2019-05-10T05:33:39-05:00 2018-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2017-07-01 560619359 GASTON MEMORIAL HOSPITAL INC GAST 7048342000 2525 COURT DRIVE GASTONIA NC 28054 DAVID O'CONNOR EVP, CFO 7048342000 2019-05-10 1 AMY BIBBY P00445891 8282542254 24.241.144.70 2019-05-10 05:20:23 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 3C4A73C7F70BFF54BAAC11A85090BDFB39FC8B01 2017 2019-02-21 02:37:17Z CAROMONT REGIONAL MEDICAL CTR DAVID O'CONNOR 2525 COURT DRIVE GASTONIA NC 28054 514011774 0 X WWW.CAROMONT.ORG X 1945 NC TO PROVIDE COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE. 14 10 3657 228 296857 100178 484202 430093 479845593 509644495 30286 -21865 3487850 3444700 483847931 513497423 913014 1025814 0 0 199154895 209386609 0 0 0 250531058 259960954 450598967 470373377 33248964 43124046 425694209 436498125 315375438 305672790 110318771 130825335 TO PROVIDE COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE. 0 0 438673578 1025814 509734940 CAROMONT HEALTH'S PHILOSOPHY OF CARE IS FOUNDED IN THREE DISTINCT WAYS. IT IS A HEALTH SYSTEM THAT INVESTS IN THE FUTURE OF HEALTHCARE FROM RESEARCH TO EDUCATION. IT IS AN ACTIVE COMMUNITY PARTNER, SUPPORTING AND DRIVING PROGRAMS THAT ENCOURAGE HEALTHIER LIFESTYLES. IT IS ALSO A DYNAMIC ORGANIZATION FOCUSED ON CONTINUOUS DAILY IMPROVEMENT, ADVANCED MEDICINE AND THE DELIVERY OF COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE. THE FISCAL YEAR ENDING JUNE 30, 2018 SAW CAROMONT HEALTH LIVING ITS VISION TO BE OUR COMMUNITY'S MOST TRUSTED HEALTHCARE PARTNER. THE COMPLETE 2018 COMMUNITY BENEFIT REPORT CAN BE FOUND AT WWW.CAROMONTHEALTH.ORG. 438673578 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 280 0 1 3657 1 1 1 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X DAVID O'CONNOR 7048342000 2525 COURT DRIVE GASTONIA NC 28054 MR DONNIE LOFTIS CHAIR 2018 1.00 2.00 X X 0 0 0 MR BARRY M POMEROY CHAIR 2017/TREASUER 2018 1.00 1.00 X X 0 0 0 MR DAVID PAYSEUR VICE CHAIR 1.00 1.00 X X 0 0 0 DR ANDREW LIGHT SECRETARY 2018 1.00 1.00 X X 0 0 0 MS ANNETTE CARTER DIRECTOR 1.00 1.00 X 0 0 0 MR TIMOTHY CONNER DIRECTOR 1.00 2.00 X 0 0 0 MR TIMOTHY E GAUSE DIRECTOR 1.00 2.00 X 0 0 0 MR WILLIAM ANTHONY DIRECTOR 1.00 1.00 X 0 0 0 MR JEFFERY CASH DIRECTOR 1.00 2.00 X 0 0 0 DR CHARLES MEAKIN III DIRECTOR 1.00 3.00 X 0 0 0 MS PEARL BURRIS FLOYD DIRECTOR 1.00 2.00 X 0 0 0 MR JOE DAVIS DIRECTOR 1.00 1.00 X 0 0 0 MR TOM KEIGHER DIRECTOR 1.00 2.00 X 0 19405 0 MR JAMES BEAM DIRECTOR (THROUGH DEC. '17) 1.00 1.00 X 0 0 0 DR PATRICK RUSSO CHIEF OF STAFF (THRU DEC 17) 1.00 1.00 X 0 673645 36941 DR ERIC T EMERSON CHIEF-OF-STAFF (BEG. JAN. '18) 1.00 2.00 X 20959 0 0 K CHRISTOPHER PEEK CEO/PRESIDENT 45.00 10.00 X 363421 0 99063 DAVID O'CONNOR EVP/CFO/ASST. TREASURER 45.00 10.00 X 591058 0 112821 LEIGH HICKMAN CLO/AS 45.00 10.00 X 224559 0 21331 KATHLEEN K BESSON EVP/COO 40.00 X 533474 0 110144 TODD DAVIS MD EVP/CMO (FRMR INTERIM CEO) 45.00 10.00 X 535562 0 102319 ANDREA K SERRA VP COMMUNITY CARE 40.00 X 525560 0 32176 ELIZABETH MCCRAW VP HUMAN RESOURCES 40.00 X 526911 0 39960 MICHAEL R JOHNSON VP CIO 40.00 X 391623 0 42507 RICHARD C BLACKBURN VP SUPPORT SERVICES 40.00 X 434950 0 53078 MOHAMADSALIM M SAIYED CHIEF MEDICAL INFO OFFICER 40.00 X 405172 0 23348 DOUG LUCKETT FORMER OFFICER 45.00 10.00 X 353078 0 49833 MARIA LONG FORMER OFFICER 45.00 10.00 X 624045 0 23409 5530372 693050 746930 172 1 1 0 EDIFICE INC PO BOX 36349 CHARLOTTE NC 28236 CONTRACTOR 6316820 ARAMARK CT 12483 COLLECTION CENTER DRIVE CHICAGO IL 60693 BIOMED EQUIPMENT SERVICES 2247274 BLAKE CONTRACTING LLC 1994 REMOUNT RD GASTONIA NC 28054 CONTRACTOR 1984532 CROSS COUNTRY STAFFING PO BOX 404674 ATLANTA GA 30384 TEMPORARY PERSONNEL 1683511 FEREBEE LANE CO 201 WEST MCBEE AVE GREENVILLE SC 29601 ADVERTISING 1018861 46 420691 9402 430093 PATIENT SERVICES REVENUE 621500 505674972 505674972 ANCILLARY REVENUE 621500 3969523 3969523 509644495 82416 82416 531 0 104812 531 -104812 -104281 -104281 416680 409539 7141 7141 CAFETERIA & VENDING INCOME 722210 2136659 2136659 MISCELLANEOUS 900099 713927 713927 OUTSIDE LAB SERVICES 621500 261907 261907 325066 90445 34950 199671 3437559 513497423 509734940 296857 3035533 968819 968819 56995 56995 1166363 233273 933090 73711 73711 163410688 145768235 17642453 5353463 4749497 603966 27872316 24727822 3144494 11510068 10211527 1298541 499921 499921 155000 155000 63171 63171 11 11 46459672 43026209 3433463 1232297 101442 1130855 4569829 2616267 1953562 1627485 1627485 10867784 10867784 181492 101011 80481 663225 287849 375376 7466186 7466186 38644824 38644824 2241528 2241528 UBI TAX 7748 7748 SUPPLIES 83737794 83737794 BAD DEBT 50233456 50233456 NC MEDICAID ASSESSMENT 5512699 5512699 5796832 5419165 377667 470373377 438673578 31699799 0 85308 112167 59370305 59190545 8636439 9109888 7359203 6473298 646803098 386175687 270467113 260627411 10012 67697 6309913 7399808 2311646 71144270 93517311 425694209 436498125 44093209 41445455 177366739 172335374 93915490 91891961 315375438 305672790 X 107430448 88689725 2888323 42135610 110318771 130825335 425694209 436498125 X 43124046 -45 -22617437 X X 0 1 X 1 0 X 1 1 0 0 0 0 1 89832 0 1 83772 173604 0 PART II-B, LINE 1: ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $23,772 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. AN ADDITIONAL $60,000 IN FEES WERE PAID FOR LOBBYING EXPENDITURES. LOBBYING REGISTRATION IS IN THE NAME OF CAROMONT HEALTH, INC. LOBBYING EXPENDITURES ARE REPORTING ON THE GASTON MEMORIAL HOSPITAL, INC FORM 990. 9841 703 495 10049 9521 1013 693 9841 10002 -278 203 9521 10186 630 405 1219 10002 9488 1251 553 10186 1.00000 0 0 4630019 4630019 322183862 164841507 157342355 10277784 7896437 2381347 296740430 211456577 85283853 12971003 1981166 10989837 260627411 NET PENSION ASSET & PENSION DEFERRAL 44236393 DEFERRED FINANCING COSTS 1344241 OTHER RECEIVABLES 3248339 457B PLAN ASSETS 11603844 DEFERRED CHARGE - INTEREST RATE SWAP 16501175 457F PLAN ASSETS 1068319 PREPAID COUNTY LEASE 15515000 93517311 457B PLAN LIABILITY 11603844 ESTIMATED 3RD PARTY SETTLEMENTS 55781161 INTEREST RATE SWAP LIABILITY 16501175 457F PLAN LIABILITY 1068319 PENSION DEFERRED INFLOW 6937462 91891961 X 442929188 -45 -45 442929233 11 70568179 70568190 513497423 420139415 0 420139415 11 50233951 50233962 470373377 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR ONCOLOGY MEDICATIONS FOR INDIGENT PATIENTS. PART X, LINE 2: THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2018 AND 2017. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 50,233,456. INTERCOMPANY TRANSFER FROM AFFILIATE 20,081,966. CHANGE IN VALUE OF INTEREST RATE SWAP 245,121. EXPENSES IN REVENUES 495. AUXILIARY REVENUES 7,141. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 50,233,456. EXPENSES IN REVENUES 495. 1 1 1 X 1 X 1 1 0 1 1 11993642 11993642 0.02850 71537077 54117095 17419982 0.04150 83530719 54117095 29413624 0.07000 1929870 8277 1921593 0.00460 2019323 2019323 0.00480 694930 172084 522846 0.00120 1124279 1124279 0.00270 5768402 180361 5588041 0.01330 89299121 54297456 35001665 0.08330 1551047 1551047 0.00370 1551047 1551047 0.00370 50233454 9607620 93683109 110910398 -17227289 X 1 1 1 1 CAROMONT REGIONAL MEDICAL CENTER 2525 COURT DRIVE GASTONIA NC 28054 X X X 4 DIAGNOSTIC IMAGING CENTERS AND 6 OP SERIVCE CENTER CAROMONT REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X 15 1 0 1 1 X WWW.CAROMONTHEALTH.ORG X WWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMAN-SERVICES X X 1 15 1 HTTP://WWW.CAROMONTHEALTH.ORG/DOCUMENTS/FOR-HEALTHCARE-PROFESSIONALS/GASTON 0 1 X 200.000000000000 200.000000000000 X X X 1 1 X X X X 1 X SEE DISCLOSURE X SEE DISCLOSURE X SEE DISCLOSURE X X X X X X X 1 X 0 X X X X 1 X 0 0 CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: GASTON COUNTY COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY THE FOLLOWING PARTNERS: THE GASTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, GASTON TOGETHER, UNITED WAY OF GASTON COUNTY AND CAROMONT HEALTH. DATA IN THIS ASSESSMENT IS DERIVED FROM THREE SOURCES: 1) GASTON COUNTY HEALTH DATA, 2) COUNTY HEALTH RANKINGS AND 3) GASTON COUNTY QUALITY OF LIFE SURVEY, 2015. THE QUALITY OF LIFE SURVEY WAS CONDUCTED TO ASSESS THE OPINIONS OF GASTON COUNTY RESIDENTS REGARDING THEIR PERSONAL HEALTH. TO GET A COMPREHENSIVE PICTURE OF THESE OPINIONS, FOUR DIVERSE GROUPS WERE INTERVIEWED: 1) COMMUNITY LEADERS, 2) COMMUNITY RESIDENTS, 3) HIGH SCHOOL JUNIORS AND 4) PERSONS LIVING IN LOW-INCOME AREAS THROUGHOUT THE COUNTY. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: THE HOSPITAL CONDUCTED THEIR CHNA WITH THE FOLLOWING ORGANIZATIONS: GASTON COUNTY HEALTH DEPARTMENT, GASTON TOGETHER, AND UNITED WAY OF GASTON COUNTY. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7D: PARTNERING AGENCIES PRESENTED THE CHNA AT WORKSHOPS, MEETING AND ON AGENCY WEBSITES TO ENCOURAGE COMMUNITY STAKEHOLDERS TO USE THEM TO ENHANCE THE WELLBEING OF GASTON COUNTY AND ITS RESIDENTS. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: THE CHNA WAS PRESENTED TO THE CAROMONT HEALTH BOARD ON 5/23/16 WHICH LED INTO A DISCUSSION RESULTING IN THE FOLLOWING PRIORITIES BEING APPROVED: 1) INCREASE MENTAL HEALTH SERVICES PROVIDED BY LCSWS IN CAROMONT MEDICAL GROUP PRACTICES AND 2) STANDARDIZATION OF CHRONIC OPIOID MANAGEMENT IN CAROMONT MEDICAL GROUP. THESE PRIORITIES ARE A PART OF CAROMONT HEALTH'S CORPORATE GOALS. IDENTIFIED NEEDS THAT ARE NOT BEING ADDRESSED ARE: 1) ILLEGAL DRUG ABUSE, 2) TEEN PREGNANCY AND 3) ALCOHOL ABUSE. THESE CAN BE BETTER ADDRESSED BY OTHER LOCAL ORGANIZATIONS. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13B: REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY: EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO ONE ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE ALSO EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 15E: CAROMONT HEALTH HAS A TEAM DEDICATED TO EDUCATING AND/OR ASSISTING PATIENTS WITH OTHER STATE OR GOVERNMENT AGENCIES THAT MAY BE A SOURCE OF ASSISTANCE. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16J: PLAIN LANGUAGE BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBALLY OR IN WRITING TO SCHEDULED PATIENTS PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER SERVICE TO THOSE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 18E: COLLECTION ACTIONS ARE TAKEN AFTER REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE PATIENT'S ELIGIBILITY FOR ASSISTANCE. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 20E: PLAIN LANGUAGE BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBALLY OR IN WRITING TO SCHEDULED PATIENT PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER SERVICE TO THOSE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. PART I, LINE 3C: FREE CARE IS PROVIDED TO PATIENTS WITH A FPG OF 200% OR LESS. ALL OTHER PATIENTS RECEIVE AN INSURANCE DISCOUNT BASED ON THEIR INDIVIDUAL INSURANCE PLAN AGREEMENT OR AN UNINSURED DISCOUNT FOR THE SELF PAY. UNINSURED DISCOUNTS ARE COMPARABLE TO OUR INSURANCE DISCOUNTS.REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY:EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO ONE ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS UP TO $25,000 INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS ARE ALSO EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION.PART 1, LINE 6A:COMMUNITY BENEFIT REPORT: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT MADE AVAILABLE TO THE PUBLIC CONTAINS COMMUNITY BENEFITS FOR ALL RELATED ORGANIZATIONS TO THE HOSPITAL. PART I, LINE 7: THE COSTING METHODOLOGY USED IS A COST ACCOUNTING SYSTEM. ALL PATIENT SEGMENTS ARE INCLUDED. THIS SYSTEM ASSIGNS DIRECT COSTS TO SUPPLIES, PROCEDURES, ROUTINE AND SPECIALTY ROOM RATES BASED ON THE DEPARTMENT OF ORIGINATION. FIXED COSTS ARE ALLOCATED BASED ON STATISTICAL BASIS. THESE COSTS ARE THEN AGGREGATED AT THE PATIENT LEVEL AND TABULATED BY PAYOR TYPE. NO COST TO CHARGE RATIOS WERE USED IN THE CALCULATIONS. PART I, LN 7 COL(F): 50,233,456 BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES PRIOR TO CALCULATING PERCENT OF TOTAL EXPENSE. PART I, LINE 7H: RESEARCH ACTIVITIES: CAROMONT HEALTH IS INVOLVED IN APPROXIMATELY 40 RESEARCH STUDIES, APPROXIMATELY 45% OF WHICH ARE CLINICAL TRIALS COOPERATIVE GROUP PROGRAM STUDIES SPONSORED BY THE NATIONAL CANCER INSTITUTE (NCI). CAROMONT HEALTH ALSO PARTICIPATES IN DRUG AND DEVICE STUDIES SPONSORED BY VARIOUS PHARMACEUTICAL, BIOTECHNOLOGY, AND DEVICE COMPANIES, AS WELL AS UNFUNDED ONCOLOGY, NURSING AND PHARMACY RESEARCH STUDIES. PART II, COMMUNITY BUILDING ACTIVITIES: WORKFORCE DEVELOPMENT - CAROMONT HEALTH'S RECRUITMENT OF EMPLOYEES, PHYSICIANS AND ADVANCED CARE PRACTITIONERS INTO THE FIVE COUNTIES THE SYSTEM SERVES IS DRIVEN BY THE CHANGING LANDSCAPE OF HEALTH CARE. THE SYSTEM RECRUITS BASED ON A MEDICAL STAFF DEVELOPMENT PLAN THAT IDENTIFIES COMMUNITY HEALTH CARE NEEDS FOR THE NEXT FIVE YEARS. THE SYSTEM'S GOAL IS TO BE PRO-ACTIVE AND ANTICIPATORY SO THAT THE HEALTH CARE NEEDS OF THE COMMUNITY ARE MET IN A QUALITY-DRIVEN AND CONVENIENT MANNER. PART III, LINE 2: CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPARTMENT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING AND/OR APPLICATIONS FILED BY THE PATIENTS. IF NO MEANS TESTING IS DONE AND NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPARTMENT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY. PART III, LINE 2: CHARGES WRITTEN OFF TO BAD DEBT WERE TABULATED AT THE PATIENT LEVEL AND ARE REPORTED AT THE AMOUNT CHARGED TO PATIENTS. ACCOUNTS ARE RESERVED AS BAD DEBT BASED ON AN ACCOUNTS RECEIVABLE AGING METHODOLOGY. WHEN ACCOUNTS ARE SENT TO A COLLECTION AGENCY, THEY ARE WRITTEN OFF THE ACCOUNTS RECEIVABLE SYSTEM. ANY SUBSEQUENT COLLECTIONS ON THE ACCOUNTS ARE POSTED AS RECOVERIES AND REDUCE THE EXPENSE. ALL UNINSURED PATIENTS RECEIVE A DISCOUNT ON THEIR BILL, WHICH IS RECORDED AS A CONTRACTUAL ADJUSTMENT. THE AMOUNT OF THE UNINSURED DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE. PART III, LINE 3: CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPARTMENT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING AND/OR APPLICATIONS FILED BY THE PATIENTS. IF NO MEANS TESTING IS DONE AND NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPARTMENT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. BAD DEBT EXPENSE IS REPORTED AS A DEDUCTION FROM PATIENT REVENUE. PART III, LINE 8: THE MEDICARE COST REPORT STANDARD COSTING METHODOLOGY WAS FOLLOWED WHEN FILING THE COST REPORT. THIS IS A STEP DOWN METHODOLOGY THAT APPLIES THE AVERAGE PATIENT COST TO MEDICARE PATIENTS. THE COST REPORT DOES NOT ALLOW HOSPITALS TO REPORT ALL OPERATING COSTS. BECAUSE OF THESE TWO ISSUES, THE MEDICARE COST REPORT METHODOLOGY UNDERSTATES THE TRUE COST OF TREATING MEDICARE PATIENTS. USING TOTAL COSTS FROM MEDICARE PATIENTS, THE HOSPITAL HAD AN ACTUAL MEDICARE SHORTFALL OF $37.0 MILLION. PART III, LINE 9B: THE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BELOW IS VERBIAGE FROM THE CHARITY POLICY:CAROMONT REGIONAL MEDICAL CENTER OFFERS MEDICAL SERVICES FREE OF CHARGE THROUGH THE CHARITY CARE PROGRAM. DETERMINATION OF CHARITY CARE WILL BE BASED ON THE PATIENT'S INCOME, FAMILY SIZE, AND ASSETS. POTENTIAL ELIGIBILITY EXISTS ONLY AFTER THE REIMBURSEMENT EFFORTS FROM ALL OTHER THIRD PARTY RESOURCES, FEDERAL, STATE, AND LOCAL ASSISTANCE PROGRAMS HAVE BEEN EXHAUSTED. PART VI, LINE 2: CAROMONT HEALTH ESTABLISHES COMMUNITY PRIORITIES THROUGH A NUMBER OF MECHANISMS:1. LEADERSHIP OPINIONS ARE SOUGHT TO HELP IDENTIFY NEEDED SERVICES IN THE COMMUNITY VIA PARTNERSHIPS WITH THE GASTON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, LOCAL NON-PROFIT ORGANIZATIONS FOCUSED ON HEALTH IMPROVEMENT IN OUR COMMUNITIES AND OTHER HEALTH-FOCUSED ENTITIES. CAROMONT HEALTH ALSO WORKS WITH COMMUNITY AGENCIES TO CONDUCT COMMUNITY NEEDS ASSESSMENTS AND QUALITY OF LIFE SURVEYS EVERY TWO TO THREE YEARS. 2. PATIENT SATISFACTION DATA IS ANALYZED TO DETERMINE WHERE AND/OR HOW SERVICES NEED TO BE IMPROVED.3. SERVICE AREA DATA (VITAL STATISTICS, DEMOGRAPHICS AND UTILIZATION) ARE ANALYZED FOR TRENDS. THIS INFORMATION IS COORDINATED WITH PUBLIC HEALTH DATA TO DETERMINE VOIDS AND SERVICE AREA HEALTH PROBLEMS.4. FINDINGS FROM COMMUNITY SURVEYS/REPORTS PUBLISHED BY OTHER ORGANIZATIONS (UNITED WAY, CHAMBER OF COMMERCE, PARTNERSHIP FOR CHILDREN, GASTON COUNTY GOVERNMENT, ETC.) ARE GATHERED AND REVIEWED FOR PERTINENCE TO COMMUNITY HEALTH PROBLEMS.5. BOARD MEMBERS, SENIOR LEADERSHIP, AND DEPARTMENT DIRECTORS ARE INVOLVED IN NUMEROUS ORGANIZATIONS IN THE COMMUNITY. THROUGH THIS NETWORK OF RELATIONSHIPS, FURTHER INFORMATION ABOUT THE COMMUNITY AND THE NEEDS OF AREA RESIDENTS AND ORGANIZATIONS ARE USED IN THE DEVELOPMENT OF PROGRAMS AND SERVICES AVAILABLE THOUGH CAROMONT HEALTH. PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES THE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE IN SEVERAL WAYS. A CHARITY AND FINANCIAL SUMMARY IS ON OUR WEBSITE, AND BROCHURES ARE DISTRIBUTED IN THE EMERGENCY ROOM AND ALL OTHER REGISTRATION SITES. SPECIFICALLY TRAINED STAFF (FINANCIAL COUNSELORS AND BENEFIT ELIGIBILITY SPECIALISTS) PROACTIVELY MAKE CONTACT WITH PATIENTS PRIOR TO, AT TIME OF SERVICE, AND/OR AFTER DISCHARGE TO DISCUSS ELIGIBILITY FOR MEDICAID AND OTHER INSURANCE BENEFITS AND OFFER ASSISTANCE WITH THE APPLICATIONS. THE COMMUNICATION IS ATTEMPTED AS SOON AS POSSIBLE. WRITTEN COMMUNICATION IS MADE PRIOR TO COLLECTION AGENCY PLACEMENT. PART VI, LINE 4: GASTON COUNTY, LOCATED IN THE PIEDMONT REGION OF NORTH CAROLINA, IS THE ORGANIZATION'S PRIMARY MARKET. LINCOLN, CLEVELAND AND YORK COUNTY, AS WELL AS THE NORTHWEST PORTION OF MECKLENBURG COUNTY, MAKE UP THE HEALTH SYSTEM'S SECONDARY MARKET. ACCORDING TO THE U.S. CENSUS BUREAU, GASTON COUNTY HAD AN ESTIMATED POPULATION OF 220,182, A MEDIAN HOUSEHOLD INCOME OF $44,288 (2012-2016) AND 15.7% OF PERSONS IN POVERTY . THE ETHNIC/RACIAL DEMOGRAPHICS STATE THAT 78.7% OF THE POPULATION IDENTIFY THEMSELVES AS WHITE, 17.1% AS BLACK OR AFRICAN AMERICAN, 7.1% AS HISPANIC AND 1.6% AS ASIAN. PART VI, LINE 5: COMMUNITY HEALTHOUR COMMUNITY HEALTH INITIATIVES ARE FOCUSED PRIMARILY ON DISEASE PREVENTION AND BETTER MANAGEMENT OF CHRONIC ILLNESSES. THAT INCLUDES WORKING WITH LOCAL EMPLOYERS ON INNOVATIVE PROGRAMS AND COLLABORATING WITH OUR HEALTH CARE NEIGHBORS, MANAGING ILLNESS WITHIN THE HEALTH SYSTEM'S WORKFORCE AND INTENSE FOCUS ON SUCCESSFUL CARE COORDINATION FOR PATIENTS WITH CHRONIC DISEASE. ADDITIONALLY, CAROMONT PROVIDES NEARLY $1 MILLION ANNUALLY IN SPONSORSHIP AND GRANT SUPPORT FOR LOCAL NON-PROFITS, COMMUNITY PROGRAMS AND SERVICES, AND OTHER COMMUNITY INITIATIVES AIMED AT IMPROVING THE HEALTH OF OUR COMMUNITY. THROUGH INNOVATION AND A FOCUS ON COMMUNITY WELLNESS, CAROMONT HEALTH IS DETERMINED TO MAKE POSITIVE IMPACT ON HEALTH AND WELLNESS OF THE POPULATIONS WE SERVE. PATIENT CENTERED MEDICAL HOMETHE PATIENT-CENTERED MEDICAL HOME IS A HEALTH CARE SETTING THAT FACILITATES PARTNERSHIPS BETWEEN PATIENTS AND THEIR PERSONAL PHYSICIANS. THE PROGRAM PROVIDES MEDICAL PRACTICES WITH INFORMATION ABOUT ORGANIZING PATIENT-CENTERED CARE, WORKING IN TEAMS, AND COORDINATING AND TRACKING DURING THE CONTINUUM OF CARE. CURRENTLY, ALL PRIMARY CARE PRACTICES IN OUR SYSTEM ARE RECOGNIZED AS LEVEL 3 PATIENT-CENTERED MEDICAL HOMES BY THE NATIONAL COMMITTEE OF QUALITY ASSURANCE (NCQA) - THE HIGHEST RECOGNITION A CLINIC CAN OBTAIN. PART VI, LINE 6: CAROMONT REGIONAL MEDICAL CENTER IS A 435-BED ACUTE CARE HOSPITAL ASSOCIATED WITH CAROMONT HEALTH, A REGIONAL, INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE SYSTEM LOCATED IN GASTONIA, NC. THE SYSTEM IS ALSO COMPRISED OF COURTLAND TERRACE, A 96-BED SKILLED NURSING FACILITY; GASTON HOSPICE, WHICH INCLUDES THE 19-BED ROBIN JOHNSON HOUSE INPATIENT FACILITY; AND CAROMONT MEDICAL GROUP, A NETWORK OF 42 PRIMARY AND SPECIALTY PHYSICIAN OFFICES. CAROMONT HEALTH'S VISION IS TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED PARTNER IN PROMOTING INDIVIDUAL HEALTH AND VIBRANT COMMUNITIES.CAROMONT REGIONAL MEDICAL CENTER HAS 4 OFF-SITE IMAGING LOCATIONS, A SAME-DAY SURGERY CENTER, AND 1 OFF-SITE EMERGENCY DEPARTMENT. CAROMONT HEALTH ALSO HAS A FREE-STANDING ENDOSCOPY CENTER, 1 AMBULATORY SURGERY CENTER, AND 1 OCCUPATIONAL MEDICINE CLINIC. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 GASTON FAMILY HEALTH SERVICES 991 WEST HUDSON BOULEVARD GASTONIA NC 28052 581958398 501(C)(3) 119556 FEDERALLY QUALIFIED HEALTH DEPARTMENT OFFERING MEDICAL CARE TO LOW INCOME RESIDENTS. GASTON COUNTY 128 WEST MAIN AVE GASTONIA NC 28052 566000300 GOVERNMENTAL 463635 COMMUNITY ASSISTANCE GASTON REGIONAL CHAMBER 601 W FRANKLIN BLVD GASTONIA NC 28053 560232990 501(C)(6) 19000 COMMUNITY ASSISTANCE MEDASSIST OF MECKLENBURG 4428 TAGGART CREEK RD SUITE 101 CHARLOTTE NC 28208 562018957 501(C)(3) 12500 COMMUNITY ASSISTANCE GASTON COUNTY FAMILY YMCA 201 SOUTH CLAY STREET GASTONIA NC 28052 560655420 501(C)(3) 100000 COMMUNITY ASSISTANCE COMMUNITY FOUNDATION 1201 E GARRISON BLVD GASTONIA NC 28052 581340834 501(C)(3) 15000 COMMUNITY ASSISTANCE MONTCROSS AREA CHAMBER OF COMMERCE PO BOX 368 BELMONT NC 28012 560710166 501(C)(6) 11500 COMMUNITY ASSISTANCE GASTONIA GRIZZLIES PO BOX 177 GASTONIA NC 28053 421554288 N/A 35000 COMMUNITY ASSISTANCE HOLY ANGELS FOUNDATION 660 WILKINSON BLVD BELMONT NC 28012 561762654 501(C)(3) 16128 COMMUNITY ASSISTANCE CATHERINE PHARR CARSTARPHEN PO BOX 1939 MCADENVILLE NC 28101 560623961 501(C)(3) 10000 COMMUNITY ASSISTANCE GASTON COUNTY SCHOOLS PO BOX 1397 GASTONIA NC 280531397 566001032 GOVERNMENTAL 65000 COMMUNITY ASSISTANCE UNITED WAY OF GASTON COUNTY 200 EAST FRANKLIN BLVD GASTONIA NC 28052 560653356 501(C)(3) 10000 COMMUNITY ASSISTANCE GIRLS ON THE RUN 190 S OAKLAND STREET GASTONIA NC 28052 474179257 501(C)(3) 10000 COMMUNITY ASSISTANCE BOYS AND GIRLS CLUB OF GREATER GASTON PO BOX 23 GASTONIA NC 28053 561419498 501(C)(3) 6000 FMV NUTRITIONAL SUPPLEMENTS COMMUNITY ASSISTANCE MOUNT HOLLY FARMERS MARKET PO BOX 352 MT HOLLY NC 28120 260464156 501(C)(3) 6000 COMMUNITY ASSISTANCE GASTON CITY EDUCATION FOUNDATION PO BOX 1397 GASTONIA NC 28053 561764830 501(C)(3) 5000 COMMUNITY ASSISTANCE NCPHP 220 HORIZON DRIVE SUITE 201 RALEIGH NC 27615 561846599 501(C)(3) 5000 COMMUNITY ASSISTANCE HEART SOCIETY OF GASTON CTY 1201 EAST GARRISON BLVD GASTONIA NC 28054 561330921 501(C)(3) 6200 COMMUNITY ASSISTANCE BACKPACK WEEKEND PO BOX 551030 GASTONIA NC 28055 471591744 501(C)(3) 5000 COMMUNITY ASSISTANCE PHOENIX COUNSELING AND CRISIS CENTERS 839 MAJESTIC COURT GASTONIA NC 28054 202493799 501(C)(3) 26300 COMMUNITY ASSISTANCE GASTONIA FAMILY HEALTH SERVICES 200 EAST 2ND AVENUE GASTONIA NC 28052 581958398 501(C)(3) 22000 COMMUNITY ASSISTANCE 23 3 AUXILLIARY SCHOLARSHIPS 36 56500 ONCOLOGY PHARMACY FUND 4 495 PART I, LINE 2: OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED. SCHEDULE I, PART III THE PURPOSE OF THE GERTRUDE CLINTON HEALTH CAREERS SCHOLARSHIP IS TO ENCOURAGE MEDICAL AND HEALTH-RELATED PROFESSIONALS IN THE FIELD OF HUMAN SERVICES TO PRACTICE THEIR SPECIALTIES AT CAROMONT REGIONAL MEDICAL CENTER OR IN GASTON COUNTY. X X 1 0 X X X X X 1 1 0 0 0 1 1 0 0 DR PATRICK RUSSO CHIEF OF STAFF (THRU DEC 17) 0 569054 0 103195 0 1396 0 18900 0 18041 0 710586 0 0 K CHRISTOPHER PEEK CEO/PRESIDENT 362416 0 0 0 1005 0 89251 0 9812 0 462484 0 0 0 DAVID O'CONNOR EVP/CFO/ASST. TREASURER 399842 0 106447 0 84769 0 94643 0 18178 0 703879 0 79563 0 LEIGH HICKMAN CLO/AS 202982 0 20933 0 644 0 9184 0 12147 0 245890 0 0 0 KATHLEEN K BESSON EVP/COO 366232 0 96090 0 71152 0 91983 0 18161 0 643618 0 69420 0 TODD DAVIS MD EVP/CMO (FRMR INTERIM CEO) 386394 0 93542 0 55626 0 84157 0 18162 0 637881 0 54691 0 ANDREA K SERRA VP COMMUNITY CARE 217926 0 64073 0 243561 0 26245 0 5931 0 557736 0 147483 0 ELIZABETH MCCRAW VP HUMAN RESOURCES 229892 0 65015 0 232004 0 26157 0 13803 0 566871 0 149053 0 MICHAEL R JOHNSON VP CIO 273362 0 73909 0 44352 0 24450 0 18057 0 434130 0 42247 0 RICHARD C BLACKBURN VP SUPPORT SERVICES 222977 0 59625 0 152348 0 35039 0 18039 0 488028 0 140299 0 MOHAMADSALIM M SAIYED CHIEF MEDICAL INFO OFFICER 332823 0 71211 0 1138 0 14414 0 8934 0 428520 0 0 0 DOUG LUCKETT FORMER OFFICER 204587 0 0 0 148491 0 46634 0 3199 0 402911 0 0 0 MARIA LONG FORMER OFFICER 216701 0 0 0 407344 0 22922 0 487 0 647454 0 217831 0 PART I, LINE 1A THE ORGANIZATION HAS A POLICY TO ADDRESS WHEN SPOUSAL TRAVEL IS PERMITTED AND PAYS CLUB DUES FOR THE EXECUTIVE FOR BUSINESS PURPOSES AS PART OF THE EMPLOYMENT CONTRACT. PART I, LINES 4A-B DURING THE YEAR THE ORGANIZATION PAID SEVERANCE PAYMENTS TO THE FORMER OFFICER, KEY EMPLOYEE, AND HIGHLY COMPENSATED EMPLOYEES IDENTIFIED BELOW: MARIA LONG - $188,976 DOUG LUCKETT - 147,677 ELIZABETH MCCRAW - 82,553 ANDREA SERRA - 95,213 THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM THE FILING ORGANIZATION FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 78,443 MARIA LONG - 16,022 DOUG LUCKETT - 38,396 ANDREA K. SERRA - 18,575 KATHLEEN K. BESSON - 72,127 ELIZABETH MCCRAW - 18,483 TODD DAVIS, MD - 72,973 RICHARD C. BLACKBURN - 16,792 K. CHRISTOPHER PEEK - 89,251 PART I, LINE 6 EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES WHICH INCLUDE A FINANCIAL GOAL ATTRIBUTABLE TO OPERATING MARGIN. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS. CERTAIN CAROMONT MEDICAL GROUP, INC. PHYSICIAN'S COMPENSATION PACKAGES ARE BASED ON THE INDIVIDUAL PHYSICIANS NET RESULTS FROM OPERATIONS AS CALCULATED BASED SOLELY ON HIS/HER NET CHARGES LESS HIS/HER ALLOCABLE SHARE OF CLINIC OVERHEAD COSTS. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HVF7 2003-01-23 120000000 SEE PART VI 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HG23 2008-01-31 118400000 SEE PART VI 1 0 0 A 1400000 123594002 5150936 1256069 3386000 91583288 22217709 2005 0 1 1 1 B 103870000 39815000 118650687 610174 917471 1553718 28952424 86616900 2009 1 0 1 1 A 0 0 1 1 1 1 0.00140 0.00140 0 1 0.00110 0 1 B 0 0 1 1 1 1 0.00020 0.00020 0 1 0.03660 0 1 A 0 0 0 1 1 1 MERRILL LYNCH CAPITAL SERVICES 31.600000000000 1 0 0 0 1 B 0 0 0 1 0 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 12/05/2017 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 03/17/2017 SCHEDULE K SUPPLENTAL INFORMATION THREE 501(C)(3) ORGANIZATIONS WITHIN THE PARENT-SUBSIDIARY CONTROLLED GROUP BENEFIT FROM THE BONDS AS FOLLOWS: GASTON MEMORIAL HOSPITAL, INC. (56-0619359) CAROMONT HEALTH, INC. (58-1636959) CAROMONT HEALTH SERVICES, INC. (56-1455630) CAROMONT REGIONAL MEDICAL CENTER HOLDS THE LIABILITY FOR THE BONDS, PER AUDITED FINANCIAL STATEMENTS. SCHEDULE K, PART I, LINE A, COLUMNS (C): BOND A: THIS BOND ISSUE INCLUDES TWO CUSIPS MATURING ON THE SAME DATE: 65820HVG5 AND 65820HVF7. BOND B : THIS BOND ISSUE INCLUDES TWO CUSIPS: 65820HG23 AND 65820HG31. SCHEDULE K, PART I, COLUMN (F); DESCRIPTION OF PURPOSE: ISSUE A - THE SYSTEM USED THE PROCEEDS FROM THESE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO, A NEW WOMEN'S CENTER AND PARKING DECK, RENOVATIONS TO EXISTING FACILITIES, AND EQUIPMENT. IN ADDITION, PROCEEDS WERE USED TO REFUND IN ADVANCE OF THEIR MATURITIES $17,000,000 IN PRINCIPAL AMOUNT OF THE SERIES 1998 HOSPITAL REVENUE BONDS. ISSUE B - THE SYSTEM USED THE PROCEEDS FROM THE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO, THE RENOVATION OF CERTAIN FLOORS OF THE PATIENT TOWER, RENOVATION OF THE DAY OF SURGERY UNIT, INSTALLATION OF FIRE SPRINKLERS IN NON-SPRINKLED AREAS, AND THE UPGRADE OF LIFE SAFETY AND CRITICAL POWER. IN ADDITION, THE HOSPITAL USED THE PROCEEDS TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1995 REVENUE BONDS IN THE AMOUNT OF $41,210,000 AND TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1998 REVENUE BONDS IN THE AMOUNT OF $49,710,000. SCHEDULE K, PART II, LINE 3 COLUMN (A): LINE 3 COLUMN (A) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 3,594,002. SCHEDULE K, PART II, LINE 3 COLUMN (B): LINE 3 COLUMN (B) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 250,687. SCHEDULE K, PART II, LINE 11; OTHER SPENT PROCEEDS: OTHER SPENT PROCEEDS INCLUDE DEPOSITS MADE INTO A REFUNDING ESCROW ACCOUNT ALONG WITH INTEREST EARNED ON THE ACCOUNT, BOTH OF WHICH WERE SUBSEQUENTLY USED TO PAY PRINCIPLE AND INTEREST ON THE REFUNDED BONDS. SEE THE RESPONSE FOR PART I, COLUMN (F) FOR DETAILS. SCHEDULE K, PART IV, LINES 3 AND 4A, COLUMN (B): THE SERIES 2008 BONDS WERE ORIGINALLY ISSUED AS VARIABLE BONDS BEARING INTEREST AT WEEKLY RATES. ON SEPTEMBER 1, 2010, THE NORTH CAROLINA MEDICAL CARE COMMISSION CONVERTED THE SERIES 2008 BONDS WITH AN AGGREGATE BALANCE OF $106,460,000 TO A FIXED MODE WHICH BEARS INTEREST AT FIXED RATES RANGING FROM 0.580% TO 4.625%. INTEREST IS PAYABLE ON FEBRUARY 15 AND AUGUST 15. THE STANDBY BOND PURCHASE AGREEMENT WAS TERMINATED SIMULTANEOUSLY WITH THE CONVERSION OF THE BONDS. THE FINANCIAL GUARANTY INSURANCE POLICY REMAINS IN PLACE. ON MAY 21, 2018, THE $39,815,000 CALLABLE PORTION OF THE OUTSTANDING SERIES 2008 BONDS WAS ADVANCE REFUNDED. THERE IS $14,530,000 IN SERIES 2008 BONDS REMAINING THAT WERE NOT REFUNDED BECAUSE THEY ARE NOT CALLABLE PRIOR TO MATURITY. THE REMAINING SERIES 2008 BONDS MATURE FEBRUARY 15, 2020. GENA POMEROY FAMILY RELATIONSHIP WITH BOARD MEMBER 51293 COMPENSATION FOR EMPLOYEE SERVICES 0 STEPHEN O'CONNOR FAMILY RELATIONSHIP WITH OFFICER 22418 COMPENSATION FOR EMPLOYEE SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS CONSISTS OF FOURTEEN (14) MEMBERS, ALL OF WHOM ARE THE MEMBERS OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC., AND ALL OF WHOM ARE APPOINTED BY THE BOARD OF DIRECTORS OF CAROMONT HEALTH. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF SENIOR LEADERSHIP, ANY PHYSICIAN HOLDING A LEADERSHIP OR ADMINISTRATIVE POSITION WITHIN THE ORGANIZATION, DIRECTORS, MANAGERS AND ALL STAFF MEMBERS OF THE PURCHASING AND MARKETING DEPARTMENTS AND ANY OTHER DEPARTMENT DEEMED TO HAVE MATERIAL DECISION MAKING RESPONSIBILITIES ON BEHALF OF CAROMONT HEALTH SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE INDIVIDUAL'S OBLIGATION TO IMMEDIATELY MAKE THE CORPORATE RESPONSIBILITY OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID INDIVIDUAL'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. QUESTIONNAIRES SUBMITTED BY DIRECTORS ARE REVIEWED ANNUALLY BY THE NOMINATING COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, CFO, COO, CMO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY CAROMONT REGIONAL MEDICAL CENTER, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. A MAJORITY OF THE BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND ALL ARE FREE FROM ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE MANAGEMENT UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFER FROM AFFILIATE -20,081,966. CHANGE IN VALUE OF INTEREST RATE SWAP -245,121. GASB 85 ADJUSTMENT -2,394,758. AUXILIARY NET ASSETS 104,408. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM LAST YEAR. FORM 990, PART V AND PART VII COMMON PAYMASTER: THE FILING ORGANIZATION USES A RELATED ORGANIZATION FOR ITS PAYROLL FUNCTION. ALL W-2S ARE FILED BY THE COMMON PAYMASTER. HOWEVER, AMOUNTS PAID BY THE COMMON PAYMASTER ARE TREATED AS IF PAID DIRECTLY BY THE ORGANIZATION FOR WHICH SERVICES ARE PERFORMED. CAROMONT HEALTH INC 2525 COURT DRIVE GASTONIA NC 28054 581636959 MEDICAL SERVICES NC 501(C)(3) LINE 12C, III-FI N/A 0 CAROMONT HEALTH SERVICES INC 2526 COURT DRIVE GASTONIA NC 28054 561455630 OUTPATIENT SERVICES NC 501(C)(3) LINE 3 CAROMONT HEALTH INC 0 GASTON MEMORIAL HOSPITAL FOUNDATION INC 2527 COURT DRIVE GASTONIA NC 28054 561479699 FOUNDATION NC 501(C)(3) LINE 11 CAROMONT HEALTH INC 0 CAROMONT MEDICAL GROUP INC 2528 COURT DRIVE GASTONIA NC 28054 561479712 MEDICAL GROUP NC 501(C)(3) LINE 11 CAROMONT HEALTH INC 0 HOSPICE OF GASTON COUNTY INC 2529 COURT DRIVE GASTONIA NC 28054 581341530 HOSPICE CARE NC 501(C)(3) LINE 7 CAROMONT HEALTH INC 0 GASTON EMERGENCY PHYSICIANS INC 2531 COURT DRIVE GASTONIA NC 28054 562209423 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 12B, II CAROMONT HEALTH INC 0 GASTON COUNTY PO BOX 1578 GASTONIA NC 280531578 566000300 GOVERNMENT ADMINISTRATION NC N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1