA 22939 542042365 SUPPORTING ORGANIZATION VA 501(c)(3) Line 12a, I AUGUSTA HEALTH CARE INC 1 AUGUSTA MEDICAL GROUP PO BOX 1000 FISHERSVILLE VA 22939 262559916 HEALTHCARE VA 501(c)(3) Line 10 AUGUSTA HEALTH CARE INC 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 1 1 AUGUSTA MEDICAL GROUP J 615768 AUGUSTA MEDICAL GROUP Q 8000000 AUGUSTA HEALTH FOUNDATION C 239415 AUGUSTA HEALTH FOUNDATION R 469972 AUGUSTA MEDICAL GROUP R 5009186