2018-07-24T15:42:50-05:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-10-01 566000674 LENOIR MEMORIAL HOSPITAL INC LENO 2525227927 100 AIRPORT ROAD KINSTON NC 28501 GARY BLACK CEO 2525227927 2018-07-24 1 Amy Bibby P00445891 8282542254 2016 2022-09-23 18:48:47Z UNC LENOIR HEALTH CARE GARY BLACK 100 AIRPORT ROAD KINSTON NC 28501 134049041 0 X www.lenoirmemorial.org X 1950 NC PROVIDING EXCEPTIONAL HEALTHCARE AS AN OUTSTANDING COMMUNITY HOSPITAL 17 15 1144 235 686622 22149 831795 396536 132842900 127468009 2518339 2561816 2615497 2441969 138808531 132868330 166795 185440 0 0 60585871 62485940 0 0 40219 73692269 75315839 134444935 137987219 4363596 -5118889 191870995 189241562 41613901 41871530 150257094 147370032 X THE MISSION OF LENOIR MEMORIAL IS TO ENSURE EXCEPTIONAL HEALTHCARE FOR THE PEOPLE WE SERVE. 0 0 117623138 185440 128239899 SEE SCHEDULE O FOR DESCRIPTION OF THE ORGANIZATIONS PROGRAM SERVICE ACCOMPLISHMENTS:Community Value Five-Star Hospital 2017 UNC Lenoir was named a "Five-Star Hospital" in this year's Community Value Index Leadership Award by Cleverly & Associates. The Community Value Index (CVI) is composed of four key dimensions that evaluate a hospital's performance in four areas: 1.) Financial Viability & Plant reinvestment; 2.) Hospital Cost Structure; 3.) Hospital Charge Structure; 4.) Hospital Quality Indicators. To see all the winners on the "Top 100 Hospital" list, the winners on the "Five Star Hospital" list, as well as more about the Community Value Index, go to: https://communityvalue.cleverleyassociates.com/AboutTheCVI/CommunityValueFiveStar.aspxStroke Prevention and Care UNC Lenoir earns the Joint Commission's Gold Seal of Approval and the American Heart Association/American Stroke Association's Heart Check mark for Advanced Certification for Primary Stroke Centers. Economic DevelopmentCash donations included support and sponsorships for STEMEAST and PRIDE of Kinston downtown park concert series. Donations were also made to support the CSS Neuse Gunboat Association historical presentations, and the regional Kinston/Lenoir County Chamber of Commerce signature event: Festival on the Neuse. Community DonationsCash donations included support for SAFE in Lenoir County, Lions Industries for the Blind, American Heart Association Heart Walk, Lenoir-Greene Partnership for Children StoryWalk on the river, Common Ground of ENC walking track, and several area non-profit runs, walks and bike rides including Kinston Community Health Center's inaugural Run for Your Life.Kinston/Lenoir County Farmers MarketUNC Lenoir assisted 75 underserved residents of the community having diabetes with access to local fresh fruits and vegetables through an incentive Rx coupon program in partnership with Kinston Community Health Center, Kate B. Reynolds Charitable Trust and Lenoir County Cooperative Extension. Additionally, UNC Lenoir provided two onsite cooking demonstrations by a dietitian. Community Health Needs Assessment The three year cycle process (2017) identified three priority issues for the community: Obesity, Substance Abuse/Mental Health, and Responsible Parenting. The 2017 cycle, initiated by UNC Lenoir Health Care, Lenoir County Health Department and KCHC includes written action plans and implementation strategies. The full 2017 Community Health Assessment and implementation strategies can be found at www.unclenoir.org. on the healthy communities page. UNC Lenoir also provided staff to the eastern region steering committee for regionalization and standardizing planning for community health needs assessment process planning in the east, to be initiated in 2018.Healthy Communities InstituteThe Healthy Communities Institute, a comprehensive health status database at www.lenoirmemorial.org, provides the latest Lenoir County demographics and leading health indicators. It allows the user to search and report on over 50 specific health indicators, demographics, and comparisons with NC and national benchmarks. The database provides promising practices for community health interventions and allows the community to add local reports for a one stop inspection for local community health assessment. Community leaders have been informed of the free resource. The resource is provided to the community through a joint effort of UNC Lenoir and the Lenoir Hospital Foundation.SMARTfitThe Lenoir Hospital Foundation and UNC Lenoir partnered with the Boys & Girls Club of the Coastal Plain to provide evidenced-based physical activity equipment and initiative at the new Kinston club site for over 100 youth in the area. SMARTfit systems, an initiative in other Boys and Girls Clubs addresses aspects of the body, mind, and soul with academic features that revolve around physical activities.Community Coalition Activities UNC Lenoir provides leadership and administrative support for community health coalitions. The Lenoir County Alliance for a Healthy Community meets on a monthly basis for community networking and information sharing. Almost 20 different community organizations participate in the meetings. The Lenoir County Crisis Collaborative brings Eastpointe Mental Health, Easter Seals Mobile Crisis, UNC Lenoir, local law enforcement, EMS, and other agencies together quarterly. The group focuses on the community mental health crisis needs to identify solutions and meet challenges to problems in Lenoir County. This year, UNC Lenoir Health Care team members have also participated in the newly formed Lenoir County Opiate Task Force.Maternal/Child Health Initiatives - "Baby Friendly "practices such as "rooming in and "skin to skin" for mom and baby are a focus. - Breastfeeding support is provided for those moms who want to breastfeed and proper bottle feeding techniques for those that choose to formula feed. - Participating in a collaborative with the North Carolina Hospital Association to prevent elective deliveries prior to 39 weeks. 98% compliant with this standard.- Providing screening tests for all newborns to rule out Critical Congenital Heart Defects prior to discharge. Approximately 18 out of every 10,000 babies are born with a critical congenital heart defect (CCHD). CCHD is life threatening and requires intervention in infancy. CCHD is not always detected prenatally or upon exam in the nursery, as a result, some infants with CCHD are discharged from the nursery to home, where they quickly decompensate. To improve the early detection of CCHD, the Secretary of Health and Human Services (HHS) recommended that CCHD screening be added to the uniform newborn screening panel. - Providing a Neonatal Abstinence Program to screen all newborns that have a history of exposure to illegal substances in utero. Neonatal abstinence syndrome (NAS) is a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother's womb.Three Community Blood Pressure MachinesProvided 23,380 screening blood pressures at sites for blood pressure machines at hospital entrances, and a machine that travels to various community churches each month. A free community blood pressure management class was offered to the community monthly.Support GroupsCoordinated 11 hospital based groups, attended by 1857 participants. Emergency Preparedness UNC Lenoir participates in the local emergency planning committee (LEPC), the Eastern Regional Advisory Council, the Eastern Healthcare Preparedness Coalition for 29 counties to plan, coordinate, and execute disaster readiness and drills. UNC Lenoir participates in the North Carolina Emergency Management Domestic Preparedness Region 2 (DPR2) emergency preparedness committee for 10 counties to develop and expand regional prevention, preparedness, response, and recovery capabilities for all hazards, both man-made and natural. UNC Lenoir's Public Safety Director serves as the Vice-Chair of the Committee and the Chair of the Municipal Police Subcommittee. UNC Lenoir also participates in the NC Hospital Emergency Management Committee which is comprised of healthcare emergency managers from across the state. UNC Lenoir participates in the NC Chapter of the International Association of Healthcare Security and Safety. UNC Lenoir's Public Safety Director serves as the Secretary for the NC Chapter.Minges Wellness CenterThe on-site medically based fitness center for the community has 78 pieces of stationary exercise equipment with an average of 25 beginner's group exercise classes weekly. With a membership of 1135 active individual members in FY17, monthly membership rates of $20 per month assist an underserved community to initiate exercise plans. Our program partners with Silver Sneakers and Silver & Fit benefits for eligible community members. A number of free physical activity oriented educational sessions are offered through the year free to the community by our exercise specialists. SEE SCHEDULE O FOR CONTINUATION OF PROGRAM SERVICE ACCOMPLISHMENTSScreening EventsProvided early detection screening events of diseases/ disorders/risks including free colorectal cancer, mammogram, cholesterol, and blood pressures. A lung cancer screening program using low dose CT is offered through physician referral to increase access to lung cancer screening for individuals most at risk for lung cancer. Cancer Resource Center The Cancer Resource Center (CRC) is a visible collaboration between UNC Lenoir and the American Cancer Society. The CRC provides resources for individuals and families who have received a cancer diagnosis and need services to support their myriad of needs during treatment and care. Patients and families received formal support by a dedicated full-time licensed social worker to assist patients and families with a cancer diagnosis. Dozens more interacted with staff informally. Staff are available to assist in identifying cancer resources from 8-12 each weekday.UNC Lenoir Health Care Community Walking Track Averages over 500 walkers per month. Offered the use of the track for community organizations' walks x 4 in FY 17 for no fees.Corporate Health ServicesServices included 71 corporate clients, 187 worksite wellness visits with 1543 employee contacts. Flu shots, CPR training, urine drug screens, and targeted health education for risk factor reduction was provided.Diabetes Wellness ProgramLocated in the Minnie P. Stackhouse Diabetes Center, the AADE accredited Diabetes Wellness Program provided free diabetes self-management education and follow up management to 177 individuals living with diabetes. Outreach education and off-site screenings were provided each month reaching 426 community members. Additionally, a registered dietitian/diabetes educator provided 202 medical nutrition counseling sessions during this year. A three year grant continued from Kate B. Reynolds supporting the program expansion of the DSME/T program into Kinston Community Health Center.Community Health Education Programming Provided 2380 participants on and off-site health and wellness programming. Programming included Infant CPR, tobacco cessation, exercise, nutrition and other health education offerings. A three-part heart series with featured cardiologist speakers led educational programs this year. Sponsored a parenting education seminar through Triple P-positive parenting by trained child educators for the community. Hands-Only CPR Education EventsPartnered with Lenoir County EMS to provide a special 2017 Valentine Day CPR event at the entrance to the hospital where Hands Only CPR education was provided to over 100 individuals. Partnered with Down East Wood Ducks and Lenoir County EMS for 2017 Health Night at the Ballpark where the entire stadium was instructed on Hands-Only CPR technique.Advanced Directives Provided 33 community residents with support in completing advanced directives.Family Birth Center Community Education Lamaze/Sibling/Early Prenatal classes included 30 attendees.Patient Advisory CommitteeDuring 2017, the patient advisory council met five times and was made up of 23 representatives from throughout the community, medical staff, Hospital Board, volunteers, and hospital staff to solicit input on how we might improve our patient care process. This fosters a continuing opportunity for us to listen to our customers and use the information to help us improve our systems and processes. The focus of this group is to feed information back to the organization from the community in order to deliver care that is patient centered and community perspective driven. Topics covered during the year included Carolina Care, Patient Information System, Cancer Care Initiative, LEAN Update, UNC Lenoir Update, Pet Therapy, Bedside Reporting Initiative, Hospitalist Inpatient Coverage, UNC/Carolinas Partnership, Volunteer History Briefing, Hospitalist Follow Up, UNC Physicians Network, Strategic Plan, Sleep Lab, UNC Lenoir Health Care Imaging, Chief Medical Officer Presentation and Highly Reliable Patient Care.Employee OutreachUNC Lenoir employees show good community stewardship by participating in fundraising to support the American Cancer Society Relay for Life, Lenoir Hospital Foundation outreach, and Lenoir- Greene United Way. Employees worked together to give time, talent and personal donations of $86,321 during FY17 towards great causes in the community. Employees collected 7120 lbs of food to feed 13 local families during the holiday season and provided food to Friends of the Homeless and three church food banks. Employees kept the long tradition of playing Secret Santa to 25 needy children in the Northeast Elementary School with gifts from their own pockets. Community Healthcare ScholarshipsNursing Leadership, High School Health Occupation students and teen volunteers receive scholarship awards to support ongoing high school and college health career education.Hospital Volunteer ProgramDuring FY 16, 245 volunteers including youth volunteers provided 36,764 volunteer hours in a variety of hospital settings enriching the patient experience and performing the work of 17.5 unpaid FTEs. The community donations for Lights of Love Holiday tree lighting fund a number of hospital programs and projects each year. Pet TherapyIn July 2017, UNC Lenoir initiated safe and therapeutic dog visits to the patients on approved patient care units. Research indicates that pet therapy helps to reduce and manage patient's anxiety by focusing patient's attention on the dog, stimulates positive feelings in patients, and offers a means of relaxation and social interaction. Our Pet Therapy volunteer, and his dogs Micki and Casey, had 389 interactions with visitors and family members and 49 patient visits from July to December 2017.Physician RecruitmentFive new providers joined the community in 2017. Dr. Shaniqua McGraw, Family Medicine Physician joined UNC Lenoir Family Medicine. Dr. Josh Coltrane joined Kinston Pediatrics. In addition, Dr. Kushatha West-Quire, MD, ObGYN, Elizabeth Coats, Certified Nurse Midwife, and Dr. Kathy Anne Charles, MD, Family Physician joined Kinston Community Health Center. STEM OutreachUNC Lenoir partnered with Lenoir County Public Schools in a STEM partnership to obtain a technology grant through LCPS, for app innovation. Additionally, UNC Lenoir provided support for STEMEAST with sponsorship and in-kind time to the region's leadership team at STEMEAST. Kinston- Lenoir County Parks and Rec/ Health and Science MuseumDonated planning, videos, and retired equipment for a radiology and health career exhibit at the museum. Videos feature high technology health careers in radiology and laboratory to spark youth interest in health careers.Health LibraryA comprehensive health library is located at www.lenoirwellness.org. This free community resource contains national health news headlines and articles, condition guides, and interactive calculators and quizzes to help assess current health knowledge and status. Calculate a Body Mass Index or Target Heart Rate. Check out the Health Library for popular topic areas such as women's health, men's health, pregnancy, diet and exercise, and dozens of more relevant topics and easily print articles.Rosalind McDonald Nursing SeminarThe annual community nursing educational event was provided. Area nurses were invited to the free continuing education event for CEUs and showcased a national nursing speaker in honor of a retired nursing leader at Hospital.Healthy Community Hero AwardCommunity health heroes are nominated via an online process and recognized for impacting community health in Lenoir County. There were three awardees in 2017 highlighting a number of impressive individuals and strong work in our area to impact lives and health. 117623138 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 1 1 1 0 0 0 1 125 0 1 1144 1 1 1 0 0 0 0 0 0 0 0 0 X 17 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X MICHELLE MITTEN CPA FINANCE DIR 2525227927 100 AIRPORT ROAD KINSTON NC 285031678 RAY COLLIER JR CHAIRPERSON 2.00 1.00 X X 0 0 0 MARY M CAULEY EDD VICE CHAIR 2.00 1.00 X X 0 0 0 ARMISTEAD MAUCK SECRETARY 2.00 1.00 X X 0 0 0 CARLTON YOUNGER JR TREASURER 2.00 1.00 X X 0 0 0 DEXTER FLOYD ASSISTANT TREASURER 2.00 1.00 X X 0 0 0 MICHEL HADDAD MD BOARD MEMBER 2.00 1.00 X 0 0 0 WILLIAM S HARVEY III DDS BOARD MEMBER 2.00 1.00 X 0 0 0 CRAIG HILL BOARD MEMBER 2.00 1.00 X 0 0 0 SHIRLEY DOVE EDD BOARD MEMBER 2.00 1.00 X 0 0 0 CLIFTON HARRISON BOARD MEMBER 2.00 1.00 X 0 0 0 JOHN MCPHAUL BOARD MEMBER 2.00 1.00 X 0 0 0 JOHN HERLONG MD BOARD MEMBER 2.00 1.00 X 6250 0 0 FELICIA SOLOMON BOARD MEMBER 2.00 1.00 X 0 0 0 MICHAEL WHITFIELD CPA BOARD MEMBER 2.00 1.00 X 0 0 0 DAPHNE POLLOCK BOARD MEMBER 2.00 1.00 X 0 0 0 LADDIE M CRISP JR MD BOARD MEMBER 2.00 1.00 X 0 0 0 GARY BLACK CEO 40.00 1.00 X X 219628 0 14466 SARAH MAYO CFO 40.00 X 332434 0 48177 LAUREL MOLLOY CNO 40.00 X 204644 0 36455 KARL VANDERSTOUW CIO 40.00 X 205107 0 44972 JIM DOBBINS VP - HUMAN RESOUCES 40.00 X 224248 0 35637 DEBBIE LANIER ASSISTANT SECRETARY 40.00 X 64670 0 19203 SCOTT STEGBAUER MD ORTHOPEDIC SURGEON 40.00 X 522345 0 28315 ROBERT GALLAHER PULMONOLOGIST 40.00 X 638798 0 23736 RALPH L COX MD UROLOGIST 40.00 X 502891 0 28415 EDGAR CHARLES MOORE JR MD SURGEON 40.00 X 385688 0 11584 JOEL ROSE SURGEON 40.00 X 432868 0 28115 3739571 0 319075 50 0 1 0 UHS PHYSICIANS LLC 2100 Stantonsburg Road GREENVILLE NC 27835 HOSPITALIST SERVICES 3218866 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 30353 Dietary and Engineering Services 906687 SLEEP SERVICES OF AMERICA PO BOX 198320 ATLANTA GA 30384 Sleep Diagnostics Services 507850 CA LEWIS 2825 S CHARLES BLVD GREENVILLE NC 27858 Construction Contractor 505303 UNC HOSPITALS 211 FRIDAY CENTER DR CHAPEL HILL NC 27517 HOSPITAL MANAGEMENT 483140 23 318625 77911 396536 PATIENT SERVICES 621990 126381216 125747975 633241 MEANINGFUL USE REVENUE 900099 487451 487451 AUXILLARY SERVICE REVENUE 621990 374020 368450 5570 WELLNESS CENTER REVEUNE 713940 159799 159799 LAB REVENUE 541380 44139 8828 35311 21384 12422 8962 127468009 3092582 3538 3089044 752759 0 752759 752759 752759 358884 171882 -358884 -171882 -530766 -530766 1352160 649945 702215 702215 DIETARY AND CAFETERIA 900099 942431 942431 VENDING 900099 44564 44564 986995 132868330 128239899 686622 3545273 45974 45974 139466 139466 1227383 138875 1056271 32237 273619 273619 48584597 40039488 8545109 1697785 1371228 325464 1093 7183737 5801995 1377118 4624 3518819 2841999 674555 2265 661381 661381 408259 408259 95403 95403 248980 248980 13537675 10827147 2710528 410531 42766 367765 6913925 3357478 3556447 1941787 1941787 2448488 2370366 78122 107342 63698 43644 82198 55441 26757 128706 128706 6272894 6272894 1222544 1222544 BAD DEBT EXPENSE 26771482 26771482 MEDICAL SUPPLIES 13736310 13716957 19353 RECRUITMENT 327934 327934 137987219 117623138 20323862 40219 6281364 3258591 16031163 15870152 10159238 8761163 287934 95978 2671732 2589585 2170193 2384538 153550933 99480679 55274931 54070254 97518115 100587535 1476325 1623766 191870995 189241562 11640062 14733355 6213899 4987861 17000000 16460000 4000000 3500000 2759940 2190314 41613901 41871530 X 116017103 113259778 34239991 34110254 150257094 147370032 191870995 189241562 -5118889 2231827 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8788 8788 0 Part II-B, Line 1: THE ORGANIZATION IS A MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THE NCHA ARE ALLOCATED EACH YEAR TO LOBBYING EFFORTS ON BEHALF OF ITS MEMBERSHIP BODY. ACCORDING TO THE NCHA, 16.11% OF OUR ANNUAL DUES OF $54,551 CAN BE ALLOCATED TO LOBBYING EXPENSE, WHICH IS APPROXIMATELY $8,788. 425406 425406 63345680 31014216 32331464 80376551 63599041 16777510 9403296 4867422 4535874 54070254 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2190314 2190314 X 108978620 2231827 649945 2881772 106096848 26771482 26771482 132868330 111865682 649945 649945 111215737 26771482 26771482 137987219 Part X, Line 2: The Company 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. The Company has determined that they do not have any material unrecognized tax benefits or obligations as of September 30, 2017. Part XI, Line 2d - Other Adjustments: COGS 649,945. Part XI, Line 4b - Other Adjustments: BAD DEBT INCOME 26,771,482. Part XII, Line 2d - Other Adjustments: COGS 649,945. Part XII, Line 4b - Other Adjustments: BAD DEBT EXPENSE 26,771,482. 1 1 1 X 1 X 1 1 1 0 1 1 2116875 171645 1945230 0.01750 18891792 16314465 2577327 0.02320 21008667 16486110 4522557 0.04070 978385 262934 715451 0.00640 855052 855052 0.00770 2954060 2900437 53623 0.00050 3247 3247 0.00000 215704 215704 0.00190 5006448 3163371 1843077 0.01650 26015115 19649481 6365634 0.05720 1 751 751 0.00000 2 53899 53899 0.00050 3 374 447771 447771 0.00400 6 374 502421 502421 0.00450 0 27230037 2325203 40463511 44350497 -3886986 X 1 1 1 1 LENOIR MEMORIAL HOSPITAL INC 100 AIRPORT ROAD KINSTON NC 28501 X X X X DISPROPORTIONARE SHARE HOSPITAL LENOIR MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X www.unclenoir.org X www.co.lenoir.nc.us X X 1 16 1 www.unclenoir.org 0 1 X 100.000000000000 250.000000000000 X X X X X X 1 1 X X X 1 X www.unclenoir.org X www.unclenoir.org X www.unclenoir.org X X X X X X X 1 X 0 X X X 1 X 0 0 LENOIR MEMORIAL HOSPITAL, INC. Part V, Section B, Line 5: The three year CHNA cycle process (2017) identified three priority issues for the community: Obesity, Substance Abuse/Mental health, and Responsible Parenting. The 2017 cycle, initiated by UNC Lenoir Health Care, Lenoir County Health Department and Kinston Community Heath includes written action plans and implementation strategies. The full 2017 Community Health Assessment and implementation strategies can be found at www.unclenoir.org, on the healthy communities page. UNC Lenoir also provided staff to the eastern region steering committee for regionalization and standardizing planning for community health needs assessment process planning in the east, to be initiated in 2018. LENOIR MEMORIAL HOSPITAL, INC. Part V, Section B, Line 6a: THE CHNA WAS MAILED OUT TO COMMUNITY LEADERS LENOIR MEMORIAL HOSPITAL, INC. Part V, Section B, Line 11: Lenoir Memorial is not currently involved in the illegal drugs and drug abuse/substance and youth violence/gangs issue but a group of community organizations led by Kinston Public Safety has formed a task force to work on this issue. Lenoir Memorial hosted meeting space and a breakfast for leaders in this regard to get the initiative started. Youth access and use of guns may also be closely related to this issue and Safe Kids ENC works to provide the community with gun locks and gun safety education.Job opportunities were identified as a top issue in the community and even though Lenoir Memorial received a workforce development grant from the Golden Leaf Foundation in 2010 and trained 20 certified nursing assistants for the local workforce, Lenoir Memorial does not have any current plans in this area other than serving as a training site for students who may join the workforce once they complete their programs. Lenoir Memorial is a major employer in Lenoir County and will hire as vacant positions necessitate. Hospital leadership participates in a variety of economic development committees and projects throughout the year.Drinking and Driving continues to be seen as a priority issue in the 2017 CHNA. Local law enforcement and statewide programs have initiated programs in our community such as Booze It and Lose It and other road stop programs in an effort to address the problem.Lenoir Memorial offers smoking cessation programming through the Minges Wellness Center and does not limit the programs to adults only. The issue of cigarette smoking among people under age 18 has been a discussion at the Lenoir County School Health Advisory Committee on which Lenoir Memorial serves. It will not be a priority for Lenoir Memorial since services for cessation exist and the hospital serves as an organizational role model as a tobacco-free campus. LENOIR MEMORIAL HOSPITAL, INC. Part V, Section B, Line 13h: Sliding Scale based on % of FPG LENOIR MEMORIAL HOSPITAL, INC. Part V, Section B, Line 16j: SIGNS ARE POSTED NOTIFYING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND INCLUDED ON PATIENT'S STATEMENTS. BROCHURES ARE ALSO PROVIDED NOTIFYING OF PATIENTS AVAILABILITY. 1 1 - LENOIR PHYSICIAN NETWORK 100 AIRPORT ROAD KINSTON NC 28501 PHYSICIAN OFF, ORTHO,, GEN. SURGERY, NEURO., UROLOGY, CARDIO PULM., & OBGYN Part I, Line 3c: IN ADDITION TO DETERMINING ELIGIBILITY FOR FREE OR REDUCED-PRICE CARE USING INCOME LEVELS AND FEDERAL POVERTY GUIDELINES, PATIENTS MAY ALSO QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR ELIGIBILITY FOR SUBSIDIZED HOUSING UNDER HUD GUIDELINES. ALTHOUGH THE HOSPITAL PREFERS TO BE ABLE TO DISCUSS OPTIONS FOR FINANCIAL ASSISTANCE WITH HEALTHCARE COSTS - INCLUDING POSSIBLE ELIGIBILITY FOR MEDICAID OR OTHER PROGRAMS - WITH PATIENTS, IF EFFORTS TO DO SO PROVE UNSUCCESSFUL, ELIGIBILITY FOR LMH'S FINANCIAL ASSISTANCE PROGRAM MAY BE DETERMINED BASED UPON PATIENT ADDRESS IN A SUBSIDIZED HOUSING COMMUNITY. COMMUNITIES MEETING THIS DEFINITION, AS WELL AS INCOME AND ASSET CRITERIA FOR RESIDENTS, ARE REVIEWED PERIODICALLY WITH THE LOCAL HOUSING AUTHORITY. ADDITIONALLY, PATIENTS FACING EXTENSIVE MEDICAL COSTS WHO DO NOT MEET STANDARD FINANCIAL INDIGENCE CRITERIA BASED UPON INCOME LEVEL MAY QUALIFY FOR DISCOUNTED CARE IF THEY ARE DETERMINED TO BE "MEDICALLY INDIGENT; THAT IS, HAVING INCURRED COSTS OF CARE IN EXCESS OF 20% OF FAMILY GROSS INCOME, AND FOR WHICH PAYMENT WOULD REQUIRE LIQUIDATION OF THOSE ASSETS CRITICAL TO LIVING OR EARNING A LIVING. THEREFORE, FINANCIAL AND OTHER ASSETS MUST BE FULLY DISCLOSED BY PATIENTS SEEKING THIS DESIGNATION IN ORDER FOR A MEDICAL INDIGENCE DETERMINATION TO BE MADE. ADDITIONALLY, DISCOUNTS FOR PROMPT PAYMENT OF BALANCES ARE AVAILABLE FOR ALL UNINSURED PATIENTS, AND ARE TIERED BASED UPON THE AMOUNT OWED (LARGER DISCOUNTS ARE APPLIED TO HIGHER BALANCES). PATIENT ACCOUNT LIAISONS (PALS) AND FINANCIAL COUNSELORS SCREEN PATIENTS FOR FINANCIAL ASSISTANCE EITHER AT THE POINT OF SERVICE OR AFTER SERVICE HAS BEEN RENDERED. THE STAFF ALSO UTILIZES A SOFTWARE SYSTEM THAT SCREENS PATIENTS FOR MEDICAID ELIGIBILITY AS WELL AS FINANCIAL ASSISTANCE. PALS INTERVIEW SCHEDULED PATIENTS PRIOR TO SERVICE, AFTER ADMISSION AS AN INPATIENT AND AFTER SERVICE IS RECEIVED THROUGH THE EMERGENCY DEPARTMENT REGARDING THEIR LIABILITY AND DISCUSS OPTIONS FOR PAYMENT INCLUDING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS CONTACT PATIENTS AFTER THEY RECEIVE A STATEMENT FOR SERVICES TO DISCUSS PAYMENT OPTIONS INCLUDING FINANCIAL ASSISTANCE. Part I, Line 7g: THE SUBSIDIZED HEALTH SERVICES PROGRAMS INCLUDED DIABETES, ENDOCRINOLOGY, HEMATOLOGY/ONCOLOGY, AND NEONATOLOGY. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 26,771,482. Part II, Community Building Activities: LENOIR MEMORIAL PARTNERS WITH AREA ORGANIZATIONS TO PROVIDE COMMUNITY HEALTH PROGRAMMING, HEALTH COALITION WORK, AND IN-KIND LEADERSHIP TO AREA BOARDS, AND NON-PROFITS. HOSPITAL LEADERSHIP TEAM MEMBERS SERVE ON COMMUNITY TASK FORCES AND ACTION GROUPS. SOME OF THESE INCLUDE THE LENOIR COUNTY SCHOOL HEALTH ADVISORY COMMITTEE, EASTERN AHEC, KINSTON-LENOIR COUNTY CHAMBER OF COMMERCE, PRIDE OF KINSTON, LENOIR COMMITTEE OF 100, LENOIR-GREENE UNITED WAY, KINSTON COMMUNITY HEALTH CENTER, LENOIR COUNTY ALLIANCE FOR A HEALTHY COMMUNITY, THE COMMUNITY MARKETING COMMITTEE, AND LENOIR-GREENE ASTHMA COALITION. LENOIR ALSO PARTICIPATES IN A MENTORING PROGRAM WITH SOUTH EAST ELEMENTARY SCHOOL. LENOIR PROVIDES MEETING SPACE FOR VARIOUS LOCAL COMMITTEES. Part III, Line 3: Data pulled from the NC Department of Commerce indicates that 32.8% of Kinston residents live below the poverty level and that 23.7% of Lenoir County residents live below the poverty level. Lenoir County is the largest service area for UNC Lenoir Health Care (Lenoir Memorial Hospital). The 23.7% was multiplied by the total bad debt to develop an estimate for the amount of bad debt that may qualify for financial assistance. This amount was then multiplied by the Cost to Charge ratio to provide this estimate. Part III, Line 4: BAD DEBT EXPENSE FOR FY16 IS PRESENTED AS CHARGED NOT COST. Part III, Line 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE MEDICARE ALLOWABLE COSTS OF CARE. Part III, Line 9b: THE HOSPITAL SENDS PATIENTS A STATEMENT EACH MONTH NOTING THE BALANCE DUE. INFORMATION IS INCLUDED ON THE STATEMENT REGARDING OPTIONS FOR PAYMENT INCLUDING FINANCIAL ASSISTANCE AND CONTACT NUMBERS. SELF PAY PATIENTS ARE OFFERED A PROMPT PAY DISCOUNT. NOTIFICATION OF THE DISCOUNT IS INCLUDED ON THE PATIENT'S STATEMENTS.FINANCIAL COUNSELORS AND PATIENT ACCOUNT LIAISONS ARE TRAINED TO INFORM PATIENTS OF FINANCIAL ASSISTANCE AS AN OPTION SHOULD THEY HAVE DIFFICULTY PAYING THEIR ACCOUNTS. THE PALS UTILIZE A SOFTWARE SYSTEM (RAMP) THAT SCREENS PATIENTS FOR POTENTIAL MEDICAID ELIGIBILITY AND FOR FINANCIAL ASSISTANCE. THE SCREENING IS BASED ON SOME PRELIMINARY QUESTIONS, AND THEN PATIENTS ARE SCHEDULED FOR AN INTERVIEW TO COMPLETE THE APPLICATION AND SUBMIT THE NECESSARY DOCUMENTS. PATIENTS RECEIVING LESS THAN 100% FINANCIAL ASSISTANCE WILL BE REQUESTED TO MAKE PAYMENT ARRANGEMENTS FOR THE REMAINING BALANCE.TELEPHONE CONTACTS TO DISCUSS ACCOUNT BALANCES WITH PATIENTS AND OFFER OPTIONS FOR RESOLUTION ARE ATTEMPTED ON MOST ACCOUNTS. THE HOSPITAL WILL OFFER PAYMENT PLANS TO PATIENTS THAT ARE ABLE TO PAY WITH A MINIMUM MONTHLY PAYMENT OF $50.00. PATIENTS ARE ALSO OFFERED ASSISTANCE WITH MEDICAID ELIGIBILITY APPLICATIONS. IF THE PATIENT IS NONRESPONSIVE AFTER RECEIVING THREE STATEMENTS (120 DAYS FROM DATE OF SERVICE OR LAST PAYMENT DATE), THE ACCOUNT MAY BE FORWARDED TO A COLLECTION AGENCY FOR FURTHER COLLECTION PROCEDURES. THE HOSPITAL DOES NOT UTILIZE PRACTICES SUCH AS GARNISHMENTS, LIENS, AND PERSONAL ATTACHMENTS AS PART OF THE COLLECTION PROCESS. Part VI, Line 2: Lenoir Memorial works closely with the Lenoir County Health Department to conduct the community health needs assessment for Lenoir County, our largest population served. Our communities are surveyed with both English and Spanish survey instruments. Local demographic and health statistics are compiled along with community survey data about perceived health issues in order to develop targeted community health strategies. Lenoir Memorial provides leadership to the Lenoir County Alliance for a Healthy Community , which is a broad base of community agencies and organizations that meet monthly to promote a healthy community. Lenoir Memorial also partners with Lenoir, Greene, and Jones counties in healthy initiatives to promote and support healthier living activities. Annual cancer reporting and hospital diagnosis trends are used to prioritize programming, services, and initiatives as well as physician needs assessments. Part VI, Line 3: - THE HOSPITAL HAS POSTED SIGNS INFORMING PATIENTS OF PAYMENT OPTIONS INCLUDING THE FINANCIAL ASSISTANCE PROGRAM IN THE CASHIER'S OFFICE AND REGISTRATION AREAS OF THE HOSPITAL. - BROCHURES (PATIENT FINANCIAL HEALTH GUIDELINES) ARE PUBLISHED EXPLAINING "WHAT YOU NEED TO KNOW ABOUT PAYING FOR YOUR HEALTH SERVICES, AND INCLUDE INFORMATION REGARDING THE AVAILABILITY OF OUR FINANCIAL ASSISTANCE PROGRAM. THESE BROCHURES ARE INCLUDED AS PART OF THE INPATIENT ADMISSION INFORMATION PACKET, ARE ON DISPLAY IN WAITING ROOMS THROUGHOUT THE HOSPITAL AND ARE PROVIDED TO PATIENTS DURING INTERVIEWS SHOULD THEY HAVE ANY QUESTIONS. THE BROCHURE OFFERS ASSISTANCE THROUGH THE HOSPITAL INTERPRETER FOR SPANISH SPEAKING PATIENTS AND THE HOSPITAL HAS ACCESS TO TRANSLATION TELEPHONES FOR OTHER LANGUAGES.- THE FINANCIAL ASSISTANCE POLICY OVERVIEW IS ALSO INCLUDED ON THE HOSPITAL'S WEBSITE. - INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON PATIENT'S STATEMENT.- THE FINANCIAL COUNSELORS AND PATIENT ACCOUNT LIAISONS DISCUSS FINANCIAL ASSISTANCE AS AN OPTION FOR PATIENTS THAT CONTACT THE HOSPITAL WITH CONCERNS ABOUT PAYING THEIR ACCOUNT WITH PATIENTS AND THEIR FAMILY MEMBERS (WITH APPROPRIATE CONSENT). - THE HOSPITAL ALSO SCREENS SELF PAY PATIENTS FOR MEDICAID OR OTHER GOVERNMENT PROGRAMS. Part VI, Line 4: LENOIR MEMORIAL HOSPITAL IS LOCATED IN KINSTON, NORTH CAROLINA (POPULATION 21,677), WHICH IS THE COUNTY SEAT AND LARGEST TOWN IN LENOIR COUNTY (POPULATION 59,495); KINSTON AND OTHER LENOIR COUNTY MUNICIPALITIES CONSTITUTE THE HOSPITAL'S PRIMARY SERVICE AREA. LMH IS DESIGNATED A SOLE COMMUNITY HOSPITAL BY CMS. THOUGH STRONG ECONOMIC AND CORRESPONDING POPULATION GROWTH OCCURRED THROUGHOUT MUCH OF NORTH CAROLINA DURING THE MOST RECENT DECADE (2000-2010), LOCAL TRENDS DID NOT FOLLOW SUIT. LENOIR COUNTY WAS ONE OF ONLY SEVEN COUNTIES STATEWIDE THAT LOST POPULATION (-.3%), VS. THE NC AVERAGE OF +18.5%. KINSTON'S DECLINE WAS EVEN STEEPER, AT -8.5%. OVER THE LAST TWO DECADES THE LOCAL AREA HAS WITNESSED THE CLOSING OR SIGNIFICANT DOWNSIZING OF FORMERLY LARGE EMPLOYERS PARTICULARLY LIGHT MANUFACTURING ENTERPRISES AS LESS EXPENSIVE LABOR HAS BEEN SOUGHT OVERSEAS. IN THE MOST RECENT YEARS, THE AREA'S CHALLENGES HAVE BEEN EXACERBATED BY THE DRAMATIC NATIONWIDE ECONOMIC DOWNTURN, AND LENOIR COUNTY'S UNEMPLOYMENT RATE HAS TYPICALLY EXCEEDED BOTH STATE AND NATIONAL AVERAGES. THE COUNTY HAS BEEN DESIGNATED TIER 1 I.E., THE RANKING GIVEN TO THE MOST ECONOMICALLY DISTRESSED COUNTIES IN THE STATE BY THE NC DEPARTMENT OF COMMERCE. POVERTY LEVELS IN KINSTON AND LENOIR COUNTY EXCEED STATE AVERAGES; IN 2010 THE COUNTY'S POVERTY LEVEL WAS RANKED THIRD HIGHEST FOR COUNTIES WITH POPULATIONS GREATER THAN 20,000 BY THE NC JUSTICE CENTER. THE ECONOMICALLY DISADVANTAGED PERCENTAGE OF CHILDREN IN LENOIR COUNTY SCHOOLS FOR 2009-2010 WAS 66.53%, AND ALL SCHOOLS WITH ELEMENTARY AND MIDDLE GRADES WERE TITLE 1. PORTIONS OF KINSTON ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS. THE TABLE BELOW PROVIDES CURRENT ESTIMATES OF POPULATION, INCOME, AND POVERTY STATISTICS FROM THE US CENSUS BUREAU, INCLUDING THE AMERICAN COMMUNITY SURVEY. KINSTON LENOIR COUNTY NORTH CAROLINAPOPULATION CHANGE, 2000-2015 -9.7% -2.5% 24.8%PERCENT BELOW POVERTY LEVEL, 2014 32.8% 23.7% 17.2%MEDIAN HOUSEHOLD INCOME, 2014 $28,608 $35,687 $46,693CHILDREN IN POVERTY, 2014 55.1% 37.7% 25%THE HISTORICAL DEPENDENCE UPON FARMING AND LIGHT MANUFACTURING JOBS, AS WELL AS POVERTY AND EDUCATION LEVELS THAT ARE HIGHER AND LOWER, RESPECTIVELY, THAN NC AVERAGES WILL LIKELY CONTINUE TO BE LIMITING FACTORS TO CONSISTENTLY STRONG OR RAPID ECONOMIC GROWTH. IN ORDER TO ADDRESS THESE CHALLENGES, NUMEROUS AREA ORGANIZATIONS CONTINUE TO WORK TOWARD DEVELOPMENT INITIATIVES THAT WILL CREATE LONG TERM SOCIAL AND ECONOMIC IMPROVEMENT. Part VI, Line 5: THE HOSPITAL BOARD IS COMPRISED OF UNRELATED COMMUNITY MEMBERS. LOCAL PHYSICIANS HAVE PRIVILEDGES IN A MAJORITY OF HOSPITAL DEPARTMENTS. SURPLUS FUNDS MAY BE USED TO PURCHASE CAPTIAL EQUIPMENT OR OTHER MEDICAL EQUIPMENT USED IN PATIENT CARE. THEY ARE ALSO USED TO PURCHASE TECHNOLOGY, SUCH AS COMPUTER EQUIPMENT, SOFTWARE, AND CONNECTIVITY. THESE FUNDS ALSO SUPPORT GENERAL BUILDING REFURBISHMENTS AS WELL AS REPAIRS AND MAINTENANCE. Part VI, Line 7, Reports Filed With States NC 1 NC EASTERN ALLIANCE CORPORATION 3802 HIGHWAY 58N A KINSTON NC 28504 510422797 501(C)(3) 5600 OPERATIONAL SUPPORT BOYS AND GIRLS CLUB OF THE COASTAL PLAIN 621 W FIRETOWNER WINTERVILLE NC 28590 560927694 501(C)(3) 22190 PROGRAM DEVELOPMENT/SUPPORT NORTH CAROLINA HOSPITAL ASSOCIATION 2400 WESTON PARKWAY CARY NC 27513 560641290 501(C)(6) 5832 MRI GAP TECHNICAL ASSISTANCE FUND 2 1 SCHOLARSHIPS 31 31102 N/A N/A TUITION REIMBURSEMENT 47 108364 N/A N/A Part I, Line 2: THE ORGANIZATION PROVIDES PRE-APPROVED FUNDS TO SELECTED ORGANIZATIONS AND INDIVIDUALS BASED UPON APPROVED CRITERIA. THE FUNDS ARE ONLY DISBURSED FOR THE APPROVED ACTIVITIES. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 GARY BLACK CEO 198696 0 0 0 20932 0 8640 0 5826 0 234094 0 0 0 SARAH MAYO CFO 269129 0 18620 0 44685 0 37206 0 10971 0 380611 0 0 0 LAUREL MOLLOY CNO 184785 0 12920 0 6939 0 24560 0 11895 0 241099 0 0 0 KARL VANDERSTOUW CIO 188661 0 14061 0 2385 0 27746 0 17226 0 250079 0 0 0 JIM DOBBINS VP - HUMAN RESOUCES 181931 0 13491 0 28826 0 26028 0 9609 0 259885 0 0 0 SCOTT STEGBAUER MD ORTHOPEDIC SURGEON 475010 0 25184 0 22151 0 10600 0 17715 0 550660 0 0 0 ROBERT GALLAHER PULMONOLOGIST 369254 0 237545 0 31999 0 8220 0 15516 0 662534 0 0 0 RALPH L COX MD UROLOGIST 350002 0 152081 0 808 0 10600 0 17815 0 531306 0 0 0 EDGAR CHARLES MOORE JR MD SURGEON 325000 0 42896 0 17792 0 10600 0 984 0 397272 0 0 0 JOEL ROSE SURGEON 325000 0 67990 0 39878 0 10300 0 17815 0 460983 0 0 0 Part I, Line 1a THE HOSPITAL PERMITS BOARD MEMBERS TO TRAVEL WITH THEIR SPOUSES TO EDUCATIONAL SEMINARS AND IS PART OF THE BOARD OF DIRECTOR TRAVEL POLICY. Part I, Line 4b THE FOLLOWING INDIVIDUALS RECEIVED AMOUNTS FROM A 457F PLAN: - SARAH MAYO, CFO $26,606 - JAMES CLINE DOBBINS, VP HUMAN RESOURCES $18,565 - LAUREL MOLLOY, CNO $17,027 - KARL VANDERSTOUW, VP ITS AND ENGINEERING $20,170 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657902Y63 2005-09-22 22000000 CAPITAL PROJECTS 0 0 0 A 5540000 22021552 178646 20213 9657270 12165423 2005 1 0 1 1 A 0 0 1 1 0 0.00000 0.00000 0 0 1 A 0 0 1 1 1 0 0 0 1 A 1 Schedule K Supplental Information THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I (E) AND THE TOTAL PROCEEDS IN PART II (3) IS DUE TO INTEREST EARNINGS THAT HAVE ACCRUED ON INVESTED BOND PROCEEDS. ISSUE DATES OF BONDS REFUNDED BY THE SERIES 2005 BONDS LISTED IN COLUMN A: NOVEMBER 16, 1995 AND MARCH 19,1998. PART IV, LN 2C - THE REBATE COMPUTATION WAS PERFORMED AS OF MARCH 22, 2006. PART III, LN 7 - AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF THE AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE. ALAN KIROLLOS MD BOARD MEMBERS PLEASE SEE SCHEDULE L, PART V X 551873 95978 0 1 1 95978 CARLA MONROE FAMILY MEMBER OF A BOARD MEMBER 36166 PAYMENT FOR EMPLOYMENT AS HR SUPPORT. 0 FAYE HILL FAMILY MEMBER OF A BOARD MEMBER 58839 PAYMENT FOR EMPLOYMENT AS RADIOLOGY TECH. 0 EDWARD EARL HILL FAMILY MEMBER OF A BOARD MEMBER 39300 PAYMENT FOR EMPLOYMENT AS PLANT ENGINEER MECHANIC. 0 Michael Haddad MD BOARD MEMBER 139314 PAYMENT FOR PROFESSIONAL MEDICAL SERVICES 0 Form 990, Part VI, Section A, line 1 THE CHAIRMAN OF THE BOARD, VICE CHAIRMAN, SECRETARY, PRESIDENT, AND OTHERS AS APPOINTED BY THE CHAIRMAN SHALL CONSTITUTE THE EXECUTIVE COMMITTEE. THE CHAIRMAN OF THE BOARD OF DIRECTORS SHALL SERVE AS CHAIRMAN OF THE EXECUTIVE COMMITTEE AND THE VICE CHAIRMAN OF THE BOARD OF DIRECTORS SHALL SERVE AS VICE CHAIRMAN OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE FULL AUTHORITY TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN THE REGULAR MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT ANY ACTION WHICH IT MAY TAKE SHALL NOT CONFLICT WITH THESE BYLAWS, RULES AND REGULATIONS OR ARTICLES OF INCORPORATION OR WITH THE POLICIES AND DECISIONS OF THE BOARD OF DIRECTORS. SHOULD ANY MATTERS OF EXTREME URGENCY ARISE BETWEEN REGULAR MEETINGS OF THE BOARD OF DIRECTORS, IT SHALL BE THE PREROGATIVE OF THE EXECUTIVE COMMITTEE TO REQUEST THE CHAIRMAN OF THE BOARD TO CALL A SPECIAL MEETINGS, WHICH SHALL BE HELD AT LEAST TWICE ANNUALLY UPON CALL BY THE CHAIRMAN. A MAJORITY OF THE MEMBERS OF THE COMMITTEE SHALL CONSTITUTE A QUORUM. Form 990, Part VI, Section A, line 3 Through the Management Services Agreement, UNC Health Care System provides oversight and assistance with a broad array of business, administrative, and executive functions of Lenoir Memorial Hospital, Inc. (the Hospital), including but not limited to: financial reporting and budgeting, managed care contracting, purchasing, physician recruitment and retention, marketing, and clinical service quality. The Board of Directors of Lenoir Memorial remains locally appointed and retains ultimate authority over the governance and operations of the Hospital. Form 990, Part VI, Section B, line 11b THE ORGANIZATION'S MANAGEMENT TEAM REVIEWED THE FORM 990 IN DETAIL. THE 990 WAS PLACED ON THE ORGAINZATION BOARD PORTAL FOR BOARD MEMBER REVIEW PRIOR TO FILING THE RETURN AND FORMALLY PRESENTED AT A LATER DATE. Form 990, Part VI, Section B, line 12c UPON THEIR APPOINTMENT TO THE BOARD, AND BEFORE ACTUALLY PARTICIPATING IN MEETINGS, MEMBERS MUST READ THE CONFLICTS OF INTEREST POLICY AND DISCLOSE ANY FINANCIAL INTERESTS THAT COULD CREATE A CONFLICT OF INTEREST. AS LONG AS THEY CONTINUE TO SERVE ON THE BOARD, MEMBERS THEN COMPLETE THESE FINANCIAL RELATIONSHIP DISCLOSURE STATEMENTS ON AN ANNUAL BASIS. IF SUCH INTERESTS ARE NOT DISCLOSED, THE CEO, BOARD CHAIR, OR ANY OTHER BOARD MEMBER MAY BRING THE FINANCIAL INTEREST OR ACTUAL/POSSIBLE CONFLICT TO THE ATTENTION OF THE BOARD; THUS THE ENTIRE BOARD IS RESPONSIBLE FOR ONGOING MONITORING OF POTENTIAL CONFLICTS AND THEIR DISCLOSURE. INTENTIONAL FAILURE TO DISCLOSE SUCH FINANCIAL INTERESTS WILL, BY POLICY, RESULT IN APPROPRIATE CORRECTIVE ACTION BY THE BOARD. SHOULD A CONFLICT OF INTEREST ARISE IN CONDUCTING THE BUSINESS OF THE HOSPITAL, THE AFFECTED MEMBER(S) MAY NOT PARTICIPATE IN DISCUSSION REGARDING THE RELEVANT TRANSACTION, AND DEPENDING UPON THE SPECIFIC NATURE OF THE MATTER, THE BOARD CAN TAKE A RANGE OF ACTIONS, SUCH AS APPOINTING A DISINTERESTED PERSON TO INVESTIGATE POSSIBLE ALTERNATIVES, REQUIRING THE INTERESTED PERSON TO REFRAIN FROM PERFORMING ANY FUNCTIONS RELATED TO THE INTEREST CREATING THE CONFLICT, OR REQUIRING THE INTERESTED PERSON TO DIVEST HIMSELF OF THE CONFLICT-CREATING INTEREST IN ORDER TO REMAIN ON THE BOARD. EDUCATION AND COMPLIANCE FORMS ARE UPDATED ANNUALLY BY THE HOSPITAL'S CORPORATE COMPLIANCE OFFICER. Form 990, Part VI, Section B, line 15 THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS CONTRACTS YEARLY WITH AN OUTSIDE, INDEPENDENT, PROFESSIONAL FIRM TO EXAMINE AND REVIEW THE WAGES AND BENEFITS OF THE CEO AND TOP MANAGEMENT OFFICALS OF THE HOSPITAL. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ADDITIONALLY, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. Form 990, Part VI, Section C, line 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XII, Line 2c: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. LENOIR PHYSICIANS NETWORK LLC 100 AIRPORT RD KINSTON NC 28501 460687300 PHYSICIANS SERVICES NC 4875128 1632092 LENOIR MEMORIAL HOSPITAL LENOIR MEMORIAL HOSPITAL FOUNDATION INC 100 AIRPORT ROAD KINSTON NC 28501 581584139 SUPPORT THE CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF LMH, INC. NC 501(C)(3) Line 12a, I LENOIR MEMORIAL HOSPITAL 1 LENOIR HEALTH SERVICES INC 100 AIRPORT ROAD KINSTON NC 28501 581705689 SUPPORT CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF LMH, INC. NC 501(C)(3) Line 12a, I LENOIR MEMORIAL HOSPITAL 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 LENOIR MEMORIAL HOSPITAL FOUNDATION C 269019 LENOIR MEMORIAL HOSPITAL FOUNDATION O 109586