2021-11-12T10:01:16-06:00 2020-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2020-01-01 541453954 AUGUSTA HEALTH CARE INC D/B/A AUGUSTA HEALTH AUGU 5409324685 PO BOX 1000 FISHERSVILLE VA 22939 JOHN KATSIANIS CFO 5409324685 2021-11-11 1 JOHN KATSIANIS XXX-XX-XXXX AMY BIBBY P00445891 8282542254 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z AUGUSTA HEALTH MARY N MANNIX FACHE PO BOX 1000 FISHERSVILLE VA 22939 734872625 0 X WWW.AUGUSTAHEALTH.COM X 1988 VA PROMOTE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH ACCESS TO EXCELLENT CARE. 15 12 2378 170 4128376 0 956999 1243421 351816484 354455790 23359880 18665181 4754871 3858107 380888234 378222499 615890 325069 0 0 143265053 152371660 0 0 0 166793460 166843067 310674403 319539796 70213831 58682703 826767939 968899948 52233791 94948871 774534148 873951077 X THE MISSION OF AUGUSTA HEALTH IS TO PROMOTE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH ACCESS TO EXCELLENT CARE. 0 0 271921898 325069 350327414 AUGUSTA HEALTH CARE, INC. IS A 501(C)(3) ORGANIZATION DOING BUSINESS AS AUGUSTA HEALTH. THE ORGANIZATION INCLUDES A MEDICAL CENTER WITH 255 LICENSED INPATIENT BEDS; AN EMERGENCY DEPARTMENT TREATING APPROXIMATELY 51,000 COMMUNITY MEMBERS PER YEAR; FOUR URGENT CARE CENTERS TREATING APPROXIMATELY 46,000 PATIENTS; A STATE OF THE ART CANCER CENTER PROVIDING TAILOR-MADE COMPREHENSIVE CARE INCLUDING MEDICAL ONCOLOGY AND RADIATION ONCOLOGY; A HOME HEALTH AND HOSPICE PROGRAM SERVING PATIENTS WHO WISH TO REMAIN AT HOME DURING THEIR TREATMENT OR FINAL DAYS; A WOUND HEALING CLINIC PROVIDING A COMPREHENSIVE TREATMENT REGIMEN FOR CHRONIC NON-HEALING WOUNDS; AND A SKILLED NURSING UNIT PROVIDING COMPREHENSIVE REHABILITATION FOR PATIENTS RECOVERING FROM ORTHOPEDIC SURGERY.THE CAMPUS OF AUGUSTA HEALTH IS DESIGNED TO PROVIDE NOT ONLY HOSPITAL SERVICES BUT COMMUNITY ORIENTED SERVICES. THE CAMPUS INCLUDES THE HOSPITAL PROPER; A MAJOR FITNESS CENTER; AN EDUCATIONAL BUILDING THAT HOUSES AUGUSTA HEALTH EDUCATIONAL SERVICES; A COMMUNITY BUILDING WITH LARGE CONFERENCE ROOMS AVAILABLE TO OTHER COMMUNITY ORGANIZATIONS; AND A BEHAVIORAL HEALTH BUILDING FOR THE PROVISION OF OUTPATIENT PSYCHIATRIC AND SUBSTANCE ABUSE SERVICES. THIS WIDE RANGE OF FACILITIES HELPS TO SUPPORT AUGUSTA HEALTH'S VISION OF PROVIDING THE COMMUNITY WITH A FULL CONTINUUM OF HEALTH AND COMMUNITY SERVICES. AUGUSTA HEALTH IS SUPPORTED BY AUGUSTA MEDICAL GROUP, A 240 EMPLOYED PROVIDER NETWORK TREATING APPROXIMATELY 600,000 PEOPLE PER YEAR. THE MEDICAL GROUP WAS ESTABLISHED TO SUPPORT THE CHARITABLE PURPOSES OF AUGUSTA HEALTH CARE INC. THIS GROUP ENABLES THE GREATER AUGUSTA COUNTY, VIRGINIA TO BENEFIT FROM A STABLE BASE OF PHYSICIANS IN A BROAD ARRAY OF SPECIALTIES.THE HOSPITAL SERVES AS THE SOLE CORPORATE MEMBER OF AUGUSTA CARE PARTNERS, LLC (THE "LLC"). THE LLC WAS ORGANIZED TO PROVIDE A NETWORK OF INDIVIDUAL PRACTICES OF ACCOUNTABLE CARE ORGANIZATION PROFESSIONALS, WITH 280 PROVIDERS AND FLOW OF $80 MILLION IN MEDICARE CLAIMS COVERING 8,500 BENEFICIARIES.IN 2020, AUGUSTA HEALTH RECEIVED THE FOLLOWING HONORS, AWARDS, AND ACCREDITATIONS: 2020 BEST HOSPITAL IN SHENANDOAH VALLEY BY U.S. NEWS & WORLD REPORT, 2020 LEAP FROG TOP GENERAL HOSPITAL, AND GET WITH GUIDELINES STROKE GOLD PLUS WITH TARGET: STROKE HONOR ROLL.AUGUSTA HEALTH'S NET COMMUNITY BENEFIT FOR 2020 IS ESTIMATED TO BE $17,219,827. THIS BENEFIT CAN BE CATEGORIZED AS FOLLOWS: $3,258,434 CHARITY $9,647,590 MEDICAID $943,555 COMMUNITY HEALTH SERVICES $346,669 HEALTH PROFESSIONAL EDUCATION $2,597,636 SUBSIDIZED HEALTH SERVICES $425,943 CASH & IN-KIND CONTRIBUTIONS 271921898 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 631 0 2378 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 X 15 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X X SARAH HASH-RODGERS 5403324685 78 MEDICAL CENTER CIRCLE FISHERSVILLE VA 22939 LAUREL L LANDES BOARD CHAIR 1.00 1.00 X X 0 0 0 JOHN B DAVIS VICE-CHAIRMAN 1.00 X X 0 0 0 BURNIE POWERS SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 JOHN P BOWERS BOARD MEMBER 1.00 X 0 0 0 DEBRA S CALLISON BOARD MEMBER 1.00 X 0 0 0 ROBIN G CROWDER BOARD MEMBER 1.00 X 0 0 0 RONALD W DENNY BOARD MEMBER 1.00 X 0 0 0 RICHARD EVANS MD BOARD MEMBER 1.00 1.00 X 0 0 0 DAVID FOSNOCHT MD BOARD MEMBER 1.00 X 0 0 0 CHRISTOPHER HECK MD BOARD MEMBER 1.00 X 0 66746 0 HOMER HITE BOARD MEMBER 1.00 1.00 X 0 0 0 A WHIT MORRISS MD BOARD MEMBER 40.00 1.00 X 0 0 0 JACK OTTENI MD BOARD MEMBER 1.00 X 0 0 0 REV JOHN C PETERSON BOARD MEMBER 1.00 X 0 0 0 MARY N MANNIX PRESIDENT & CEO 39.00 1.00 X X 896897 0 151883 JOHN KATSIANIS VP AND CFO 40.00 X 471865 0 57900 KAREN CLARK VP OPERATIONS 40.00 X 401393 0 44457 DAN O'CONNOR VP OF POPULATION HEALTH 40.00 X 374897 0 48158 MIKE CANFIELD VP AND CIO 40.00 X 352911 0 50301 MARK LAROSA VP OF BUSINESS DEVELOPMENT 40.00 X 309749 0 37999 SCOTT JUST MD PRESIDENT, AMG 40.00 X 482806 0 62333 VICKIE TAYLOR ASSISTANT CHIEF NURSING OFFICER 40.00 X 228166 0 11164 CRYSTAL FARMER VP AND CNO 40.00 X 326812 0 28022 SCOTT CRABTREE ASSISTANT VP 40.00 X 224553 0 31440 BILL DOHERTY VP AND CMO 40.00 X 434882 0 10500 SCOTT JONES VP OF COMPLIANCE & PRIVACY OFFICER 40.00 X 212488 0 30527 JEAN VEILLEUX VP OF LEGAL AFFAIRS AND GENERAL COUNSEL 40.00 X 164049 0 28083 JOHN BOSWELL VP OF HUMAN RESOURCES 40.00 X 255339 0 46560 ANDREW WEST CMIO 40.00 X 380859 0 13733 ANTHONY LONG ADMINISTRATIVE DIRECTOR 40.00 X 221186 0 9516 ANDREA HALEY ADMINISTRATIVE DIRECTOR OF 40.00 X 190237 0 5699 SARAH HASH-RODGERS CORPORATE CONTROLLER 40.00 X 185994 0 15595 JOHN GIRARD ADMINISTRATIVE DIRECTOR 40.00 X 182739 0 19521 DOUG JENA ADMINISTRATIVE DIRECTOR 40.00 X 182325 0 10857 6480147 66746 714248 100 0 1 0 RIDDLEBERGER BROTHERS 6127 SOUTH VALLEY PIKE MT CRAWFORD VA 22841 CONTRACTOR 2905188 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 30353 NUTRITION SERVICES MANAGER 2654190 QUALIVIS PO BOX 123847 DALLAS TX 75312 TRAVELERS 1932724 US SECURITY ASSOCIATES PO BOX 828854 PHILADELPHIA PA 19182 SECURITY 1775443 BLUE RIDGE PATHOLOGISTS 70 MEDICAL CENTER CIRCLE SUITE 309 FISHERSVILLE VA 22939 PHYSICIAN SERVICES 1135898 61 1243421 1243421 NET PATIENT SERVICE REVENUE 621400 338231508 337517182 714326 OTHER PROGRAM SERVICE REVENUE 900099 12351157 12219510 131647 RETAIL PHARMACY 446110 2546485 2546485 FITNESS CENTER 713940 1144667 590722 553945 DME 621400 181973 181973 354455790 18608861 18608861 890331 444532 445799 445799 445799 356261914 356205594 56320 56320 56320 AFFILIATED REVENUES/LOSSES 900099 2408641 2408641 CAFETERIA/VENDING 722210 957183 957183 MISCELLANEOUS 900099 46484 46484 3412308 378222499 350327414 4128376 22523288 325069 325069 6312958 6312958 69682 69682 116855301 100949462 15905839 4730649 3877752 852897 16450165 13484334 2965831 7952905 6519061 1433844 755290 755290 2817780 2817780 196318 196318 180410 180410 31772114 23114609 8657505 1313836 24801 1289035 24902726 20571140 4331586 2762695 1937236 825459 6298842 6298842 482317 472062 10255 503773 338555 165218 301356 301356 15718655 15718655 1330087 1330087 MEDICAL SUPPLIES 32502348 32502348 COST OF DRUGS SOLD 26906055 26906055 BAD DEBTS 14834733 14834733 COST OF FOOD 1793520 1793520 1470212 552539 917673 319539796 271921898 47617898 0 13313658 13388528 41863977 40409793 6596949 7424616 5247860 4701605 427665410 275036351 149572238 152629059 433939911 496852967 6235402 8448911 151200368 176114723 1078460 1715434 17719116 67214312 826767939 968899948 27566829 30608297 63534 37894 7937083 461492 305100 273433 16361245 63567755 52233791 94948871 X 774287684 873610925 246464 340152 774534148 873951077 826767939 968899948 X 58682703 41380330 -646104 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 33384 33384 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION (VHHA). THESE ORGANIZATIONS ROUTINELY ENGAGE IN LOBBYING EFFORTS ON BEHALF OF ITS MEMBERSHIP BODY, AND A PORTION OF EACH MEMBER'S DUES ARE ALLOCATED TO THOSE LOBBYING EXPENDITURES. THE PORTION OF THE HOSPITAL'S DUES ALLOCATED TO LOBBYING WAS $ 33,384. 1511837 5671635 7183472 147859466 67839022 80020444 1116289 175394 940895 245875044 196632409 49242635 25631139 10389526 15241613 152629059 INVESTMENT IN AMG 176114723 C 176114723 BENEFIT ENDOWMENT 17032771 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN 2993260 MEDICARE ADVANCE PROVIDER PAYMENTS 47188281 67214312 OTHER LIABILITIES 13806797 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN 2993260 MEDICARE ADVANCE PAYMENT PAYABLE 46767698 63567755 X 401554574 41380330 41380330 360174244 18048255 18048255 378222499 302137645 0 302137645 17402151 17402151 319539796 PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON INCOME DERIVED FROM ITS EXEMPT PURPOSE AS A NOT-FOR-PROFIT ORGANIZATION UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAX. THE COMPANY HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH REVENUE 14,834,733. GRANTS EXPENSE NET WITH REVENUE 325,069. EQUITY TRANSFERS BETWEEN AFFILIATES 646,104. EXPENSES IN REVENUES 2,242,349. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH REVENUE 14,834,733. GRANTS EXPENSE NET WITH REVENUE 325,069. EXPENSES IN REVENUES 2,242,349. CENTRAL AMERICA AND THE CARIBBEAN - 0 0 INVESTMENT 8192207 0 0 0 0 0 0 8192207 0 8192207 1 0 1 1 0 0 PART III ACCOUNTING METHOD: PART IV, QUESTION 4 THE ORGANIZATION IS NOT REQUIRED TO FILE THE FORM 8621. 1 1 1 X 1 X 1 1 1 0 1 0 3258434 3258434 0.01070 37258378 27610788 9647590 0.03170 40516812 27610788 12906024 0.04240 943555 943555 0.00310 385588 38919 346669 0.00110 10181756 7584120 2597636 0.00850 425943 425943 0.00140 11936842 7623039 4313803 0.01410 52453654 35233827 17219827 0.05650 11 0 10010 10010 0.00000 1 0 10099 10099 0.00000 7 84 28446 28446 0.00010 19 84 48555 48555 0.00010 1 14834733 1377754 96057119 101568430 -5511311 X 1 1 1 1 AUGUSTA HEALTH 78 MEDICAL CENTER DR FISHERSVILLE VA 22939 X X X HOME HEALTH; SNF; PSYCH, DME; HOSPICE AUGUSTA HEALTH 1 0 0 1 X X X X X X X X X X 19 1 0 0 1 X SEE DISCLOSURE X 1 20 1 SEE DISCLOSURE 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.AUGUSTAHEALTH.COM/BUSINESS-OFFICE/FINANCIAL-ASSISTANCE X SEE PART VI X HTTPS://WWW.AUGUSTAHEALTH.COM/BUSINESS-OFFICE/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X 1 X 0 0 AUGUSTA HEALTH PART V, SECTION B, LINE 3J: INFORMATION GAPS THAT LIMIT THE HOSPITAL FACILITY'S ABILITY TO ACCESS THE COMMUNITY'S HEALTH NEEDS. AUGUSTA HEALTH PART V, SECTION B, LINE 5: TO SOLICIT INPUT FROM KEY INFORMANTS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED AS PART OF THIS PROCESS. A LIST OF RECOMMENDED PARTICIPANTS WAS PROVIDED BY AUGUSTA HEALTH; THIS LIST INCLUDED NAMES AND CONTACT INFORMATION FOR PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. KEY INFORMANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE; REMINDER EMAILS WERE SENT AS NEEDED TO INCREASE PARTICIPATION. IN ALL, 134 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. AUGUSTA HEALTH PART V, SECTION B, LINE 11: AUGUSTA HEALTH, THROUGH ITS MISSION TO PROMOTE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH ACCESS TO EXCELLENT CARE, HAS DEVELOPED GOALS, OBJECTIVES AND STRATEGIES TO ADDRESS SELECTED TOP PRIORITY HEALTH NEEDS IN THE AREAS OF: 1) ACCESS TO HEALTHCARE SERVICES 2) BEHAVIORAL HEALTH, 3) DIABETES, AND 4) NUTRITION AND PHYSICAL ACTIVITY. THE ACTION PLANS WILL BE IMPLEMENTED IN COLLABORATION WITH VARIOUS COMMUNITY PARTNERS OVER THE NEXT THREE YEARS. DURING THE CHNA PROCESS, THE DATA REVEALED A TOTAL OF 14 DISTINCT AREAS OF OPPORTUNITY. AUGUSTA HEALTH'S 2020-2022 IMPLEMENTATION STRATEGIES ARE DESIGNED TO ADDRESS THE TOP FOUR HIGHEST PRIORITY AREAS. AUGUSTA HEALTH HAS SELECTED THESE FOUR PRIORITIES BECAUSE OF ITS ABILITY TO WORK IN PARTNERSHIP WITH OTHER ORGANIZATIONS AND AGENCIES TO MAKE THE GREATEST IMPACT. OTHER NEEDS THAT WERE IDENTIFIED HAVE THE POTENTIAL TO BE ADDRESSED THROUGH COLLABORATIVE PROGRAMMING THAT MAY OR MAY NOT INVOLVE AUGUSTA HEALTH AS A FACILITATOR, PARTNER OR FUNDER. AUGUSTA HEALTH PART V, SECTION B, LINE 13H: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS POLICY SHALL NOT BE CHARGED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) TO INDIVIDUALS WHO HAVE INSURANCE. THIS VALUE SHALL BE CALCULATED USING THE "LOOK-BACK" METHOD BASED ON ACTUAL PAID CLAIMS FROM MEDICARE FEE-FOR-SERVICE AND PRIVATE HEALTH INSURERS. THE CURRENT AGB IS 32% AND IS UPDATED ANNUALLY. AUGUSTA HEALTH PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS DISCUSSED AND OFFERED BY OUR SELF PAY EXTENDED BUSINESS OFFICE PARTNER DURING THE COLLECTION PROCESS. PART V, SECTION B, LINE 7A AND 10A: WEBSITE ADDRESS FOR THE CHNA AND IMPLEMENTATION STRATEGY:HTTPS://WWW.AUGUSTAHEALTH.COM/COMMUNITY-OUTREACH/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART I, LINE 7: FOR PURPOSES OF PART I, LINE 7(A) THE ORGANIZATION USED THE METHODS PROVIDED IN THE SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO TO CONVERT CHARITY CARE WRITE-OFFS TO COST. AMOUNTS REPORTED ON LINES 7(B) AND 7(G) WERE DERIVED FROM THE ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM. PART I, LINE 7G: INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES ACCOUNT FOR $1,822,311 OF THE NET COMMUNITY BENEFIT OF SUBSIDIZED SERVICES. THESE SERVICES PROVIDE SHORT-TERM PSYCHIATRIC CARE FOR ADULTS AND GERIATRIC PATIENTS IN A SUPPORTIVE ENVIRONMENT WITH 24-HOUR NURSING CARE. HOME HEALTH SERVICES PROVIDED BY THE ORGANIZATION CONTRIBUTED $775,325 IN NET COMMUNITY BENEFIT. AUGUSTA HEALTH'S HOME HEALTH PROGRAM OFFERS SKILLED NURSING CARE, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, AND MEDICAL SOCIAL WORKERS. PART I, LN 7 COL(F): TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25 INCLUDES BAD DEBT IN THE AMOUNT OF $14,834,733. THIS AMOUNT FOR BAD DEBT HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENTAGE OF TOTAL EXPENSE ON SCHEDULE H, PART I, LINE 7, COL (F). PART III, LINE 2: ACCOUNTS ARE WRITTEN OFF TO BAD DEBT WHEN MANAGEMENT DETERMINES THAT RECOVERY IS UNLIKELY AND THE COMPANY CEASES COLLECTION EFFORTS. PART III, LINE 4: EXCERPT FROM 2020 FINANCIAL AUDIT, PATIENT ACCOUNTS RECEIVABLE:"THE COMPANY GRANTS CREDIT WITHOUT COLLATERAL TO ITS PATIENTS, MOST OF WHOM ARE LOCAL RESIDENTS AND ARE INSURED UNDER THIRD-PARTY PAYOR AGREEMENTS, PRIMARILY WITH MEDICARE, MEDICAID, AND VARIOUS COMMERCIAL INSURANCE COMPANIES. PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. FOR ACCOUNTS RECEIVABLE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE THE COMPANY ESTIMATES NET REALIZABLE VALUE BASED ON THE ESTIMATED CONTRACTUAL REIMBURSEMENT PERCENTAGE, WHICH IS PREDICATED ON CURRENT CONTRACT PROVISIONS AND HISTORICAL PAID CLAIMS BY PAYOR. FOR SELF-PAY ACCOUNTS RECEIVABLE, INCLUDING UNINSURED AND PATIENT RESPONSIBILITY ACCOUNTS, THE NET REALIZABLE VALUE IS DETERMINED USING HISTORICAL COLLECTION EXPERIENCE, ADJUSTED FOR ESTIMATED CONVERSIONS OF PATIENT RESPONSIBILITY PORTIONS, EXPECTED RECOVERIES AND CHANGE IN TRENDS TO ESTIMATE IMPLICIT PRICE CONCESSIONS. MANAGEMENT CONTINUALLY REVIEWS THE ESTIMATED NET REALIZABLE VALUE OF ACCOUNTS RECEIVABLE BY MONITORING CASH COLLECTIONS, ECONOMIC CONDITIONS AND TRENDS, CHANGES IN PAYOR MIX, CHANGES IN FEDERAL OR STATE HEALTHCARE COVERAGE AND OTHER MATTERS." THE BAD DEBT AMOUNT LISTED IN PART III SECTION A, NUMBER 2 WAS CALCULATED USING WORKSHEET A ON PAGE 4 OF THE 2020 SCHEDULE H INSTRUCTIONS.THE PORTION OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS BASED ON DISCHARGES IN 2020. PATIENTS THAT WERE CLASSIFIED AS "SELF PAY" WERE UN-INSURED AND THEREFORE CONSIDERED WITHOUT RESOURCES. THEIR ACCOUNT STATUS WAS "BD" MEANING THAT THE ACCOUNT WAS CONSIDERED UNCOLLECTABLE AT THE TIME OF THE REPORT. PART III, LINE 8: THE HOSPITAL CONSIDERS THE FULL AMOUNT OF $5,511,311 TO BE RECOGNIZED AS COMMUNITY BENEFIT. PART III, LINE 9B: ONCE A PATIENT HAS BEEN DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ALL COLLECTION EFFORTS CEASE FOR CURRENT AND PAST DUE BALANCES AND THE NECESSARY ADJUSTMENTS ARE TAKEN TO THE ACCOUNTS RECEIVABLE. SHOULD THE PATIENT ONLY BE ELIGIBLE FOR A PORTION OF FINANCIAL ASSISTANCE (THROUGH OUR SLIDING SCALE), NO-INTEREST, LOW-PAYMENT, AND LONG TERM PAYMENT PLANS ARE AVAILABLE. PART V, LINE 16B HTTPS://WWW.AUGUSTAHEALTH.COM/SITES/DEFAULT/FILES/DOCUMENTS/BUSINESS-OFFICE/FINANCIAL_ASSISTANCE_APPLICATION_06-22-2020.PDF PART VI, LINE 2: AUGUSTA HEALTH COMPLETED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN 2019 TO DETERMINE THE PRIORITY HEALTH NEEDS OF STAUNTON, AUGUSTA COUNTY AND WAYNESBORO VIRGINIA. AUGUSTA HEALTH'S CHNA IS A SYSTEMATIC, DATA-DRIVEN APPROACH TO DETERMINING THE HEALTH STATUS, BEHAVIORS AND NEEDS OF RESIDENTS IN THE SERVICE AREA OF AUGUSTA HEALTH AND THE INFORMATION GATHERED IS USED TO INFORM DECISIONS AND GUIDE EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELLNESS. THE CHNA SERVES AS TOOL TO REACH THREE BASIC GOALS:TO IMPROVE RESIDENT'S HEALTH STATUS, INCREASE THEIR LIFE SPANS, AND ELEVATE THEIR OVERALL QUALITY OF LIFE. A HEALTHY COMMUNITY IS NOT ONLY ONE WHERE ITS RESIDENTS SUFFER LITTLE FROM PHYSICAL AND MENTAL ILLNESS, BUT ALSO ONE WHERE ITS RESIDENTS ENJOY A HIGH QUALITY OF LIFE. TO REDUCE THE HEALTH DISPARITIES AMONG RESIDENTS. BY GATHERING DEMOGRAPHIC INFORMATION ALONG WITH HEALTH STATUS AND BEHAVIOR DATA, IT IS POSSIBLE TO IDENTIFY POPULATION SEGMENTS THAT ARE MOST AT-RISK FOR VARIOUS DISEASES AND INJURIES. INTERVENTION PLANS AIMED AT TARGETING THESE INDIVIDUALS MAY THEN BE DEVELOPED TO COMBAT SOME OF THE SOCIO-ECONOMIC FACTORS WHICH HAVE HISTORICALLY HAD A NEGATIVE IMPACT ON RESIDENTS' HEALTH.TO INCREASE ACCESSIBILITY TO PREVENTATIVE SERVICES FOR ALL COMMUNITY RESIDENTS. MORE ACCESSIBLE PREVENTIVE SERVICES ARE BENEFICIAL TO IMPROVING HEALTH STATUS, AS WELL AS LOWERING THE COSTS ASSOCIATED WITH CARING FOR LATE-STAGE DISEASE RESULTING FROM A LACK OF PREVENTIVE CARE. THE CHNA INCORPORATES DATA FROM BOTH QUANTITATIVE AND QUALITATIVE SOURCES. QUANTITATIVE DATA INCLUDES PRIMARY RESEARCH (COMMUNITY HEALTH PHONE SURVEY OF COMMUNITY RESIDENTS) AND SECONDARY RESEARCH (VITAL STATISTICS AND OTHER EXISTING HEALTH-RELATED DATA); THESE QUANTITATIVE COMPONENTS ALLOW FOR COMPARISON TO BENCHMARK DATA AT THE STATE AND NATIONAL LEVELS (VIRGINIA RISK FACTOR DATA AND NATIONWIDE RISK FACTOR DATA, RESPECTIVELY). QUALITATIVE DATA INPUT INCLUDES PRIMARY RESEARCH GATHERED THROUGH AN ONLINE KEY INFORMANT SURVEY OF REPRESENTATIVES FROM VARIOUS COMMUNITY SECTORS. THE SURVEY INSTRUMENT USED FOR THE STUDY IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, AS WELL AS VARIOUS PUBLIC HEALTH SURVEYS AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES.THE STUDY AREA FOR THE SURVEY EFFORT IS DEFINED AS EACH OF THE RESIDENTIAL ZIP CODES COMPRISING STAUNTON CITY, WAYNESBORO CITY AND AUGUSTA COUNTY IN VIRGINIA. THIS COMMUNITY DEFINITION WAS DETERMINED BASED ON ZIP CODES OF RESIDENCE OF AUGUSTA HEALTH PATIENTS (APPROXIMATELY 79% OF ADMISSIONS GENERATE FROM THESE AREAS). A PRECISE AND CAREFULLY EXECUTED METHODOLOGY IS CRITICAL IN ASSERTING THE VALIDITY OF RESULTS GATHERED IN THE COMMUNITY HEALTH SURVEY. THUS, TO ENSURE THE BEST REPRESENTATION OF THE POPULATION SURVEYED, A TELEPHONE INTERVIEW METHODOLOGY, ONE THAT INCORPORATES BOTH LANDLINE AND CELL PHONE INTERVIEWS, WAS EMPLOYED. THE SAMPLE DESIGN FOR THIS EFFORT CONSISTED OF A STRATIFIED RANDOM SAMPLE OF 601 INDIVIDUALS AGE 18 AND OLDER IN THE TOTAL AREA (INCLUDING 151 IN STAUNTON CITY, 150 IN WAYNESBORO CITY AND 300 IN AUGUSTA COUNTY). ONCE THE INTERVIEWS WERE COMPLETED, THESE WERE WEIGHTED IN PROPORTION TO THE ACTUAL POPULATION DISTRIBUTION SO AS TO APPROPRIATELY REPRESENT THE AREA AS A WHOLE. TO SOLICIT INPUT FROM KEY INFORMANTS (INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY), AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED AS PART OF THIS PROCESS. THE LIST INCLUDED BUSINESS LEADERS, COMMUNITY LEADERS, EDUCATORS, GOVERNMENT REPRESENTATIVES, MEDIA HEALTH REPRESENTATIVES, HEALTH PROVIDERS AND PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES AND SOCIAL SERVICES PROVIDERS. PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS THE COMMUNITY OVERALL. KEY INFORMANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE. REMINDER CALLS WERE SENT AS NEEDED. IN ALL, 134 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. FOURTEEN AREAS OF SIGNIFICANT HEALTH AREAS OF OPPORTUNITY WERE IDENTIFIED INCLUDING ACCESS TO HEALTHCARE SERVICES, CANCER, DIABETES, HEART DISEASE AND STROKE, HOUSING, INJURY AND VIOLENCE, KIDNEY DISEASE, MENTAL HEALTH, NUTRITION, PHYSICAL ACTIVITY AND WEIGHT, POTENTIALLY DISABLING CONDITIONS, RESPIRATORY DISEASES, SEXUAL HEALTH, SUBSTANCE ABUSE, AND TOBACCO USE. THESE AREAS OF OPPORTUNITY WERE DETERMINED AFTER CONSIDERATION OF VARIOUS CRITERIA, INCLUDING COMPARISON TO BENCHMARK DATA, IDENTIFIED TRENDS, THE PREPONDERANCE OF SIGNIFICANT FINDINGS WITHIN TOPIC AREAS, THE MAGNITUDE OF THE ISSUE IN TERMS OF THE NUMBER OF PERSONS AFFECTED, AND THE POTENTIAL HEALTH IMPACT OF THE GIVEN ISSUE. A GROUP OF COMMUNITY STAKEHOLDERS, REPRESENTING A CROSS-SECTION OF COMMUNITY-BASED ORGANIZATIONS, WAS CONVENED TO EVALUATE, DISCUSS AND PRIORITIZE THE FOURTEEN AREAS OF OPPORTUNITY IDENTIFIED IN THE CHNA. IN ORDER TO ASSIGN PRIORITY TO THE IDENTIFIED HEALTH NEEDS, A WIRELESS AUDIENCE RESPONSE SYSTEM WAS USED IN WHICH EACH PARTICIPANT WAS ABLE TO REGISTER HIS/HER RATINGS BASED ON TWO CRITERIA: SCOPE AND SEVERITY AND THE ABILITY TO IMPACT. COMPOSITE SCORES WERE USED TO PRIORITIZE THE NEEDS. THE TOP THREE AREAS OF FOCUS SELECTED BASED ON THIS CRITERIA INCLUDE: 1)ACCESS TO HEALTHCARE SERVICES; 2)BEHAVIORAL HEALTH (INCLUDING SUBSTANCE ABUSE); 3)DIABETES; AND 4)NUTRITION AND PHYSICAL ACTIVITY. AUGUSTA HEALTH, THROUGH ITS MISSION TO PROMOTE THE HEALTH AND WELL-BEING OF OUR COMMUNITY THROUGH ACCESS TO EXCELLENT CARE, HAS CREATED INTERNAL, CROSS-DISCIPLINARY WORKGROUPS AROUND EACH OF THE FOUR PRIORITY AREAS. EACH WORKGROUP HAS DEVELOPED GOALS, OBJECTIVES AND STRATEGIES TO ADDRESS SELECTED TOP PRIORITY HEALTH NEEDS IN THE AREAS OF: 1) ACCESS TO HEALTHCARE SERVICES, 2) BEHAVIORAL HEALTH, 3) DIABETES, AND 4) NUTRITION AND PHYSICAL ACTIVITY. THE ACTION PLANS ARE BEING IMPLEMENTED WITH THE COLLABORATIVE FROM COMMUNITY PARTNERS. AUGUSTA HEALTH'S 2020-2022 IMPLEMENTATION STRATEGIES ARE DESIGNED TO ADDRESS THE TOP FOUR HIGHEST PRIORITY AREAS. AUGUSTA HEALTH HAS SELECTED THESE FOUR PRIORITIES BECAUSE OF ITS ABILITY TO WORK IN PARTNERSHIP WITH OTHER ORGANIZATIONS AND AGENCIES TO MAKE THE GREATEST IMPACT. OTHER NEEDS THAT WERE IDENTIFIED HAVE THE POTENTIAL TO BE ADDRESSED THROUGH COLLABORATIVE PROGRAMMING THAT MAY OR MAY NOT INVOLVE AUGUSTA HEALTH AS A FACILITATOR, PARTNER OR FUNDER. PART VI, LINE 3: AUGUSTA HEALTH HAS A MEDICAID ELIGIBILITY TEAM ONSITE TO SCREEN ITS PATIENTS FOR MEDICAID ELIGIBILITY, INCLUDING DISABILITY. AS FOR THE ORGANIZATION'S FINANCIAL ASSISTANCE PROGRAM, AUGUSTA HEALTH INFORMS ITS PATIENTS ABOUT IT IN THE FOLLOWING WAYS:1. DETAILED INFORMATION ABOUT FINANCIAL ASSISTANCE IS SENT ALONG WITH THE STATEMENTS.2. FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE ON THE HOSPITAL'S WEBSITE WWW.AUGUSTAHEALTH.COM. 3. COPIES OF THE FINANCIAL ASSISTANCE GUIDELINES AND APPLICATION FORM ARE AVAILABLE AT THE POINTS OF SERVICE (EMERGENCY ROOM, OUTPATIENT AND INPATIENT AREAS, DOCTOR'S OFFICES, ETC.). PART VI, LINE 4: OUR PRIMARY SERVICE AREA, THE COMBINED AREA OF STAUNTON, WAYNESBORO AND AUGUSTA COUNTY , ENCOMPASSES 1002.02 SQUARE MILES AND HOUSES A TOTAL POPULATION OF 119,016 RESIDENTS, ACCORDING TO LATEST CENSUS ESTIMATES. BETWEEN THE 2000 AND 2010 US CENSUSES, THE TOTAL AREA POPULATION INCREASED BY 9,514 PERSONS, OR 8.7%. WHILE AUGUSTA COUNTY IS PREDOMINANTLY RURAL, THE CITIES OF STAUNTON AND WAYNESBORO ARE NEARLY ENTIRELY URBAN. IN THE TOTAL AREA, 20.7% OF THE POPULATION ARE INFANTS, CHILDREN OR ADOLESCENTS AGE 17 AND UNDER, ANOTHER 61.3% ARE AGE 18 TO 64, WHILE 18% ARE AGE 65 OR OLDER. THE PERCENTAGE OF OLDER ADULTS IS MUCH HIGHER THAN THE STATE AND US FIGURES. IN LOOKING AT RACE INDEPENDENT OF ETHNICITY, 88.9% OF RESIDENTS OF THE TOTAL ARE WHITE AND 7.1% ARE BLACK. THE CITIES OF STAUNTON AND WAYNESBORO ARE MORE RACIALLY DIVERSE THAN AUGUSTA COUNTY. A TOTAL OF 3.1% OF TOTAL AREA RESIDENTS ARE HISPANIC OR LATINO, WITH THE LARGEST POPULATION IN WAYNESBORO. BETWEEN 2000 AND 2010, THE HISPANIC POPULATION IN THE TOTAL AREA INCREASED BY 1,846 PEOPLE, OR 120.7% PART VI, LINE 5: AS A COMMUNITY OWNED HOSPITAL, 100% OF THE SURPLUS GOES BACK INTO THE COMMUNITY THROUGH INVESTMENT IN A NETWORK OF CLINICAL PROVIDERS TO SERVE THE COMMUNITY, FACILITY UPGRADES, STATE OF THE ART EQUIPMENT PURCHASES, INCREASED PATIENT CARE SERVICES, AND ACCESS POINTS THROUGHOUT THE SERVICE AREA, AS WELL AS PROVIDING SUPPORT TO OTHER LOCAL NON-PROFIT AGENCIES THAT COMPLIMENT AND/OR SUPPORT THE MISSION OF AUGUSTA HEALTH. AUGUSTA HEALTH IS IN A LEADERSHIP POSITION FOR COMMUNITY BENEFIT AS A RESULT OF THE AUGUSTA HEALTH COMMUNITY PARTNERSHIP COMMITTEE. THE COMMUNITY PARTNERSHIP COMMITTEE IS APPOINTED BY THE AUGUSTA HEALTH BOARD OF DIRECTORS. THE COMMITTEE IMPROVES THE HEALTH OF THE COMMUNITY BY PROVIDING INPUT AND OVERSIGHT ON AUGUSTA HEALTH'S COMMUNITY BENEFIT INITIATIVES, COLLABORATIVE PARTNERSHIPS AND STRATEGIC FUNDING AND ENSURES ALIGNMENT WITH THE PRIORITY AREAS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE COMMITTEE IS RESPONSIBLE FOR OVERSEEING THE ADMINSTRATION OF THE CHNA EVERY THREE YEARS AS WELL AS OVERSIGHT OF THE CHNA IMPLENTATION PLAN. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 CENTRAL SHENANDOAH PLANNING 112 MACTANLEY PLACE STAUNTON VA 24401 540857625 501(C)(3) 34944 OPERATIONAL SUPPORT SHENANDOAH LGBQ CENTER 123 W FREDERICK ST STAUNTON VA 24401 464265280 501(C)(3) 7000 OPERATIONAL SUPPORT ELK HILL FARM 1975 ELK HILL RD GOOCHLAND VA 23063 237071154 501(C)(3) 25000 OPERATIONAL SUPPORT VALLEY MISSION 1513 WEST BEVERLY STREET STAUNTON VA 24401 540930419 501(C)(3) 15000 OPERATIONAL SUPPORT PROJECT GROWS PO BOX 781 STAUNTON VA 24401 461070735 501(C)(3) 10000 OPERATIONAL SUPPORT BLUE RIDGE COURT SERVICES 125 SOUTH NEW ST STAUNTON VA 24401 546001631 501(C)(3) 15000 OPERATIONAL SUPPORT BOYS & GIRLS CLUB 302 E MAIN ST WAYNESBORO VA 22980 130997525 501(C)(3) 7000 OPERATIONAL SUPPORT ARROW PROJECT 1011 SPRINGHILL ROAD STAUNTON VA 24401 833396084 501(C)(3) 15000 OPERATIONAL SUPPORT BLUE RIDGE CASA FOR CHILDREN 119 WEST FREDRICK ST STAUNTON VA 24401 541721227 501(C)(3) 10000 OPERATIONAL SUPPORT CREATIVE WORKS CAMP PO BOX 446 CRIMORA VA 24431 900814949 501(C)(3) 8000 OPERATIONAL SUPPORT VALLEY PROGRAM FOR AGING SERVICES PO BOX 817 WAYNESBORO VA 22980 540958526 501(C)(3) 8000 OPERATIONAL SUPPORT 11 PART I, LINE 2: AUGUSTA HEALTH MADE GRANTS THROUGHOUT THE YEAR TO NON-PROFIT AND GOVERNMENTAL COMMUNITY PARTNERS WHO DEVELOPED PROJECTS OR PROVIDED SERVICES TO ADDRESS THE COMMUNITY'S HEALTH PRIORITIES IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. X 1 0 X X X X X 0 1 0 0 0 1 0 0 0 MARY N MANNIX PRESIDENT & CEO 715439 0 161958 0 19500 0 137583 0 14300 0 1048780 0 181458 0 SCOTT JUST MD PRESIDENT, AMG 392437 0 70869 0 19500 0 48961 0 13372 0 545139 0 90369 0 JOHN KATSIANIS VP AND CFO 382353 0 70012 0 19500 0 44318 0 13582 0 529765 0 89512 0 KAREN CLARK VP OPERATIONS 328852 0 53041 0 19500 0 41807 0 2650 0 445850 0 72541 0 BILL DOHERTY VP AND CMO 368779 0 66103 0 0 0 5575 0 4925 0 445382 0 66103 0 DAN O'CONNOR VP OF POPULATION HEALTH 308860 0 46537 0 19500 0 38576 0 9582 0 423055 0 66037 0 MIKE CANFIELD VP AND CIO 274412 0 50054 0 28445 0 36958 0 13343 0 403212 0 69554 0 ANDREW WEST CMIO 350122 0 30737 0 0 0 8550 0 5183 0 394592 0 30737 0 CRYSTAL FARMER VP AND CNO 261777 0 45535 0 19500 0 21024 0 6998 0 354834 0 65035 0 MARK LAROSA VP OF BUSINESS DEVELOPMENT 248169 0 42080 0 19500 0 32398 0 5601 0 347748 0 61580 0 JOHN BOSWELL VP OF HUMAN RESOURCES 250012 0 0 0 5327 0 32050 0 14510 0 301899 0 5327 0 SCOTT CRABTREE ASSISTANT VP 207279 0 17274 0 0 0 23763 0 7677 0 255993 0 17274 0 SCOTT JONES VP OF COMPLIANCE & PRIVACY OFFICER 195161 0 17327 0 0 0 27103 0 3424 0 243015 0 17327 0 VICKIE TAYLOR ASSISTANT CHIEF NURSING OFFICER 211337 0 16829 0 0 0 4016 0 7148 0 239330 0 16829 0 ANTHONY LONG ADMINISTRATIVE DIRECTOR 204379 0 16807 0 0 0 6132 0 3384 0 230702 0 16807 0 JOHN GIRARD ADMINISTRATIVE DIRECTOR 167735 0 15004 0 0 0 5082 0 14439 0 202260 0 15004 0 SARAH HASH-RODGERS CORPORATE CONTROLLER 172791 0 13203 0 0 0 4873 0 10722 0 201589 0 13203 0 ANDREA HALEY ADMINISTRATIVE DIRECTOR OF 174851 0 15386 0 0 0 5699 0 0 0 195936 0 15386 0 DOUG JENA ADMINISTRATIVE DIRECTOR 168498 0 13827 0 0 0 5539 0 5318 0 193182 0 13827 0 JEAN VEILLEUX VP OF LEGAL AFFAIRS AND GENERAL COUN 164049 0 0 0 0 0 18892 0 9191 0 192132 0 0 0 PART I, LINE 1A THE FOLLOWING BOARD MEMBERS HAD TRAVEL FOR COMPANION EXPENSES: - LAUREL LANDES: MEETING WITH LEGISLATURES, DINNER CHARGE OF 179.23 - THOMAS ROBERTS: MEETING WITH LEGISLATURES, DINNER CHARGE OF 179.23 PART I, LINE 4B THE FOLLOWING INDIVIDUALS HAD EMPLOYER CONTRIBUTIONS FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE AMOUNTS ARE REPRESENTED IN PART II, COLUMN (C): $109,533 - MARY MANNIX 13,757 - KAREN CLARK 11,008 - DAN O'CONOR 8,908 - MIKE CANFIELD 5,933 - MARK LAROSA 20,051 - JOHN KATSIANIS 20,911 - SCOTT JUST, MD 2,038 - SCOTT CRABTREE 1,172 - SCOTT JONES 6,700 - JOHN BOSWELL 7,125 - CRYSTAL FARMER PART I, LINE 6 THE TOP EXECUTIVES OF AUGUSTA HEALTH WERE REQUIRED TO SET ANNUAL PERFORMANCE GOALS THAT ALIGNED WITH THE ORGANIZATION'S COMMITMENT TO PERFORMANCE EXCELLENCE. THE GOALS WERE ESTABLISHED WITH FOCUS ON THE FOLLOWING SIX AREAS: QUALITY, SERVICE, PEOPLE, COMMUNITY, GROWTH, AND FINANCE. EACH GOAL WAS REQUIRED TO HAVE MEASURABLE OUTCOMES AND WAS REVIEWED AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD TO ENSURE THAT IT SUPPORTED THE ORGANIZATION'S QUEST FOR SERVICE AND OPERATIONAL EXCELLENCE. WHILE NET EARNINGS WERE A CONSIDERATION IN THE AREA OF FINANCE, THE GOALS WERE ALSO CENTERED AROUND QUALITY, SERVICE, PEOPLE, COMMUNITY, AND GROWTH. EACH EXECUTIVE'S GOALS WERE WEIGHTED ACROSS THE PILLAR GOALS BASED ON THEIR AREA OF RESPONBILITY. WHEN AWARDING VARIABLE COMPENSATION, THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD REVIEWED THE YEAR-END ACCOMPLISHMENTS OF THE TOP EXECUTIVES AND AWARDED INCENTIVE COMPENSATION BASED ON THEIR ACTUAL PERFORMANCE AS COMPARED TO THE ESTABLISHED PERFORMANCE BENCHMARKS. ANDREW DAVIS FAMILY RELATIONSHIP WITH A BOARD MEMBER 69682 COMPENSATION FOR SERVICES 0 FORM 990, PART VI, SECTION A, LINE 1 EXECUTIVE COMPENSATION PROGRAM IS ADMINISTERED BY THE EXECUTIVE COMMITTEE OF THE BOARD, BASED ON A COMPENSATION PHILOSOPHY APPROVED BY THE BOARD AT LARGE. QUALIFIED THIRD PARTY CONSULTANTS ARE ENGAGED TO PROVIDE APPROPRIATE MARKET COMPARABILITY, SURVEY DATA, AND TO ASSIST THE COMMITTEE WITH REVIEWS. THE BASE SALARY BENCHMARKS ARE TARGETED AT THE 50TH PERCENTILE WITH FLEXIBILITY TO PAY ABOVE OR BELOW THE 50TH PERCENTILE USING SALARY RANGES WITH A 50% RANGE SPREAD TO RECOGNIZE AN INCUMBENT'S INDIVIDUAL EXPERIENCE, SKILL, PERFORMANCE, OR OTHER RELEVANT RECRUITMENT OR RETENTION FACTORS. INCENTIVE OPPORTUNITIES ARE ESTABLISHED AT LEVELS THAT WHEN COMBINED WITH SALARIES POSITIONED AT THE 50TH PERCENTILE, ARE SUFFICIENT TO PROVIDE TOTAL CASH COMPENSATION THAT TARGETS UP TO THE APPROXIMATELY MARKET 75TH PERCENTILE OF TOTAL CASH COMPENSATION LEVELS. TOTAL COMPENSATION SHALL NOT EXCEED THE 90TH PERCENTILE FOR ANY INDIVIDUAL WITHOUT FULL BOARD APPROVAL AND DOCUMENTATION OF THE BOARD'S REASONS FOR SUCH COMPENSATION. THE BOARD OF DIRECTORS RECEIVES AN ANNUAL REPORT FROM THE EXECUTIVE COMMITTEE ON THE COMPENSATION PROGRAM AT AUGUSTA HEALTH IN AN EXECUTIVE SESSION OF THE BOARD. CONFLICTED MEMBERS ARE EXCUSED FROM THE MEETING. MATERIAL COVERED INCLUDES THE DESIGN OF THE COMPENSATION PROGRAM, AS WELL AS A DISCLOSURE ON RANGE OF BASE SALARIES, MARKET BENCHMARK DATA, AND EARNED INCENTIVE COMPENSATION LEVELS. ADDITIONALLY, PREREQUISITES SUCH AS THE SENIOR EXECUTIVE RETIREMENT PLAN (SERP) PROGRAM AND OTHER RELATED BENEFITS ARE PERIODICALLY REVIEWED WITH THE BOARD. FOR THOSE MEMBERS WHO ARE NOT PRESENT FOR THIS MEETING AND REMAIN FREE OF CONFLICT OF INTEREST, THE CHAIRMAN OF THE BOARD MAY PRESENT THE SAME MATERIAL IN A SEPARATE SESSION. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES CMO DUTIES TO BE SMITH. THE MANAGEMENT COMPANY PROVIDES PHIL PERRY AS AN INTERIM CMO. THE ORGANIZATION PAID BE SMITH $87,740 FOR SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE ACCOUNTING DEPARTMENT WILL MAKE COPIES OF THE FORM 990 AVAILABLE TO THE CFO AND CEO FOR REVIEW. ALL QUESTIONS WILL BE RESOLVED AND ANSWERED BEFORE PRESENTATION TO THE EXECUTIVE COMMITTEE OF THE BOARD. THE FINAL DRAFT OF THE RETURN WILL BE POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE WITH ACCESS RESTRICTED TO THE BOARD AND KEY ADMINISTRATIVE PERSONNEL FOR REVIEW. ALL QUESTIONS WILL BE RESOLVED AND ANSWERED BY THE CEO, CFO OR CORPORATE CONTROLLER. ANY REVISIONS AS A RESULT OF THE BOARD REVIEW WILL BE SENT TO THE TAX PREPARER AND SUBSEQUENT REVIEW BY THE BOARD WILL BE SCHEDULED ACCORDINGLY. FORM 990, PART VI, SECTION B, LINE 12C THE GOVERNANCE COMMITTEE IS CHARGED WITH REVIEWING THE CONFLICT OF INTEREST STATEMENTS EACH YEAR. THE REVIEW IS CONDUCTED AFTER THE ANNUAL BOARD MEETING IN APRIL. CONFLICT OF INTEREST REVIEWS OCCUR AT THE BEGINNING OF EACH BOARD AND COMMITTEE MEETING. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THOSE FOUND TO BE IN A CONFLICT OF INTEREST MAY BE ASKED TO ABSTAIN FROM VOTING AND MAY BE ASKED TO LEAVE THE MEETING DEPENDING ON THE TOPIC AND THEIR DEGREE OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AUGUSTA HEALTH UTILIZES THE SERVICES OF GALLAGHER PO BOX 71696, CHICAGO, IL 60694-1696 TO DETERMINE COMPETITIVE WAGE RANGES, VARIABLE COMPENSATION AND PERQUISITES FOR EXECUTIVE POSITIONS. IT IS THE GOAL OF THE AUGUSTA HEALTH BOARD TO SATISFY THE FOLLOWING OBJECTIVES: 1.) COMPETITIVENESS: THE PROCESS MUST PRODUCE COMPENSATION AND BENEFIT LEVELS THAT ENABLE THE BOARD TO ATTRACT AND RETAIN THE MANAGEMENT LEADERSHIP ESSENTIAL TO CARRYING OUT ITS MISSION. 2.) STRATEGIC ALIGNMENT: THE PROCESS MUST ALIGN EXECUTIVE COMPENSATION WITH THE INSTITUTION'S STRATEGIC GOALS. IT MUST REWARD MANAGEMENT FOR ACCOMPLISHING THESE GOALS. 3.) REGULATORY COMPLIANCE: THE PROCESS MUST ASSURE THAT THE INSTITUTION MEETS ITS CHARITABLE PURPOSE OBLIGATIONS TO REMAIN TAX-EXEMPT AND THEREFORE WILL REVIEW AND APPROVE ALL FORMS OF EXECUTIVE COMPENSATION AND BENEFITS IN A MANNER NECESSARY TO QUALIFY FOR THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" UNDER THE INTERMEDIATE SANCTIONS RULES OF SECTION 4958 OF THE IRC SO AS TO AVOID THE IMPOSITION OF INTERMEDIATE SANCTIONS IN THE FORM OF EXCISE TAXES PENALTIES ON ITS TRUSTEES AND EXECUTIVES. 4.) PUBLIC TRUST: BOARD MEMBERS ARE INVESTED WITH A PUBLIC TRUST TO SHEPHERD INSTITUTIONAL ASSETS AS RESPONSIBLE FIDUCIARIES AND REPRESENTATIVES. THEREFORE, THE PROCESS MUST ASSURE THAT COMPENSATION AND BENEFIT LEVELS ARE REASONABLE, NOT EXCESSIVE, AND DEFENSIBLE IF AND WHEN SUBJECTED TO PUBLIC SCRUTINY. BASE SALARIES TARGETED AT THE 50TH PERCENTILE, WITH FLEXIBILITY TO PAY ABOVE OR BELOW THE 50TH PERCENTILE USING SALARY RANGES WITH A 50% RANGE SPREAD TO RECOGNIZE AN INCUMBENT'S INDIVIDUAL EXPERIENCE, SKILL, PERFORMANCE OR OTHER RELEVANT RECRUITMENT OR RETENTION FACTORS. VARIABLE COMPENSATION LEVELS THAT, WHEN COMBINED WITH SALARIES POSITIONED AT THE 50TH PERCENTILE, ARE SUFFICIENT TO PROVIDE TOTAL CASH COMPENSATION THAT TARGETS UP TO THE APPROXIMATE MARKET 75TH PERCENTILE OF TOTAL CASH COMPENSATION LEVELS. TOTAL COMPENSATION SHALL NOT EXCEED THE 90TH PERCENTILE FOR ANY INDIVIDUAL WITHOUT FULL BOARD APPROVAL AND DOCUMENTATION OF THE BOARD'S REASONS FOR SUCH COMPENSATION. COMPENSATION, INDIVIDUAL PERFORMANCE AND COMPETITIVE DATA ARE REVIEWED ANNUALLY FOR ALL EXECUTIVE POSITIONS AS FOLLOWS: CEO CFO VP OF OPERATIONS CNO CMO CIO PRESIDENT, MEDICAL GROUP VP OF LEGAL AFFAIRS VP OF HUMAN RESOURCES VP OF BUSINESS DEVELOPMENT AND CSO VP OF POPULATION HEALTH VP OF COMPLIANCE & PRIVACY ASSISTANT VP OF PROFESSIONAL SERVICES THE BOARD OF DIRECTORS RECEIVED A SUMMARY FROM THE EXECUTIVE COMMITTEE ON THE COMPENSATION PROGRAM AT AUGUSTA HEALTH IN AN EXECUTIVE SESSION OF THE BOARD. CONFLICTED MEMBERS WERE EXCUSED FROM THE MEETING. MATERIAL COVERED INCLUDED THE DESIGN OF THE COMPENSATION PROGRAM, AS WELL AS AN OVERVIEW OF BASE SALARIES, MARKET BENCHMARK DATA, AND VARIABLE COMPENSATION EARNED. ADDITIONALLY, PREREQUISITES SUCH AS THE SERP PROGRAM AND OTHER RELATED BENEFITS WERE REVIEWED WITH THE BOARD. FOR THOSE MEMBERS WHO WERE NOT PRESENT FOR THIS MEETING AND REMAINED FREE OF CONFLICT OF INTEREST, THE CHAIRMAN OF THE BOARD OFFERS TO PRESENT THE SAME MATERIAL IN A SEPARATE SESSION. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ACCOUNTING OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ACCOUNTING OFFICE. PLEASE DIRECT ALL REQUESTS TO: AUGUSTA HEALTH CARE, INC. ATTN: CORPORATE CONTROLLER P.O. BOX 1000 FISHERSVILLE, VA 22939-1000 FORM 990, PART XI, LINE 9: EQUITY TRANSFERS BETWEEN AFFILIATES -646,104. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VII BOARD MEMBER CHRISTOPHER HECK IS PAID AS AN EMPLOYEE OF AUGUSTA MEDICAL GROUP, A RELATED ORGANIZATION AND HE IS NOT COMPENSATED FOR HIS BOARD MEMBER SERVICE. AUGUSTA CARE PARTNERS LLC 78 MEDICAL CENTER DR FISHERSVILLE VA 22939 462840076 HEALTHCARE VA 0 0 AHC COMMUNITY HEALTH FOUNDATION PO BOX 1000 FISHERSVILLE VA 22939 542042365 SUPPORTING ORGANIZATION VA 501(C)(3) LINE 12A, I AUGUSTA HEALTH CARE INC 1 AUGUSTA MEDICAL GROUP PO BOX 1000 FISHERSVILLE VA 22939 262559916 HEALTHCARE VA 501(C)(3) LINE 10 AUGUSTA HEALTH CARE INC 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 1 1 AUGUSTA MEDICAL GROUP A 808215 AUGUSTA MEDICAL GROUP Q 22700000 AUGUSTA HEALTH FOUNDATION R 646104 AUGUSTA HEALTH FOUNDATION C 469099