2019-05-14T20:12:44-05:00 2018-06-30 ERNST & YOUNG US LLP 425 HOUSTON ST STE 600 FORT WORTH TX 76102 990 2017-07-01 753054855 Mercy Restorative Care Hospital Inc % MIKE MURRAY MERC 9729436400 7800 N DALLAS PARKWAY SUITE 200 Plano TX 75024 JAMES HILL TREASURER 9729436400 2019-05-14 true Jodi Rosser P01255710 8173351900 71.56.5.91 75306120191345000135 2019-05-14 P 0FD3178183619286035AA06C9BAA1B15F55AB8A5 BEE816BADD25910960E744A98AF4267C63CAEDF6 2017 2019-02-21 02:37:17Z See Schedule O JAMES HILL 7800 N Dallas Parkway STE 200 Plano TX 75024 19006334 false X HTTP://CONTINUECARE.ORG/PINEVILLE/ X 2000 NC OUR MISSION IS TO PROVIDE EXCEPTIONAL HEALTHCARE WITH DEDICATION AND COMPASSION TO MEDICALLY COMPLEX EXTENDED STAY PATIENTS. 7 5 255 5 0 0 0 0 16448342 18880188 11389 8070 3579 118076 16463310 19006334 4000 0 0 0 9185145 7777117 0 0 0 8976008 13886470 18165153 21663587 -1701843 -2657253 8527114 9006278 1580412 4716829 6946702 4289449 X OUR MISSION IS TO PROVIDE EXCEPTIONAL HEALTHCARE WITH DEDICATION AND COMPASSION TO MEDICALLY COMPLEX EXTENDED STAY PATIENTS. false false 18571402 0 18997183 MERCY RESTORATIVE CARE HOSPITAL INC., D/B/A CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE (CAROLINAS CCH AT PINEVILLE), IS A STAND-ALONE 40-BED LTACH HOUSED IN A MODERN FACILITY THAT WAS CUSTOM DESIGNED TO TREAT CRITICALLY ILL AND MEDICALLY COMPLEX PATIENTS. CAROLINAS CCH AT PINEVILLE IS LOCATED IN SOUTHERN CHARLOTTE ON THE CAROLINAS HEALTHCARE SYSTEM PINEVILLE CAMPUS. CAROLINAS CCH AT PINEVILLE IS SPECIFICALLY LICENSED AND ADMINISTERED TO PROVIDE CARE FOR PATIENTS WHO REQUIRE DAILY PHYSICIAN AND STAFF ATTENTION FOR COMPLEX CONDITIONS. CAROLINAS CCH AT PINEVILLE'S EMPLOYEES ARE A DEDICATED TEAM WHO WORK TOGETHER DELIVERING THE BEST POSSIBLE CARE FOR OUR PATIENTS. SINCE CAROLINAS CCH AT PINEVILLE HAS A LONGER LENGTH OF STAY, THE STAFF HAS THE OPPORTUNITY TO KNOW PATIENTS AND FAMILIES. CAROLINAS CCH AT PINEVILLE BELIEVES SPENDING QUALITY TIME MAKES A DIFFERENCE. CAROLINAS CCH AT PINEVILLE IS A SEPARATE YET FULLY LICENSED ACUTE-CARE HOSPITAL WITH THE ABILITY TO PROVIDE INTENSIVE AND COMPLEX MEDICAL TREATMENT. CAROLINAS CCH AT PINEVILLE'S SPECIALTY PROGRAMS ARE SPECIFICALLY DESIGNED TO MEET THE NEEDS OF LONG-TERM, ACUTE-CARE PATIENTS. DURING THE FISCAL YEAR ENDED JUNE 30, 2018, CAROLINAS CCH AT PINEVILLE'S TOTAL PATIENTS ADMITTED WERE 350 AND THE TOTAL NUMBER OF PATIENT CARE DAYS PROVIDED WAS 8,843. THE AVERAGE DAILY CENSUS WAS 24 PATIENTS AND THE AVERAGE LENGTH OF STAY OF THE DISCHARGED PATIENTS EXCEEDED 25.3 DAYS. 18571402 true false false true false false false false false false true false false false true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false false 21 0 true 255 true false false false false false false false false false false X 7 5 false true false false true true true true false false false true true true true true true false false false NC X MIKE MURRAY 9729431225 7800 N DALLAS PARKWAY SUITE 200 PLANO TX 75024 Joseph Bowers Director 1.0 0.0 X 0 0 0 Joyce Korzen Director 1.0 0.0 X 0 0 0 Alan Sauber Director 1.0 0.0 X 0 0 0 Earl Scott Warrick Director 1.0 0.0 X 0 0 0 COLLIN LANE DIRECTOR 1.0 0.0 X 0 0 0 JIM Kendrick DIRECTOR 1.0 39.0 X 0 670443 103823 APRIL MYERS DIRECTOR/PRESIDENT 1.0 39.0 X X 0 210488 43747 David Butler Secretary 1.0 39.0 X 0 382510 31287 JAMES HILL TREASURER 1.0 39.0 X 0 254689 38013 DEREK MURZYN CEO 40.0 0.0 X 0 183963 21951 Hajrudin Begic Registered Nurse 40.0 0.0 X 127992 0 27818 Janet Combs director of rehab 40.0 0.0 X 117811 0 4905 Teshia Davis Carr CNO 40.0 0.0 X 0 132672 8242 Noreen Kipp nursing manager 40.0 0.0 X 109394 0 24582 Stephen Gambrell Market Administrator 40.0 0.0 X 0 108767 7263 Leslie Boney FORMER Director/president 0.0 0.0 X 0 109271 0 Michael Williams Former Director 0.0 0.0 X 0 2098576 20774 355197 4151379 332405 6 true true false McDermott Will Emery LLP 444 West Lake Street CHICAGO IL 60606 legal services 324956 Charlotte eye ears nose throat 6035 Fairview Road CHARLOTTE NC 28210 physician svcs 125000 2 0 INPATIENT REVENUE 623000 18880188 18880188 18880188 8070 8070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MEDICAL RECORDS 900099 1081 1081 MISC. INCOME - RESPIRATORY THERAPY SVC. 900099 116995 116995 118076 19006334 18997183 9151 X 0 0 0 0 0 0 0 6089515 5494570 594945 99224 89302 9922 1132190 1018971 113219 456188 410570 45618 540000 540000 194109 194109 111512 111512 1863 1863 0 0 3805665 3670805 134860 27386 27386 67344 67344 50 50 0 1431280 1431280 35109 35109 0 6680 6680 73143 73143 0 347257 347257 205372 205372 BAD DEBT EXPENSE 5331072 5331072 MEDICAL SUPPLIES 1403471 1403471 EQUIPMENT LEASES 110261 110261 MAINTENANCE CONTRACTS 66569 66569 128327 128327 21663587 18571402 3092185 0 322607 218161 0 0 0 0 3393412 4394776 0 0 0 0 0 0 47081 43576 484949 425280 2900076 1489570 1754257 1410506 0 0 0 0 0 0 2524808 2513979 0 0 8527114 9006278 2336954 3540373 0 0 0 0 0 0 0 0 0 0 0 0 1031932 748229 -1788474 428227 1580412 4716829 X 6946702 4289449 0 0 0 0 6946702 4289449 8527114 9006278 -2657253 X X false true X true false X false false false false false false false false true 1863 1863 false false Schedule C, Part II-B, Line 1i MERCY RESTORATIVE CARE HOSPITAL, INC. PAID $5,417 TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) and $5,084 TO THE National Association of Long Term Hospitals (NALTH) IN FISCAL YEAR 2018. THE PORTION OF AHA DUES REPORTED FOR LOBBYING PURPOSES WAS 22.98% and THE PORTION OF NALTH DUES REPORTED FOR LOBBYING PURPOSES WAS 12.16%. TOTAL DUES PAID AND REPORTED FOR LOBBYING ACTIVITIES FOR AHA WERE $5,417 X 22.98% = $1,245 and FOR NALTH WERE $5,084 X 12.16% = $618. 94894 36304 58590 2805182 1453266 1351916 1410506 0 INTERCOMPANY PAYABLES 365201 ESTIMATED THIRD PARTY SETTLEMENTS 63026 428227 true true true X true X true true false true true 301094 215335 85759 0.00520 301094 215335 85759 0.00520 6960 0 6960 0.00040 6960 0 6960 0.00040 308054 215335 92719 0.00560 true 5331072 9483378 8737212 746166 X true true 1 1 Carolinas CCH at Pineville 10648 PARK ROAD CHARLOTTE NC 28210 HTTP://CONTINUECARE.ORG/PINEVILLE/ H0278 X X Carolinas CCH at Pineville 1 false false true X X X X X X X X X 16 true false false true X See Part V, Section C X true 16 true See Part V, Section C false true X 200. 400. X X X true true X X X true X See Part V, Section C X See Part V, Section C X SEE PART V, SECTION C X X X X X X true X false X X false X X false false PART V, LINE 3E The significant health needs of the community identified in the CHNA are presented as a prioritized description. Part V, Line 5 A comprehensive, six-step community health needs assessment (CHNA) was conducted for MERCY RESTORATIVE CARE HOSPITAL, INC. D/B/A CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE (CAROLINAS CCH AT PINEVILLE) by CHC ContinueCARE. This CHNA utilizes relevant health data and stakeholder input to identify the significant community health needs in Mecklenburg County, North Carolina. Community input was received during interviews conducted from January 27, 2017 - February 10, 2017. The Carolinas CCH at Pineville Board reviewed and adopted the 2016 Community Health Needs Assessment and Implementation Plan on May 3, 2017. Carolinas CCH at Pineville provided CHC ContinueCARE with a list of persons with special knowledge of public health in Mecklenburg County, including public health representatives, not-for-profit organization professionals, charities and other individuals who focus specifically on underrepresented groups. From that list, eleven in depth interviews were conducted using a structured interview guide with the two groups outlined in internal revenue service final regulations issued December 29, 2014. Discussed were the health needs of the community, access issues, barriers and issues related to specific populations. With respect to individuals providing input it was noted in the CHNA that 90.9% of those providing input are members of a medically underserved, low-income or minority population in the community, or individuals or organizations serving or representing the interests of such populations. 9.1% of those providing input work for a state, local, tribal or regional governmental public health department with knowledge, information or expertise relevant to the health needs of the community. Interviewees included: -Life share of the Carolinas -Program for all inclusive care for the elderly (PACE) of the Southern Piedmont -Brian Center Reddman -Carolinas Healthcare System -Helping Hands Specialized Transport -Pulmonary & Critical Care Consultants -Mecklenburg County Health Department -Carolinas Healthcare System North East -Carolinas Wound Care Center Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.) served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported. Populations that were identified as the most underserved in the community by interviewees were: the elderly, youth, veterans, and un/underinsured populations in the community. These underserved groups were identified as most at risk for inadequate care due to the following: Elderly -Transportation barriers -Issues affording health services and medication -Lack of long term care resources for low income seniors -Difficulty navigating and understanding the health care system Teen/Adolescents -High need for maternal services and preventive education -Tobacco control Veterans -Limited access to health care services -Need for more mental and behavioral health care sources Un/Underinsured -Lack of access to primary care services and providers -Lack of affordable care options -Overuse of the emergency room/lack of an established medical home Part V, Lines 7a & 10a The CHNA can be found on the following website: http://continuecare.org/pineville/community-health-needs-assessment/ Part V, Line 11 The most recently conducted CHNA indicated that there were three main needs in the community served by Carolinas CCH at Pineville. Hospital leadership prioritized those needs and decided to address the first two. OBJECTIVE #1: INCREASE HEALTHY LIFESTYLE EDUCATION AND PREVENTION RESOURCES AT THE HOSPITAL AND IN THE COMMUNITY. 1.A. Carolinas CCH at Pineville will continue to participate in and/or host community health fairs on a regular basis. 1.B. Carolinas CCH at Pineville will continue to provide various health screenings at no cost, such as glucose, pulse oximetry, and blood pressure checks, at its vendor/fair events. 1.C. Carolinas CCH at Pineville will continue to participate in lunch and learn seminar events to educate local health care providers and the community on services offered by the Long Term Acute Care (LTAC) facility on a regular basis. 1.D. Carolinas CCH at Pineville is available to speak at community events, provide information, or participate in other educational opportunities by request. 1.E. Carolinas CCH at Pineville will continue to offer liaisons to give education on LTAC services and patients who may need LTAC services as opportunities arise. 1.F. Carolinas CCH at Pineville will continue to train all clinical staff on Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) for all RN and Respiratory Therapy (RT) staff. 1.G. Carolinas CCH at Pineville will continue to provide meeting space at no cost for support groups and community organizations upon request. 1.H. Carolinas CCH at Pineville will continue to participate in or provide space for meetings held by various local, state and national organizations to share information about services offered at the LTAC facility, such as the Case Management Society of America meeting that includes a keynote speaker who provides education to the audience on a significant health topic within the community. Continuing Education Units (CEUs) may be offered at some of the events. 1.I. Carolinas CCH at Pineville will continue to participate in conferences focused around their patient population's needs, such as the American Case Management Association (ACMA) North Carolina Conference (bi-annually), Case Management Society of America (CMSA) North Carolina Conference (bi-annually), and the Northwest Area Health Education Center (NWAHEC) Annual High Country Conference on Respiratory Care. 1.J. Carolinas CCH at Pineville will continue to partner with and support the local chapter of the American Lung Association (ALA). 1.K. Carolinas CCH at Pineville staff will continue to provide board representation for ALA, as well as sponsorship and support for the ALA Climb event to raise money and awareness for ALA within the community. 1.L. Carolinas CCH at Pineville will engage in a variety of employee wellness initiatives, including a health plan that is prevention driven. If employees meet certain criteria they will receive a reduction on a portion of their premiums. Other initiatives include: promote employee and family wellness via Accountable Health (formerly Principal Wellness Program); offer Need Specific Special Programs; smoking cessation opportunities; and weight management. 1.M. Carolinas CCH at Pineville will continue to incentivize employees to maintain healthy lifestyles on their health plans through offering a reduction on a portion of their premiums if employees meet certain criteria. 1.N. Carolinas CCH at Pineville will continue to offer the Employee Assistance Program (EAP) through Beacon Health Options to help employees navigate various life challenges. 1.O. Carolinas CCH at Pineville employees have access to the healthier options in the cafeteria, such as a salad bar, as well as nutritional facts for food that is served. 1.P. Carolinas CCH at Pineville will continue to serve as a tobacco-free facility. 1.Q. Carolinas CCH at Pineville will continue to host interdisciplinary team meetings on a weekly basis that include all necessary persons in discussions regarding individual patient care for a more comprehensive, patient-centered approach. Carolinas CCH at Pineville staff encourage family members to attend as well in order to fully understand the needs of the patient. 1.R. Carolinas CCH at Pineville will continue to provide patients' other physicians with a copy of their discharge summaries upon request. 1.S. Carolinas CCH at Pineville will continue to conduct post discharge follow up calls for every patient that has been discharged. For patients that are discharged to their home, a call is placed within the first 24-72 hours to assess the transition home, and to identify and address any issues or problems (i.e., inability to obtain prescriptions, home health care start of care, pain and symptom management, equipment concerns, or effectiveness of discharge planning). Follow up calls are also performed on every patient 30 days after discharge from the LTAC to determine if patient was readmitted to a LTAC within 30 days of discharging. 1.T. Carolinas CCH at Pineville will continue to conduct a thorough medication management education process for patients that involves patient demonstration of proper medication methods and documentation of the patient's proper medication methods before allowing the patient to be discharged. OBJECTIVES #2: PARTICIPATE IN INITIATIVES AND CREATE OPPPORTUNITIES TO INCREASE ACCESS TO AFFORDABLE CARE AND REDUCE HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS. 2.A. Carolinas CCH at Pineville wil PART I, LINE 7, COLUMN (F) COMMUNITY BENEFIT EXPENSE The TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) IS $21,663,587. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS 5,331,072 THIS LEFT A TOTAL EXPENSE OF $16,332,515 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). SINCE MERCY RESTORATIVE CARE HOSPITAL, INC. is a long term acute care hospital, it will have lower percentages than an acute care hospital. PART III, LINE 2 BAD DEBT COSTING METHODOLOGY THE BAD DEBT COSTING METHODOLOGY VARIES BY PAYER TYPE. FOR MEDICARE, BAD DEBT IS RECORDED WHEN RECOGNIZED TO THE EXTENT OF 35%. MEDICARE REIMBURSES THE ORGANIZATION FOR ALLOWABLE BAD DEBT AT 65%. MEDICARE BAD DEBT RELATES TO THE PRIVATE PAY PORTION OF CARE SUCH AS CO-PAY AND DEDUCTIBLE AMOUNTS. FOR MANAGED CARE, WE RESERVE BAD DEBT WHEN RECOGNIZED AT 100% OF CO-PAY AND DEDUCTIBLE AMOUNTS. PART III, LINE 4 BAD DEBT EXPENSE FOOTNOTE MERCY RESTORATIVE CARE HOSPITAL, INC. DOES NOT HAVE ITS OWN AUDIT. RATHER, IT IS PART OF COMMUNITY HOSPITAL CORPORATION AND THE BAD DEBT DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS DOES NOT COMPLETELY MATCH THE ORGANIZATION'S PRACTICE. THE BAD DEBT COSTING METHODOLOGY VARIES BY PAYER TYPE. FOR MEDICARE, BAD DEBT IS RECORDED WHEN RECOGNIZED TO THE EXTENT OF 35%. MEDICARE REIMBURSES THE ORGANIZATION FOR ALLOWABLE BAD DEBT AT 65%. MEDICARE BAD DEBT RELATES TO THE PRIVATE PAY PORTION OF CARE SUCH AS CO-PAY AND DEDUCTIBLE AMOUNTS. FOR MANAGED CARE, WE RESERVE BAD DEBT WHEN RECOGNIZED AT 100% OF CO-PAY AND DEDUCTIBLE AMOUNTS. PART III, LINE 8 COSTING METHODOLOGY THE COSTING METHODOLOGY USED ON LINE 6 COMES FROM THE COST REPORT (INPATIENT PPS COST-TO-CHARGE RATIO COMPUTATION). PART III, LINE 9B Application of collection practices to those qualifying for financial assistance IF A PATIENT OF MERCY RESTORATIVE CARE HOSPITAL, INC. QUALIFIES FOR ITS CHARITY CARE POLICY THE PATIENTS ACCOUNT IS ADJUSTED ACCORDINGLY. PATIENT ACCOUNTS WITH REMAINING BALANCES WILL BE REASSESSED TO DETERMINE THEIR ABILITY TO PAY AND WILL EITHER BE ELIGIBLE TO PARTICIPATE IN A PAYMENT PLAN OR THEIR ACCOUNT BALANCE WILL BE WRITTEN OFF. PART VI, LINE 2 NEEDS ASSESSMENT MERCY RESTORATIVE CARE HOSPITAL, INC. D/B/A CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE (MRC) IS A 40-BED LONG-TERM ACUTE CARE HOSPITAL. THE HOSPITAL WAS INCORPORATED UNDER THE LAWS OF NORTH CAROLINA FOR THE PURPOSE OF PROMOTING AND IMPROVING THE HEALTH STATUS OF THE COMMUNITY BY DEVELOPING AND PROVIDING LONG-TERM ACUTE CARE SERVICES FOR THE BENEFIT OF CITIZENS OF MECKLENBURG AND SURROUNDING COUNTIES. AS REPORTED IN SCHEDULE H, PART V, SECTION B, LINES 1-7, THE HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING 2017. The Carolinas ContinuCare Hospital at Pineville Board reviewed and adopted the 2017 Community Health Needs Assessment and Implementation Plan on May 3, 2017. THE HOSPITAL'S CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN THE FINAL REGULATIONS RELEASED DECEMBER 29, 2014. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. Carolinas CONTINUECARE HOSPITAL AT Pineville WILL BE WORKING TO PROVIDE VARIOUS CHARITABLE SERVICES AND TO CONDUCT VARIOUS COMMUNITY ACTIVITIES TO AND WITHIN THE LOCAL COMMUNITY IN THE NEAR FUTURE. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES ARE INFORMED UPON ADMISSION TO THE HOSPITAL BY A FACE TO FACE VISIT WITH THE HOSPITAL/ADMISSIONS STAFF. THE PATIENT FINANCIAL OBLIGATION IS DISCUSSED WITH THE RESPONSIBLE PARTY. THE HOSPITAL CHARITY CARE POLICY IS DISCUSSED WITH EACH RESPONSIBLE PARTY AND IF IT IS FELT THAT THE PATIENT WOULD QUALIFY FOR THE CHARITY PROGRAM THEN THE NECESSARY DOCUMENTS WOULD BE PRESENTED BY THE RESPONSIBLE PARTY TO THE BUSINESS OFFICE ASSOCIATE FOR REVIEW. The charity care policy is also posted in the admissions office and on its website. PART VI, LINE 4 COMMUNITY INFORMATION MERCY RESTORATIVE CARE HOSPITAL, INC. (MRC) SERVES PRIMARILY THOSE PATIENTS WHO ARE FROM MECKLENBURG AND THE SURROUNDING COUNTIES OR THOSE WHO HAVE FAMILY SUPPORT FROM MEMBERS LIVING IN THESE COUNTIES. GIVEN THE SPECIALIZED SERVICES MRC REACHES OUT TO ALL OF THE NORTH AND SOUTH CAROLINA COMMUNITITES AS WELL AS SOUTHERN VIRGINIA AND SOUTHERN WEST VIRGINIA. MRC's PRIMARY SERVICE AREA (CABARRUS, NC, GASTON, NC, MECKLENBERG, NC, UNION, NC, AND YORK, SC - 2010 CENSUS) SERVES 1,731,090 RESIDENTS OF WHICH 173,584 ARE GREATER THAN 65 YEARS OF AGE. THE SECONDARY SERVICE AREA (CHESTER, SC, CLEVELAND, NC, IREDELL, NC, LANCASTER, SC, LINCOLN, NC, ROWAN, NC, AND STANLY, NC - 2010 CENSUS) SERVES 644,585 RESIDENTS OF WHICH 91,555, ARE GREATER THAN 65 YEARS OF AGE. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH Mercy Restorative Care Hospital, Inc. is a community-based LTACH dedicated to serving the needs of the local community by delivering superior services with a collaborative spirit. The hospital is working to provide various charitable services as well as conduct various community activites to and within the local community. The hospital sponsored a healthcare convention and is exploring participating in drive events (ex: toy, food, school supply, and clothing drives). The hospital continues to serve in leadership roles and volunteers with many agencies in the community. Mercy Restorative Care Hospital, Inc. educates patients and families about LTACHs and about what services can be provided in conjunction with community resources through speaking at local events and by providing educational brochures. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM THE HOSPITAL IS HOUSED IN ANOTHER HOSPITAL BUT THE TWO ARE SEPARATE FOR PURPOSES OF SPONSORSHIP AND COMMUNITY RELATED HEALTHCARE EVENTS. PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT N/A true true false false false false false true false Leslie Boney FORMER Director/president 0 0 0 0 0 109271 0 0 0 0 0 109271 0 0 Michael Williams Former Director 0 527618 0 0 0 1570958 0 7950 0 12824 0 2119350 0 0 David Butler Secretary 0 359967 0 0 0 22543 0 5505 0 25782 0 413797 0 0 Hajrudin Begic Registered Nurse 116063 0 8500 0 3429 0 4025 0 23793 0 155810 0 0 0 JIM Kendrick DIRECTOR 0 467742 0 0 0 202701 0 83594 0 20229 0 774266 0 0 JAMES HILL TREASURER 0 240108 0 0 0 14581 0 7669 0 30344 0 292702 0 0 DEREK MURZYN CEO 0 180821 0 0 0 3142 0 12041 0 9910 0 205914 0 0 APRIL MYERS DIRECTOR/PRESIDENT 0 199139 0 0 0 11349 0 14954 0 28793 0 254235 0 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 3 MERCY RESTORATIVE CARE HOSPITAL INC.'S EXECUTIVES ARE EMPLOYED BY ITS WHOLLY-OWNED SUBSIDIARY, COMMUNITY HOSPITAL CONSULTING, WHICH FOLLOWS THE COMPENSATION POLICIES OF COMMUNITY HOSPITAL CORPORATION (CHC). CHC ENGAGED SULLIVAN COTTER TO CONDUCT A COMPETITIVE MARKET ANALYSIS OF THE COMPENSATION OF CHC'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS AND KEY EMPLOYEES. SULLIVAN COTTER GATHERED DATA RELATED TO JOB DESCRIPTIONS, SCOPE OF RESPONSIBILITIES, AND CURRENT INCUMBENTS' COMPENSATION. SULLIVAN COTTER RECOMMENDED APPROPRIATE COMPARISON DATA AND UTILIZED SURVEY DATA FROM FOUR MAJOR EXECUTIVE COMPENSATION SURVEY PROVIDERS TO PROVIDE MARKET DATA AND EXECUTIVE COMPENSATION RECOMMENDATIONS THAT MEET CHC'S COMPENSATION PHILOSOPHY. SULLIVAN COTTER'S RECOMMENDATIONS WERE PRESENTED TO THE CHC COMPENSATION COMMITTEE OF THE BOARD FOR REVIEW AND APPROVAL. CHC ALSO CONDUCTS PERIODIC REVIEWS OF COMPENSATION TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. The organization followed the process for the year ended 6/30/18 for its officers, directors, trustees and key employees and other management officials. Schedule J, Part I, Line 4a Severance Payment MICHAEL WILLIAMS, A FORMER DIRECTOR, RECEIVED A SEVERANCE PAYMENT UPON HIS TERMINATION OF EMPLOYMENT. LESLIE BONEY, A FORMER DIRECTOR, RECEIVED $109,271 IN SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION DURING 2018. Schedule J, Part I, Line 4b NONQUALIFIED RETIREMENT PLAN PARTICIPATION WAS PAID TO: MICHAEL WILLIAMS - $157,802 DAVID BUTLER - $12,706 JAMES HILL - $10,225 APRIL MYERS - $1,740 JIM KENDRICK - $76,924 SCHEDULE J, PART I, LINE 7 COMPENSATION CONTINGENT ON NET EARNINGS A PORTION OF THE DISCRETIONARY INCENTIVE COMPENSATION PROGRAM WAS BASED ON THE EBIDA OF CHC. DOING BUSINESS AS FORM 990, BOX C MERCY RESTORATIVE CARE HOSPITAL, INC. IS DOING BUSINESS AS CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE. DESCRIPTION OF MANAGEMENT ARRANGEMENT FORM 990, PART VI, QUESTION 3 CHC COMMUNITY CARE, LLC PROVIDES CERTAIN FINANCIAL, TECHNICAL AND MANAGERIAL SUPPORT SERVICES TO THE HOSPITAL. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 THE SOLE SHAREHOLDER OF MERCY RESTORATIVE CARE HOSPITAL, INC. IS CAROLINAS COMMUNITY CARE, LLC ("CARCC"). DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTION 7A THE SOLE SHAREHOLDER SHALL MAINTAIN A MINORITY VOTING INTEREST OF THE BOARD OF DIRECTORS. ANY DIRECTOR MAY BE REMOVED AT ANY TIME, WITH OR WITHOUT CAUSE BY THE SOLE MEMBER. THE BOARD OF DIRECTORS SHALL BE COMPRISED OF 5 VOTING DIRECTORS PLUS 2 NON-VOTING EX-OFFICIO DIRECTORS. DESCR CLASSES OF PERSONS/DECISIONS REQUIRING APPR/TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 7B THE BOARD OF DIRECTORS MAY RECOMMEND, BUT SHALL NOT, WITHOUT EXPRESS WRITTEN CONSENT OF THE SOLE MEMBER, HAVE THE POWER TO TAKE ANY OF THE FOLLOWING ACTIONS: 1. ANY FUNDAMENTAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE HOSPITAL 2. THE INCURRANCE OF DEBT, INCLUDING WITHOUT LIMITATION, BORROWINGS, GUARANTEES, LOANS, ENCUMBRANCES, OPERATING LEASES, PURCHASE OF LEASE OF REAL ESTATE, AND CAPITAL LEASES 3. ANY MERGER OR CONSOLIDATION TO WHICH THE HOSPITAL IS A PARTY 4. THE SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL 5. POLICY CHANGES PERTAINING TO CHARITY CARE 6. APPOINTMENT AND REMOVAL OF CORPORATE DIRECTORS 7. ANY RELEASE OR CANCELLATION OF INDIVIDUAL CLAIMS IN EXCESS OF $25,000 GOVERNING BODY FORM 990, PART VI, QUESTION 8B THERE WERE NO COMMITTEES OF THE GOVERNING BODY. DESCRIBE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11B THE DETAILED REVIEW OF THE FORM 990 IS CONDUCTED BY THE HOSPITAL'S MANAGEMENT FOLLOWING THE PREPARATION AND REVIEW OF THE RETURN BY THE ORGANIZATION'S PAID PREPARER. AN ELECTRONIC COPY OF THE FINAL FORM 990 IS EMAILED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE IRS. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C THE ORGANIZATION FOLLOWS THE CONFLICT OF INTEREST DISCLOSURE PROCESS ADOPTED BY ITS SOLE MEMBER, CAROLINAS COMMUNITY CARE, LLC, WHICH IN TURN FOLLOWS THE CONFLICT OF INTEREST DISCLOSURE PROCESS ADMINISTERED BY ITS PARENT, COMMUNITY HOSPITAL CORPORATION (CHC), WHICH REQUIRES ALL OFFICERS, DIRECTORS, KEY EMPLOYEES, HIGHLY COMPENSATED EMPLOYEES AND OTHER MANAGEMENT OFFICIALS ("COVERED PERSONS") TO DISCLOSE POTENTIAL CONFLICTS. THE ORGANIZATION'S BOARD FORMALLY ADOPTED CHC'S CONFLICT OF INTEREST POLICY FOR THE YEAR ENDED 6-30-15. PURSUANT TO THE POLICY, A DISCLOSURE STATEMENT IS CIRCULATED ANNUALLY TO COVERED PERSONS IN WHICH THE INDIVIDUAL MUST DISCLOSE TRANSACTIONS THAT MAY RESULT IN A CONFLICT. COVERED PERSONS ARE ALSO ENCOURAGED TO NOTIFY THE BOARD, APPROPRIATE MANAGEMENT PERSONNEL, CHIEF COMPLIANCE OFFICER, GENERAL COUNSEL OR THE AUDIT AND COMPLIANCE COMMITTEE OF THE GOVERNING BODY AS NECESSARY. WHEN NECESSARY, THE BOARD CHAIR OR APPROPRIATE BOARD COMMITTEE MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE POTENTIAL CONFLICT OF INTEREST AND RECOMMEND ALTERNATIVES TO THE APPLICABLE TRANSACTION OR ARRANGEMENT OR OTHERWISE DETERMINE IF THE CONFLICT CAN BE RESOLVED. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER THE CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF THE ORGANIZATION, AND WHETHER IT IS REASONABLE. THE GOVERNING BOARD OR COMMITTEE MAKES THE DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. ANY MEMBER OF THE BOARD OPERATING UNDER A CONFLICT IS NOT PERMITTED TO BE PRESENT OR OTHERWISE PARTICIPATE IN THE VOTE ON ANY MATTER TO WHICH THE CONFLICT RELATES. IF THE GOVERNING BOARD OR COMMITTEE OF THE ORGANIZATION HAS REASONABLE CAUSE TO BELIEVE THAT A COVERED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST AND AFTER INVESTIGATION THE BOARD OR COMMITTEE DETERMINES THAT THE COVERED PERSON FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE ORGANIZATION TAKES APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION, WHICH MAY INCLUDE, TERMINATION OF THE INDIVIDUAL'S MEMBERSHIP, EMPLOYMENT OR CONTRACT. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, QUESTIONS 15A & 15B THE ORGANIZATION FOLLOWS THE COMPENSATION POLICY OF COMMUNITY HOSPITAL CORPORATION (CHC). CHC ENGAGED SULLIVAN COTTER TO CONDUCT COMPETITIVE MARKET ANALYSIS OF THE COMPENSATION OF CHC'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS AND KEY EMPLOYEES. SULLIVAN COTTER GATHERED DATA RELATED TO JOB DESCRIPTIONS, SCOPE OF RESPONSIBILITIES AND CURRENT INCUMBENTS' COMPENSATION. SULLIVAN COTTER RECOMMENDED APPROPRIATE COMPARISON DATA AND UTILIZED SURVEY DATA FROM FOUR MAJOR EXECUTIVE COMPENSATION SURVEY PROVIDERS TO PROVIDE MARKET DATA AND EXECUTIVE COMPENSATION RECOMMENDATIONS THAT MEET CHC'S COMPENSATION PHILOSOPHY. SULLIVAN COTTER'S RECOMMENDATIONS WERE PRESENTED TO THE CHC COMPENSATION COMMITTEE OF THE BOARD FOR REVIEW AND APPROVAL. CHC ALSO CONDUCTS PERIODIC REVIEWS OF COMPENSATION TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. THE ORGANIZATION FOLLOWED THE PROCESS FOR THE YEAR ENDED 6-30-18 FOR ITS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES AND OTHER MANAGEMENT OFFICIALS. THIS PROCESS IS PERFORMED EACH YEAR PRIOR TO THE ANNUAL EMPLOYEE EVALUATION PROCESS, WHICH ENDS ON OCTOBER 1ST OF EACH YEAR. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AVAILABLE TO PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE AT ITS BUSINESS OFFICE UPON REQUEST. OVERSIGHT OR SELECTION PROCESS FORM 990, PART XII, QUESTION 2C THE AUDIT COMMITTEE OF COMMUNITY HOSPITAL CORPORATION, WHICH IS THE PARENT ORGANIZATION OF MERCY RESTORATIVE CARE HOSPITAL, INC. IS RESPONSIBLE FOR OVERSEEING THE EXTERNAL AUDIT OF THE CONSOLIDATED FINANCIALS. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - MEDICAL TOTAL FEES:2178524 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SVCS - PLANT MAINT. TOTAL FEES:542148 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - PHARMACY TOTAL FEES:480856 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - LAB TOTAL FEES:216167 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - IT TOTAL FEES:193614 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - OTHER TOTAL FEES:153326 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - ADMIN TOTAL FEES:41030 SOUTHWEST COMMUNITY HOSPITAL INC 7800 N DALLAS PKWY STE 200 PLANO TX 75024 752725353 SUPPORT ORG TX 501(C)(3) 12C-III-FI CHC false YOAKUM COMMUNITY HOSPITAL 1200 CARL RAMERT DRIVE YOAKUM TX 77995 742323822 HOSPITAL TX 501(C)(3) 3 CHC false CONTINUECARE HOSPITAL OF TYLER 800 E DAWSON STREET TYLER TX 75701 200991990 HOSPITAL DE 501(C)(3) 3 CCC false CONTINUECARE HOSPITAL OF SOUTHEAST TEXAS 7800 N DALLAS PKWY STE 200 PLANO TX 75024 201150480 HOSPITAL TX 501(C)(3) 3 CCC false ST MARK'S MEDICAL CENTER ONE ST MARKS PLACE LA GRANGE TX 78945 743019849 HOSPITAL TX 501(C)(3) 3 CHC false CHC COMMUNITY CARE LLC 7800 N DALLAS PKWY STE 200 PLANO TX 75024 371485773 SUPPORT ORG DE 501(C)(3) 12C-III-FI CHC false CONTINUECARE HOSPITAL OF MIDLAND 4214 ANDREWS HIGHWAY MIDLAND TX 79703 463053684 HOSPITAL DE 501(C)(3) 3 CCC false CONTINUECARE HOSPITAL HENDRICK MED CTR 1900 PINE ST 5TH FLOOR ABILENE TX 79601 463607347 HOSPITAL DE 501(C)(3) 3 CCC false CONTINUECARE HOSPITAL AT BAKERSFIELD 7800 N DALLAS PKWY STE 200 PLANO TX 75024 465236524 HOSPITAL DE 501(C)(3) 3 CCC false CONTINUECARE HOSP BAP HLT MADISONVILLE 900 Hospital Drive 4th Floor Madisonville KY 42431 465033192 HOSPITAL DE 501(C)(3) 3 CCC false CONTINUECARE HOSP AT BAP HLT PADUCAH 2501 Kentucky Avenue 5th Fl Paducah KY 42003 465032999 HOSPITAL DE 501(C)(3) 3 CCC false CONTINUECARE HOSPITAL AT BAPTIST HEALTH 1 TRILLIUM WAY CORBIN KY 40701 200925675 HOSPITAL KY 501(C)(3) 3 CCC false CRAWLEY MEMORIAL HOSPITAL 706 KINGS STREET KINGS MOUNTAIN NC 28086 560691100 HOSPITAL NC 501(C)(3) 3 CAR CC false CAROLINAS COMMUNITY CARE LLC 7800 N DALLAS PKWY STE 200 PLANO TX 75024 465590355 SUPPORT ORG DE 501(C)(3) 12B-II CHC false JELLICO COMMUNITY HOSPITAL INC 188 Hospital Lane Jellico TN 37762 620924706 HOSPITAL TN 501(C)(3) 3 CHC false CONTINUECARE HOSPITAL AT ODESSA INC 500 W 4th Street Odessa TX 79761 473539943 HOSPITAL DE 501(C)(3) 3 CCC false COMMUNITY HOSPITAL CORPORATION 7800 N DALLAS PKWY STE 200 PLANO TX 75024 752638469 SUPPORT ORG TX 501(C)(3) 12C-III-FI NA false BAPTIST HOSPITALS OF SOUTHEAST TEXAS POST OFFICE BOX 1591 BEAUMONT TX 77704 741303720 HOSPITAL TX 501(C)(3) 3 SWCH INC false BAPTIST PHYSICIAN NETWORK 3080 COLLEGE STREET BEAUMONT TX 77701 760453250 PRIMARY CARE TX 501(C)(3) 3 BHSET false YOAKUM COMMUNITY HOSPITAL FOUNDATION 1200 CARL RAMERT DRIVE YOAKUM TX 77995 453609830 SUPPORT ORG TX 501(C)(3) 12A-I YCH false BHSETX FOUNDATION 810 HOSPITAL DRIVE 235 BEAUMONT TX 77701 611557670 SUPPORT ORG TX 501(C)(3) 7 BHSET false CONTINUECARE HOSPITAL AT PALMETTO HEALTH 7800 N DALLAS PKWY STE 200 PLANO TX 75024 813048423 HOSPITAL TX 501(C)(3) 3 CCC false RURAL AND COMMUNITY HEALTHCARE COLLABORA 7800 N DALLAS PKWY STE 200 PLANO TX 75024 814337246 SUPPORT ORG TX 501(C)(3) 7 CHC false Critical Access HospCoalition 120 G St NW STE 1000 WA DC 11111 hosp. coalitiON DE na COMMUNITY HEALTH ASSURANCE SPC LTD POB 69GT GRAND CAYMAN CJ captive insurANCE CJ CHC C Corp false COMMUNITY HOSPITAL CONSULTING 7800 N DALLAS PARKWAY 200 PLANO TX 75024 204710183 MGMT CONSULTING TX CHC C Corp false false false false false false false false false false false false false false false true true false false false Community Hospital Corporation P 1695019 cost CHC Community Care LLC p 615642 Cost CHC Community Care LLC o 314096 Cost