2020-08-13T08:44:16-05:00 2019-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2018-10-01 560603898 HARNETT HEALTH SYSTEM INC HARN 9108921000 PO BOX 1706 DUNN NC 28335 JESSICA LANG CFO 9108921000 2020-08-12 1 JOHN NORMAN P01506766 7049985200 2020-08-11 67.137.57.251 2020-08-12 15:36:58 ED P 4352940A9571D7C5DDA6B43C112B0F5A28A64F72 C7045CBC9FEEFDC3BC9385C32B7CC9B9CF6029B2 2018 2020-09-23 17:36:50Z BETSY JOHNSON REGIONAL HOSPITAL JESSICA LANG PO BOX 1706 DUNN NC 28335 101444815 0 X WWW.MYHARNETTHEALTH.ORG X 1937 NC PROVIDING MEDICAL CARE FOR PATIENTS OF THE HOSPITAL 13 12 1070 105 0 0 226340 91552 95161470 100550425 61903 86049 803516 716789 96253229 101444815 0 0 0 0 53631470 58396865 0 0 0 41164844 41947148 94796314 100344013 1456915 1100802 98294839 95706242 107178328 103053631 -8883489 -7347389 X 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 86417751 100575406 THE HOSPITAL SERVED THE HARNETT COUNTY POPULATION AND REACHED INTO THE COUNTIES OF SAMPSON, JOHNSTON AND CUMBERLAND. THE HOSPITAL SERVED 19,709 INPATIENTS DAYS FOR FY19. THE HOSPITAL EXPERIENCED 496 DELIVERIES, THE OUTPATIENTS/EMERGENCY VISITS TOTALED 118,368, PHYSICAL THERAPY-OCCUPATIONAL THERAPY-SPEECH THERAPY VISITS AND ALL OTHER OUTPATIENT VISITS TOTALED 20,975, PULMONARY REHAB SAW 40 NEW PATIENTS, AND CARDIAC REHAB TREATED 149 NEW PATIENTS. SOME OF THE OUTCOMES WERE THE FOLLOWING - FERRANS AND POWERS SURVEY, OVERALL QUALITY OF LIFE IMPROVED 4% - HEALTH AND FUNCTIONING SUB-SCORE IMPROVED 8% POINTS; EDUCATIONAL ASSESSMENT SCORE IMPROVED 11%; NUTRITIONAL IMPROVEMENT 7%. MEDICATION MANAGEMENT OF HARNETT COUNTY (BETSY JOHNSON REGIONAL HOSPITAL) ENCOUNTERED 47 NEW PATIENTS WITH A TOTAL OF 376 ACTIVE PARTICIPATES IN THE PROGRAM. WE RECEIVED 1563 MEDICATIONS WITH A TOTAL VALUE OF $2,741,983. THE HOSPITAL IS INCLUDED IN SEVERAL OUTREACH PROGRAMS: - THE TEENS AS PARENTS PROGRAM, WHICH COLLABORATES WITH TWO OTHER COUNTY AGENCIES, PROVIDES A HOME VISITATION PROGRAM AND THE CONTINUATION OF EDUCATION CLASSES ON CHILDBIRTH AND PARENTING. THE PROGRAM ALSO PROVIDES HARNETT COUNTY TEEN PARENTS WITH OPPORTUNITIES TO DEVELOP SELF-RESPECT, PARENTING, AND DECISION-MAKING SKILLS WHILE CONTINUING THEIR EDUCATION. - TAP SERVED 24 TEENS. THE REPEAT PREGNANCY RATE FOR TAP PARTICIPANTS IS 0%, COMPARED TO THE COUNTY RATE OF 26.1%. THE TAP PROGRAM PARTICIPANTS RECEIVED 227.14 HOURS HOME VISITATION, 200 HOURS GROUP INSTRUCTION, 4 HOURS ACADEMIC SUPPORT, 96 HOURS OF PARENTING EDUCATION, 2.75 HOURS OF INDIVIDUAL COUNSELING, 72 HOURS OF LIFE SKILLS TRAINING, AND 2.50 HOURS OF FAMILY COUNSELING.- HEALTH HARNETT PROGRAM, OR "GO RED", IS A PROGRAM THAT PROMOTES HEALTHY EATING, WHICH LEADS TO A HEALTHY LIFESTYLE. HARNETT HEALTH COLLABORATED WITH THE NC COOPERATIVE EXTENSION AND THE HARNETT COUNTY HEALTH DEPARTMENT. THERE WERE A TOTAL OF 90 PARTICIPANTS IN ONE PRESENTATION GIVEN BY THE HARNETT HEALTH CARDIAC REHAB DEPARTMENT. THE PROGRAM ALSO OFFERED FREE EDUCATIONAL BROCHURES AND INFORMATION AT ALL EVENTS. - HARNETT HEALTH ALSO PARTICIPATES IN PROJECT ACCESS OF JOHNSON/HARNETT COUNTY WHICH IS A PHYSICIAN LED VOLUNTEER INITIATIVE THAT GIVES LOW INCOME, UNINSURED COUNTY RESIDENTS ACCESS TO COMPREHENSIVE MEDICAL CARE PHYSICIANS AND COMMUNITY PARTNERS. - HARNETT HEALTH DONATES MEDICAL SERVICES WITHOUT RECEIVING REIMBURSEMENT OR COMPENSATION. THE PROGRAM HAS ASSISTED 159 PATIENTS FOR THE LAST FISCAL YEAR. HARNETT HEALTH PROVIDED $60,071.25 IN FREE CARE TO THE PARTICIPANTS IN THIS PROGRAM. 86417751 1 1 0 1 0 0 0 0 0 0 1 1 0 1 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 1 179 0 1070 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JESSICA LANG 9108921000 800 TILGHMAN DRIVE 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 THOMAS BUTLER BOARD MEMBER 2.00 X X 0 0 0 GEORGE WOMBLE BOARD MEMBER 2.00 X X 0 0 0 SUSAN CHRISCOE 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 0 0 0 MIKE JONES VP 40.00 X 195042 0 25226 JESSICA LANG CFO 40.00 4.00 X 0 0 0 OLALEKAN FOLARIN MD COMS 40.00 X 0 0 0 MICHAEL ZICH PHYSICIAN 40.00 X 327525 0 34679 BRAD BUTLER PHYSICIAN 40.00 X 254496 0 33558 MONICA STANTON PHYSICIAN 40.00 X 245306 0 142 BEVERLY YEARWOOD PHYSICIAN 40.00 X 239836 0 9724 ASIF ZIA PHYSICIAN 40.00 X 215755 0 33238 1477960 0 136567 41 0 1 0 TRAVEL NURSE ACROSS AMERICA LLC 5020 NORTHSHORE DR STE 2 NORTH LITTLE ROCK AR 72118 STAFFING 693275 BYERS DEAN & ASSOCIATES LLC 155 COMMERICE PARK SUITE 6 WESTERVILLE OH 430828384 BILLING SVC 671228 DIVERSIFIED CLINICAL SERVICES 28525 NETWORK PLACE CHICAGO IL 606731285 STAFFING MGMT 566840 LEXICODE CORPORATION (SOURCEHOV HEALTHCA PO BOX 142589 IRVING TX 75014 CODING/STAFF 484866 AYA HEALTHCARE INC PO BOX 123519 DALLAS TX 75312 STAFFING 469992 26 66565 24981 6 91552 NET PATIENT SERVICE REVENUE 621400 99463867 99463867 1086558 1086558 100550425 86049 86049 245475 0 245475 245475 245475 CAFETERIA SALES 900099 471314 471314 471314 101444815 100550425 0 802838 800931 680791 120140 48933338 41593337 7340001 5451041 4633385 817656 3211555 2729822 481733 1562580 1562580 149709 149709 80000 80000 483854 483854 128586 128586 1639106 1639106 2460975 2460975 117916 117916 3577641 3577641 5034120 5034120 767819 767819 CONTRACT SERVICES/ CONT 7522223 7522223 MEDICAL SUPPLIES 6875085 6875085 MAINT. & REPAIRS 3986042 3986042 DRUGS 2986572 2986572 4574920 1200477 3374443 100344013 86417751 13926262 0 7908483 8775493 9650199 9505187 908 570 2013091 2147104 732052 842332 147712786 84253125 66477365 63459661 5228401 5095267 6284340 5880628 98294839 95706242 16278282 15036334 58687 18905000 18110000 64286395 63238523 7708651 6610087 107178328 103053631 X -14893849 -12442656 6010360 5095267 -8883489 -7347389 98294839 95706242 X 1100802 435298 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 8448 8448 0 PART II-B, LINE 1: HARNETT HEALTH PAID $34,851 TO NCHA FOR MEMBERSHIP FEES IN DECEMBER, 2018. NCHA DETERMINED 24.24% OF ITS MEMBERSHIP DUES WERE USED FOR LOBBYING PURPOSES, WHICH CAUSED AN INDIRECT LOBBYING EXPENSE OF $8,448 FOR HARNETT HEALTH. 1189620 1189620 91898497 38550270 53348227 659674 590861 68813 53611846 45111994 8499852 353149 353149 63459661 DEBT SERVICE RESERVE FUNDS 5095267 C 5095267 PREPAID PENSION COSTS 2951691 UNAMORTIZED LOSS ON EXTINGUISHMENT OF DEBT 1283082 DEFERRED INFLOWS 1645855 5880628 ESTIMATED THIRD PARTY SETTLEMENTS 5338909 DUE TO HHS FOUNDATION 8080 DEFERRED INFLOWS OF RESOURCES (PENSION RELATED) 1263098 6610087 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 1 0 1 1 2095245 2095245 0.02090 14423123 15611119 0 0.00000 317457 144161 173296 0.00170 16835825 15755280 2268541 0.02260 8398 8398 0.00010 134195 134195 0.00130 4790 4790 0.00000 147383 147383 0.00140 16983208 15755280 2415924 0.02400 1 6719856 0 23624568 20085196 3539372 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 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 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. 7 1 - HARNETT HEALTH ANGIER MEDICAL SERVICES 185 RAWLS ROAD ANGIER NC 27501 PHYSICIAN PRACTICE 2 - HARNETT HEALTH LILLINGTON MEDICAL SERVIC 716 10TH STREET LILLINGTON NC 27546 PHYSICIAN PRACTICE 3 - HARNETT HEALTH DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE 700 DUNN NC 28335 PHYSICIAN PRACTICE 4 - HARNETT HEALTH HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE 5 - HARNETT HEALTH PREMIER PEDIATRICS 802 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE 6 - COATS MEDICAL SERVICES 25 N JOHNSON STREET COATS NC 27521 PHYSICIAN PRACTICE 7 - HARNETT HEALTH ORTHO & SPORTS MED 716 10TH ST LILLINGTON NC 27546 PHYSICIAN PRACTICE 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 48.5%, MEDICAID 26.2%, MANAGED CARE 11.7%, SELF PAY 8.5%, TRICARE AND ALL OTHER 5.1%. 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 1 0 0 0 0 0 0 0 0 0 0 MIKE JONES VP 170112 0 24930 0 0 0 3737 0 21489 0 220268 0 0 0 MICHAEL ZICH PHYSICIAN 324525 0 3000 0 0 0 6660 0 28019 0 362204 0 0 0 BRAD BUTLER PHYSICIAN 195507 0 58989 0 0 0 4491 0 29067 0 288054 0 0 0 MONICA STANTON PHYSICIAN 218139 0 27167 0 0 0 0 0 142 0 245448 0 0 0 BEVERLY YEARWOOD PHYSICIAN 207986 0 31850 0 0 0 4189 0 5535 0 249560 0 0 0 ASIF ZIA PHYSICIAN 182471 0 33284 0 0 0 4320 0 28918 0 248993 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 ON NOVEMBER 3, 2014, HARNETT HEALTH SYSTEM ENTERED INTO AN AGREEMENT WITH CUMBERLAND COUNTY HOSPITAL SYSTEM DBA CAPE FEAR VALLEY HEALTH SYSTEM ("CFVH") TO PROVIDE DAY-TO-DAY MANAGEMENT SERVICES, PRIMARILY A CHIEF EXECUTIVE OFFICER. THE AGREEMENT REQUIRES THE SYSTEM TO REIMBURSE CFVH FOR THE SALARY AND BENEFITS ASSOCIATED WITH THE PRESIDENT POSITION AND ANY OTHER POSITION APPROVED IN THE CONTRACT. IN ADDITION, CAPE FEAR VALLEY HEALTH SYSTEM RECEIVES A MANAGEMENT FEE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES OF THE ORGANIZATION IS COMPRISED OF THIRTEEN RESIDENTS OF HARNETT COUNTY, NC AND 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 SIX 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. 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. FORM 990, PART XI, LINE 9: MISCELLANEOUS 435,298. ANGIER MEDICAL SERVICES LLC 185 RAWLS RD ANGIER NC 27501 270906936 PRIMARY CARE PROVIDER NC 1193783 685855 HARNETT HEALTH SYSTEM COATS MEDICAL SERVICES LLC 25 JOHNSON ST N COATS NC 27521 462540799 PRIMARY CARE PROVIDER NC 1026005 202045 HARNETT HEALTH SYSTEM DUNN MEDICAL SERVICES LLC 803 TILGHMAN DR 100 DUNN NC 28334 273320115 PRIMARY CARE PROVIDER NC 933598 78279 HARNETT HEALTH SYSTEM HARNETT OBGYN LLC 700 TILGHMAN DR DUNN NC 28334 273320275 OBSTETRICS/GYNECOLOGY SERVICES NC 705661 19249 HARNETT HEALTH SYSTEM LILLINGTON MEDICAL SERVICES LLC 716 S 10TH STREET LILLINGTON NC 27546 272944176 INTERNAL MEDICINE, INFECTIOUS DISEASE, AND GYNECOLOGY NC 694837 855984 HARNETT HEALTH SYSTEM HARNETT HEALTH SYSTEM FOUNDATION 800 TILGHMAN DRIVE DUNN NC 28334 201929953 FUNDRAISING NC 501(C)(3) LINE 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0