2017-05-09T08:23:24-05:00 2016-06-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2015-07-01 560611546 CHATHAM HOSPITAL INC CHAT 9197994000 PO BOX 649 SILER CITY NC 27344 JEFF LEGAY CFO 9197994000 2017-05-08 1 JOHN NORMAN P01506766 7049985200 2017-05-08 2015 2021-01-29 14:40:06Z ROBERT ENDERS PO BOX 649 SILER CITY NC 27344 36272402 0 X WWW.CHATHAMHOSPITAL.ORG X 1939 NC PROVIDES SHORT-TERM MEDICAL CARE ON AN INPATIENT AND OUTPATIENT BASIS. 12 8 287 15 371287 -100473 0 0 34929341 35972973 90863 120586 180146 161944 35200350 36255503 0 1630 0 0 11842028 11392413 0 0 0 24273982 26149073 36116010 37543116 -915660 -1287613 38624311 39723334 32698122 33757680 5926189 5965654 TO PARTICIPATE IN AND PROMOTE THE PROVISION OF PATIENT CARE, FACILITATE THE EDUCATION OF PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, PROMOTE RESEARCH IN COLLABORATION WITH THE HEALTH SCIENCES SCHOOLS OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL. 0 0 32396620 1630 35616561 CHATHAM HOSPITAL, INC. IS A PRIVATE, NOT-FOR-PROFIT HEALTH CARE ORGANIZATION LOCATED IN SILER CITY, NORTH CAROLINA. THE FACILITY IS A 25-BED CRITICAL ACCESS HOSPITAL. THE HOSPITAL HAS A 75-YEAR HISTORY OF PROVIDING QUALITY HEALTH SERVICES. THE HOSPITAL PROVIDES COMPREHENSIVE CARE, INCLUDING EMERGENCY, GENERAL SURGERY, INTENSIVE CARE, LAB, CT, MRI, NUCLEAR MEDICINE, PHARMACY, CARIOPULMONARY, CARDIAC REHABILITATION, PHYSICIAL THERAPY, AND DIABETES EDUCATION ON ITS CAMPUS. 32396620 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 1 287 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CFO 9197994000 PO BOX 649 SILER CITY NC 27344 MARY BECK DIRECTOR 2.00 0.00 X 0 53866 8193 JAMES DAVIS MD DIRECTOR (LEFT 12/31/15) 2.00 0.00 X 0 0 0 CODY DEEN MD DIRECTOR 2.00 0.00 X 0 0 0 ETTA FOUSHEE DIRECTOR 2.00 0.00 X 0 0 0 BARRY HAYES DIRECTOR 2.00 0.00 X 0 0 0 MEL HURSTON DIRECTOR 2.00 58.00 X 0 304294 73046 JOHN LEWIS DIRECTOR 2.00 58.00 X 0 796972 284421 TODD PETERSON DIRECTOR 2.00 0.00 X 0 0 0 WALTER PETTY DIRECTOR 2.00 0.00 X 0 0 0 PAUL POWELL DDS DIRECTOR 2.00 0.00 X 0 0 0 DONALD SPENCER MD DIRECTOR (LEFT 12/31/15) 2.00 58.00 X 0 386434 88035 BARRY WILKIE DIRECTOR 2.00 0.00 X 0 0 0 MARK ZERINQUE MD DIRECTOR 2.00 0.00 X 0 0 0 BOB ENDERS CEO 60.00 0.00 X X 0 253745 72569 TAMMY NEEDHAM CNO 60.00 0.00 X 0 155585 29356 DAVID PAUGH CFO (LEFT 6/24/16) 60.00 0.00 X 0 173915 33492 SHERLYNN POWELL DIRECTOR OF PHARMACY 60.00 0.00 X 152532 0 13552 DAVID STRONG DIRECTOR (LEFT 3/31/15) 0.00 0.00 X 0 1226662 16758 152532 3351473 619422 1 1 1 0 LABCORP 458 S MAIN STREET BURLINGTON NC 27215 LABORATORY 942861 ALLIANCE HEALTHCARE 100 BAY VIEW CIRCLE NEWPORT BEACH CA 92660 MEDICAL EQUIPMENT 368171 RAO KOTHAPALLI MD PO BOX 767 SILER CITY NC 27344 PHYSICIAN 129941 ELLINGTON & SON CONTRACTING 183 ISAAC DRIVE SILER CITY NC 27344 CONSTRUCTION 116385 KARL STORZ ENDOSCOPY AMERICAN 2151 E GRAND AVENUE EL SEGUNDO CA 90245 MEDICAL EQUIPMENT 116385 7 PATIENT REVENUE 621110 35503495 35503495 469478 98191 371287 35972973 24644 24644 151910 0 151910 151910 151910 112841 16899 95942 95942 95942 MISCELLANEOUS 624100 10034 10034 10034 36255503 35601686 371287 282530 X 1630 1630 9609852 6420110 3189742 91339 56863 34476 1105891 602308 503583 585331 364397 220934 8863627 7868764 994863 8324 45 8279 899656 758803 140853 309 309 594475 594475 75900 22467 53433 1181875 1181875 2397461 2397461 301412 301412 BAD DEBT EXPENSE 5405844 5405844 HOME OFFICE ALLOCATION 4259463 4259463 PATIENT CARE SUPPLIES & 1414967 1414967 MINOR EQUIPMENT AND R&M 535406 535406 210354 210330 24 37543116 32396620 5146496 0 2031 2381 2304013 3184919 6357077 7498998 403434 337240 129126 100632 42963922 21497520 22704318 21466402 6692634 7101084 31678 31678 38624311 39723334 3315340 3536912 138738 26672209 25782349 2710573 4299681 32698122 33757680 X 5926189 5965654 5926189 5965654 38624311 39723334 X -1287613 -7520 1334598 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 3157 3157 0 PART II-B, LINE 1: AS A MEMBER OF AHA AND NCHA, A PERCENTAGE OF THE ORGANIZATION'S MEMBERSHIP DUES ARE ATTRIBUTED TO LOBBYING ACTIVITIES. 402081 402081 30570830 16227118 14343712 2505050 558640 1946410 9139916 4711762 4428154 346045 346045 21466402 INVESTMENTS 508331 F RESTRICTED ASSETS 6592753 F 7101084 X 30842139 -7520 -5405844 -5413364 36255503 0 36255503 32137272 0 32137272 5405844 5405844 37543116 PART X, LINE 2: THE HOSPITAL IS INCORPORATED AS A NONPROFIT ORGANIZATION UNDER THE LAWS OF THE STATE OF NORTH CAROLINA AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -5,405,844. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 5,405,844. 1 1 1 X 250.000000000000 0 1 1 1 0 1 1 2900596 2900596 0.09030 5603451 7654009 -2050558 0.00000 624610 51117 573493 0.01780 9128657 7705126 1423531 0.10810 9128657 7705126 1423531 0.10810 1 2638778 1701731 12157779 13866356 -1708577 X 1 1 1 1 CHATHAM HOSPITAL 475 PROGRESS BLVD SILER CITY NC 27344 X X X X CHATHAM HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X SEE PART V X 1 15 1 SEE PART V 0 0 1 X 250.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X 1 0 X X X X 1 X 0 0 CHATHAM HOSPITAL PART V, SECTION B, LINE 5: THE FIRST STEP OF THE CHNA PROCESS WAS TO FORM A STEERING COMMITTEE. THE STEERING COMMITTEE GUIDES THE PROCESS, PROVIDING INPUT AND FEEDBACK TO THOSE WORKING ON EACH TASK. THE STEERING COMMITTEE IS ALSO RESPONSIBLE FOR PRIORITIZING HEALTH ISSUES BASED ON THE DATA COLLECTED AND REVIEWING THE FINAL CHNA REPORT. HEALTH DEPARTMENT STAFF WORKED WITH COMMUNITY PARTNERS TO RECRUIT MEMBERS OF THE STEERING COMMITTEE.THE STEERING COMMITTEE MEMBERS REPRESENTED A BROAD DIVERSITY OF INDIVIDUALS WITH DIFFERENT BACKGROUNDS AND AREAS OF EXPERTISE FROM ALL AREAS OF THE COUNTY. THE RECRUITMENT PROCESS RESULTED IN A GROUP OF APPROXIMATELY FIFTY MEMBERS THAT INCLUDED COUNTY RESIDENTS AS WELL AS REPRESENTATIVES FROM VARIOUS LOCAL AGENCIES AND ORGANIZATIONS. THE STEERING COMMITTEE BROUGHT A WEALTH OF KNOWLEDGE AND EXPERTISE ON A VARIETY OF ISSUES AND POPULATIONS IN THE COUNTY, AND THE BROAD RANGE OF BACKGROUNDS ENSURED OBJECTIVITY THROUGHOUT THE PRIORITIZATION PROCESS. THE STEERING COMMITTEE MET SEVERAL TIMES BETWEEN DECEMBER 2013 AND DECEMBER2014 TO REVIEW STRATEGIES FOR CONDUCTING THE CHA AND TO STAY INFORMED OF THE PROCESS. WITHIN THE STEERING COMMITTEE, THE FOLLOWING SUBCOMMITTEES WERE FORMED TO FOCUS ON SPECIFIC TASKS: SURVEY DESIGN AND DATA COLLECTION, PRIORITIZING ISSUES, COMMUNITY FORUMS, AND DISSEMINATION OF FINDINGS. THESE SUBCOMMITTEES MET AS NEEDED TO PLAN THEIR DESIGNATED PHASE OF THE ASSESSMENT PROCESS.BEYOND THE STEERING COMMITTEE, THE HOSPITAL WORKED IN CONJUCTION WITH THE NORTH CAROLINA INSTITUTE FOR PUBLIC HEALTH TO CONDUCT SURVEYS AND FOCUS GROUPS IN THE COMMUNITY. CHATHAM HOSPITAL PART V, SECTION B, LINE 6B: CHATHAM COUNTY PUBLIC HEALTH DEPARTMENT CHATHAM HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL HAS IDENTIFIED THE FOLLOWING AREAS AS THEIR TOP PRIORITIES:DECREASE OBESITYCHATHAM HOSPITAL, AS ONE OF THE TOP EMPLOYERS IN THE COUNTY WILL FOCUSON OBESITY / POPULATION HEALTH OF ITS EMPLOYEES THROUGH STRATEGIES THATENCOURAGE HEALTHY LIFESTYLES. STRATEGIES IDENTIFIED INCLUDE:- ADVOCATE FOR STAND-UP, ERGONOMIC OPTIONS FOR CHATHAM EMPLOYEES- PROVIDE HEALTHY EATING OPTIONS IN THE CHATHAM HOSPITAL CAFETERIA- COMMIT TO THE HEALTHY FOOD IN HEALTH CARE PLEDGE THROUGH THE HEALTH CARE WITHOUT HARM ORGANIZATION- PARTICIPATE IN THE CHATHAM HEALTH ALLIANCE SUBCOMMITTEE FOR REDUCING OBESITY- PARTICIPATE IN THE EXERCISE IS MEDICINEIMPROVE AND SUPPORT ACCESS TO MENTAL HEALTH SERVICESCHATHAM HOSPITAL WILL PROMOTE MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT AND COUNSELING SERVICES. CHATHAM HOSPITAL, IN PARTNERSHIP WITH THE LOCAL MANAGEMENT ENTITY (LME), CARDINAL INNOVATIONS, WILL CONTINUE TO FOCUS ON IMPROVING THE MENTAL HEALTH/SUBSTANCE ABUSE PATIENT EXPERIENCE BY PROVIDING THE RIGHT CARE, AT THE RIGHT PLACE, AT THE RIGHT TIME, BY THE RIGHT PROVIDER. STRATEGIES IDENTIFIED INCLUDE:- CONTINUE TO IMPROVE CHATHAM HOSPITAL RESOURCE OF PSYCHIATRIC TELEHEALTH- PARTICIPATE IN MENTAL HEALTH ROUNDTABLE THROUGH THE UNC HEALTH CARE SYSTEM- PARTICIPATE WITH COMMUNITY PARTNERS IN THE CHATHAM HEALTH ALLIANCE ACCESS TO MENTAL HEALTH CARE SUBCOMMITTEEIMPROVE ACCESS TO HEALTHCARE IN CHATHAM COUNTYCHATHAM HOSPITAL WILL COLLABORATE WITH STRATEGIC PARTNERS TO PROMOTE, PROVIDE AND ASSIST IN COORDINATION OF HEALTHCARE SERVICES. STRATEGIES IDENTIFIED INCLUDE:- CONTINUE CHATHAM HOSPITAL CHARITY CARE PROGRAM - CONTINUE CHATHAM HOSPITAL CARDIAC AND PULMONARYREHAB SCHOLARSHIP PROGRAM - SUPPORT AND PROMOTE RECENT CHATHAM HOSPITAL ADDITIONAL SERVICES PROVIDED BY SPECIALISTS IN THE CHATHAM PARK MEDICAL OFFICE (GENERAL SURGERY, ORTHOPEDICS, OPHTHALMOLOGY, CARDIOLOGY, ENT, IMAGING, PHYSICAL THERAPY) - PARTICIPATE WITH COMMUNITY PARTNERS IN THE CHATHAM HEALTH ALLIANCE SUBCOMMITTEE - ACCESS TO HEALTHCARETHE CHATHAM CHNA SIP TASK FORCE WILL MAKE ADJUSTMENTS ALONG THE WAY ENABLING COLLABORATION WITH COMMUNITY PARTNERS WHILE RESPONDING TO LOCAL CONDITIONS AND CHANGES IN COMMUNITY PRIORITIES AND LEADERSHIP. THE TASK FORCE WILL EVALUATE PROGRESS AT THE END OF EACH CALENDAR YEAR AND MODIFY THE PLAN ACCORDINGLY. CHATHAM HOSPITAL PART V, SECTION B, LINE 22D: DISCOUNTS ARE AVAILABLE BASED ON MEANS TESTING AND PROMPT PAY ARRANGEMENTS. PART V, SECTION B, LINES 7A AND 10A HTTPS://WWW.CHATHAMHOSPITAL.ORG/CH/ABOUT-US/COMUNITY-NEEDS-HEALTH-ASSESSEMENT/ PART V, SECTION B, LINES 16A-C HTTP://WWW.UNCMEDICALCENTER.ORG/UNCMC/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE-PROGRAMS/ 1 1 - CHATHAM HOSPITAL MEDICAL OFFICE BUILDING 163 MEDICAL PARK DRIVE SILER CITY NC 27344 CARDIAC REHABILITATION, DIABETES EDUCATION, PT/OT, AND OTHER ADMIN FUNCTIONS PART I, LINE 3C: CHARITY CARE IS AVAILABLE FOR NORTH CAROLINA RESIDENTS WHO HAVE A HOUSEHOLD INCOME AT OR LESS THAN 250% OF THE FEDERAL POVERTY GUIDELINES FOR THEIR FAMILY SIZE. A COMPLETE APPLICATION WITH SUPPORTING DOCUMENTATION OF INCOME IS PROVIDED FOR A FINAL DETERMINATION TO BE MADE. CHARITY CARE IS A BENEFIT WHERE 100% OF THE PATIENTS BALANCE WILL BE WRITTEN OFF EXCEPT FOR CERTAIN LIMITATIONS SUCH AS ELECTIVE, NON-MEDICALLY NECESSARY SERVICES AND THOSE BALANCES COVERED BY OTHER EXTERNAL FUNDING SOURCES.FPG IS USED FOR CHARITY CARE/FREE CARE. FOR SELF PAY, PROVIDE STRAIGHT 35% DISCOUNT ON CHARGES. PART I, LINE 7: AMOUNTS SHOWN IN PART I, LINE 7, COLUMN C WERE COMPUTED USING THE COST-TO-CHARGE RATIO WORKSHEET (WORKSHEET 2) FROM THE IRS INSTRUCTIONS FOR SCHEDULE H. PART I, LN 7 COL(F): THE HOSPITAL DOES NOT HAVE A PROCESS FOR ESTIMATING THE AMOUNT OF THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY. PART II, COMMUNITY BUILDING ACTIVITIES: CHATHAM HOSPITAL STRIVES TO IMPROVE EMERGENCY CARE FOR KIDS BY INCREASING MEDICATION SAFETY. ALSO, THE HOSPITAL HAS A DIABETES SELF-MANAGEMENT PROGRAM FOR INDIVIDUALS WITH DIABETES WITHIN THE COMMUNITY. CHATHAM HOSPITAL PARTICIPATES IN NUMEROUS COMMUNITY HEALTH FAIRS, PARTNERS WITH OTHER COMMUNITY LEADERS IN ADDRESSING HEALTH RELATED MATERS, PARTICIPATES IN COMMUNITY FUND RAISING EVENTS. PART III, LINE 4: NET PATIENT SERVICE REVENUE IS RECORDED AT ESTABLISHED RATES WHEN SERVICES ARE PROVIDED WITH CONTRACTUAL ADJUSTMENTS, ESTIMATED BAD DEBT EXPENSES, AND SERVCIES QUALIFYING AS CHARITY CARE DEDUCTED TO ARRIVE AT NET PATIENT SERVCIE REVENUE. CONTRACTUAL ADJUSTMENTS ARISE UNDER REIMBURSEMENT AGREEMENTS WITH CERTAIN INSURANCE CARRIERS, HEALTH MAINTENANCE ORGANIZATIONS AND PREFERRED PROVIDER ORGANIZATIONS, WHICH PROVIDE FOR PAYMENTS THAT GENERALLY LESS THAN ESTABLISHED BILLING RATES. SPECIFIC PATIENT BALANCES ARE WRITTEN OFF AT THE TIME THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: AS A CRITICAL ACCESS HOSPITAL, THE DIFFERENCE BETWEEN REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COST IS THE AMOUNT DUE FROM THE PATIENTS IN THE FORM OF CO-PAYMENTS, CO-INSURANCE AND DEDUCTIBLES. THE PATIENT AMOUNTS THAT ARE NOT COLLECTED END UP AS BAD DEBTS WHICH ARE PARTIALLY RECOVERABLE ON FUTURE COST REPORTS. PART III, LINE 9B: POLICY DOES CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE PART VI, LINE 2: LESS THAN 20% OF OUR COUNTY'S RESIDENTS LIVE IN INCORPORATED TOWNS. THE COUNTY HAS ABOUT 85 RESIDENTS PER SQUARE MILE, WHICH REFLECTS ITS GENERALLY RURAL NATURE. A CRITICAL ACCESS HOSPITAL IS ESSENTIAL FOR A RURAL COMMUNITY SUCH AS THIS.CHATHAM HOSPITAL ADDRESSES THE COMMUNITY'S EMERGENCY HEALTH NEEDS BY PROVIDING AROUND-THE-CLOCK EMERGENCY SERVICES TO MORE THAN 1,000 PATIENTS EACH MONTH. OUR 5,500-SQUARE FOOT EMERGENCY ROOM IS NEWLY RENOVATED AND EQUIPPED WITH THE ADVANCED DIAGNOSTIC AND MONITORING EQUIPMENT REQUIRED TO DELIVER EXCELLENT CARE.CHATHAM HOSPITAL STRIVES TO IMPROVE EMERGENCY CARE FOR KIDS BY INCREASING MEDICATION SAFETY. ALSO, THE HOSPITAL HAS A DIABETES SELF-MANAGEMENT PROGRAM FOR INDIVIDUALS WITH DIABETES WITHIN THE COMMUNITY. PART VI, LINE 3: NOTICES OF PATIENT FINANCIAL PROGRAMS ARE POSTED IN SERVICE AREAS, AND BROCHURES ARE AVAILABLE DESCRIBING THE PROGRAMS AND PHONE NUMBERS FOR QUESTIONS OR TO REQUEST APPLICATIONS. FINANCIAL COUNSELORS ARE LOCATED IN SERVICE AREAS FOR DISCUSSIONS REGARDING FUNDING SOURCES, INCLUDING CHARITY CARE. AND, SELF PAY PATIENT ACCOUNTS ARE AUTOMATICALLY ROUTED TO MEDICAID ASSISTANCE COUNSELORS FOR REVIEW OF ELIGIBILITY POTENTIAL FOR MEDICAID. REGISTRATION COVERS THE CHARITY PROGRAM WITH PATIENTS DURING REGISTRATION AND GIVES CHARITY APPLICATIONS TO THOSE WHO DON'T HAVE INSURANCE OR WHO MEET CERTAIN CRITERIA. REGISTRATION ALSO INFORMS PATIENTS THAT PATIENT FINANCIAL SERVICES IS AVAILABLE TO PATIENTS WHO WISH TO DISCUSS PAYMENT OPTIONS. PART VI, LINE 4: POPULATION INFORMATION: THE OFFICIAL 2010 CENSUS PLACES OUR 2010 POPULATION AT 63,505, AN INCREASE OF 28.74% SINCE 2000. THE STATE AVERAGE GROWTH FOR THIS DECADE WAS 18.5%. LESS THAN 20% OF OUR COUNTY'S RESIDENTS LIVE IN INCORPORATED TOWNS. THE COUNTY HAS ABOUT 85 RESIDENTS PER SQUARE MILE, WHICH REFLECTS ITS GENERALLY RURAL NATURE. ETHNIC/RACIAL DIVERSITY: THE OVERALL, RACIAL/ETHNIC COMPOSITION OF CHATHAM COUNTY IS: 71% WHITE, 13% AFRICAN AMERICAN, 12% HISPANIC, 2% ASIAN AND 2% OTHER.AGE: THE 2009 ESTIMATED MEDIAN AGE FOR CHATHAM COUNTY RESIDENTS IS 42, UP FROM 38.7 IN 2007 AND ABOVE THE STATE AVERAGE. THE GREATEST PERCENTAGE OF OUR POPULATION (54%) IS IN THE RANGE OF 20 TO 60 YEARS OLD, AND 21.9% ARE AGE 60 OR OLDER. INCOME AND POVERTY: THE ESTIMATED MEDIAN HOUSEHOLD INCOME FOR CHATHAM COUNTY IN 2008 WAS $46,574, A SIGNIFICANT DROP FROM $51,794 IN 2007, BUT STILL RANKS US 8TH IN THE STATE PER CAPITA INCOME FOR 2008 WAS $43,894, WHICH RANKS THIRD OUT OF THE 100 COUNTIES. THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IN 2008 WAS ESTIMATED AT 10.3%, LOWER THAN THE STATE AVERAGE OF 14.6%, BUT STILL SIGNIFICANT. THIS POINTS OUT THE CHALLENGES OF A COUNTY WITH RESIDENTS AT EXTREME ENDS OF THE INCOME SPECTRUM. PART VI, LINE 5: CHATHAM HOSPITAL STRIVES TO FURTHER ITS EXEMPT PURPOSES BY PARTNERING IN THE COMMUNITY TO ASSESS HEALTH NEEDS AND TO HELP DEVELOP STRATEGIES TO FULLFUL THOSE NEEDS. CHATHAM HOSPITAL IS WELL ENGAGED IN THE COMMUNITY THROUGH JOINT EFFORTS WITH OTHER ORGANIZATIONS, COMMUNITY OUTREACH THROUGH EDUCATION AND HEALTH FAIRS, DIRECTLY CONTRIBUTING TO FUNDRAISING EFFORTS, WORKING TO QUALIFY PATIENTS FOR EITHER INSURANCE OR CHARITY CARE AND IF NOT, PROVIDING DISCOUNTS TO HEALTH SERVICES. PART VI, LINE 6: CHATHAM HOSPITAL AND UNC HEALTH CARE ARE PARTNERING TO BRING NATIONALLY-RECOGNIZED HEALTH CARE TO CHATHAM COUNTY. OUR PARTNERSHIP MEANS YOU'LL CONTINUE TO HAVE ACCESS TO ADVANCED HEALTH CARE CLOSE TO HOME, WITH THE PERSONAL TOUCH YOU'VE COME TO EXPECT FROM US. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 X X X X X 0 1 0 0 0 1 1 0 0 MEL HURSTON DIRECTOR 0 224950 0 41649 0 37695 0 65463 0 7583 0 377340 0 0 JOHN LEWIS DIRECTOR 0 529689 0 94139 0 173144 0 264827 0 19594 0 1081393 0 136890 DONALD SPENCER MD DIRECTOR (LEFT 12/31/15) 0 307169 0 54307 0 24958 0 68896 0 19139 0 474469 0 0 BOB ENDERS CEO 0 215146 0 34115 0 4484 0 52975 0 19594 0 326314 0 0 TAMMY NEEDHAM CNO 0 133763 0 21502 0 320 0 23963 0 5393 0 184941 0 0 DAVID PAUGH CFO (LEFT 6/24/16) 0 142822 0 24632 0 6461 0 27867 0 5625 0 207407 0 0 SHERLYNN POWELL DIRECTOR OF PHARMACY 141558 0 10974 0 0 0 4436 0 9116 0 166084 0 0 0 DAVID STRONG DIRECTOR (LEFT 3/31/15) 0 153361 0 0 0 1073301 0 13919 0 2839 0 1243420 0 246929 PART I, LINE 4B DURING THE CALENDAR YEAR 2015, DAVID STRONG, FORMER DIRECTOR, RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN TOTALING $246,929, FROM A RELATED ORGANIZATION. DURING THE CALENDAR YEAR 2015, JOHN LEWIS RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN TOTALING $136,890. HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $159,496, WHICH IS PAYABLE IN THE FUTURE. PART I, LINE 6 EMPLOYEES IN MANAGERIAL ROLES PARTICIPATE IN AN ANNUAL INCENTIVE COMPENSATION PLAN. THE COMPENSATION EARNED UNDER THIS PLAN IS BASED PARTLY ON THE EARNINGS OF CHATHAM MEMORIAL HOSPITAL AND THE UNC HEALTH CARE SYSTEM. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657905ES0 2007-02-08 30540000 FHA INSURED MORTGAGE REVENUE BONDS 0 0 0 A 5600000 30540000 2303775 622810 329280 28221503 2008 1 0 1 1 A 0 0 0 0 0 0 1 A 1 0 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 6 SEE RESPONSE TO QUESTION 7A. FORM 990, PART VI, SECTION A, LINE 7A IN ADDITION TO SUCH POWERS AND RIGHTS AS ARE VESTED IN IT BY LAW, THE AMENDED AND RESTATED ARTICLES OF INCORPORATION OF THE CORPORATION OR THE AMENDED AND RESTATED BYLAWS, THE MEMBER ("UNCHCS") SHALL HAVE THE FOLLOWING POWERS: (A) THE POWER TO APPOINT THE CHAIRMAN OF THE BOARD, VICE CHAIRMAN, PRESIDENT, EXECUTIVE VICE PRESIDENTS, SECRETARY/TREASURER AND OTHER CORPORATE OFFICERS OF THE CORPORATION; (B) THE POWER TO APPOINT INDIVIDUAL MEMBERS OF THE CORPORATION'S BOARD OF TRUSTEES; (C) THE POWER TO ESTABLISH AND MAINTAIN QUALITY, SERVICE DELIVERY, AND FINANCIAL STANDARDS TO BE OBSERVED BY ALL MEMBERS OF UNCHCS, INCLUDING THE CORPORATION; (D) THE POWER TO ESTABLISH A SCHEDULE OF COST-BASED ASSESSMENTS PAYABLE BY PROVIDER COMPONENTS OF UNCHCS FOR THE SUPPORT OF THAT PORTION OF ITS OPERATING BUDGET ATTRIBUTABLE TO UNCHCS-WIDE ADMINISTRATION AND INITIATIVES AND REFLECTING OPERATING ENTITY PERFORMANCE; (E) THE POWER TO NEGOTIATE, DEVELOP, AND APPROVE ALL MANAGED CARE PRODUCTS AND CONTRACTS FOR THE CORPORATION; (F) THE POWER TO APPROVE (I) THE CORPORATION'S NAME, (II) CAPITAL AND OPERATING BUDGETS OF THE CORPORATION, AND (III) NON-BUDGETED MATERIAL EXPENDITURES OF THE CORPORATION (AS "MATERIAL" IS ESTABLISHED BY THE MEMBER FROM TIME TO TIME), PROVIDED THAT ONLY THE BOARD OF TRUSTEES SHALL HAVE THE AUTHORITY TO INITIATE A CHANGE IN THE NAME OF THE CORPORATION OF THE HOSPITAL, WHICH SHALL BE SUBJECT TO FINAL APPROVAL BY UNCHCS; AND (G) OTHER POWERS MUTUALLY AGREED TO BY UNCHCS AND THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B SEE RESPONSE TO QUESTION 7A. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED PRIOR TO FILING BY THE PRESIDENT AND CFO OF THE HOSPITAL. IN ADDITION, IT WAS MADE AVAILABLE TO EVERY MEMBER OF THE GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY THE BOARD MEMBERS ANNUALLY TO BE REVIEWED BY THE HOSPITAL PRESIDENT. THE CHATHAM HOSPITAL CONFLICT OF INTEREST POLICY OUTLINES THE PROCESS TO BE FOLLOWED IN DETERMINING THE EXISTENCE OF A POTENTIAL CONFLICT, AND HOW TO ADDRESS THE SITUATION. FORM 990, PART VI, SECTION B, LINE 15 EFFECTIVE AUGUST 1, 2006, THE HOSPITAL ENTERED INTO A FIVE-YEAR CONTRACT WITH UNCH TO PROVIDE A CEO AND A CFO TO MANAGE THE DAY-TO-DAY OPERATIONS OF THE HOSPITAL. THE PRESIDENT OF CHATHAM HOSPITAL REPORTS MONTHLY TO THE PRESIDENT OF UNC HOSPITALS, DISCUSSING SURVEYS OF COMPENSATION DATA AND PLANNED RANGES OF SALARY OFFERS FOR EMPLOYEES OF CHATHAM. TARGET LEVELS ARE BASED ON LEVEL OF EDUCATION AND EXPERIENCE. WITH INPUT FROM THE MANAGEMENT OF UNC HOSPITALS, THE PRESIDENT OF CHATHAM HOSPITAL MAKES THE FINAL DECISION ON SALARIES, WITH THE EXCEPTION OF HIS/HER OWN, WHICH IS SET BY THE PRESIDENT OF UNCH WITH INPUT FROM THE UNC HOSPITAL'S MANAGEMENT TEAM. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE FORM 1023 AND RECENT COPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT COPIES OF FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 7,868,764. MANAGEMENT AND GENERAL EXPENSES 994,863. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,863,627. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTED (TO) FROM SOLE MEMBER 1,334,598. FORM 990, PART XII, LINE 2C: PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CHATHAM IMAGING SERVICES OF PITTSBORO LLC 75 US-1 PITTSBORO NC 27812 811651110 IMAGING SERVICES NC 251621 251621 CHATHAM HOSPITAL INC UNC HEALTH CARE SYSTEM 101 MANNING DRIVE CHAPEL HILL NC 27514 562206970 HEALTHCARE NC SECTION 115 SECTION 115 0 UNC HOSPITALS 211 FRIDAY CENTER DRIVE SUITE 2029 CHAPEL HILL NC 27517 561118388 HEALTHCARE NC SECTION 115 SECTION 115 0 CALDWELL MEMORIAL HOSPITAL PO BOX 1890 LENOIR NC 28645 560554204 HEALTHCARE NC 501(C)(3) LINE 3 0 CALDWELL MEMORIAL HOSPITAL FOUNDATION INC PO BOX 1890 LENOIR NC 28645 581935514 SUPPORT OF CALDWELL MEMORIAL HOSPITAL NC 501(C)(3) LINE 7 0 HIGH POINT REGIONAL HEALTH 601 N ELM STREET HIGH POINT NC 27261 560532309 HEALTHCARE NC 501(C)(3) LINE 3 0 HIGH POINT REGIONAL HEALTH SERVICES INC 601 N ELM STREET HIGH POINT NC 27261 561497163 HEALTHCARE NC 501(C)(3) LINE 11B, II 0 HIGH POINT REGIONAL HEALTH FOUNDATION INC 601 N ELM STREET HIGH POINT NC 27261 272854711 SUPPORT OF HIGH POINT REGIONAL HEALTH NC 501(C)(3) LINE 11A, I 0 REX HEALTHCARE INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509129 HEALTHCARE NC 501(C)(3) LINE 11A, I 0 REX HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 HEALTHCARE NC 501(C)(3) LINE 3 0 THE REX HEALTHCARE FOUNDATION INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 566052117 SUPPORT OF REX HOSPITAL, INC. 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