2011-08-15T15:00:46-05:00 2010-09-30 LarsonAllen LLP 101 N Tryon Street Suite 1000 Charlotte NC 28246 990 2009-10-01 561484844 Wayne Memorial Hospital Inc WAYN 9197316142 PO Box 8001 Goldsboro NC 27533 Rebecca Craig 9197316142 2011-08-15 1 7049985200 2009 2016-02-24 21:20:13Z j william paugh PO Box 8001 Goldsboro NC 27533 199000361 0 X www.waynehealth.org X 1896 NC to provide the community quality healthcare services. 12 11 1853 130 18977 0 912651 0 196240318 195922270 2572169 2150958 1713123 927133 201438261 199000361 210000 213466 0 96037223 92365236 0 0 97210007 100824051 193457230 193402753 7981031 5597608 205371326 214548605 137940621 146139215 67430705 68409390 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 180037505 195922270 Providing Compassionate Progressive Healthcare Including Inpatient, Outpatient, Intensive Care, and Emergency Care. 180037505 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 134 0 1853 1 1 1 0 0 0 0 0 0 0 0 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC CA X X Rebecca Craig cfo 9197316142 PO Box 8001 Goldsboro NC 27533 Harold D Brashear 1.00 X 0 0 0 William W Broadaway 1.00 X 0 0 0 C Munroe 'Jack Best 1.00 X 0 0 0 Christopher P Griffin MD 1.00 X 0 0 0 Samuel P Hunter 1.00 X 0 0 0 Stephen Lies MD 1.00 X 0 0 0 Susan McCall 1.00 X 0 0 0 Ray McDonald Jr 1.00 X 0 0 0 Leon Stockton MD 1.00 X 0 0 0 Robert D Walker Jr 1.00 X 0 0 0 Charlotte M Weaver 1.00 X 0 0 0 J William Paugh 40.00 X 834208 0 131660 Thomas Bradshaw 40.00 X 223092 0 63975 Rebecca Craig 40.00 X 214342 0 59489 Shirley Harkey 40.00 X 183423 0 51278 Richard Rogers 40.00 X 159335 0 44733 Angela Whitten 40.00 X 187669 0 24491 Jacqueline Wharton 40.00 X 186874 0 11362 George Haywood 40.00 X 182405 0 16680 Crystal Winstead 40.00 X 181627 0 15158 Amy Willouhby 40.00 X 180579 0 11271 2533554 0 430097 48 0 1 0 rn rouse and company inc po box 10249 goldsboro NC 27532 contractor 911034 PETERSON ASSOCIATES 2115 rexford road suite 500 charlotte NC 28211 ARCHITECTS 825778 American Management 2719 graves drive unit 11 goldsboro NC 27533 Debt Collections 746440 Sodexho INc & Affiliates 500 Russ Street Pittsburg PA 15262 Consultants 737585 Aramark po box 828441 philadelphia PA 19182 Contract Mgmt 722444 5 patient revenue 621110 189952750 189952750 5969520 5969520 195922270 2150958 2150958 distributions from mem 900099 1082852 1082852 premier purchasing gai 561000 18977 18977 asset disposal 900099 -174696 -174696 927133 199000361 195922270 18977 3059114 150000 150000 63466 63466 1605914 1605914 71713312 65106458 6606854 5479149 4969588 509561 8339189 7563644 775545 5227672 4741499 486173 801664 801664 201308 201308 217703 217703 14730791 13841631 889160 3352873 3162415 190458 2567974 2567974 3037150 3037150 26862 18018 8844 262530 168311 94219 3060301 3060301 8728423 8689064 39359 489000 489000 medical supplies 33310005 33310005 bad debt expense 23671106 23671106 6366361 6077271 289090 193402753 180037505 13365248 0 3032843 10817048 38142 27709708 20813931 4090338 4111581 2305190 2385320 176951361 89999027 87156457 86952334 73243577 80014299 7833213 9415950 205371326 214548605 22869080 23312884 64156020 60865584 842804 108992 50072717 61851755 137940621 146139215 X 66535510 67484094 895195 925296 67430705 68409390 205371326 214548605 X 0 1 1 X 0 X 0 0 0 0 0 0 0 0 1 18423 18423 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: (NCHA Dues) $18,423 89638631 35550578 54088053 40058312 28044086 12014226 36319276 23032836 13286440 10935142 3371527 7563615 86952334 investments 80014299 F 80014299 OTHER LIABILITIES 18384286 minimum pension liability 43467469 61851755 1 1 1 X 1 X 1 1 1 0 1 1 10969107 10251321 717786 0.00370 10969107 10251321 717786 0.00370 2121883 2121883 0.01100 2789900 2789900 0.01440 100000 100000 0.00050 5011783 5011783 0.02590 15980890 10251321 5729569 0.02960 432525 432525 0.00220 11134 11134 0.00010 443659 443659 0.00230 1 23671106 10113281 179826886 0 179826886 X 1 1 Wayne MRI LLC mri 0.66700 0.33300 wayne memorial hospital inc

2700 wayne memorial drive goldsboro NC 27533

X X X 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 6a: n/a Part I, Line 7: The costing methodology used was a facility wide cost-to-charge ratio derived from Worksheet 2. Part III, Line 4: To be consistent, the costing methodology used for calculating Bad Debt Expense was a facility wide cost-to-charge ratio derived from Worksheet 2. Part III, Line 8: The costing methodology used to determine the Medicare allowable costs is Medicare's standard cost-to-charge ratio as calculated in the Medicare Cost Report. The rationale for using this methodology is that it is the standard and widely accepted methodology for calculating Medicare Cost. Part III, Line 9b: The hospital attempts to identify patients that may qualify for charity by reviewing prior patient history of charity eligibility or by using a credit scoring tool that will indicate potential charity cases based on our charity care guidelines. Schedule H Part II Workforce developmentThe Hospital is active in its support for organizations seeking to make encourage growth in Wayne County, by making it a desirable location to live and work. Attracting quality employers is the key to job growth. Having a high quality hospital is the Hospital's first priority, and that includes recruitment of physicians to meet growth needs, replace retiring physicians, and supplement clinical areas which need more expertise. Recruitment of additional physicians and other providers, particularly in areas of diabetes treatment and primary care, has been a key goal for several years. The medical staff development plan adopted by the Board of Directors in late 2009 is the platform for moving ahead. The hospital began hiring physicians in 2009, and will continue to do this, as the market demand continues. Nationally, there is a move by physicians to be employed by hospitals, versus running individual/group practices, and the Hospital is responding to that desire, which is benefiting Wayne County. Part VI, Line 2: Every three years, the Hospital partners with Wayne County Department of Health, Wayne Action Teams for Community Health (WATCH) and other agencies in Wayne County to sponsor a community-wide health assessment, which is then updated by the health department annually, using state and local statistics. This annual health assessment is published on the Wayne County Health Department website, and is referred to by virtually all entities in Wayne County who are interested in improving health. External consultants are engaged to put together community surveys (every third year) and help set priorities. The hospital has taken a leadership role in recruiting physicians to Wayne County with skills that are in short supply. This is handled through a formal physician needs assessment, which was completed in FY 2010, and adopted by the Board of Directors in December 2009. Part VI, Line 3: Provide counseling to patients, provide patient brochures with information and hospital website. Part VI, Line 4: Like most of eastern North Carolina, Wayne County is a rural and relatively poor county with a per capita income of $17,000, below North Carolina and national averages. About 15% of its 122,000 population have incomes at the poverty rate [US Census - 2010] and 25% of Wayne County children live in poverty. Wayne County has the third highest agricultural production of all 100 North Carolina counties. Its deep roots in agriculture have propagated generations of smokers and unhealthy eaters, much of which was offset, before agriculture became so mechanized, with physical exercise. Now, Wayne ranks 53 out of 100 North Carolina counties in health behaviors. [County Health Rankings, Robert Wood Johnson Foundation]. This is actually an improvement over prior years, and there is a commitment from local health leaders to continue to improve the ranking, through combined efforts to combat childhood obesity, diabetes, and other health issues. Wayne County residents are involved in high numbers of cancer trials, which bring hope to local cancer patients, and which may lead to breakthroughs in cancer treatment and possibly cures. The county is small enough that cooperation between local health providers is easy to achieve, and networks exist to improve the health of Wayne County residents. Part VI, Line 5: The Hospital is active in its support for organizations seeking to make encourage growth in Wayne County, by making it a desirable location to live and work. Attracting quality employers is the key to job growth. Having a high quality hospital is the Hospital's first priority, and that includes recruitment of physicians to meet growth needs, replace retiring physicians, and supplement clinical areas which need more expertise. Recruitment of additional physicians and other providers, particularly in areas of diabetes treatment and primary care, has been a key goal for several years. The medical staff development plan adopted by the Board of Directors in late 2009 is the platform for moving ahead. The hospital began hiring physicians in 2009, and will continue to do this, as the market demand continues. Nationally, there is a move by physicians to be employed by hospitals, versus running individual/group practices, and the Hospital is responding to that desire, which is benefiting Wayne County. Part VI, Line 6: The Hospital has been governed, since 1985, by a board of community representatives, from business, law, and medicine, and has had the benefit, over these years, of consistent professional accounting and legal advice. It has a stated commitment to care for patients who are unable to pay for care, and with greater than 5% of revenues dedicated to this task, it makes good on this commitment every year. In addition, the hospital has been the bedrock of the Wayne Action Teams on Community Health (WATCH), which reaches uninsured persons throughout the county. Rates for hospital care are among the lowest in the State of North Carolina, in an attempt to keep hospital care affordable. Charity policy is generous, and the hospital works with patients on payment plans daily. The medical staff is open to all qualified providers, and is represented on the board of directors. Surplus funds are dedicated to improvement of facilities and to providing financial stability to allow the hospital to borrow funds if necessary to purchase long term assets, to improve health care in Wayne County. No private person benefits from cash generated from hospital operations. Part VI, Line 7: n/a NC 1 raleigh crna school 3900 barrett drive suite 200 raleigh NC 27609 561684241 501(c)(3) 50000 healthcare education the foundation of wayne community college po box 8002 goldsboro NC 27533 561556512 501(c)(3) 100000 healthcare education 2 educational grant 7 63466 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 X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 J William Paugh 490422 0 43701 0 300085 0 70092 0 61568 0 965868 0 0 0 Thomas Bradshaw 222625 0 0 0 467 0 35960 0 28015 0 287067 0 0 0 Rebecca Craig 214342 0 0 0 0 0 43129 0 16360 0 273831 0 0 0 Shirley Harkey 183423 0 0 0 0 0 24976 0 26302 0 234701 0 0 0 Richard Rogers 159335 0 0 0 0 0 17117 0 27616 0 204068 0 0 0 Angela Whitten 187669 0 0 0 0 0 13117 0 11374 0 212160 0 0 0 Jacqueline Wharton 186874 0 0 0 0 0 0 0 11362 0 198236 0 0 0 George Haywood 182405 0 0 0 0 0 5554 0 11126 0 199085 0 0 0 Crystal Winstead 181627 0 0 0 0 0 5903 0 9255 0 196785 0 0 0 Amy Willouhby 180579 0 0 0 0 0 0 0 11271 0 191850 0 0 0 Part I, Line 1a 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. north carolina medical care commission 521309402 65820Hb93 2009-03-19 35720000 capital expenditures 0 0 35720000 2009 1 0 1 1 0 0 0 0 1 1 0 1 1 0 0 0 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. form 990, part xi, line 2c: The process for approving audited financial statements and for selecting independent accountants has not changed from the prior year. american management associates llc 2719 graves drive goldsboro NC 27534 561622637 collections NC N/A wayne health foundation inc 2700 Wayne Memorial Drive goldsboro NC 27533 581881912 support NC 501(c)(3) 509(a)(2) N/A Wayne Health Corporation po box 8001 goldsboro NC 27534 561479733 healthcare NC 501(c)(3) 509(a)(3) N/A Wayne MRI LLC 2700 Wayne Memorial Drive Goldsboro NC 27533 342043934 mri services NC N/A related 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 wayne health corporation J 250000 wayne health foundation inc N 489834 wayne health foundation inc P 583035