2017-08-08T07:51:21-05:00 2016-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2015-10-01 560603898 HARNETT HEALTH SYSTEM INC HARN 9108911000 800 TILGHMAN DRIVE DUNN NC 28334 KEVIN JACKSON PRESIDENT/CEO 9108911000 2017-08-07 1 JOHN NORMAN P01506766 7049985200 2017-08-07 2015 2021-01-29 14:40:06Z BETSY JOHNSON REGIONAL HOSPITAL KEVIN JACKSON 800 TILGHMAN DRIVE DUNN NC 28334 101716504 0 X WWW.MYHARNETTHEALTH.ORG X 1937 NC PROVIDING MEDICAL CARE FOR PATIENTS OF THE HOSPITAL 13 12 1136 54 0 0 118827 83719 92029103 100846771 17874 33720 738051 752294 92903855 101716504 0 0 0 0 52854176 53914616 0 0 0 46093967 45696388 98948143 99611004 -6044288 2105500 183081424 102149103 212334624 121809425 -29253200 -19660322 X HARNETT HEALTH IS DEDICATED TO PROVIDING QUALITY AND PERSONALIZED CARE WITH RESPECT AND COMPASSION. WE ARE COMMITTED TO MAKING A DIFFERENCE THROUGHOUT OUR COMMUNITIES WITH SERVICE EXCELLENCE. 1 0 86990458 101172818 THE HOSPITAL SERVED THE HARNETT COUNTY POPULATION AND REACHED INTO THE COUNTIES OF SAMPSON, JOHNSTON AND CUMBERLAND. THE HOSPITAL SERVED 26,081 INPATIENTS FOR FY16. THE HOSPITAL EXPERIENCED 567 DELIVERIES THE OUTPATIENTS SERVED WERE 62,206 EMERGENCY VISITS, 16,636 PHYSICAL THERAPY-OCCUPATIONAL THERAPY-SPEECH THERAPY VISITS AND ALL OTHER OUTPATIENT VISITS TOTALED 31,753 CARDIACREHAB, TREATED 113 PATIENTS AND SOME OF THE OUTCOMES WERE THE FOLLOWING - FERRANS AND POWERS SURVEY, OVERALL QUALITY OF LIFE IMPROVED 2 POINTS (GOAL IS 2-3 POINT INCREASE)- HEALTH AND FUNCTIONING SUB-SCORE IMPROVED 3 POINTS (GOAL IS 2-3 POINT INCREASE)EDUCATIONAL ASSESSMENT SCORE IMPROVED 2% MEDICATION MANAGEMENT OF HARNETT COUNTY (BETSY JOHNSON REGIONAL HOSPITAL) ENCOUNTERED 15 NEW PATIENTS WITH A TOTAL OF 148 ACTIVE PARTICIPATES IN THE PROGRAM WE RECEIVED 359 MEDICATIONS WITH A TOTAL VALUE OF $403,918. OUTREACH PROGRAMS THE HOSPITAL ARE INVOLVED WITH TEENS AS PARENTS PROGRAM, WHICH COLLABORATES WITH TWO OTHER COUNTY AGENCIES, PROVIDES A HOME VISITATION PROGRAM AND THE CONTINUATION OF EDUCATION CLASSES ON CHILDBIRTH AND PARENTING THE PROGRAM ALSO PROVIDES HARNETT COUNTY TEEN PARENTS WITH OPPORTUNITIES TO DEVELOP SELF-RESPECT, PARENTING, AND DECISION-MAKING SKILLS WHILE CONTINUING THEIR EDUCATION TAP SERVED 24 TEENS THE REPEAT PREGNANCY RATE FOR TAP PARTICIPATES IS 4%, COMPARED TO THE COUNTY RATE OF 23.2% THE TAP PROGRAM PARTICIPANTS RECEIVED 226 HOURS OF GROUP INSTRUCTION INCLUDING THE FOLLOWING TOPICS 18 HOURS ACADEMIC SUPPORT, 117 HOURS OF COLLEGE PREPAREDNESS, 8 HOURS OF INDIVIDUAL COUNSELING AND 14.5 HOURS OF FAMILY COUNSELING, 97.75 HOURS OF LIFE SKILLS TRAINING, 257.5 HOURS OF IN HOME VISITATION. 3. HEALTH HARNETT PROGRAM OR "GO RED" IS A PROGRAM THAT PROMOTES HEALTHY EATING, WHICH LEADS TO A HEALTHY LIFESTYLE HARNETT HEALTH COLLABORATED WITH THE NC COOPERATIVE EXTENSION AND THE HARNETT COUNTY HEALTH DEPARTMENT THERE WERE A TOTAL OF 93 PARTICIPATES IN TWO PRESENTATIONS GIVEN BY THE HARNETT HEALTH CARDIAC REHAB DEPARTMENT AS WELL AS 2 SUPPORTING PHYSICIANS. OFFERED FREE EDUCATIONAL BROCHURES AND INFORMATION AT ALL EVENTS. WE PARTICIPATE IN PROJECT ACCESS OF JOHNSON/HARNETT COUNTY WHICH IS A PHYSICIAN LED VOLUNTEER INITIATIVE THAT GIVES LOWINCOME, UNINSURED COUNTY RESIDENTS ACCESS TO COMPREHENSIVE MEDICAL CARE PHYSICIANS AND COMMUNITY PARTNERS, LIKE HARNETT HEALTH, DONATE MEDICAL SERVICES WITHOUT RECEIVING REIMBURSEMENT OR COMPENSATION THE PROGRAM HAS ASSISTED 90 PATIENTS FOR THE LAST FISCAL YEAR 86990458 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 114 0 1 1136 1 0 0 0 0 0 0 0 0 0 0 X 13 12 1 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 0 1 1 0 X DEBORAH WHITTINGTON 9108921000 800 TILGHMAN DRIVE DUNN NC 28334 HEATHER WILLIAMS CHAIR 4.00 X X 0 0 0 TEDDY BYRD VICE-CHAIR 2.00 X X 0 0 0 ERNEST ALPHIN TREASURER 2.00 X X 0 0 0 WALTER WEEKS SECRETARY 2.00 X X 0 0 0 CORNELIA STEWART TRUSTEE 2.00 X 0 0 0 BARBARA BETHEA TRUSTEE 2.00 X 0 0 0 DEWEY BLALOCK TRUSTEE 2.00 X 0 0 0 JIM MCCORMICK TRUSTEE 2.00 X 0 0 0 BARBARA MCKOY TRUSTEE 2.00 X 0 0 0 WILEY POPE TRUSTEE 2.00 X 0 0 0 FRANK STEWART TRUSTEE 2.00 X 0 0 0 MIKE NAGOWSKI TRUSTEE 2.00 X X 0 0 0 DAN WEATHERLY PRESIDENT 40.00 X 0 0 0 KEVIN JACKSON PRESIDENT 40.00 X 0 0 0 MARGARET ALEXANDER CNO 40.00 X 0 0 0 MIKE JONES VP CENTRAL HOSPITAL SUPPORT SERVICES 40.00 X 165276 0 24364 MICHAEL ZICH PHYSICIAN 40.00 X 328133 0 31951 BRAD BUTLER PHYSICIAN 40.00 X 218195 0 30828 BEVERLY YEARWOOD PHYSICIAN 40.00 X 207360 0 21162 RAID ABO-KAMIL PHYSICIAN 40.00 X 198800 0 28642 ASIF ZIA PHYSICIAN 40.00 X 191372 0 30344 VICKI ALLEN CNO/VP (FORMER) 40.00 X 141344 0 0 SONDRA DAVIS VP HR (FORMER) 40.00 X 155958 0 0 1606438 0 167291 30 1 1 0 TRINITY HEALTHCARE STAFFING PO BOX 531741 ATLANTA GA 303531741 CONTRACT LABOR 988479 WYRICK ROBBINS YATES & PONTO 4101 LAKE BOONE TRAIL SUITE 300 RALEIGH NC 27607 LEGAL 896106 KPMG LLP 5 CHESTNUT RIDGE ROAD MONTVALE NJ 07645 PATIENT BILLING 711000 DIVERSIFIED CLINICAL SERVICES PO BOX 551187 JACKSONVILLE FL 32255 WOUND CARE 653261 CAPE FEAR VALLEY 1638 OWEN DRIVE FAYETTEVILLE NC 28304 MANAGEMENT 350000 25 83719 83719 NET PATIENT SERVICE REVENUE 621400 95589546 95589546 5257225 5257225 100846771 33720 33720 326047 0 326047 326047 326047 CAFETERIA SALES 900099 426247 426247 426247 101716504 101172818 0 459967 566304 481358 84946 44142805 37521384 6621421 6312707 5365801 946906 2892800 2458880 433920 1141990 1141990 842901 842901 100000 100000 5678 5678 307995 307995 6841 6841 1642118 1642118 2193179 2193179 322198 322198 4204604 4204604 7649172 7649172 782202 782202 CONTRACT SERVICES/ CONT 8666033 8666033 MEDICAL SUPPLIES 6847218 6847218 MAINT. & REPAIRS 4098000 4098000 DRUGS 2591483 2591483 4294776 1851992 2442784 99611004 86990458 12620546 0 2255949 3073991 10996264 12576883 3473 -7307 2019048 1849975 838549 478294 145321859 70639397 81764378 74682462 4065353 4379741 81138410 5115064 183081424 102149103 32676412 24519337 830102 20965000 20330000 71615946 69347024 86247164 7613064 212334624 121809425 X -33789789 -24040063 4536589 4379741 -29253200 -19660322 183081424 102149103 X 2105500 1171 7486207 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5678 5678 0 PART II-B, LINE 1: HARNETT HEALTH PAID $35,247 TO NCHA FOR MEMBERSHIP FEES IN JUNE 2016. NCHA DETERMINED 16.11% OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES, WHICH CAUSED AN INDIRECT LOBBYING EXPENSE OF $5,678 FOR HARNETT HEALTH. 1189620 1189620 91759627 29325042 62434585 51713715 40821402 10892313 658897 492953 165944 74682462 PREPAID PENSION COSTS 561148 UNAMORTIZED LOSS ON EXTINGUISHMENT OF DEBT 1643082 DEFERRED INFLOWS 2910834 5115064 ESTIMATED THIRD PARTY SETTLEMENTS 7197577 DUE TO HHS FOUNDATION 64797 DEFERRED INFLOWS OF RESOURCES (PENSION RELATED) 350690 7613064 X PART X, LINE 2: THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. 1 1 X 1 X 1 X 1 1 1 0 1 1 5476632 5476632 0.05500 19276792 28076538 -8799746 0.00000 168817 0 168817 0.00170 24922241 28076538 -3154297 0.05670 15339 15339 0.00020 15339 15339 0.00020 24937580 28076538 -3138958 0.05690 1 13503915 4051175 38794276 38188471 605805 X 1 1 2 1 BETSY JOHNSON REGIONAL HOSPITAL 800 TILGHMAN DRIVE DUNN NC 28835 X X X DISPROPORTIONATE SHARE HOSPITAL 2 CENTRAL HARNETT HOSPITAL 215 BRIGHTWATER DRIVE LILLINGTON NC 27546 X X X BETSY JOHNSON REGIONAL HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X WWW.MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ X X 1 15 1 WWW.MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ 1 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES/ X X 0 0 X X X X 1 X 0 0 CENTRAL HARNETT HOSPITAL 2 0 0 1 X X X X X X X X X 15 1 1 1 1 X WWW.MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ X 1 15 0 1 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES/ X X 0 0 X X X X 1 X 0 0 BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 5: IN 2015, HARNETT HEALTH SYSTEM, HARNETT COUNTY HEALTH DEPARTMENT, CAPE FEAR VALLEY HEALTH SYSTEM, THE HEALTHY HARNETT COALITION, AND THE DEPARTMENT OF PUBLIC HEALTH AT CAMPBELL UNIVERSITY BEGAN DISCUSSIONS AIMED AT DEVELOPING A SHARED CHNA. ALTHOUGH EACH ENTITY HAD A DIFFERENT TIMETABLE FOR ITS "NEXT" ASSESSMENT, SCHEDULES WERE ADJUSTED WITH THE GOAL OF COMPLETING A JOINT ASSESSMENT, DURING THE 2016 CALENDAR YEAR, THAT COULD THEN BE SIMULTANEOUSLY USED BY ALL PARTNERS AND THE COMMUNITY. A WORK GROUP WAS FORMED WITH REPRESENTATIVES OF HARNETT HEALTH, HARNETT COUNTY PUBLIC HEALTH DEPARTMENT, CAMPBELL UNIVERSITY, AND CAPE FEAR VALLEY HEALTH SYSTEM TO UPDATE AND EXTEND THE AVAILABLE DATABASE AND SURVEY, ANALYZE FINDINGS, AND PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR HARNETT COUNTY. THE CHNA PROCESS ALSO INVOLVED OTHER PARTNER ORGANIZATION REPRESENTATIVES, INCLUDING PROJECT ACCESS, UNITED WAY, COOPERATIVE EXTENSION, LOCAL CHURCHES, AND OTHER INTERESTED PARTNERS IN THE SERVICE AREA. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 5: IN 2015, HARNETT HEALTH SYSTEM, HARNETT COUNTY HEALTH DEPARTMENT, CAPE FEAR VALLEY HEALTH SYSTEM, THE HEALTHY HARNETT COALITION, AND THE DEPARTMENT OF PUBLIC HEALTH AT CAMPBELL UNIVERSITY BEGAN DISCUSSIONS AIMED AT DEVELOPING A SHARED CHNA. ALTHOUGH EACH ENTITY HAD A DIFFERENT TIMETABLE FOR ITS "NEXT" ASSESSMENT, SCHEDULES WERE ADJUSTED WITH THE GOAL OF COMPLETING A JOINT ASSESSMENT, DURING THE 2016 CALENDAR YEAR, THAT COULD THEN BE SIMULTANEOUSLY USED BY ALL PARTNERS AND THE COMMUNITY. A WORK GROUP WAS FORMED WITH REPRESENTATIVES OF HARNETT HEALTH, HARNETT COUNTY PUBLIC HEALTH DEPARTMENT, CAMPBELL UNIVERSITY, AND CAPE FEAR VALLEY HEALTH SYSTEM TO UPDATE AND EXTEND THE AVAILABLE DATABASE AND SURVEY, ANALYZE FINDINGS, AND PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR HARNETT COUNTY. THE CHNA PROCESS ALSO INVOLVED OTHER PARTNER ORGANIZATION REPRESENTATIVES, INCLUDING PROJECT ACCESS, UNITED WAY, COOPERATIVE EXTENSION, LOCAL CHURCHES, AND OTHER INTERESTED PARTNERS IN THE SERVICE AREA. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 6A: CENTRAL HARNETT HOSPITAL, BETSY JOHNSON REGIONAL HOSPITAL, AND CAPE FEAR VALLEY HEALTH SYSTEM WORKED TOGETHER TO CONDUCT THE CHNA. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 6A: CENTRAL HARNETT HOSPITAL, BETSY JOHNSON REGIONAL HOSPITAL, AND CAPE FEAR VALLEY HEALTH SYSTEM WORKED TOGETHER TO CONDUCT THE CHNA. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 6B: HARNETT COUNTY HEALTH DEPARTMENTCAMPBELL SCHOOL OF PUBLIC HEALTH CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 6B: HARNETT COUNTY HEALTH DEPARTMENTCAMPBELL SCHOOL OF PUBLIC HEALTH BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL MADE THE CHNA AVAILABLE IN PRINT AT THE HEALTH DEPARTMENT. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 11: SEE IMPLEMENTATION PLAN ATTACHED. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 11: SEE IMPLEMENTATION PLAN ATTACHED. 6 1 - HARNETT HEALTH ANGIER MEDICAL SERVICES 185 RAWLS ROAD ANGIER NC 27501 PHYSICIAN PRACTICE 2 - HARNETT HEALTH LILLINGTON MEDICAL SERVIC 716 10TH STREET LILLINGTON NC 27546 PHYSICIAN PRACTICE 3 - HARNETT HEALTH DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE 700 DUNN NC 28335 PHYSICIAN PRACTICE 4 - HARNETT HEALTH HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE 5 - HARNETT HEALTH PREMIER PEDIATRICS 802 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE 6 - COATS MEDICAL SERVICES 25 N JOHNSON STREET COATS NC 27521 PHYSICIAN PRACTICE PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT IS PRESENTED AT GROSS CHARGES. PER THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS, THE ORGANIZATION ESTIMATES THAT SOME PORTION OF ITS BAD DEBT MAY QUALIFY FOR FINANCIAL ASSISTANCE DUE TO THE FACT THAT THE HOSPITAL DOES NOT HAVE 24 HOUR COVERAGE IN THE ED FOR FINANCIAL ASSISTANCE. ALSO, SOME PATIENTS TREATED REFUSE TO MEET AND DISCUSS FINANCIAL ASSISTANCE OPTIONS. THE ANDI REPORT WAS USED TO CALCULATE THE AMOUNT OF BAD DEBT THAT QUALIFIES FOR FINANCIAL ASSISTANCE. ANOTHER FACTOR CONTRIBUTING TO THE ESTIMATE OF BAD DEBT THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE IS THAT WE DO NOT VISIT OUR INSURED INPATIENTS THAT MAY HAVE HIGH DEDUCTIBLES OR CO-INSURANCES. IN FUTURE YEARS, THE ORGANIZATION PLANS TO IMPROVE CONSULTATION SESSIONS TO INLCUDE INSURED PATIENTS WITH POTENTIALLY HIGH DEDUCTIBLES OR CO-PAYMENTS. PART III, LINE 8: THE ORGANIZATION USES ITS ANDI REPORT TO COMPUTE PART III, LINES 5 AND 6. PART III, LINE 9B: ALL PATIENTS RECEIVE LETTERS AND/OR STATEMENTS REGARDING THEIR ACCOUNTS AND THEY ARE GIVEN 120 DAYS FROM THE BILL DATE TO MAKE SATISFACTORY PAYMENT ARRANGEMENTS OR TO APPLY FOR FINANCIAL ASSISTANCE BEFORE THE ACCOUNT GOES TO BAD DEBT STATUS. PATIENTS WHO APPLY FOR FINANCIAL ASSISTANCE MUST COMPLY WITH THE REQUIREMENTS OF THE APPLICATION TO AVOID THE ACCOUNT GOING INTO BAD DEBT STATUS. PATIENTS APPLYING FOR AID ARE PLACED IN A HOLD STATUS BY THE PALS TEAM TO AVOID COLLECTIONS. PATIENTS WHO HAVE MADE AN EFFORT TO COMPLETE AN APPLICATION OR WHO MAY NOT HAVE HAD AN OPPORTUNITY TO DISCUSS THEIR FINANCIAL SITUATION AND THEIR ACCOUNT GOES TO A COLLECTION STATUS ARE EVALUATED ON A CASE BY CASE BASIS TO DETERMINE IF THE ACCOUNT IS REMOVED FROM COLLECTIONS AND FINANCIAL ASSISTANCE IS PROVIDED. PART VI, LINE 2: BASED ON THE DATA FROM THE HARNETT COUNTY NEEDS ASSESSMENT WE REVIEW WHAT KEY ISSUES ARE ALIGNED WITH OUR MISSION. FROM THERE, WE DEVELOP PLANS ON WHICH STRATEGIES WILL HAVE THE MOST IMPACT ON OUR COMMUNITY. PART VI, LINE 3: THE HOSPITAL SYSTEM OFFERS FINANCIAL ASSISTANCE TO ANYONE BASED ON NEED AND ABILITY TO PAY. OUR PATIENT ACCOUNT LIAISONS WILL ASSIST PATIENTS IN APPLYING FOR FINANCIAL ASSISTANCE AND ANY OTHER FUNDING SOURCES THAT MAY BE AVAILABLE. PRE-SCREEING MAYBE CONDUCTED AT PRE-ADMISSION OR POINT OF SERVICE FOR ALL UNISURED OR UNDERINSURED PATIENTS THAT CAN NOT MEET THE DEPOSIT REQUIREMENTS; HOWEVER, ALL EMERGENT SERVICES ARE PROVIDED WITHOUT REGARD TO THE ABLITY TO PAY OR NOT. PART VI, LINE 4: HARNETT HEALTH SYSTEM, INC. IS LOCATED IN THE SOUTHEASTERN/MIDDLE SECTION OF HARNETT COUNTY NORTH CAROLINA. AS A RURAL HOSPITAL, WE ARE A KEY COMPONENT OF OUR STATE'S HEALTH CARE SAFETY NET BY TREATING EVERYONE WHO COMES THROUGH OUR DOORS. OUR PATIENT VOLUMES EXEMPLIFY OUR COMMITTMENT: % OF ADMISSIONS, MEDICARE 48.8%,MEDICAID 28.6%,MANAGED CARE 11%, SELF PAY 8%, TRICARE AND ALL OTHER 3.6%. THE HOSPITAL'S SERVICE AREA INCLUDED HARNETT AND A PORTION OF THREE NEIGHBORING COUNTIES, CUMBERLAND, JOHNSTON AND SAMPSON. AGRICULTURE AND CONSTRUCTION ARE THE LEADING INDUSTRIES OF OUR ECONOMIC STRUCTURE. THE TOP LARGEST EMPLOYER IN HARNETT COUNTY IS THE PUBLIC SCHOOL SYSTEM. PART VI, LINE 5: THE ROLE OF HARNETT HEALTH SYSTEM PLAYS IN THE COMMUNITY IS TO CARE FOR AND HEAL THE SICK AND INJURED, BUT EQUALLY IMPORTANT IS EDUCATING OUR COMMUNITY THE IMPORTANCE OF GOOD HEALTH AND WAYS TO IMPROVE THEIR LIFESTYLES. WE DEFINE OUR OBLIGATION BY HOLDING COMMUNITY EDUCATION AND WELLNESS CLASSES, PARTICIPATING IN ANNUAL COMMUNITY EVENTS, AND EDUCATING HIGH SCHOOL STUDENT ON THE MANY AREA OF EMPLOYMENT IN THE HEALTHCARE FIELD.WITH THE FEDERAL FUNDING AND STATE CUTS IN REIMBURSEMENT NO SURPLUS OF FUNDS TO PROVIDE MANY OF THE EXTRA ACTIVITIES THAT THE SYSTEM WOULD LIKE TO BE ABLE TO PROVIDE TO THE COMMUNITY. WE HAVE STILL MAINTAINED A COUPLE OF OUR COMMUNITY OUTREACH PROGRAM, "CHAMP", PROGRAM WHICH IS HOUSED IN THE ELEMENTARY SCHOOLS THROUGHOUT THE COUNTY, ASSIST CHILDREN WITH ASTHMA WHICH HAS CUT DOWN ON ABSENTEEISM. THE TEENS AS PARENTS PROGRAM, WORKS WITH TEENS WHO ARE PREGANANT OR HAVE HAD BABIES TO PROVIDE ADDITIONAL SUPPORT BY THE MEANS OF HOME BASED VISITS AND SUPPORT GROUP MEETINGS. EMPHASIS IS TO HAVE THE TEEN RETURN TO THE EDUCATION ARENA AND TO CONTINUE TO PROVIDE PARENTING SUPPORT AND HAVE HEALTHY BABIES. SOME OF OUR STAFF SERVES OR HAS SERVED ON LOCAL BOARDS WITHIN THE COMMUNITES INCLUDING THE NC COOPERATIVE EXTENSION ADVISORY BOARD, TEENS AS PARENTS EXECUTIVE AND ADVISORY BOARD,UNITED WAY BOARD AND VARIOUS OTHER CIVIC BOARDS. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NC X 0 1 X X 0 0 0 0 0 0 0 0 0 MIKE JONES VP CENTRAL HOSPITAL SUPPORT SERVICES 165276 0 0 0 0 0 3494 0 20870 0 189640 0 0 0 MICHAEL ZICH PHYSICIAN 325133 0 0 0 3000 0 6500 0 25451 0 360084 0 0 0 BRAD BUTLER PHYSICIAN 187713 0 0 0 30482 0 4154 0 26674 0 249023 0 0 0 BEVERLY YEARWOOD PHYSICIAN 204360 0 0 0 3000 0 3434 0 17728 0 228522 0 0 0 RAID ABO-KAMIL PHYSICIAN 198800 0 0 0 0 0 2168 0 26474 0 227442 0 0 0 ASIF ZIA PHYSICIAN 190172 0 0 0 1200 0 4063 0 26281 0 221716 0 0 0 VICKI ALLEN CNO/VP (FORMER) 141344 0 0 0 0 0 0 0 0 0 141344 0 0 0 SONDRA DAVIS VP HR (FORMER) 155958 0 0 0 0 0 0 0 0 0 155958 0 0 0 FORM 990, PART III, LINE 2 ADDED PULMONARY REHAB FORM 990, PART VI, SECTION A, LINE 2 ALLISON TAYLOR WAS A DIRECTOR AND HER SISTER, HEATHER WILLIAMS, WAS ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 ON NOVEMBER 3, 2014, HARNETT HEALTH SYSTEM ENTERED INTO AN AGREEMENT WITH CUMBERLAND COUNTY HOSPITAL SYSTEM DBA CAPE FEAR VALLEY HEALTH SYSTEM TO PROVIDE DAY-TO-DAY MANAGEMENT SERVICES, PRIMARILY A CHIEF EXECUTIVE OFFICER. THE AGREEMENT REQUIRES THE SYSTEM TO REIMBURSE CFVH FOR THE SALARY AND BENEFITS ASSOCIATED WITH THE PRESIDENT POSITION AND ANY OTHER POSITION APPROVED IN THE CONTRACT. IN ADDITION, CAPE FEAR VALLEY HEALTH SYSTEM RECEIVES A MANAGEMENT FEE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES OF THE ORGANIZATION IS COMPRISED OF THIRTEEN RESIDENTS OF HARNETT COUNTY, NC AND THE APPOINTED TRUSTEES SHALL SERVE A STAGGERED TERM FOR 1 TO 3 YEARS. SEVEN TRUSTEES OF THE ORGANIZATION ARE APPOINTED BY THE HARNETT COUNTY BOARD OF COMMISSIONERS, AND SHALL, AT ALL TIMES, INCLUDE AT LEAST ONE RESIDENT OF EACH OF THE FIVE COMMISSIONERS' DISTRICTS AND TWO OTHER PERSONS RESIDING IN HARNETT COUNTY. THE REMAINING SIX TRUSTEES ARE APPOINTED BY THE ORGANIZATION'S BOARD OF TRUSTEES AT ITS ANNUAL MEETING FROM NOMINEES THAT MEET RESIDENCY AND AGE REQUIREMENTS AS DEFINED IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO SUBMISSION, THE 990 WILL BE MADE AVAILABLE UPON REQUEST FOR BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE LEADERSHIP OF THE BOARD OF TRUSTEES (THROUGHOUT THE YEAR IF NEEDED) AND ADMINISTERED TO ALL VOTING BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE SALARIES ARE DETERMINED BY A MARKET ANALYSIS INVOLVING COMPARABILITY DATA, INDUSTRY STANDARDS, AND LOCAL ECONOMICS. THE CEO'S SALARY IS A CONDITION OF THE MANAGEMENT AGREEMENT BETWEEN THE BOARD OF DIRECTORS AND WAKEMED (SEE THE RESPONSE TO LINE 3 ABOVE). THE BOARD HAS INDIRECT APPROVAL OVER THE COMPENSATION PAID TO THE CEO THROUGH THIS AGREEMENT, AND HAS APPROVAL OVER ANY ADDITIONAL AMOUNTS AND INCREASES. WAKEMED PREPARES A COMPENSATION STUDY FOR OFFICERS AND KEY EMPLOYEES EXCLUDING THE CEO AND MAKES THE RECOMMENDATIONS TO THE CEO OF HARNETT HEALTH SYSTEM. THOSE RECOMMENDATIONS, INCLUDING ANY AMOUNTS ALLOCATED FOR RAISES AND INCENTIVES, ARE INCLUDED IN THE ANNUAL BUDGET PROCESS WHICH IS APPROVED BY THE FINANCE COMMITIEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART XI, LINE 9: FORGIVENESS OF DEBT 7,486,207. FORM 990, PART XII, LINE 2C: THE ORGANIZATOIN HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART XI, LINES 15 AND 25 - OTHER ASSETS AND OTHER LIABILITIES FOR THE PAST FEW YEARS, THE ORGANIZATION HAS SHOWN AN INTERCOMPANY DUE TO AND DUE FROM FOR THE TWO HOSPITAL FACILTIES THAT COMPRISE THE ORGANIZATION. THE ORGANIZATION BELIEVES THAT, AS A RESULT OF THE INCLUSION OF THESE INTERCOMPANY ASSETS/LIABILITIES, THE BALANCE SHEET FOR THE ORGANIZATION HAS SHOWN AN INFLATED TOTAL FOR ASSETS AND LIABILITIES. BEGINNING WITH THIS TAX RETURN, THE ORGANIZATION HAS DETERMINED THAT REMOVING THOSE INTERCOMPANY ENTRIES BETWEEN THE TWO HOSPITALS WOULD MORE PROPERLY REFECT THE TRUE BALANCE SHEET OF THE ORGANIZATION. ANGIER MEDICAL SERVICES LLC 185 RAWLS ROAD ANGIER NC 27501 270906936 PHYSICIAN PRACTICE NC 2225888 782102 N/A LILLINGTON MEDICAL SERVICES LLC 716 S 10TH STREET LILLINGTON NC 27546 272944176 PHYSICIAN PRACTICE NC 1494808 105847 N/A HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 273320275 PHYSICIAN PRACTICE NC 1809584 40841 N/A DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE DUNN NC 28335 273320115 PHYSICIAN PRACTICE NC 2522960 157528 N/A COATS MEDICAL SERVICES LLC 25 N JOHNSON STREET COATS NC 27521 462540799 PHYSICIAN PRACTICE NC 1409789 204811 N/A BETSY JOHNSON MEMORIAL HOSPITAL FOUNDATION 800 TILGHMAN DRIVE DUNN NC 28334 201929953 FUNDRAISING NC 501(C)(3) LINE 7 HARNETT HEALTH SYSTEM INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0