2014-07-31T10:39:08-05:00 2013-09-30 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2012-10-01 560603898 HARNETT HEALTH SYSTEM INC HARN 9108927161 PO BOX 1707 DUNN NC 28335 KENNETH BRYAN 9108927161 2014-07-30 1 JOHN NORMAN P01506766 7049985200 2012 2015-11-30 17:44:51Z BETSY JOHNSON REGIONAL HOSPITAL KENNETH BRYAN PO BOX 1707 DUNN NC 28335 84740702 0 X WWW.BJRH.ORG X 1937 NC PROVIDING MEDICAL CARE FOR PATIENTS OF THE HOSPITAL 13 13 1097 71 0 0 175608 90004 103096912 83707336 313774 -5904 846727 949266 104433021 84740702 1200 0 0 0 43381919 57999564 0 0 0 62671954 51115528 106055073 109115092 -1622052 -24374390 117102861 131241890 80769174 119262535 36333687 11979355 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. 0 0 94123186 84656602 THE HOSPITAL CELEBRATED ITS 75TH BIRTHDAY WHILE SERVING THE HARNETT COUNTY POPULATION AND REACHING INTO THE COUNTIES OF SAMPSON, JOHNSTON AND CUMBERLAND. THE HOSPITAL SERVED 27,167 INPATIENTS FOR FY12, WITH 675 INFANT DELIVERIES. THE HOSPITAL ALSO HAD 44,094 EMERGENCY VISITS AND 16,286 PHYSICAL THERAPY-OCCUPATIONAL THERAPY-SPEECH THERAPY VISITS. ALL OTHER OUTPATIENT VISITS TOTALED 26,222. CARDIACREHAB TREATED 121 PATIENTS AND SOME OF THE OUTCOMES WERE THE FOLLOWING - FERRANS AND POWERS SURVEY, OVERALL QUALITY OF UFE IMPROVED 2 POINTS (GOAL IS 2-3 POINT INCREASE; HEALTH AND FUNCTIONING SUB-SCORE IMPROVED 4 POINTS (GOAL IS 2-3 POINT INCREASE); EDUCATIONAL ASSESSMENT SCORE IMPROVED 30%. MEDICATION MANAGEMENT OF HARNETT COUNTY (BETSY JOHNSON REGIONAL HOSPITAL) ENCOUNTERED 154 NEW PATIENTS WITH A TOTAL OF 615 ACTIVE PARTICIPANTS IN THE PROGRAM. WE RECEIVED 1,968 MEDICATIONS WITH A TOTAL VALUE OF $1,029,689. OUTREACH PROGRAMS THE HOSPITAL PARTICIPATES IN ARE (1) THE ASTHMA MANAGEMENT PROGRAM, WHICH IS LOCATED IN THE COUNTY'S SCHOOLS (SAW 134 CHILDREN).(2) 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 32 TEENS. THE REPEAT PREGNANCY RATE FOR TAP PARTICIPATES IS 0%, COMPARED TO THE COUNTY RATE OF 179%. THE TAP PROGRAM PARTICIPANTS RECEIVED 642 HOURS OF GROUP INSTRUCTION INCLUDING THE FOLLOWING TOPICS: 22 HOURS ACADEMIC SUPPORT, 45 HOURS OF COLLEGE PREPAREDNESS, 72 HOURS OF COMMUNICATION SKILLS, 300 HOURS OF FAMILY NUTRITION AND PHYSICAL ACTIVITY, 48 HOURS OF INDOOR SAFETY, AND 60 HOURS OF INFANT/TODDLER PLAY. (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 103 PARTICIPATES IN TWO PRESENTATIONS GIVEN BY THE HARNETT HEALTH CARDIAC REHAB DEPARTMENT AS WELL AS THE SUPPORTING PHYSICIAN. (4) WE PARTICIPATED IN THE HARNETT COUNTY SENIOR HEALTH FAIR AND WE ALSO HOSTED MULTIPLE FREE DIABETES SCREENINGS AND PARTICIPANTS RECEIVED FREE EDUCATIONAL BROCHURES AND INFORMATION. (5) WE PARTICIPATE IN PROJECT ACCESS OF JOHNSON/HARNETT COUNTY WHICH IS A PHYSICIAN LED VOLUNTEER INITIATIVE THAT GIVES LOW INCOME, 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 158 PATIENTS FOR THE LAST FISCAL YEAR. 94123186 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 90 0 1 1097 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 1 0 1 1 0 0 0 1 1 1 1 0 1 1 0 X DEBORAH WHITTINGTON 9108927161 800 TILGHMAN DRIVE DUNN NC 28334 DR RON MADDOX PHARM D 4.00 X X 0 0 0 CORNELIA STEWART 2.00 X X 0 0 0 ERNEST ALPHIN 2.00 X X 0 0 0 TEDDY BYRD 2.00 X X 0 0 0 WALTER T WEEKS JR 2.00 X 0 0 0 JIM MCCORMICK 2.00 X 0 0 0 BARBARA BETHEA MD 2.00 X 0 0 0 WILEY POPE 2.00 X 0 0 0 HEATHER H WILLIAMS 2.00 X 0 0 0 H WEST LAWSON MD 2.00 X 0 0 0 DEWEY BLALOCK 2.00 X 0 0 0 BARBARA MCKOY 2.00 X 0 0 0 FRANK STEWART 2.00 X 0 0 0 KENNETH BRYAN 40.00 X 436621 0 80105 ROBIN NICHOLS 40.00 X 124978 0 24760 VICKI ALLEN 40.00 X 191133 0 12980 WALLACE HORNE MD 40.00 X 274660 0 8286 SONDRA DAVIS 40.00 X 151417 0 24900 MIKE JONES 40.00 X 157251 0 17420 MICHAEL ZICH 40.00 X 284428 0 42068 BEVERLY YEARWOOD 40.00 X 204023 0 18808 BRAD BUTLER 40.00 X 187083 0 25410 VIDETTE COOPER 40.00 X 181995 0 14672 ASIF ZIA 40.00 X 173119 0 35408 2366708 0 304817 36 0 1 0 BRASFIELD & GORRIE LLC 3700 GLENWOOD AVE SUITE 300 RALEIGH NC 27612 ENGINEERING & GEN CONTRACTING 6089305 HMP OF HARNETT COUNTY 4535 DRESSLER RD NW CANTON OH 44718 PHYSICIANS 1225507 AMSOL PO BOX 6633 HIGH POINT NC 27262 ANESTHIOLOGY 935119 WAKEMED 3000 NEW BERN AVE RALEIGH NC 27620 MANAGED SERVICES 719935 TRINITY HEALTHCARE PO BOX 823473 PHILADELPHIA PA 19182 STAFFING 696140 38 36542 53462 90004 NET PATIENT SERVICE REVENUE 621400 80153454 80153454 3553882 3553882 83707336 -5904 -5904 579164 0 579164 579164 579164 CAFETERIA SALES 900099 370102 370102 370102 84740702 84656602 0 -5904 1794000 1524900 269100 47677193 40551838 7125355 5196417 4417018 779399 3331954 2832161 499793 719935 719935 188312 188312 68391 68391 437113 437113 1125816 1125816 1915690 1915690 1664383 1664383 198619 198619 2258937 2258937 55453 55453 7054477 7054477 932570 932570 OTHER SUPPLIES 13302798 13302798 CONTRACTED SERVICES 9326836 9326836 OTHER EXPENSES 8163287 8163287 CONTRACT LABOR 3702911 3702911 109115092 94123186 14991906 0 3630 2282814 7703260 18435194 21085142 38897 22066 2392142 3048290 1005040 563422 148632975 51625080 84447769 97007895 964456 1131189 2112473 6101072 117102861 131241890 12444679 23952402 764814 848505 18975918 65933045 72016792 1626636 3468918 80769174 119262535 X 35369231 10848166 964456 1131189 36333687 11979355 117102861 131241890 -24374390 20058 0 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 13993 13993 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL PAID ANNUAL DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE NORTH CAROLINA HOSPITAL ASSOCIATION. THOSE ORGANIZATIONS ESTIMATED THAT $13,993 OF THE DUES WAS ATTRIBUTABLE TO LOBBYING. 1189620 1189620 91679128 20206113 71473015 654705 417400 237305 54013444 31001567 23011877 1096078 1096078 97007895 ESTIMATED THIRD PARTY SETTLEMENTS 3468918 3468918 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2962952 2962952 0.02720 23142616 20126067 3016549 0.02760 26105568 20126067 5979501 0.05480 8989 8989 0.00010 42544 42544 0.00040 11156 9536 1620 0.00000 2660 2660 0.00000 65349 9536 55813 0.00050 26170917 20135603 6035314 0.05530 87771 87771 0.00080 87771 87771 0.00080 1 48767398 14350214 39754403 44779491 -5025088 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 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 0 CENTRAL HARNETT HOSPITAL 2 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 0 5 HARNETT HEALTH ANGIER MEDICAL SERVICES

185 RAWLS ROAD ANGIER NC 27501

PHYSICIAN PRACTICE HARNETT HEALTH LILLINGTON MEDICAL SERVIC

716 10TH STREET LILLINGTON NC 27546

PHYSICIAN PRACTICE HARNETT HEALTH DUNN MEDICAL SERVICES

700 TILGHMAN DRIVE 700 DUNN NC 28335

PHYSICIAN PRACTICE HARNETT HEALTH HARNETT OBGYN

608 TILGHMAN DRIVE DUNN NC 28335

PHYSICIAN PRACTICE HARNETT HEALTH PREMIER PEDIATRICS

802 TILGHMAN DRIVE DUNN NC 28335

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. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 3: IN 2012, FIRST CHOICE COMMUNITY HEALTH CENTERS (FCCHC), HARNETT HEALTH, AND THE HARNETT COUNTY PUBLIC HEALTH DEPARTMENT (HCPHD) 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 2013, THAT COULD THEN BE SIMULTANEOUSLY USED BY ALL PARTNERS AND THE COMMUNITY. AN INVITATION TO PARTICIPATE IN THE CHNA PROCESS WAS EXTENDED TO CAMPBELL UNIVERSITY, GIVEN ITS ROLES IN THE COMMUNITY, ITS EXISTING PROGRAMS, AND THE OPENING OF ITS NEW MEDICAL SCHOOL IN AUGUST OF 2013. CAMPBELL UNIVERSITY ENTHUSIASTICALLY AGREED AND CAMPBELL'S DEPARTMENT OF PUBLIC HEALTH REPRESENTED THE UNIVERSITY.A WORK GROUP WAS FORMED WITH REPRESENTATIVES OF HARNETT HEALTH, HARNETT COUNTY PUBLIC HEALTH DEPARTMENT, CAMPBELL UNIVERSITY, AND FIRST CHOICE COMMUNITY HEALTH CENTERS TO UPDATE AND EXTEND THE AVAILABLE DATABASE AND SURVEY, ANALYZE FINDINGS, AND PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR HARNETT COUNTY. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 3: 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. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 5C: THE HOSPITAL MADE THE CHNA AVAILABLE IN PRINT AT THE HEALTH DEPARTMENT. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 7: BECAUSE THE HEALTH ASSESSMENT IS RELATIVELY NEW, WE HAVE BEEN WORKING ON STRATEGIES TO ADDRESS THE NEEDS ASSESSED. ONE NEED THAT WE HAVE ADDRESSED IS CHILDHOOD OBESITY BY IMPLEMENTING A CHILDHOOD OBESITY PROGRAM. WE WILL CONTINUE TO LOOK FOR WAYS TO ADDRESS THE OTHER NEEDS DETERMINED IN THE CHNA. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 7: BECAUSE THE HEALTH ASSESSMENT IS RELATIVELY NEW, WE HAVE BEEN WORKING ON STRATEGIES TO ADDRESS THE NEEDS ASSESSED. ONE NEED THAT WE HAVE ADDRESSED IS CHILDHOOD OBESITY BY IMPLEMENTING A CHILDHOOD OBESITY PROGRAM. WE WILL CONTINUE TO LOOK FOR WAYS TO ADDRESS THE OTHER NEEDS DETERMINED IN THE CHNA. 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. REPORTS FILED WITH STATES PART VI, LINE 7 NC X 0 1 X X 0 0 0 0 0 0 0 0 0 KENNETH BRYAN 336646 0 84883 0 15092 0 22500 0 57605 0 516726 0 0 0 VICKI ALLEN 176764 0 14369 0 0 0 3826 0 9154 0 204113 0 0 0 WALLACE HORNE MD 246620 0 28040 0 0 0 5366 0 2920 0 282946 0 0 0 SONDRA DAVIS 136900 0 14517 0 0 0 3979 0 20921 0 176317 0 0 0 MIKE JONES 144774 0 12477 0 0 0 2974 0 14446 0 174671 0 0 0 MICHAEL ZICH 278428 0 6000 0 0 0 5373 0 36695 0 326496 0 0 0 BEVERLY YEARWOOD 199523 0 4500 0 0 0 5226 0 13582 0 222831 0 0 0 BRAD BUTLER 187083 0 0 0 0 0 4843 0 20567 0 212493 0 0 0 VIDETTE COOPER 181995 0 0 0 0 0 1779 0 12893 0 196667 0 0 0 ASIF ZIA 173119 0 0 0 0 0 1096 0 34312 0 208527 0 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 2: INVOICE VALUE $0-25,000 REQUIRES DIRECTOR SIGNATURE, $25,000 AND GREATER REQUIRES DIRECTOR SIGNATURE AND A COSIGNATURE FROM A VP. PURCHASES OF PHARMACEUTICALS AND MEDICAL SUPPLIES HELD IN INVENTORY MAY BE PURCHASED UNDER THE SIGNATURE OF THE DEPT DIRECTOR WITHOUT REGARD TO THE ABOVE MENTIONED LIMITS. SUPPLEMENTAL INFORMATION PART III PART I, LINE 5 THE ORGANIZATION HAS A BONUS INCENTIVE PLAN THAT CERTAIN EMPLOYEES ARE ELIGIBLE FOR. THE PLAN IS BASED ON A COMBINATION OF PATIENT SATISFACTION, MEETING THE BUDGET, AND SAFETY REPORTS. THE BOARD OF DIRECTORS APPROVES HOW MUCH CAN BE PAID OUT IN TOTAL EACH YEAR. SUPPLEMENTAL INFORMATION PART III PART III -- COMPENSATION FROM UNRELATED ORGANIZATIONS KENNETY BRYAN, THE HOSPITAL PRESIDENT AND CEO, WAS COMPENSATED FOR HIS POSITION BY WAKEMED, AN UNRELATED ORGANIZATION. COMPENSATION FOR WAKEMED EMPLOYEES IS EVALUATED BY SULLIVAN & COTTER, AN EXECUTIVE AND PHYSICIAN COMPENSATION BENEFIT CONSULTING GROUP. HEATHER WILLIAMS BOARD MEMBER 113880 EMPLOYMENT COMPENSATION: ALLISON TAYLOR IS FAMILY MEMBER OF BOARD MEMBER HEATHER WILLIAMS. 0 KENNETH BRYAN CEO 238294 DISCOUNTS AND REBATES: PAYMENTS RECEIVED FROM VHA INC, WHERE KENNETH BRYAN IS ALSON ON THE BOARD. 0 KENNETH BRYAN CEO 9573791 PURCHASE OF SUPPLIES: PURCHASES OF MEDICAL SUPPLIES THROUGH VHA INC, WHERE KENNETH BRYAN IS ALSO ON THE BOARD. 0 FORM 990, PART VI, SECTION A, LINE 3 ON NOVEMBER 8, 2005, HARNETT HEALTH SYSTEM ENTERED INTO AN AGREEMENT WITH WAKEMED TO PROVIDE DAY-TO-DAY MANAGEMENT SERVICES, PRIMARILY A CHIEF EXECUTIVE OFFICER. THE AGREEMENT REQUIRES THE SYSTEM TO REIMBURSE WAKEMED FOR THE SALARY AND BENEFITS ASSOCIATED WITH THE CEO POSITION. IN ADDITION, WAKEMED 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 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED IN DETAIL BY THE FINANCE COMMITTEE AND THE EXECUTIVE COMMITTEE OF THE BOARD, THEN PRESENTED TO THE FULL BOARD FOR APPROVAL AT A SCHEDULED MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CONCLICT 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. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ANGIER MEDICAL SERVICES LLC 185 RAWLS ROAD ANGIER NC 27501 270906936 PHYSICIAN PRACTICE NC 1726416 924766 N/A LILLINGTON MEDICAL SERVICES LLC 716 S 10TH STREET LILLINGTON NC 27546 272944176 PHYSICIAN PRACTICE NC 806511 171814 N/A HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 273320275 PHYSICIAN PRACTICE NC 1275476 175823 N/A DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE DUNN NC 28335 273320115 PHYSICIAN PRACTICE NC 935949 165013 N/A COATS MEDICAL SERVICES LLC 25 N JOHNSON STREET COATS NC 27521 462540799 PHYSICIAN PRACTICE NC 387459 305321 N/A PREMIER PEDIATRICS LLC 802 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE NC 1883977 185079 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