2014-08-14T16:18:56-05:00 2013-09-30 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2012-10-01 561484844 WAYNE MEMORIAL HOSPITAL INC WAYN 9197316142 PO BOX 8001 GOLDSBORO NC 27533 J WILLIAM PAUGH 9197316142 2014-08-14 1 JOHN NORMAN P01506766 7049985200 2012 2015-11-30 17:44:51Z J WILLIAM PAUGH PO BOX 8001 GOLDSBORO NC 27533 225081746 0 X WWW.WAYNEHEALTH.ORG X 1896 NC TO PROVIDE THE COMMUNITY QUALITY HEALTHCARE SERVICES. 12 11 1969 694 13752 0 625081 775789 220854905 221182455 2821578 2934634 2408457 0 226710021 224892878 175455 137959 0 0 101568154 108738484 0 0 0 107283604 110132682 209027213 219009125 17682808 5883753 242316795 263046312 154489373 124252990 87827422 138793322 THE MISSION OF WAYNE MEMORIAL HOSPITAL IS TO PROVIDE THE COMMUNITY QUALITY HEALTHCARE SERVICES THROUGH THE COMPASSIONATE HANDS OF WELL-TRAINED STAFF IN A TECHNOLOGICALLY ADVANCED, COST-EFFECTIVE MANNER. 0 0 207447722 137959 221182455 PROVIDING COMPASSIONATE PROGRESSIVE HEALTHCARE INCLUDING INPATIENT, OUTPATIENT, INTENSIVE CARE, AND EMERGENCY CARE. 207447722 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 102 0 1 1969 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X REBECCA CRAIG CFO 9197316142 PO BOX 8001 GOLDSBORO NC 27533 GREGORY S BAUER MD 1.00 40.00 X 0 881605 30176 R DANIEL BOWEN 1.00 X 0 0 0 WILLIAM W BROADAWAY 1.00 X 0 0 0 JOE DAUGHTERY 1.00 X 0 0 0 CHRISTOPHER P GRIFFIN MD 1.00 X 0 0 0 STEPHEN C LIES MD 1.00 X 0 0 0 SUSAN H MCCALL 1.00 X 0 0 0 RAY MCDONALD JR 1.00 X 0 0 0 JAMES C PARKER 1.00 X 0 0 0 DAVID M PERRY 1.00 X 0 0 0 CHARLOTTE M WEAVER 1.00 X 0 0 0 J WILLIAM PAUGH 40.00 1.00 X X 762272 0 152067 THOMAS W BRADSHAW 40.00 X 277185 0 72052 RICHARD ROGERS 40.00 X 179698 0 48431 SHIRLEY S HARKEY 40.00 X 214768 0 56001 REBECCA CRAIG 40.00 X 275432 0 65224 ALLEN LANIER 40.00 X 207015 0 34736 JANICE MADDOX 40.00 X 203356 0 36424 RICHARD BAZIK 40.00 X 197491 0 33926 TOMMY KINCAID 40.00 X 193958 0 35625 WILLOUGHBY AMY 40.00 X 186393 0 32983 2697568 881605 597645 49 0 1 0 DANIELS & DANIELS CONST P O BOX 10337 GOLDSBORO NC 27532 CONTRACTORS 4537647 T A LOVING COMPANY P O BOX 919 GOLDSBORO NC 27533 CONTRACTORS 1284092 SODEXO INC P O BOX 536922 ATLANTA GA 303536922 CONTRACT MGMT 854774 ARAMARK 24863 NETWORK PLACE CHICAGO IL 606731248 CONTRACT MGMT 740417 EASTERN MEDICAL ASSOC 2609 MEDICAL OFFICE PL GOLDSBORO NC 27534 HOSPITALIST PROGRAM 645500 102 775789 775789 PATIENT REVENUE 621110 213602333 213602333 7580122 7566370 13752 221182455 3123502 3123502 188868 -188868 -188868 -188868 224892878 221168703 13752 2934634 100000 100000 37959 37959 2102634 2102634 78266835 72817007 5449828 9960477 9073995 886482 12715264 11583606 1131658 5693274 5186573 506701 505768 505768 405667 405667 3929816 3764688 165128 3103392 3103392 2962485 2698823 263662 33542 27603 5939 367828 258008 109820 2148635 2148635 9392421 9364305 28116 525888 525888 MEDICAL SUPPLIES 35855598 35855598 BAD DEBT EXPENSE 21818418 21818418 PURCHASED SERVICES 15087100 15087100 MISCELLANEOUS EXPENSE 9002479 9002479 4993645 4993645 219009125 207447722 11561403 0 2014573 895153 42817 27700086 29662581 4427645 4732956 2214541 2313264 211888637 106096375 98244545 105792262 94058445 101408329 13614143 18241767 242316795 263046312 21163547 26828731 57045434 58377172 76280392 39047087 154489373 124252990 X 86929834 137840604 897588 952718 87827422 138793322 242316795 263046312 X 5883753 8393416 36688731 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 7612 7612 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION (23.98%) OF THE DUES THE HOSPITAL PAYS TO THE NORTH CAROLINA HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 113376220 45183786 68192434 41380599 24664456 16716143 46803410 31635778 15167632 10328408 4612355 5716053 105792262 INVESTMENTS 101408329 F 101408329 BOND ISSUANCE COSTS, NET 666772 INVESTMENT IN AFFILIATE 2666666 OTHER RECEIVABLES 4234365 DUE FROM AFFILIATE 9802436 LONG-TERM RECEIVABLES 871528 18241767 OTHER LIABILITIES 12789870 MINIMUM PENSION LIABILITY 25410945 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 846272 39047087 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: WAYNE MEMORIAL HOSPITAL ("WMH") IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. WMH ADOPTED THE PROVISIONS OF THE INCOME TAX STANDARD THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. THIS GUIDANCE PRESCRIBES A RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THE ADOPTION OF THIS STANDARD HAD NO IMPACT ON WMH'S FINANCIAL STATEMENTS. 1 1 1 X 1 X 1 1 1 0 1 1 18820558 18820558 0.09540 34650266 30197066 4453200 0.02260 53470824 30197066 23273758 0.11800 2347754 2347754 0.01190 1474230 1474230 0.00750 80504 80504 0.00040 643700 643700 0.00330 4546188 4546188 0.02310 58017012 30197066 27819946 0.14110 486883 486883 0.00250 11686 11686 0.00010 498569 498569 0.00260 1 8802054 65865355 71111245 -5245890 X 1 1 1 WAYNE MRI LLC MRI 0.66700 0.33300 1 1 WAYNE MEMORIAL HOSPITAL INC

2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533

X X X WAYNE MEMORIAL HOSPITAL INC 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 1 350.000000000000 1 X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 0 PART I, LINE 3C: WE USE 200% OF FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. WE ALSO USE A PROPRIETARY CREDIT SCORING TOOL TO FURTHER DETERMINE ELIGIBILITY AND FOR NON-COMPLIANT PATIENTS. THIS PROPRIETARY TOOL USES ALGORITHMS, CONSUMER DATA, AND OTHER INFORMATION TO ASSIST WITH PATIENT ABILITY TO PAY. PART I, LINE 7: AMOUNTS SHOWN IN PART I, LINE 7, COLUMN C WERE COMPUTED USING THE COST-TO-CHARGE RATIO WORKSHEET (WORKSHEET 2) FROM THE IRS INSTRUCTIONS FOR SCHEDULE H. PART I, L7 COL(F): FOR PURPOSES OF CALCULATING THE COMMUNITY BENEFIT PERCENTAGE IN PART I, COLUMN (F), THE ORGANIZATION SUBTRACTED $21,818,418 (WHICH WAS REPORTED ON FORM 990, PART IX, LINE 25) AS BAD DEBT EXPENSE). PART II: THE HOSPITAL SURVEYS THE NEEDS OF THE MEDICAL COMMUNITY (PROVIDERS) TO ENABLE THE BOARD OF DIRECTORS TO ADOPT A MEDICAL STAFF DEVELOPMENT PLAN, FROM WHICH THEY DETERMINE RECRUITMENT TARGETS. IN THE CURRENT ENVIRONMENT, HOSPITALS ARE WORKING WITH MEDICAL STAFFS TO MEET THE NEED FOR PRIMARY CARE, AS WELL AS SPECIALTY CARE. THE HOSPITAL HAS PROVIDED SUPPORT IN THE FORM OF LOANS TO DOCTORS NEW TO THE AREA FOR THE FIRST YEAR OF PRACTICE, WHICH ARE FORGIVEN AS THESE PHYSICIANS STAY AND MEET COMMUNITY NEEDS.WAYNE MEMORIAL HOSPITALS EMPLOYS MORE THAN 700 REGISTERED NURSES, PLUS OTHER LICENSED HEALTH PROVIDERS (LAB TECHNOLOGISTS, IMAGING TECHNOLOGISTS, PHARMACISTS, PHARMACY TECHNOLOGISTS) TO CARE FOR RESIDENTS OF WAYNE COUNTY WHO NEED HOSPITAL SERVICES. IN SUPPORT OF THIS MISSION, THE HOSPITAL HAS CONTRIBUTED SCHOLARSHIP FUNDS TO ENABLE STUDENTS AT WAYNE COMMUNITY COLLEGE TO PURSUE DEGREES IN HEALTH SCIENCES. NURSES FROM WAYNE MEMORIAL ARE A VITAL PART OF SCHOOL-BASED HEALTH, AND ARE ALSO PART OF MANY LOCAL BUSINESSES WHICH SEE THE VALUE OF HAVING ON-SITE HEALTH EXPERTISE IN KEEPING THEIR EMPLOYEES PRODUCTIVE AND WELL. EDUCATING OUR LOCAL WORKFORCE IS A PRIORITY OF THIS HOSPITAL, IN TERMS OF CARE OF PATIENTS, AND CREATING A CULTURE OF WELLNESS WITHIN OUR COMMUNITY, BOTH AT SCHOOLS, IN BUSINESSES AND IN HOMES. PART III, LINE 4: THE HOSPITAL USES HISTORICAL COLLECTION EXPERIENCE AND A REVIEW OF CURRENT RECEIVABLES TO PROVIDE AN ESTIMATE OF THE ALLOWANCE FOR UNCOLLECTIBLES AND THE BAD DEBT EXPENSE. ACCOUNTS PAST DUE FOR MORE THAN 90 DAYS ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IF DEEMED UNCOLLECTIBLE, ACCOUNTS ARE REFERRED TO ONE OF TWO OUTSIDE COLLECTION AGENCIES UNLESS THE ACCOUNT IS BEING REVIEWED UNDER THE HOSPITAL'S CHARITY POLICY. THE HOSPITAL PROVIDES SERVICES TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS A RESULT, THE HOSPITAL HAS INCURRED LOSSES FROM BAD DEBT EXPENSE. THESE UNREIMBURSED SERVICES THE HOSPITAL PROVIDES TO THE COMMUNITY SHOULD BE CONSIDERED A COMMUNITY BEBEFIT SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE BE UNMET. NOTE 2 ON PAGE 18 OF THE AUDITED FINANCIAL STATEMENTS DISCUSSES BAD DEBTS.PART III, SECTION A, LINE 2:THE AMOUNT ON LINE 2 WAS DERIVED BY TAKING THE BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS AND MULTIPLYING IT BY THE RATIO OF PATIENT CARE COST TO CHARGES DERIVED USING WORKSHEET 2 OF THE IRS INSTRUCTIONS FOR SCHEDULE H.PART III, SECTION A, LINE 3:THE HOSPITAL DOES NOT HAVE A PROCESS IN PLACE THAT ESTIMATES THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER A FINANCIAL ASSISTANCE POLICY. PART III, LINE 8: THE HOSPITAL PROVIDES SERVICES TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS A RESULT, THE HOSPITAL HAS INCURRED LOSSES BY SERVING MEDICARE PATIENTS. THE UNREIMBURSED SERVICES THE HOSPITAL PROVIDES TO THE COMMUNITY SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE BE UNMET.PART III, SECTION B, LINE 8:THE COST TO CHARGE RATIO AS CALCULATED BY THE MOST RECENTLY FILED COST REPORT WAS USED TO DETERMINE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: OUR COLLECTION POLICY INDICATES OUR USE OF A CREDIT SCORING TOOL WHICH ASSISTS OUR COLLECTION STAFF IN THE IDENTIFICATION OF PATIENTS THAT QUALIFY FOR UNCOMPENSATED CARE. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5C: THE CHNA IS ALSO MADE AVAILABLE ON THE WEBSITE OF THE WAYNE COUNTY HEALTH DEPARTMENT. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 14G: ALL SELF PAY INPATIENTS RECEIVE VISITS FROM FINANCIAL COUNSELORS, AND THE CHARITY POLICY IS REVIEWED AT THAT TIME. SELF PAY OUTPATIENTS ARE SENT LETTERS OFFERING FINANCIAL ASSISTANCE. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 20D: UNINSURED PATIENTS ARE BILLED THE SAME AMOUNTS AS INSURED PATIENTS. PART VI, LINE 2: WAYNE MEMORIAL HOSPITAL ROUTINELY CONDUCTS A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE WAYNE COUNTY HEALTH DEPARTMENT. IN 2012, A JOINT CHNA WAS BEGUN, WHICH CONCLUDED IN THE FALL OF 2012, AND WAS REPORTED TO THE COMMUNITY IN JANUARY 2013, PART OF THE HOSPITAL'S FYE 9/30/2013. AS PART OF THIS CHNA, AN ELECTRONIC SURVEY WAS CONDUCTED. FOCUS GROUPS WERE CONVENED IN 11 DIFFERENT SETTINGS (DIVERSE IN GEOGRAPHY AND CULTURE) TO ADD MORE UNDERSTANDING. ACTIONS ARE BEING COORDINATED AND TAKEN BY KEY CONSTITUENTS FROM WAYNE COUNTY, IN PARTNERSHIP WITH THE WAYNE COUNTY HEALTH DEPARTMENT, THE CITY OF GOLDSBORO, THE HOSPITAL AND OTHER AGENCIES TO ENCOURAGE GOOD HEALTH COUNTY-WIDE.FINDINGS FROM THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT SHOWED SIGNIFICANT OVERLAP WITH THOSE FROM THE 2008 COMMUNITY HEALTH NEEDS ASSESSMENT. OBESITY CONTINUES TO BE THE SINGLE MORE PERVASIVE HEALTH ISSUE IN WAYNE COUNTY, FOLLOWED BY CHRONIC DISEASES. TOGETHER, THESE ARE TAKING A HEAVY TOLL ON WAYNE COUNTYS HEALTH. MORE THAN 12% OF WAYNE COUNTY ADULTS ARE DIAGNOSED WITH DIABETES. OBESITY HAS BEEN SHOWN TO CONTRIBUTE TO THE LEADING CAUSES OF DEATH INCLUDING HEART DISEASE, SOME CANCERS, AND DIABETES. THE PERCENTAGE OF OVERWEIGHT AND OBESE ADULTS IN WAYNE COUNTY HAS INCREASED TO MORE THAN 70% - MORE THAN 65,000 PEOPLE. IN RESPONSE TO THIS ISSUE, COMMUNITY PARTNERS HAVE COME TOGETHER TO FORM THE "HEALTHY WAYNE TASK FORCE", WHICH HAS PLACE HEALTHY LIVING AT ITS CENTER. ITS FIRST INITIATIVE, BEGUN IN THE SUMMER OF 2013, IS CALLED GOWAYNEGO. INITIAL EFFORTS HAVE BEEN TO CENTRALIZE COMMUNICATIONS TO LOCAL CITIZENS ABOUT THE IMPORTANCE OF INCREASING DAILY MOVEMENT, AND EDUCATING CITIZENS ABOUT FREE AND LOW-COST WAYS TO GET MORE ACTIVE IN WAYNE COUNTY. MORE THAN 3,000 T-SHIRTS WITH THE GOWAYNEGO LOGO HAVE BEEN DISTRIBUTED TO WAYNE COUNTY RESIDENTS, AND A WEBSITE HAS BEEN SET UP TO ENCOURAGE GETTING ROUTINE EXERCISE. PARTNERS IN THE HEALTHY WAYNE TASK FORCE INCLUDE WAYNE COUNTY HEALTH DEPARTMENT, WAYNE HEALTH FOUNDATION (DBA WATCH), GOLDSBORO FAMILY YMCA, CITY OF GOLDSBORO PARKS & RECREATION DEPARTMENT, NC COOPERATIVE EXTENSION, UNITED WAY OF WAYNE COUNTY, SEYMOUR JOHNSON AIR FORCE BASE, GOLDSBORO PEDIATRICS, WAYNE COUNTY PUBLIC SCHOOLS, WAYNE INITIATIVE FOR SCHOOL HEALTH, AND OTHERS. IN 2012, SEXUALLY TRANSMITTED DISEASES (STDS) WERE ALSO CITED AS A MAJOR HEALTH ISSUE IN WAYNE COUNTY. WHILE THE NUMBER OF ADULTS AFFECTED BY STDS IS SMALLER THAN OBESITY (LESS THAN 2,000), IT IS MORE DIFFICULT TO IDENTIFY PERSONS WHO NEED TREATMENT, AND YOUNG ADULTS ARE MORE APT TO BE DIAGNOSED WITH STDS. IN WAYNE COUNTY, THE WAYNE COUNTY HEALTH DEPARTMENT LEADS THE FIGHT AGAINST THE RISE OF STDS, WITH A CLINIC THAT PROVIDES SCREENING, TESTING, DIAGNOSIS AND TREATMENT. THE CLINIC PROVIDES FREE IDENTIFICATION AND PROPHYLACTIC TREATMENT AND COUNSELING FOR SEXUAL PARTNERS OF CONFIRMED CASES AND CONFIDENTIAL HIV COUNSELING, TESTING AND REFERRAL.HEALTH LITERACY AND MENTAL HEALTH WERE THE OTHER MOST SIGNIFICANT ISSUES COMING OUT OF THE 2012 COMMUNITY HEALTH ASSESSMENT. HEALTH LITERACY IS AN ISSUE IN RURAL AREAS LIKE EASTERN NORTH CAROLINA. IN WAYNE COUNTY, 10% OF ADULTS ARE NON-READERS, AND 26% STRUGGLE WITH BASIC LITERACY. WAYNE MEMORIAL HOSPITAL HAS A TEAM OF NURSES AND TRAINERS WORKING TO INCORPORATE MORE UNDERSTANDABLE DISCHARGE INSTRUCTIONS FOR PATIENTS AND FAMILIES, TO REDUCE THE NUMBERS OF PATIENTS WHO MUST RETURN TO THE HOSPITAL SOON AFTER DISCHARGE FOR PROBLEMS THAT MIGHT NOT HAVE ARISEN IF THERE WERE BETTER UNDERSTANDING OF FOLLOW UP CARE. THIS TEAM IS USING RESOURCES DEVELOPED FROM AROUND THE COUNTRY TO TRY TO GET IMPROVED RESULTS (LOWER READMISSIONS). WITH RESPECT TO TEACHING READING SKILLS, IN WAYNE COUNTY, LITERACY CONNECTIONS OF WAYNE COUNTY IS A NON-PROFIT AGENCY CREATED TO IMPROVE ADULT LITERACY. LITERACY CONNECTIONS PROVIDES FREE, CONFIDENTIAL, ONE-ON-ONE TUTORING FOR ADULTS TO IMPROVE THEIR READING SKILLS. IN SCHOOLS, WAYNE MEMORIAL PROVIDES AN AWARD-WINNING QUARTERLY "KIDS PAGE" TO EACH ELEMENTARY STUDENT TO ENCOURAGE HEALTH LITERACY. MENTAL HEALTH IS AN ISSUE THAT CONTINUES TO IMPACT HEALTH CARE IN OUR COMMUNITY, OUR STATE AND THE ENTIRE COUNTRY. IN RECOGNITION OF THE SPECIAL NEEDS OF PATIENTS WITH BEHAVIORAL HEALTH ISSUES, THE HOSPITAL DESIGNED ITS NEW EMERGENCY DEPARTMENT (OPENED IN 2012) TO ENABLE SEPARATION OF PATIENTS WITH MENTAL ISSUES FROM PATIENTS WITH PHYSICAL HEALTH ISSUES. THE OBJECTIVE WAS TO GIVE THESE PATIENTS AN AREA WHERE THEY CAN BE CARED FOR IN A CALM CONTROLLED ENVIRONMENT, WHERE THEY AND THOSE THAT ARE CARING FOR THEM CAN BE SAFE. STATE MENTAL HEALTH HOSPITALS ARE, FOR THE MOST PART, UNAVAILABLE FOR MOST BEHAVIORAL HEALTH ISSUES, WITH FEWER BEDS PER 1,000 RESIDENTS THAN ALMOST ANY OTHER STATE. WAYNE MEMORIAL HOSPITAL CONTINUES TO MAINTAIN AND STAFF AN INPATIENT BEHAVIORAL HEALTH UNIT, WHILE MANY HOSPITALS HAVE CHOSEN TO CLOSE THEIR UNITS. IN ADDITION, THE HOSPITAL, RECOGNIZING THE NEED TO REPLACE PSYCHIATRISTS WHO WERE APPROACHING RETIREMENT, RECRUITED THREE ADDITIONAL PSYCHIATRISTS, EMPLOYED BY HOSPITALS SISTER ORGANIZATION, WAYNE HEALTH PHYSICIANS, TO SEE PATIENTS IN OFFICES AS OUTPATIENTS, PLUS TREAT PATIENTS ADMITTED TO THE INPATIENT UNIT. FINALLY, IN FY 2013, THE HOSPITAL MADE PLANS TO CONTRACT WITH A NORTH CAROLINA TELE-PSYCHIATRY SERVICE TO IMPROVE RESPONSE TIME FOR THE INCREASING NUMBER OF CONSULTS NEEDED IN THE EMERGENCY DEPARTMENT. PART VI, LINE 3: WE HAVE FINANCIAL COUNSELORS THAT ASSIST WHILE THEY ARE PATIENTS. WE ALSO SEND FINANCIAL ASSISTANCE LETTERS TO PATIENTS THAT WE ARE UNABLE TO SEE WHILE THEY ARE IN HOUSE. WE ALSO PROVIDE INFORMATIONAL PAMPHLETS AND HAVE INFORMATION AVAILABLE ON THE HOSPITAL WEBSITE. PART VI, LINE 4: WAYNE MEMORIAL HOSPITAL SERVES PRIMARILY WAYNE COUNTY, NORTH CAROLINA, WITH AN ESTIMATED POPULATION OF 123,710, ACCORDING TO THE US CENSUS QUICKFACTS. THE POPULATION IS SLIGHTLY YOUNGER THAN THE AVERAGE IN NORTH CAROLINA, LIKELY DUE TO THE PRESENCE OF SEYMOUR JOHNSON AIR FORCE BASE, WITH ABOUT 5,000 ACTIVE DUTY PERSONS PLUS THEIR FAMILIES. THE AVERAGE INCOME PER CAPITA IS LOWER, AT $21,135, THAN NORTH CAROLINA'S AVERAGE, AT $25,256. PERSONS BELOW POVERTY LEVEL, AVERAGE 2007-2011, IN WAYNE COUNTY IS HIGHER, AT 20.2%, COMPARED TO NORTH CAROLINA AVERAGE OF 16.1%. WAYNE COUNTY'S POPULATION IS 55.6% WHITE, 31.1% BLACK, AND 9.9% HISPANIC, COMPARED TO NORTH CAROLINA'S 65.3% WHITE, 21.2% BLACK AND 8.4% HISPANIC. THE COUNTY IS LARGE, AT 553 SQUARE MILES, AND IT IS THE 4TH LARGEST AGRICULTURAL PRODUCER IN THE STATE. UNINSURED CHILDREN UNDER AGE 18 IN 2011 WERE ESTIMATED BY THE US CENSUS SMALL AREA INCOME AND POVERTY ESTIMATES (SAIPE) PROGRAM (DECEMBER 2012) TO BE 32%, COMPARED TO 25.4% IN NORTH CAROLINA, AND 22.5% NATIONALLY. POVERTY IMPACTS ACCESS TO CARE, WITH EMERGENCY DEPARTMENT USE HIGHER IN AREAS WITH HIGHER POVERTY. PART VI, LINE 5: WAYNE MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF, WHICH MEANS THAT ANY PHYSICIAN WHO MEETS QUALITY STANDARDS SET BY A COMMITTEE OF THE HOSPITAL (WHICH INCLUDES BOARD MEMBERS) IS WELCOME TO JOIN THE STAFF, IN RETURN FOR CERTAIN RESPONSIBILITIES RELATED TO PROVIDING CARE TO PATIENTS SEEN IN THE EMERGENCY DEPARTMENT WHO NEED INPATIENT CARE. THE BOARD OF DIRECTORS IS COMPRISED ON 12 CITIZENS OF WAYNE COUNTY, INCLUDING THE CEO, WHO ARE CHARGED WITH ENSURING THAT QUALITY, EFFICIENT CARE IS PROVIDED AT THE HOSPITAL, AND FOR ENSURING PLANNING, WITH COMMUNITY PARTNERS, FOR FUTURE HEALTH NEEDS. PART VI, LINE 6: AS THE PROVIDER OF CARE WITHIN THE COMMUNITY WITH THE MOST DIVERSE AND SOPHISTICATED EQUIPMENT, THE BOARD, MANAGEMENT AND STAFF OF WAYNE MEMORIAL HOSPITAL SEES ITS ROLE AS BOTH COORDINATOR OF CARE FOR THOSE WHO ARE THE SICKEST IN OUR COMMUNITY AS WELL AS PROMOTER OF HEALTHY LIVING FOR ALL RESIDENTS, IN COORDINATION WITH OUR PARTNERS IN HEALTH THROUGHOUT WAYNE COUNTY. THE HOSPITAL HAS TWO PRIMARY AFFILIATES THAT ARE INTEGRAL TO OPERATIONS. ONE IS WAYNE HEALTH FOUNDATION, WHICH HAS OPERATED A MOBILE VAN FOR UNINSURED SINCE THE 1990'S, AND WHOSE OTHER PRIMARY FOCUS HAS BEEN ADDRESSING COMMUNITY NEEDS IDENTIFIED IN FREQUENT HEALTH NEEDS ASSESSMENTS SINCE THAT TIME. THE SECOND SISTER CORPORATION, WAYNE HEALTH PHYSICIANS, WAS ORGANIZED IN 2009 TO HELP MEET THE NEEDS FOR PRIMARY AND SPECIALTY PHYSICIAN CARE IN WAYNE COUNTY. THIS WAS IN RESPONSE TO NATIONAL TRENDS THAT SHOWED PHYSICIANS SEEKING EMPLOYMENT IN SYSTEM ENVIRONMENTS TO ALLOW THEM MORE FOCUS ON PATIENT CARE, AND LESS ON THE BUSINESS ASPECTS OF MEDICAL PRACTICES. THIS COMPANY IS PROVIDING AN AVENUE TO WORK TOWARD LOWER OVERALL HEALTH CARE COSTS THROUGH BETTER COORDINATION OF CARE, WITH THE OBJECTIVE OF PROVIDING SERVICES TO PATIENTS IN THE LOWEST COST SETTING. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 THE FOUNDATION OF WAYNE COMMUNITY COLLEGE PO BOX 8002 GOLDSBORO NC 27533 561556512 501(C)(3) 100000 NURSING SCHOLARSHIPS EDUCATIONAL SCHOLARSHIPS 22 37959 ADDITIONAL COURSE STUDY PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: WAYNE MEMORIAL HOSPITAL, INC. MAKES GRANTS TO SUPPORT THE ACTIVITIES OF ITS RELATED ORGANIZATIONS AND TO PROMOTE GOOD COMMUNITY RELATIONS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 GREGORY S BAUER MD 0 881605 0 0 0 0 0 0 0 30176 0 911781 0 0 J WILLIAM PAUGH 533536 0 104873 0 123863 0 87718 0 64349 0 914339 0 0 0 THOMAS W BRADSHAW 252644 0 24254 0 287 0 42477 0 29575 0 349237 0 0 0 RICHARD ROGERS 179378 0 6680 0 -6360 0 19199 0 29232 0 228129 0 0 0 SHIRLEY S HARKEY 196191 0 18894 0 -317 0 42716 0 13285 0 270769 0 0 0 REBECCA CRAIG 260092 0 17688 0 -2348 0 47690 0 17534 0 340656 0 0 0 ALLEN LANIER 207015 0 0 0 0 0 9316 0 25420 0 241751 0 0 0 JANICE MADDOX 203356 0 0 0 0 0 9151 0 27273 0 239780 0 0 0 RICHARD BAZIK 197491 0 0 0 0 0 8887 0 25039 0 231417 0 0 0 TOMMY KINCAID 193958 0 0 0 0 0 8728 0 26897 0 229583 0 0 0 WILLOUGHBY AMY 186393 0 0 0 0 0 8388 0 24595 0 219376 0 0 0 PART I, LINE 1A LESS THAN $300 PAID ANNUALLY. PART I, LINE 1B CERTAIN DUES AND FEES AND COMPANION TRAVEL ARE REIMBURSED BY THE ORGANIZATION. PART I, LINE 4B J. WILLIAM PAUGH PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED $73,020 IN PAYMENTS FROM THE PLAN DURING THE YEAR. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HB93 2009-03-19 35720000 REFUND PRIOR BONDS 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 531309402 2012-07-03 23290000 REFINANCE 0 0 0 A 35720000 400705 219295 35100000 2009 1 0 1 1 B 1845000 23290000 23290000 2012 1 0 1 1 A 0 0 1 1 0 0.06000 0.06000 0 0 1 B 0 0 1 1 0 0 0 1 A 0 0 0 0 1 1 WELLS FARGO 22.000000000000 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 1 B 1 PART III, LINE 5 PRIVATE BUSINESS USE OF 2009 BONDS FOR SEVERAL YEARS, INCLUDING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013, WAYNE MEMORIAL HOSPITAL PROVIDED LAUNDRY SERVICES TO TWO NOT-FOR-PROFIT HOSPITALS WITHIN ONE HOUR OF WAYNE MEMORIAL, BY ADDING A SECOND SHIFT OF WORKERS TO HELP SPREAD THE OVERHEAD ASSOCIATED WITH THE LAUNDRY FACILITY, BUILT WITH PROCEEDS OF THE 2009 BOND ISSUE (ORIGINALLY ISSUED IN 2006). ALTHOUGH THE CUMULATIVE "PRIVATE USE" PERCENTAGE OF BOND PROCEEDS ALLOCATED TO THE LAUNDRY WAS WITHIN IRS GUIDELINES THROUGH SEPT 30, 2013, THE BOARD OF WMH VOTED TO REPAY THE BOND PROCEEDS ASSOCIATED WITH THE LAUNDRY (APPROXIMATELY $4 MILLION OF THE $35.7 MILLION ISSUE) IN FY 2014 TO ELIMINATE ANY FUTURE PRIVATE USE ISSUES RELATED TO LAUNDRY. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF FORM 990 IS MADE AVAILABLE TO THE GOVERNING BODY FOR REVIEW BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL PERSONNEL ARE RESPONSIBLE FOR ADHERING TO THE CORPORATE COMPLIANCE PLAN. THIS PLAN REQUIRES PERSONNEL TO DISCLOSE CONFLICTS AS THEY ARISE. VOTING MEMBERS OF THE GOVERNING BODY ARE RECUSED FROM VOTING WHEN A CONFLICT ARISES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS REVIEWED AGAINST COMPARABILITY DATA AND APPROVED BY THE BOARD. WRITTEN COMPENSATION AGREEMENTS ARE KEPT UP-TO-DATE. OFFICER AND KEY EMPLOYEE COMPENSATION IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE CORPORATE COMPLIANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE. ADDITIONALLY, THE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE ON WWW.DACBOND.COM. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -720,659. CHANGE IN MINIMUM PENSION LIABILITY 30,682,330. CHANGE IN VALUE OF DERIVATIVE FINANCIAL INSTRUMENT 4,571,699. DISTRIBUTIONS FROM MEMBERS 2,155,361. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. 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