2022-08-15T13:27:44-05:00 2021-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2020-10-01 560603898 HARNETT HEALTH SYSTEM INC HARN 9108921000 PO BOX 1706 DUNN NC 28335 JESSICA LANG CFO 9108921000 2022-08-13 1 JESSICA LANG 999009999 JOHN NORMAN P01506766 7049985200 2022-08-13 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z BETSY JOHNSON REGIONAL HOSPITAL JESSICA LANG PO BOX 1706 DUNN NC 28335 137837447 0 X WWW.MYHARNETTHEALTH.ORG X 1937 NC HARNETT HEALTH IS COMMITTED TO PROVIDING QUALITY HEALTHCARE TO THE RESIDENTS OF HARNETT COUNTY AND SURROUNDING COMMUNITIES. WE ARE A PRIVATE, NOT-FOR-PROFIT HEALTHCARE ORGANIZATION BASED IN HARNETT COUNTY, N.C. 11 11 1245 47 0 0 2450661 18284363 102188785 118937166 85896 65631 609643 550287 105334985 137837447 0 0 0 0 57388123 64359381 0 0 0 47316979 56961698 104705102 121321079 629883 16516368 121887306 119557525 121760020 102913871 127286 16643654 HARNETT HEALTH IS DEDICATED TO PROVIDING QUALITY AND PERSONALIZED CARE WITH RESPECT AND COMPASSION AND ARE COMMITTED TO MAKING A DIFFERENCE THROUGHOUT OUR COMMUNITIES WITH SERVICE EXCELLENCE 0 0 104600461 118937166 AS PART OF MEETING HEALTH CARE NEEDS OF THE SERVICE AREA, HHS, INC. ADMITTED 5,344 PATIENTS, PROVIDING 25,377 PATIENT DAYS OF CARE, HAD 49,634 EMERGENCY ROOM VISITS AND HAD OVER 58,000 OUTPATIENT VISITS FOR OTHER SERVICES. 104600461 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 0 0 0 0 0 0 1 1 0 0 0 1 114 0 1245 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X JESSICA LANG 9108921000 PO BOX 1706 DUNN NC 28334 WALTER MASSEY CHAIRMAN 4.00 X X 0 0 0 GENE LEWIS TREASURER 2.00 X X 0 0 0 NEIL EMORY VICE CHAIRMAN 2.00 X X 0 0 0 STEVE CLABAUGH SECRETARY 2.00 X X 0 0 0 MIKE NAGOWSKI BOARD MEMBER 2.00 X X 0 0 0 TERRILL BROWN DPM BOARD MEMBER 2.00 X X 0 0 0 BARBARA MCKOY BOARD MEMBER 2.00 X X 0 0 0 GEORGE WOMBLE BOARD MEMBER 2.00 X X 0 0 0 DR BRADLEY CREED BOARD MEMBER 2.00 X X 0 0 0 ERIC TRUESDALE BOARD MEMBER 2.00 X X 0 0 0 TEDDY BYRD BOARD MEMBER 2.00 X X 0 0 0 CORY HESS PRESIDENT 40.00 4.00 X 357717 0 17401 MIKE JONES VP 40.00 X 199816 0 15246 JESSICA LANG CFO 40.00 4.00 X 168308 0 11561 OLALEKAN FOLARIN MD COMS 40.00 X 283107 0 15568 MARLEIGH ZACEK CNO 40.00 X 154480 0 35201 BIKRAMJIT GREWAL PHYSICIAN 40.00 X 693151 0 39911 MICHAEL ZICH PHYSICIAN 40.00 X 358929 0 37142 RAID ABO-KAMIL PHYSICIAN 40.00 X 453571 0 41393 ASIF ZIA PHYSICIAN 40.00 X 304674 0 34340 BRAD BUTLER PHYSICIAN 40.00 X 312715 0 37619 3286468 0 285382 52 0 1 0 CONCORDANCE HEALTHCARE SOLUTIONS PO BOX 94631 CLEVELAND OH 44101 MEDICAL SUPPLIES 3141106 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 503310737 STAFFING 2104928 TRUSTAFF PO BOX 63-8231 CINCINNATI OH 452638231 STAFFING 1446932 BYERS DEAN & ASSOCIATES 155 COMMERCE PARK WESTERVILLE OH 430828384 BILLING SVC 828458 SIGHTPATH MEDICAL LLC1 PO BOX 204253 DALLAS TX 753204253 OPTHALMIC SURGICAL EQUIPMENT 540617 21 56617 17656402 571344 18284363 NET PATIENT SERVICE REVENUE 621400 118492747 118492747 444419 444419 118937166 65631 65631 290239 0 290239 290239 290239 CAFETERIA SALES 900099 260048 260048 260048 137837447 118937166 0 615918 908618 772325 136293 53596181 45556754 8039427 688914 585577 103337 5270249 4479712 790537 3895419 3311106 584313 1934418 1934418 343603 343603 150751 150751 5851383 5851383 385734 385734 1603468 1603468 2328292 2328292 51899 51899 2602775 2602775 5283195 5283195 1010278 1010278 CONTRACT SERVICES/ CONT 10611556 10611556 MEDICAL SUPPLIES 9048527 9048527 DRUGS 5528307 5528307 MAINT. & REPAIRS 4089606 4089606 6137906 1499967 4637939 121321079 104600461 16720618 0 10031381 4415641 25035587 22298360 10203128 15493235 3831 3490 2402682 2561795 945790 910915 153831981 90842784 63099602 62989197 4878850 5399139 5286455 5485753 121887306 119557525 15442120 17754845 115047 122317 74000258 72066597 32202595 12970112 121760020 102913871 X -4751564 11244515 4878850 5399139 127286 16643654 121887306 119557525 16516368 0 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 6359 6359 0 PART II-B, LINE 1: DURING THE YEAR, THE ORGANIZATION PAID MEMBERSHIP DUES TO NCHA. NCHA ESTIMATED THAT APPROXIMATELY 17.27% OF DUES WERE ATTRIBUTABLE TO LOBBYING EFFORTS NCHA CONDUCTED ON BEHALF OF ITS MEMBERS. 1591703 1591703 92987678 44295300 48692378 58528194 46069860 12458334 724406 477624 246782 62989197 DEFERRED INFLOWS OF RESOURCES (PENSION RELATED) 952269 ESTIMATED THIRD PARTY SETTLEMENTS 3349035 ADVANCE MEDICARE PAYMENTS 8668808 12970112 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 0 0 2119976 409280 1710696 0.01410 18919300 19986731 0 0.00000 178612 85531 93081 0.00080 21217888 20481542 1803777 0.01490 242431 0 242431 0.00200 6294202 2619246 3674956 0.03030 0 0 0 0 1759 0 1759 0.00000 6538392 2619246 3919146 0.03230 27756280 23100788 5722923 0.04720 1 8675172 23969241 20425216 3544025 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 18 1 1 1 1 X WWW.MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ X X 1 18 1 WWW.MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES X X X X X 0 0 X X X 1 X 0 0 CENTRAL HARNETT HOSPITAL 2 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ X 1 18 1 WWW.MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES X X X X X 0 0 X X X 1 X 0 0 BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 5: THE ASSESSMENT PROCESS INCLUDED DATA COLLECTION FROM A COMBINATION OF PRIMARY AND SECONDARY SOURCES. VALUABLE INPUT FROM COMMUNITY SURVEY RESPONDENTS PROVIDED PRIMARY DATA FOR THE ASSESSMENT. SECONDARY DATA SOURCES INCLUDED THE 2010 U.S. CENSUS DATA AND THE NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, AND COUNTY LEVEL DATA FROM HARNETT HEALTH SYSTEM AND HARNETT COUNTY DEPARTMENT OF HEALTH. HARNETT HEALTH SYSTEM WAS AN INTEGRAL PART OF THE COMMUNITY HEALTH ASSESSMENT TEAM (CHAT) ESTABLISHED TO ANALYZE THE COMMUNITY HEALTH NEEDS OF HARNETT COUNTY. THE CHAT REVIEWED THE PRIMARY AND SECONDARY DATA AND DISCUSSED COMMUNITY HEALTH NEEDS THAT MAY BE ADDRESSED BY THE HARNETT HEALTH SYSTEM. THE COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZED THE FOLLOWING SEVEN STEP PROCESS:THE CHAT PARTICIPANTS INCLUDED REPRESENTATIVES FROM 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. ATTENDEES PROVIDED INPUT REGARDING COMMUNITY HEALTH STRENGTHS AND CONCERNS, AS WELL AS IDENTIFIED THE TOP HEALTH CONCERNS IN HARNETT COUNTY. THOSE INDIVIDUALS, REPRESENTING DIVERSE GROUPS IN HARNETT COUNTY WERE CHOSEN TO PARTICIPATE IN THE CHAT BECAUSE OF THEIR INSIGHTS ABOUT THE COMMUNITY'S HEALTH NEEDS.THE COMMUNITY HEALTH SURVEY FOR HARNETT COUNTY WAS CONDUCTED IN SPRING 2019. A TOTAL OF 577 INDIVIDUALS WERE SURVEYED. AFTER DATA CLEANING (INCLUDING LISTWISE DELETION OF INCOMPLETE SURVEY RESPONSES), THE FINAL DATASET INCLUDED 433 RESPONSES. SURVEYS WERE COLLECTED USING A COMBINATION OF HOUSEHOLD CANVASSING USING ADDRESSES RANDOMLY SELECTED FROM A TWO-STAGE CLUSTER SAMPLING PROCESS (122 SURVEYS) AND ONLINE, SELF-ADMINISTERED CONVENIENCE SAMPLING (311 SURVEYS). MUCH OF THE DATA LOSS FROM THE CLEANING PROCESS IS ATTRIBUTED TO SURVEYS STARTED BY NON-RESIDENTS AND SURVEYS IN WHICH PARTICIPANTS COMPLETED LESS THAN 5% OF THE ONLINE SURVEY. SECONDARY DATA WAS COLLECTED THROUGH SEVERAL SOURCES, TO INCLUDE U.S. CENSUS DATA AND THE NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 5: THE ASSESSMENT PROCESS INCLUDED DATA COLLECTION FROM A COMBINATION OF PRIMARY AND SECONDARY SOURCES. VALUABLE INPUT FROM COMMUNITY SURVEY RESPONDENTS PROVIDED PRIMARY DATA FOR THE ASSESSMENT. SECONDARY DATA SOURCES INCLUDED THE 2010 U.S. CENSUS DATA AND THE NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, AND COUNTY LEVEL DATA FROM HARNETT HEALTH SYSTEM AND HARNETT COUNTY DEPARTMENT OF HEALTH. HARNETT HEALTH SYSTEM WAS AN INTEGRAL PART OF THE COMMUNITY HEALTH ASSESSMENT TEAM (CHAT) ESTABLISHED TO ANALYZE THE COMMUNITY HEALTH NEEDS OF HARNETT COUNTY. THE CHAT REVIEWED THE PRIMARY AND SECONDARY DATA AND DISCUSSED COMMUNITY HEALTH NEEDS THAT MAY BE ADDRESSED BY THE HARNETT HEALTH SYSTEM. THE COMMUNITY HEALTH NEEDS ASSESSMENT UTILIZED THE FOLLOWING SEVEN STEP PROCESS:THE CHAT PARTICIPANTS INCLUDED REPRESENTATIVES FROM 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. ATTENDEES PROVIDED INPUT REGARDING COMMUNITY HEALTH STRENGTHS AND CONCERNS, AS WELL AS IDENTIFIED THE TOP HEALTH CONCERNS IN HARNETT COUNTY. THOSE INDIVIDUALS, REPRESENTING DIVERSE GROUPS IN HARNETT COUNTY WERE CHOSEN TO PARTICIPATE IN THE CHAT BECAUSE OF THEIR INSIGHTS ABOUT THE COMMUNITY'S HEALTH NEEDS.THE COMMUNITY HEALTH SURVEY FOR HARNETT COUNTY WAS CONDUCTED IN SPRING 2019. A TOTAL OF 577 INDIVIDUALS WERE SURVEYED. AFTER DATA CLEANING (INCLUDING LISTWISE DELETION OF INCOMPLETE SURVEY RESPONSES), THE FINAL DATASET INCLUDED 433 RESPONSES. SURVEYS WERE COLLECTED USING A COMBINATION OF HOUSEHOLD CANVASSING USING ADDRESSES RANDOMLY SELECTED FROM A TWO-STAGE CLUSTER SAMPLING PROCESS (122 SURVEYS) AND ONLINE, SELF-ADMINISTERED CONVENIENCE SAMPLING (311 SURVEYS). MUCH OF THE DATA LOSS FROM THE CLEANING PROCESS IS ATTRIBUTED TO SURVEYS STARTED BY NON-RESIDENTS AND SURVEYS IN WHICH PARTICIPANTS COMPLETED LESS THAN 5% OF THE ONLINE SURVEY. SECONDARY DATA WAS COLLECTED THROUGH SEVERAL SOURCES, TO INCLUDE U.S. CENSUS DATA AND THE NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS. 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 DEPARTMENTHEALTHY HARNETT COALITIONDEPARTMENT OF PUBLIC HEALTH AT CAMPBELL UNIVERSITY 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: HARNETT HEALTH SYSTEM AND HARNETT COUNTY DEPARTMENT OF HEALTH HELD MEETINGS FOR CHAT PARTICIPANTS. AT THE FIRST, THE CHAT PARTICIPANTS REVIEWED THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, PRIMARY AND SECONDARY DATA COLLECTION METHODS, AND THE REQUIRED COMMUNITY SURVEY. ADDITIONALLY, RESULTS FROM THE 2013-2015 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN WERE SHARED WITH THE GROUP. EACH PARTICIPANT WAS ENCOURAGED TO SHARE THE FOLLOWING IDEAS: STRENGTHS AND VALUES OF THE COMMUNITY; AND CONCERNS AND BARRIERS OF THE COMMUNITY.RESULTS OF THE CHNA SURVEY WERE ANALYZED AT THE SECOND MEETING. ATTENDEES PROVIDED INPUT REGARDING COMMUNITY HEALTH STRENGTHS AND CONCERNS, AS WELL AS TOP HEALTH CONCERNS SEEN THROUGHOUT THE HARNETT COUNTY AREA. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 11: HARNETT HEALTH SYSTEM AND HARNETT COUNTY DEPARTMENT OF HEALTH HELD MEETINGS FOR CHAT PARTICIPANTS. AT THE FIRST, THE CHAT PARTICIPANTS REVIEWED THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, PRIMARY AND SECONDARY DATA COLLECTION METHODS, AND THE REQUIRED COMMUNITY SURVEY. ADDITIONALLY, RESULTS FROM THE 2013-2015 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN WERE SHARED WITH THE GROUP. EACH PARTICIPANT WAS ENCOURAGED TO SHARE THE FOLLOWING IDEAS: STRENGTHS AND VALUES OF THE COMMUNITY; AND CONCERNS AND BARRIERS OF THE COMMUNITY.RESULTS OF THE CHNA SURVEY WERE ANALYZED AT THE SECOND MEETING. ATTENDEES PROVIDED INPUT REGARDING COMMUNITY HEALTH STRENGTHS AND CONCERNS, AS WELL AS TOP HEALTH CONCERNS SEEN THROUGHOUT THE HARNETT COUNTY AREA. 9 1 - HARNETT HEALTH ANGIER MEDICAL SERVICES 185 RAWLS ROAD ANGIER NC 27501 PRIMARY CARE PROVIDER 2 - HARNETT HEALTH LILLINGTON MEDICAL SERVIC 7 EAST DUNCAN STREET LILLINGTON NC 27546 PRIMARY CARE PROVIDER 3 - HARNETT HEALTH DUNN MEDICAL SERVICES 803 TILGHMAN DRIVE STE 100 DUNN NC 28334 PRIMARY CARE PROVIDER 4 - HARNETT HEALTH HARNETT OBGYN 805-C TILGHMAN DRVE DUNN NC 28334 OBSTETRICS/GYNECOLOGY SERVICES 5 - HARNETT HEALTH PREMIER PEDIATRICS 802 TILGHMAN DRIVE DUNN NC 28334 PRIMARY CARE PROVIDER 6 - COATS MEDICAL SERVICES 25 N JOHNSON STREET COATS NC 27521 PRIMARY CARE PROVIDER 7 - HARNETT HEALTH ORTHO & SPORTS MED 716 10TH ST LILLINGTON NC 27546 ORTHOPAEDIC & SPORTS MEDICINE 8 - BUFFALO LAKES MEDICAL SERVICES 1619 BUFFALO LAKE RD SANFORD NC 27332 PRIMARY CARE PROVIDER 9 - PREMIER PEDIATRICS 716 10TH ST LILLINGTON NC 27546 PEDRIATICS PART I, LINE 3C: INCOME LEVEL, ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS PART I, LINE 7: HARNETT HEALTH USED THE COST-TO-CHARGE RATIO, ESTABLISHED FROM ITS COST REPORTS FILED, TO REPORT FINANIAL ASSISTANCE SHOWN IN PART I AND PART III OF SCHEDULE H. PART III, LINE 2: COST-TO-CHARGE RATIO APPLIED AGAINST BAD DEBT CHARGES FROM UN-DISCOUNTED SELF-PAY PATIENTS. 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 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-SCREENING 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: MEDICARE 46.8%, MEDICAID 17.9%, MANAGED CARE 19.1%, SELF PAY 11.9%, TRICARE AND ALL OTHER 4.3%. 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. 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, 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 0 0 0 0 0 0 0 0 BIKRAMJIT GREWAL PHYSICIAN 693151 0 0 0 0 0 7452 0 32459 0 733062 0 0 0 RAID ABO-KAMIL PHYSICIAN 308083 0 145488 0 0 0 4223 0 37170 0 494964 0 0 0 MICHAEL ZICH PHYSICIAN 343929 0 15000 0 0 0 5595 0 31547 0 396071 0 0 0 CORY HESS PRESIDENT 310783 0 46934 0 0 0 8550 0 8851 0 375118 0 0 0 BRAD BUTLER PHYSICIAN 281445 0 31270 0 0 0 6448 0 31171 0 350334 0 0 0 ASIF ZIA PHYSICIAN 215162 0 89512 0 0 0 4031 0 30309 0 339014 0 0 0 OLALEKAN FOLARIN MD COMS 210807 0 16259 0 56041 0 7544 0 8024 0 298675 0 0 0 MIKE JONES VP 180848 0 18968 0 0 0 3989 0 11257 0 215062 0 0 0 MARLEIGH ZACEK CNO 138783 0 15697 0 0 0 3257 0 31944 0 189681 0 0 0 JESSICA LANG CFO 156459 0 11849 0 0 0 4694 0 6867 0 179869 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 CAPE FEAR VALLEY HEALTH SYSTEM, A NORTH CAROLINA NONPROFIT HEALTH SYSTEM, PROVIDES THE DAY-TO-DAY OPERATIONAL MANAGEMENT OF HARNETT HEALTH. FORM 990, PART VI, SECTION A, LINE 4 CAPE FEAR VALLEY HEALTH WAS ADDED AS THE SOLE MEMBER OF HARNETT HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES OF THE ORGANIZATION IS COMPRISED OF ELEVEN RESIDENTS, TEN OF HARNETT COUNTY, NC AND ONE OF CUMBERLAND COUNTY. 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 THREE 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. CAPE FEAR VALLEY APPOINTS ONE TRUSTEE. FORM 990, PART VI, SECTION A, LINE 7B APPOINTED BOARD MEMBERS ARE APPROVED BY COUNTY COMMISSIONERS. FORM 990, PART VI, SECTION B, LINE 11B COPY OF THE 990 FORM IS AVAILABLE AT THE BOARD MEETING FOR REVIEW AND BOARD MEMBERS CAN REQUEST TO REVIEW OTHER TIMES OUTSIDE OF THE BOARD MEETING AS WELL. THE CHIEF FINANCIAL OFFICER REVIEWS THE 990 WITH THE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY FILE A DISCLOSURE STATEMENT WITH THE SECRETARY OF THE BOARD AT THE TIME OF THE PERSONS INITIAL APPOINTMENT AS A TRUSTEE OR COMMITTEE MEMBER AND THEREAFTER. THE STATEMENT SHALL BE ON A FORM APPROVED BY THE BOARD AND A COPY OF EACH STATEMENT SHALL BE PROVIDED TO THE CHAIR OF THE BOARD AND THE HOSPITAL'S GENERAL COUNCIL 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 CAPE FEAR (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. CAPE FEAR 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. ANGIER MEDICAL SERVICES LLC 185 RAWLS RD ANGIER NC 27501 270906936 PRIMARY CARE PROVIDER NC 1514537 680840 HARNETT HEALTH SYSTEM COATS MEDICAL SERVICES LLC 25 JOHNSON ST N COATS NC 27521 462540799 PRIMARY CARE PROVIDER NC 1228979 241824 HARNETT HEALTH SYSTEM DUNN MEDICAL SERVICES LLC 803 TILGHMAN DR 100 DUNN NC 28334 273320115 PRIMARY CARE PROVIDER NC 1150662 283272 HARNETT HEALTH SYSTEM HARNETT OBGYN LLC 805-C TILGHMAN DR DUNN NC 28334 273320275 OBSTETRICS/GYNECOLOGY SERVICES NC 783015 189837 HARNETT HEALTH SYSTEM LILLINGTON MEDICAL SERVICES LLC 7 EAST DUNCAN STREET LILLINGTON NC 27546 272944176 INTERNAL MEDICINE, INFECTIOUS DISEASE, AND GYNECOLOGY NC 1453608 198008 HARNETT HEALTH SYSTEM HARNETT HEALTH SYSTEM FOUNDATION 800 TILGHMAN DRIVE DUNN NC 28334 201929953 FUNDRAISING NC 501(C)(3) LINE 7 N/A 0 CUMBERLAND COUNTY HOSPITAL INC PO BOX 2000 FAYETTEVILLE NC 28302 560845796 HOSPITAL NC 501(C)(3) LINE 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0