2012-07-24T16:01:41-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 560554202 CALDWELL MEMORIAL HOSPITAL INC CALD 8287575100 321 MULBERRY STREET SW LENOIR NC 28645 DONALD J GARDNER JR 8287575100 2012-07-24 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z LAURA J EASTON 321 MULBERRY STREET SW LENOIR NC 28645 94262863 0 X WWW.CALDWELLMEMORIAL.ORG X 1945 NC TO PROVIDE HEALTH CARE SERVICES TO THE PEOPLE OF CALDWELL COUNTY. 12 11 1047 152 1195932 0 80335 300922 98412650 92906792 143241 -38184 878258 829331 99514484 93998861 203828 0 0 0 45581640 46326781 0 0 0 52509250 51928832 98294718 98255613 1219766 -4256752 50209672 48429934 15848627 18493680 34361045 29936254 X THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROMOTE SAFE, EFFECTIVE, COMPASSIONATE MEDICAL CARE AND TO PROMOTE HEALTHLY LIFESTYLES FOR OUR COMMUNITY. 0 0 83047272 91446181 CALDWELL MEMORIAL HOSPITAL IS PROUD TO PROVIDE THE QUALITY HEALTHCARE YOU TRUST AND THE CARING YOU DESERVE. SINCE OPENING IN 1951, CALDWELL MEMORIAL HOSPITAL HAS CONTINUED TO GROW AND CHANGE IN ORDER TO BETTER MEET THE NEEDS OF OUR COMMUNITY. THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROVIDE SAFE, EFFECTIVE, COMPASSIONATE CARE AND TO PROMOTE HEALTHY LIFESTYLES TO OUR COMMUNITY. ANCHORED BY A 110-BED ACUTE CARE FACILITY, CALDWELL MEMORIAL HOSPITAL'S SERVICES INCLUDE A VAST ARRAY OF MEDICAL AND SURGICAL SERVICES. AMONG SERVICES OFFERED, BUT BY NO MEANS A COMPLETE LIST, ARE CAROTID ARTERY STENTING; CARDIOVASCULAR AND ENDOVASCULAR CARE; RADIATION ONCOLOGY; COMPUTER-ASSISTED ORTHOPEDIC SURGERY; NEUROLOGY AND MEMORY CARE; PAIN MANAGEMENT; A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT; CALDWELL PHYSICIANS CLINICS CONVENIENTLY LOCATED COUNTY-WIDE; DIAGNOSTIC SERVICES; OUTPATIENT SURGERY; PLUS URGENT CARE; AND THE QUEST 4 LIFE WELLNESS CENTER. MULTIPLE EDUCATIONAL AND COUNSELING PROGRAMS ARE AVAILABLE FOR A WIDE ARRAY OF HEALTHCARE NEEDS INCLUDING CANCER, DIABETES, NUTRITION, JOINT CARE, PRE-NATAL CLASSES AND PARENTING SKILLS. CALDWELL PHYSICIANS IS A DIVISION OF CALDWELL MEMORIAL HOSPITAL. WITH PRACTICES IN COMMUNITIES COUNTYWIDE, CALDWELL PHYSICIANS PROVIDES THE PRIMARY AND SPECIALTY HEALTHCARE, DIAGNOSTICS AND TREATMENTS THAT OUR COMMUNITY NEEDS IN CONVENIENT LOCATIONS NEAR THEIR HOMES. CALDWELL PHYSICIANS INCLUDES: CALDWELL ACUTE CARE SPECIALISTS, FALLS MEDICAL PRACTICE, FALLS NEUROLOGY AND MEMORY CENTER, FALLS PEDIATRICS, FALLS PLUS URGENT CARE, HALLMARK FAMILY PRACTICE, MAIN STREET MEDICAL PRACTICE, MULBERRY PEDIATRICS, ROBBINS PIEDMONT VISTA ENT, ROBBINS FAMILY PRACTICE, ROBBINS INTERNAL MEDICINE, ROBBINS PLUS URGENT CARE, SOUTHFORK MEDICAL PRACTICE AND WESTPOINTE MEDICAL PRACTICE. 83047272 1 1 0 1 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 106 0 1 1047 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X X DON GARDNER & CHRIS WASHBURN 8287575221 321 MULBERRY STREET SW LENOIR NC 28645 BOYD WILSON JR 1.00 X X 0 0 0 PARKER WILLIAMSON 1.00 X X 0 0 0 BILL JOHNSON 1.00 X X 0 0 0 ALEX BERNHARDT JR 1.00 X 0 0 0 DEBORAH MURRAY 1.00 X 0 0 0 JOHN MCCORMICK MD 1.00 X 0 0 0 SHIRLEY ORRELL 1.00 X 0 0 0 STEVE LAMBRECHTS 1.00 X 0 0 0 PETER PURCELL MD 1.00 X 0 0 0 MARK BATTS MD 1.00 X 0 0 0 GARY SHORE 1.00 X 0 0 0 LAURA J EASTON 40.00 X 262323 0 70701 DONALD GARDNER JR 40.00 X 182996 0 3383 REBECCA SMITH 40.00 X 145340 0 2159 DANNY MORGAN 40.00 X 129629 0 3186 DAVID HORN 40.00 X 132165 0 3310 SHARON KIMBALL 40.00 X 157769 0 1397 EDWARD PEARCE MD 40.00 X 0 0 0 DENNICE HERMAN MD 40.00 X 198539 0 3360 DONALD SCHMECHEL MD 40.00 X 332477 0 3120 PAUL WARRICK MD 40.00 X 291274 0 3630 DAVID LOWRY MD 40.00 X 401393 0 4290 RAMESH KRISHNARAJ MD 40.00 X 272421 0 3770 RONALD H DUBOW 40.00 X 294540 0 2470 DR ERIC DRAVLAND 40.00 X 0 0 0 JOHN POWELL MD X 0 0 0 BOB FLOYD JR X 0 0 0 WESLEY COLLINS X 0 0 0 GENE HENDRICKS X 0 0 0 WILLIAM HOWARD III X 0 0 0 BRENT CAUSEY X 0 0 0 DON BARRIER X 0 0 0 MARK BATT MD X 0 0 0 GEORGE NICHOLS MD X 0 0 0 2800866 0 104776 12 0 1 0 CALDWELL FAMILY PHYSICIANS PA CONNELLY SPRINGS ROAD LENOIR NC 28645 PROFESSIONAL MEDICAL SERVICES 1097650 TIM BLINSON CONSTRUCTION 2377 MILLS COVE PLACE LENOIR NC 28645 MINOR CONTRUCTION PROJECTS 444989 DLP CARDIAC PARTNERS LLC (MEDCATH) 3700 ARCO CORPORATE OFFICE SUITE 4 CHARLOTTE NC 28273 CATH LAB PARTNER 352423 SIMPLER NORTH AMERICA LP PO BOX 643979 PITTSBURGH PA 152643979 LEAN-STRATEGIC ADVISORY WORK 222386 KAUFMAN HALL 5202 OLD ORCHARD ROAD SUITE N700 SKOKIE IL 60077 STRATEGIC PLANNING & FORECASTING 192394 10 288124 12798 300922 PATIENT SERVICES 621500 89417230 89335333 81897 OTHER PATIENT REVENUE 900099 980594 980594 WELLNESS CENTER 713990 924346 924346 LAB SERVICES 621400 730497 730497 JOINT VENTURE INCOME 541900 596963 399757 197206 257162 257162 92906792 225818 -7517 233335 206349 206349 206349 206349 257789 6213 -257789 -6213 -264002 -264002 OTHER INCOME 900099 622982 622982 622982 93998861 91446181 1195932 1055826 994039 600863 393176 37602983 31817134 5785849 534340 448797 85543 4800649 4032110 768539 2394770 2011390 383380 56199 56199 51460 51460 9170057 5455190 3714867 277327 277327 1797472 576290 1221182 2188304 2188304 129119 63918 65201 371704 371704 4176575 4176575 973102 973102 SUPPLIES 15034419 14629732 404687 BAD DEBT EXPENSE 10974145 10974145 EQUIPMENT RENTAL & MAIN 6251843 4584393 1667450 RECRUITMENT 333481 333481 143625 143625 98255613 83047272 15208341 0 5860 6715 10945320 4544071 10899837 10628701 431306 279450 2314862 2582996 1499782 1307785 76448978 56145815 16509724 20303163 3578732 5319593 0 2245172 2039644 521376 215310 1257701 1202506 50209672 48429934 6802970 7732680 184156 254528 6294461 9377698 2567040 1128774 15848627 18493680 X 34358100 29936254 2945 0 34361045 29936254 50209672 48429934 X -4256752 -168039 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12413 12413 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $12,413 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. 1137587 1137587 33174807 25731209 7443598 1391276 1215048 176228 39501363 29199558 10301805 1243945 1243945 20303163 INVESTMENTS IN JOINT VENTURES 2039644 C 2039644 REFUNDABLE SALES TAX 624106 OTHER RECEIVABLES 325809 SECURED BENEFIT PLAN 252591 1202506 REFUNDS PAYABLE AND PATIENT DEPOSITS 531260 ESTIMATED THIRD PARTY SETTLEMENTS 196006 PHYSICIAN RECRUITMENT OBLIGATIONS 401508 1128774 93998861 98255613 -4256752 -168039 -168039 -4424791 93830822 -168039 -168039 93998861 0 93998861 98255613 0 98255613 0 98255613 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT, PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL'S LAB SERVICES TO NON-PATIENTS AND SALES FROM THE QUEST 4 LIFE WELLNESS CENTER CONSTITUTE UNRELATED BUSINESS INCOME UNDER THE INTERNAL REVENUE CODE. THE HOSPITAL AND FOUNDATION HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2011 AND 2010. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XII, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 1 1 1 X 125.000000000000 1 X 205.000000000000 1 1 1 0 1 0 1819451 25000 1794451 0.02060 13366743 7957378 5409365 0.06200 1163105 579186 583919 0.00670 16349299 8561564 7787735 0.08930 68658 68658 0.00080 38029 38029 0.00040 375401 25000 350401 0.00400 482088 25000 457088 0.00520 16831387 8586564 8244823 0.09450 1 4352000 1170419 24360215 25494227 -1134012 X 1 1 1 GUARDIAN HEALTH CARE SERVICES HOME HEALTH SERVICES 0.50000 0.50000 2 AMERICAN HOME PATIENT DURABLE MEDICAL EQUIPMENT 0.25000 0.25000 1 1 CALDWELL MEMORIAL HOSPITAL INCORPORATED

321 MULBERRY STREET SW PO BOX 1890 LENOIR NC 28645

X X X DISPROPORTIONATE SHARE HOSPITAL NA FOR 2010 1 11 HANCOCK SURGERY CENTER

1031 MORGANTON BLVD LENIOR NC 28645

OUTPATIENT SURGERY CENTER FALLS MEDICAL PARK

4355 HICKORY BLVD GRANITE FALLS NC 28630

FALLS MEDICAL PRACTICE, FALLS NEURO & MEMORY, FALLS PEDIATRIC PRACTICE MAIN STREET MEDICAL PRACTICE

589 MAIN STREET HUDSON NC 28638

MAIN STREET MEDICAL PRACTICE MULBERRY PEDIATRICS

401 MULBERRY STREET LENIOR NC 28645

MULBERRY PEDIATRIC PRACTICE ROBBINS MEDICAL PARK

322 MULBERRY STREET LENOIR NC 28645

ROBBINS ENT PRACTICE, FAMILY CARE, INTERNAL MEDICINE, AND URGENT CARE SOUTHFOLK MEDICAL PARK

1731 CONNELLY SPRINGS ROAD LENIOR NC 28645

SOUTHFOLK MEDICAL PRACTICE WESTPOINTE MEDICAL PRACTICE

2651 MORGANTON BLVD LENIOR NC 28645

WESTPOINTE MEDICAL PRACTICE THE WOUND CARE CENTER

401 MULBERRY STREET LENIOR NC 28645

WOUND CARE CENTER AMERICAN HOMEPATIENT OF UNIFOUR LLC

1929 TATE BLVD HICKORY NC 28602

DURABLE MEDICAL EQUIPMENT LTD. PARTNERSHIP JOINT VENTURE GUARDIAN HEALTH SERVICES LLC

1771 TATE BLVD SUITE 101 HICKORY NC 28602

HOME HEALTH AGENCY JOINT VENTURE HALLMARK FAMILY PHYSICIANS INC

321 MULBERRY STREET SE LENIOR NC 28645

FAMILY PHYSICIANS PART I, LINE 7: THE ORGANIZATION USED WORKSHEET 2 OF THE 2010 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. PART I, L7 COL(F): FOR PURPOSES OF CALCULATING PERCENT OF TOTAL EXPENSE FOR LINE 7, COLUMN (F), TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25 HAS BEEN ADJUSTED TO REMOVE $ 10,974,145 BAD DEBT EXPENSE. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE:THE HOSPITAL HAS PROVIDED SERVICES TO PERSONS WHO HAVE NOT PAID FOR SUCH SERVICES EITHER BECAUSE THEY HAVE BEEN UNWILLING OR UNABLE TO PAY. EFFORTS ARE MADE BY THE HOSPITAL TO DETERMINE IF A PATIENT MEETS CHARITY POLICY GUIDELINES THAT ARE ESTABLISHED BY THE HOSPITAL. IF THESE GUIDELINES ARE MET AND CAN BE VERIFIED, THEN SUCH AMOUNTS ARE INCLUDED IN CHARITY CARE. UNTIL SUCH TIME, SUCH AMOUNTS ARE COMBINED IN BAD DEBTS BECAUSE THEY HAVE NOT BEEN VERIFIED OR DOCUMENTED AS CHARITY CARE DUE TO LACK OF SUPPORTING FINANCIAL INFORMATION. IN SOME CASES, PATIENTS WHO WOULD (OR COULD) QUALIFY FOR CHARITY CARE ARE UNWILLING OR UNABLE TO PRODUCE THE NECESSARY INFORMATION TO SUBSTANTIATE THEIR QUALIFICATION. THUS, BAD DEBTS INCLUDE AMOUNTS THAT WOULD OTHERWISE QUALIFY FOR CHARITY CARE UNDER THE HOSPITAL'S GUIDELINES. PATIENTS WHO HAVE NO THIRD PARTY COPAY RECEIVE A DISCOUNT COMPARABLE TO THE HOSPITALS AVERAGE DISCOUNT PROVIDED TO MANAGED CARE PAYORS. IF IT IS DETERMINED THE PATIENT QUALIFIES FOR CHARITY CARE AND THE APPLICATION FORM IS APPROVED, THE DISCOUNT IS NOT APPLIED AS IT IS NOT APPLICABLE. THE ESTIMATED COST OF UNREIMBURSED SERVICES ATTRIBUTABLE TO BAD DEBTS - EFFECTIVELY "FREE" SERVICES PROVIDED TO PATIENTS - HAS BEEN DETERMINED BY APPLYING A COST TO CHARGE RATIO TO THE AMOUNT OF BAD DEBTS. SUCH ESTIMATED COSTS WERE $4,681,000 AND $4,352,000 IN 2011 AND 2010, RESPECTIVELY.COSTING METHODOLOGY:THE AMOUNTS DISCLOSED ON LINES 2 AND 3 OF PART III, SECTION A ARE REPORTED ON THE ORGANIZATION'S MOST RECENTLY FILED MEDICARE COST REPORT (FY 2009). THE ORGANIZATION HAS ESTIMATED THE AMOUNT OF UNREIMBURSED COSTS OF TREATING MEDICARE PATIENTS FOR FY 2010 TO BE $25,494,227. PART III, LINE 8: WITH COUNTYWIDE DOUBLE-DIGIT UNEMPLOYMENT AND A POPULATION ALREADY HEAVILY DEPENDENT UPON MEDICARE AND MEDICAID, THE ENTIRETY OF THE MEDICARE SHORTFALL (REPORTED IN LINE 7) IS COMMUNITY BENEFIT, EQUATING DIRECTLY TO "FREE" CARE PROVIDED BY CALDWELL MEMORIAL. PART VI, LINE 2: CALDWELL MEMORIAL HOSPITAL ACTIVELY ENGAGES WITH OUR COMMUNITY PARTNERS TO ASSESS THE HEALTH CARE NEEDS OF CALDWELL COUNTY, NORTH CAROLINA. MEMBERS OF OUR STAFF SERVE AS PART OF THE ADVISORY GROUP FOR THE COMMUNITY HEALTH ASSESSMENT PERFORMED EVERY FOUR YEARS BY PUBLIC HEALTH. THE LAST STUDY WAS PERFORMED IN 2007 AND WILL BE PERFORMED EVERY THREE YEARS BEGINNING IN 2011 IN ACCORDANCE WITH THE INTERNAL REVENUE CODE 501(R). WE COMPARE THIS HEALTH AND BEHAVIORAL DATA TO THAT OF OUR STATE AND NATION AND EVALUATE THE COMMUNITY'S NEEDS BASED ON NUMBER AND SEVERITY OF CASES OF ANY PARTICULAR ILLNESS, INCIDENCE, OR DISEASE. PART VI, LINE 3: CALDWELL MEMORIAL HOSPITAL POSTS OUR CHARITY CARE POLICY ON OUR WEBSITE AND UPDATES IT ANNUALLY. OUR FINANCIAL COUNSELORS WORK CLOSELY WITH OUR PATIENTS TO HELP THEM DETERMINE THEIR ELIGIBILITY AND UNDERSTAND THEIR FINANCIAL OBLIGATIONS. THE HOSPITALS FINANCIAL AID POLICY IS ALSO POSTED IN THE LOBBY OF THE E.R. AND ON THE HOSPITALS WEBSITE. PART VI, LINE 4: CALDWELL MEMORIAL HOSPITAL PRIMARILY SERVES CALDWELL COUNTY AND THE SURROUNDING AREA. CALDWELL COUNTY IS LOCATED IN THE FOOTHILLS REGION OF THE STATE AND OUR POPULATION IS 83,000. WE HAVE 472 SQUARE MILES AND THERE ARE 176 PEOPLE PER SQUARE MILE COMPARED TO AN AVERAGE OF 196 AT THE STATE LEVEL. APPROXIMATELY 15.4% OF OUR POPULATION IS OVER THE AGE OF 65 WHILE THE STATE AVERAGE IS 12.9%; OUR MEDIAN HOUSEHOLD INCOME IS $37,000 COMPARED TO THE STATE AVERAGE OF $46,000. RIGHT AT 15% OF OUR POPULATION IS BELOW THE FEDERALLY DESIGNATED POVERTY LEVEL AND ON AVERAGE 13% OF OUR POPULATION IS UNEMPLOYED. PART VI, LINE 6: THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INTERESTED PERSONS. IN ADDITION, THE HOSPITAL EXTENDS STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PART VI, LINE 7: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 NC X 1 1 X X X X X 0 1 0 0 0 1 0 0 0 LAURA J EASTON 204564 0 57759 0 0 0 63423 0 7278 0 333024 0 0 0 DONALD GARDNER JR 140328 0 42668 0 0 0 0 0 3383 0 186379 0 0 0 SHARON KIMBALL 126681 0 31088 0 0 0 0 0 1397 0 159166 0 0 0 DENNICE HERMAN MD 198539 0 0 0 0 0 0 0 3360 0 201899 0 0 0 DONALD SCHMECHEL MD 332477 0 0 0 0 0 0 0 3120 0 335597 0 0 0 PAUL WARRICK MD 291274 0 0 0 0 0 0 0 3630 0 294904 0 0 0 DAVID LOWRY MD 401393 0 0 0 0 0 0 0 4290 0 405683 0 0 0 RAMESH KRISHNARAJ MD 272421 0 0 0 0 0 0 0 3770 0 276191 0 0 0 RONALD H DUBOW 294540 0 0 0 0 0 0 0 2470 0 297010 0 0 0 PART I, LINE 1A MEMBERSHIPS AT THE ORGANIZATION'S ON-SITE QUEST 4 LIFE FITNESS CENTER ARE PROVIDED TO CERTAIN OFFICERS AND KEY EMPLOYEES. THE FITNESS CENTER IS OPERATED DIRECTLY BY THE ORGANIZATION. PART I, LINE 4B LAURA EASTON (CEO) HAS A SECURED BENEFIT PLAN WHICH IS INCLUDED IN THE STUDY COMPLETED BY THE INDEPENDENT COMPENSATION CONSULTANT. THE LOAN UNDER THIS ARRANGEMENT IS RECORDED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND FULLY SECURED BY A LIFE INSURANCE POLICY ON THE LIFE OF THE CEO. PART I, LINE 6 SENIOR MANAGEMENT HAS AN INCENTIVE PROGRAM WHICH IS PARTIALLY EARNED BASED ON PROFIT MARGIN AND DAYS CASH ON HAND. THE EARNED INCENTIVE IS REVIEWED BY THE HR COMMITTEE OF THE BOARD AND APPROVED ANNUALLY. EMPLOYED PHYSICIANS ARE PAID ON A PRODUCTIVITY BASIS BASED ON RVU'S GENERATED IN THEIR PRACTICE OPERATIONS. THESE ARE TIED TO MGMA BENCHMARKS. LAURA J EASTON SECURED BENEFIT PLAN DEFERRED COMPENSATION LOAN X 252591 0 1 1 PAUL WARRICK START UP LOAN X 324600 26859 0 1 1 279450 FORM 990, PART VI, SECTION A, LINE 2 GARY SHORE AND BILL JOHNSON SHARE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. IT WAS REVIEWED IN DETAIL BY THE AUDIT AND COMPLIANCE COMMITTEE AND PRESENTED TO THE FULL BOARD DURING THE AUDIT AND COMPLIANCE REPORT. THE FULL BOARD RECEIVED A COPY OF THE FORM 990 FOR THEIR REVIEW AND FOR ANY QUESTIONS. THE FULL BOARD VOTED FOR A FINAL APPROVAL OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE AUDIT & COMPLIANCE COMMITTEE OF THE BOARD ANNUALLY REVIEWS THE CONFLICT OF INTEREST STATEMENTS. MINUTES OF BOARD MEETINGS REFLECT ANY DECLARED CONFLICT OF INTEREST. THE HOSPITAL COO ATTENDS BOARD MEETINGS AND IS OBSERVANT TO ANY POTENTIAL CONFLICT OF INTERESTS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION COMPLETES THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DESCRIBED IN TREASURY REGULATION 4958(6)(C) FOR EACH OFFICER AND KEY EMPLOYEE. THIS PROCESS IS PERFORMED BY AN OUTSIDE INDEPENDENT COMPENSATION SPECIALIST. THE CONSULTANT'S FINDINGS ARE PRESENTED TO THE HR COMMITTEE OF THE BOARD AND ARE ULTIMATELY APPROVED BY THE FULL BOARD. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILING OF THE FORM 990 ARE AVAILABLE ON GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. PLEASE USE THE ORGANIZATION'S "CONTACT US" LINK ON ITS WEBSITE FOR REQUESTS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -168,039. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HALLMARK FAMILY PHYSICIANS INC 1766 CONNELLY SPRINGS ROAD LENOIR NC 28645 202088324 PHYSCIAN PRACTICE NC N/A CALDWELL MEMORIAL HOSPITAL FOUNDATION INC PO BOX 1890 LENOIR NC 28645 581935514 FOUNDATION NC 501(C)(3) LINE 7 CALDWELL MEMORIAL HOSPITAL INC 1 GUARDIAN HEALTH SERVICE LLC 343 SECOND STREET HICKORY NC 28601 752950776 HOME HEALTHCARE NC N/A RELATED 561792 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 CALDWELL MEMORIAL HOSPITAL FOUNDATION C 288124 CASH CALDWELL MEMORIAL HOSPITAL FOUNDATION O 221314 ACTUAL COSTS