2017-05-12T15:39:38-05:00 2016-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2015-07-01 636000090 REGIONAL MEDICAL CENTER BOARD REGI 2562355255 PO BOX 2208 ANNISTON AL 36202 LOUIS A BASS CEO 2562355255 2017-05-12 1 AMY BIBBY P00445891 8282542254 2015 2021-01-29 14:40:06Z LOUIS A BASS PO BOX 2208 ANNISTON AL 36202 211459207 0 X WWW.RMCCARES.ORG X 1974 AL TO PROVIDE PERSONALIZED HEALTHCARE TO CITIZENS OF NORTHEAST ALABAMA 15 11 2119 210 179659 91562 220965 191072 204128393 205690084 2575323 2391729 602599 693312 207527280 208966197 381566 414273 0 0 80874273 97150039 0 0 0 122015592 122910090 203271431 220474402 4255849 -11508205 178194081 195447942 53575083 82122161 124618998 113325781 X THE BOARD'S MISSION IS PROVIDING STATE OF THE ART HEALTH CARE WITH INTEGRITY, TO THE PEOPLE WE SERVE. 0 0 202133477 414273 205510425 DURING THE YEAR ENDED JUNE 30, 2016, NORTHEAST ALABAMA REGIONAL MEDICAL CENTER AND JACKSONVILLE MEDICAL CENTER HAD 13,453 ADULT AND PEDIATRIC INPATIENT ADMISSIONS, 1,825 NEWBORN ADMISSIONS AND SERVED PATIENTS THROUGH AMBULATORY CARE INCLUDING: 3,643 OBSERVATION PATIENTS, 57,609 EMERGENCY DEPARTMENT PATIENTS, 66,159 REFERRED OUTPATIENTS, 6,798 SAME DAY SURGERY PATIENTS. THE MEDICAL CENTER IS ALSO INVOLVED IN EDUCATION, RESEARCH, AND COMMUNITY BENEFIT ACTIVITIES DESIGNATED TO PROVIDE HEALTH AND WELLNESS. REGIONAL MEDICAL CENTER HOLDS DESIGNATIONS FOR THE FOLLOWING: BLUE CROSS DISTINCTION CENTER FOR HIP AND KNEE REPLACEMENT; BLUE CROSS BLUE SHIELD DISTINCTION CENTER PLUS FOR MATERNITY CARE; IS THE FIRST HOSPITAL TO RECEIVE THE "BABY FRIENDLY" DESIGNATION FROM THE STATE OF ALABAMA; ASCR GOLD STANDARD AWARD (ALABAMA STATEWIDE CANCER REGISTRY).REGIONAL MEDICAL CENTER IS PROUD TO BE CATEGORIZED AS A TIER 1 HOSPITAL BY BLUE CROSS AND BLUE SHIELD OF ALABAMA. HOSPITALS DESIGNATED AS TIER 1 ARE RECOGNIZED AS HAVING ATTAINED THE HIGHEST LEVEL OF COMPLIANCE ACROSS THE FOLLOWING AREAS: QUALITY AWARENESS, PATIENT SAFETY AWARENESS, FINANCIAL AWARENESS, AND PATIENT SATISFACTION. 202133477 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 453 0 1 2119 1 1 1 0 0 0 0 0 0 0 0 0 X 15 11 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X X SUSAN MARNEY 2562355678 400 EAST TENTH STREET ANNISTON AL 36202 BILLY DON GRIZZARD CHAIRMAN 1.00 X X 109 0 0 JAMES E ROBERTS VICE CHAIRMAN 1.00 1.00 X X 138 0 0 ARTHUR F FITE III SECRETARY 1.00 1.00 X X 0 0 0 SANDRA FOX SUDDUTH BOARD MEMBER 1.00 1.00 X X 112 0 0 JIMMIE THOMPSON BOARD MEMBER 1.00 X 0 0 0 FRED WILSON BOARD MEMBER 1.00 1.00 X 105 0 0 GEORGE CRAWFORD MD BOARD MEMBER 1.00 X 300 0 0 TRUDY D HARDEGREE BOARD MEMBER 1.00 1.00 X 0 0 0 W E WILLIAMS BOARD MEMBER 1.00 X 0 0 0 BRIAN JOHNSON BOARD MEMBER 1.00 X 0 0 0 ELLEN BASS BOARD MEMBER 1.00 X 427 0 0 PAULA WATKINS BOARD MEMBER 1.00 X 0 0 0 BUD OWSLEY BOARD MEMBER 1.00 X 0 0 0 GORDON HARDY MD CHIEF OF STAFF 1.00 1.00 X 237 0 0 BLANE BATEMAN VICE CHIEF OF STAFF 1.00 X 947 0 0 LOUIS BASS CEO 50.00 1.00 X 363711 0 0 MARK NORTH CFO 50.00 X 202192 0 324 JOSEPH WEAVER COO 50.00 X 243127 0 190 TERRY M PHILLIS JR MD PHYSICIAN 50.00 X 754594 0 4088 BARRY J BILLINGS MD PHYSICIAN 50.00 X 680010 0 4088 MOHAMED JASSER MD PHYSICIAN 50.00 X 654599 0 3764 FRANK H KIM MD PHYSICIAN 50.00 X 371519 0 3764 MASUMI YAMAMURO MD PHYSICIAN 50.00 X 500765 0 3764 J DAVID MCCORMACK CEO (THROUGH SEPT 14) 50.00 X 300000 0 0 4072892 0 19982 56 1 1 0 ANESTHESIA SOLUTIONS OF ANNISTON LLC PO BOX 6633 HIGH POINT NC 27262 CRNA SERVICES 2887137 MORRISONS HEALTH CARE DIVISION PO BOX 102289 ATLANTA GA 303682289 MANAGEMENT OF FOOD SERVICE 1661458 ALIGN MD 624 28TH STREET NORTH BIRMINGHAM AL 35203 EMERGENCY DEPT PHYSICIAN SERVICES 661523 GREATER ALABAMA LITHOTRIPSY LLC PO BOX 847324 DALLAS TX 75284 PATIENT LITHOTRIPSY SERVICE 650702 FORSYTH BUILDING COMPANY INC PO BOX 1147 ANNISTON AL 36202 CONSTRUCTION SERVICES 577375 30 55882 13856 8930 112404 191072 NET PATIENT SERVICE 621400 199114190 199114190 MEDICAID DISP SHARE 900099 3893035 3893035 EHR PAYMENT 900099 1597574 1597574 OTHER PROGRAMS 900099 592330 412671 179659 LONG TERM CARE HOSPITAL 621400 430159 430159 62796 62796 205690084 2493763 2493763 1953562 9824 2390976 0 -437415 9824 -427591 -427591 102034 -102034 -102034 -102034 0 55882 0 0 FOOD SERVICE & VENDING 722210 963303 963303 OTHER INCOME 900099 104055 104055 GIFT SHOP REVENUE 453220 53545 53545 1120903 208966197 205510425 179659 3085041 101714 101714 312559 312559 799126 266375 532751 217224 217224 74374839 67883612 6491227 6399088 5802993 596095 9676742 8775323 901419 5683020 5153629 529391 11903 11903 687311 687311 18500 18500 18167358 15012725 3154633 70785 70785 3030702 2213011 817691 2988787 1262602 1726185 4131231 4129779 1452 76759 61506 15253 233782 152157 81625 1235967 1235967 12676640 12676640 1190460 1182604 7856 UNRELATED BUSINESS INCO 19381 19381 MEDICAL SUPPLIES 41902525 41902525 BAD DEBT 32029636 32029636 OTHER EXPENSES 2013972 138208 1875764 2424391 1532522 891869 220474402 202133477 18340925 0 921383 469805 7459294 5067435 19441165 19683020 1975251 1319810 5702127 5654431 2296408 2621184 292132508 224978696 65870402 67153812 56730185 49784276 9006269 9006269 164000 164000 8627597 34523900 178194081 195447942 14695273 17455064 963721 1066768 36754545 48960664 1161544 14639665 53575083 82122161 X 124608958 113315741 10040 10040 124618998 113325781 178194081 195447942 -11508205 214988 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 37417 37417 0 PART II-B, LINE 1: A PORTION OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE ALABAMA HOSPITAL ASSOCIATION (ALAHA) IS ALLOCATED TO LOBBYING ACTIVITIES PERFORMED FOR THE BENEFIT OF THOSE ORGANIZATIONS' MEMBER BODIES. IN 2015, 22.80% OF DUES TO THE AHA ($7,023) AND 22.12% OF DUES PAID TO THE ALAHA ($19,031) WERE ALLOCATED TO LOBBYING EFFORTS. THE ORGANIZATION ALSO PAID THE SKIPPER GROUP TO PROVIDE LOBBYING EFFORTS. 10040 10040 10040 10040 10065 -25 10040 10100 -35 10065 10160 -60 10100 1.00000 0 0 5426831 5426831 91932312 68502989 23429323 4472409 3005360 1467049 188842980 153470347 35372633 1457976 1457976 67153812 OTHER ASSETS 10497 INTEREST RATE SWAP DEFERRED CHARGE 2286300 DUE FROM AFFILIATES 8339440 THIRD PARTY SETTLEMENTS 61899 PENSION DEFERRALS 23825764 34523900 PROFESSIONAL LIABILITY SELF INSURANCE 545938 WORKER'S COMPENSATION LIABILITY 50000 PENSION DEFERRALS 106225 NET PENSION LIABILITY 13937502 14639665 X 178275283 214988 2390976 2605964 175669319 33296878 33296878 208966197 189568500 2390976 2390976 187177524 33296878 33296878 220474402 PART V, LINE 4: THE KNOX ENDOWMENT WAS ESTABLISHED IN THE 1940'S BY THE KNOX FAMILY TO PROVIDE MATERNITY CARE FOR INDIGENT HOSPITAL PATIENTS. INVESTMENT EARNINGS ON THE FUND ARE PUT TOWARDS INDIGENT MATERNITY PATIENTS ANNUALLY. THE HOSPITAL HAS DISCRETION TO USE THE FUNDS FOR MEDICAL EXPENSES BESIDES MATERNITY CARE IF NECESSARY. PART X, LINE 2: THE BOARD IS A POLITICAL SUBDIVISION AND THE AFFILIATE IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN 501(C)(3) OF THE INTERNAL REVENUE CODE; THEREFORE, NO PROVISION HAS BEEN RECORDED FOR INCOME TAXES FOR THESE ENTITIES. THE FILING ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2016 AND 2015. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE NET W/ REVENUES 2,390,976. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 32,029,636. EXPENSES NET W/REVENUES 1,267,242. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE NET W/ REVENUES 2,390,976. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 32,029,636. EXPENSES NET W/REVENUES 1,267,242. JEWELRY SALES 27362 27362 UNIFORM SALES 22087 22087 2 6433 6433 55882 55882 1 1 1 X 1 X 1 1 1 0 1 1 6990610 6990610 0.03710 21838431 21761342 77089 0.00040 28829041 21761342 7067699 0.03750 10476 10476 0.00010 5200 5200 0.00000 20601463 10404701 10196762 0.05410 101714 101714 0.00050 20718853 10404701 10314152 0.05470 49547894 32166043 17381851 0.09220 1 5000 3000 3000 0.00000 16 717 12216 12216 0.00010 2 100 1240 1240 0.00000 1 100 10000 10000 0.00010 20 5917 26456 26456 0.00020 0 32029636 4397669 54277021 57058506 -2781485 X 1 1 2 1 NORTHEAST ALABAMA REGIONAL MEDICAL CTR 400 EAST 10TH STREET ANNISTON AL 36207 X X X 2 REGIONAL MEDICAL CENTER - JACKSONVILLE 1701 PELHAM ROAD JACKSONVILLE AL 36265 X X X FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X 15 1 1 0 1 X RMCCARES.ORG/COMMUNITY-REPORTS/ 1 15 1 RMCCARES.ORG/COMMUNITY-REPORTS/ 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X RMCCARES.ORG/FINANCIAL-ASSISTANCE/ X RMCCARES.ORG/FINANCIAL-ASSISTANCE/ X RMCCARES.ORG/FINANCIAL-ASSISTANCE/ X X X X X 1 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A GROUP A-FACILITY 1 -- NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 5: RMC'S CHNA TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE INTERVIEW PROCESS TOOK INTO ACCOUNT INPUT FROM PERSONS, BASED ON RECOMMENDATIONS FROM THE HOSPITAL'S MANAGEMENT TEAM, WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL INCLUDING HOSPITAL MANAGEMENT, HOSPITAL BOARD, HOSPITAL MEDICAL STAFF / COMMUNITY PHYSICIANS, LOCAL AGENCIES AND PROVIDERS, AND COMMUNITY LEADERS. COLLECTIVELY, THE COMMUNITY MEMBERS SURVEYED REPRESENT HUNDREDS OF YEARS OF LIVING EXPERIENCE IN THE PRIMARY SERVICE AREA OF THE HOSPITAL AND THEREFORE PROVIDE HIGH PROBABILITY THAT RESPONDENTS KNOW AND UNDERSTAND THE COMMUNITY DYNAMICS AND ISSUES OF THE PRIMARY SERVICE AREA. GROUP A-FACILITY 1 -- NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 6A: NORTHEAST ALABAMA REGIONAL MEDICAL CENTER AND REGIONAL MEDICAL CENTER JACKSONVILLE JOINTLY CONDUCTED THE CHNA. GROUP A-FACILITY 1 -- NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 11: THE ORGANIZATION PRIORITIZED THE HEALTH NEEDS ADDRESSED BASED ON FIVE CONSIDERATIONS: 1) CONSISTENCY WITH THE ORGANIZATION'S MISSION, 2) QUALITY CONSIDERATIONS, 3)GOVERNANCE AND ORGANIZATION STRUCTURE ISSUES, 4)FINANCIAL OPERATIONS IMPACTS, 5)AND RISK. GROUP A-FACILITY 1 -- NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 22D: THE ORGANIZATION USES THE METHODS DESCRIBED IN REGULATION SECTION 1.501(R)-(5) TO COMPUTE AMOUNTS GENERALLY BILLED. GROUP A-FACILITY 2 -- REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 2: GROUP A-FACILITY 2 -- REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 5: RMC'S CHNA TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE INTERVIEW PROCESS TOOK INTO ACCOUNT INPUT FROM PERSONS, BASED ON RECOMMENDATIONS FROM THE HOSPITAL'S MANAGEMENT TEAM, WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL INCLUDING HOSPITAL MANAGEMENT, HOSPITAL BOARD, HOSPITAL MEDICAL STAFF / COMMUNITY PHYSICIANS, LOCAL AGENCIES AND PROVIDERS, AND COMMUNITY LEADERS. COLLECTIVELY, THE COMMUNITY MEMBERS SURVEYED REPRESENT HUNDREDS OF YEARS OF LIVING EXPERIENCE IN THE PRIMARY SERVICE AREA OF THE HOSPITAL AND THEREFORE PROVIDE HIGH PROBABILITY THAT RESPONDENTS KNOW AND UNDERSTAND THE COMMUNITY DYNAMICS AND ISSUES OF THE PRIMARY SERVICE AREA. GROUP A-FACILITY 2 -- REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 6A: NORTHEAST ALABAMA REGIONAL MEDICAL CENTER AND REGIONAL MEDICAL CENTER JACKSONVILLE JOINTLY CONDUCTED THE CHNA. GROUP A-FACILITY 2 -- REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 11: THE ORGANIZATION PRIORITIZED THE HEALTH NEEDS ADDRESSED BASED ON FIVE CONSIDERATIONS: 1) CONSISTENCY WITH THE ORGANIZATION'S MISSION, 2) QUALITY CONSIDERATIONS, 3)GOVERNANCE AND ORGANIZATION STRUCTURE ISSUES, 4)FINANCIAL OPERATIONS IMPACTS, 5)AND RISK. GROUP A-FACILITY 2 -- REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 22D: THE ORGANIZATION USES THE METHODS DESCRIBED IN REGULATION SECTION 1.501(R)-(5) TO COMPUTE AMOUNTS GENERALLY BILLED. 2 1 - NORTHEAST AL REGIONAL MED CENTER PSYCH U 400 EAST 10TH STREET ANNISTON AL 36202 INPATIENT PSYCH UNIT 2 - JACKSONVILLE REGIONAL MED CENTER PSYCH U 1701 PELHAM RD S JACKSONVILLE AL 36265 INPATIENT PSYCH UNIT PART I, LINE 3C: OUR ORGANIZATION PROVIDES A 60% DISCOUNT TO THE BILL FOR ALL SELF PAY (UNINSURED) PATIENTS. THIS ADJUSTMENT IS APPLIED TO THE BILL PRIOR TO STATEMENTS BEING MAILED TO THE PATIENT OR GUARANTOR. WE ALSO RETAIN ON A CONTRACTED BASIS VENDORS THAT ASSIST IN SCREENING PATIENTS FOR QUALIFICATION FOR FREE OR CHARITY CARE. THIS IS ACCOMPLISHED BY MEANS OF INTERVIEWS WITH THE PATIENT AS PART OF OUR NORMAL COLLECTION PROCESS. PART I, LN 7 COL(F): FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSE IN LINE 7, COLUMN (F), A BAD DEBT EXPENSE OF $32,029,636 HAS BEEN ADJUSTED FROM TOTAL EXPENSES PRESENTED ON FORM 990, PART X, LINE 25. PART III, LINE 3: BAD DEBT EXPENSE IS CALCULATED BY MULTIPLYING TOTAL CHARGES WRITTEN OFF TO BAD DEBT BY THE COST TO CHARGE RATIO. PART III, LINE 4: BAD DEBT EXPENSE AT COST WAS CALCULATED BY MULTIPLYING TOTAL BAD DEBT EXPENSE BY THE HOSPITAL'S COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS BY DIVIDING TOTAL OPERATING COSTS INTO TOTAL CHARGES. PART III, LINE 8: THE AMOUNTS COME FROM THE MEDICARE COST REPORT. THIS SHORTFALL IS ALL COMMUNITY BENEFIT AS IT REPRESENTS THE HOSPITAL'S COMMITMENT TO TREAT ALL MEDICARE BENEFICIARIES REGARDLESS OF THE REIMBURSEMENT AND COSTS. PART III, LINE 9B: THE CHARITY POLICY DOES NOT SPECIFICALLY ADDRESS COLLECTION PRACTICES. HOWEVER, ONCE A PERSON IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ALL COLLECTION ACTIVITY STOPS DUE TO THE FACT THAT THE ACCOUNTS ARE ADJUSTED TO A ZERO BALANCE. FOR THE INSTANCES WHERE THE PATIENT QUALIFIES FOR PARTIAL FINANCIAL ASSISTANCE, THE ACCOUNTS ARE ADJUSTED TO THE APPROPRIATE BALANCE AND THEN FOLLOW THE NORMAL COLLECTION SCHEDULES ESTABLISHED BY THE OUTSOURCED COLLECTION AGENCIES. PART VI, LINE 2: EVERY THREE YEARS, OUR SYSTEM CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT. THIS ASSESSMENT IS CONDUCTED WITH THE ASSISTANCE OF AN OUTSIDE FIRM AND IS USED TO SET GOALS AND STRATEGY FOR THE DEVELOPMENT OF FUTURE HEALTH SERVICES THAT MEET THE NEEDS OF OUR PATIENTS. PART VI, LINE 3: ALL PATIENT BILLS INCLUDE A STATEMENT THAT CHARITY CARE IS AVAILABLE TO QUALIFYING INDIVIDUALS, ALONG WITH INFORMATION ON HOW TO CONTACT PERSONNEL AT THE HOSPITAL IF THE PATIENT IS INTERESTED IN DETERMINING IF THEY QUALIFY FOR FINANCIAL ASSISTANCE. SIGNS ARE ALSO POSTED IN ALL REGISTRATION AREAS, AND INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY IS ALSO PROVIDED ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: OUR SERVICE AREA IS COMPRISED OF APPROXIMATELY 200,000 PEOPLE RESIDING IN THE COUNTIES OF CALHOUN, CLEBURNE, CLAY, RANDOLPH, AND TALLADEGA. ALL AGE GROUPS FROM NEBORNS TO THE ELDERLY ARE SERVED. SERVICES INCLUDE MEDICAL/SURGICAL, INTENSIVE CARE, OBSTETRICS, PEDIATRICS, PSYCHIATRIC, CARDIOLOGY, AND ONCOLOGY. ALL CITIZENS ARE SERVED REGARDLESS OF PAYER OR ABILITY TO PAY. WHILE RMC ANNISTON IS THE ONLY FULL SERVICE HOSPITAL IN THE SERVICE AREA, SMALLER HOSPITALS IN CALHOUN COUNTY INCLUDE STRINGFELLOW HOSPITAL AND RMC JACKSONVILLE. OTHER HOSPITALS IN OUR 5 COUNTY SERVICE AREA INCLUDE WEDOWEE HOSPITAL, CLAY COUNTY HOSPITAL IN CLAY COUNTY, CITIZENS HOSPITAL, AND COOSA VALLEY MEDICAL CENTER IN TALLADEGA COUNTY. CELBURNE AND RANDOLPH COUNTIES ARE CONSIDERED FEDERALLY DESIGNATED MEDICALLY UNDERSERVED FOR PRIMARY CARE, AND ALL COUNTIES ARE CONSIDERED UNDERSERVED FOR SPECIALTY PHYSICIANS. THE AREA ALSO QUALIFIES AS UNDERSERVED FOR PSYCHIATRIC SERVICES BY THE NATIONAL HEALTH SERVICE CORPS. PART VI, LINE 5: REGIONAL MEDICAL CENTER PROMOTES HEALTH WITHIN THE COMMUNITY WE SERVE IN A VARIETY OF WAYS. AS A NONPROFIT, WE PROVIDE SERVICES FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, AND WE SEE A VERY HIGH NUMBER OF UNINSURED, UNDERINSURED AND INDIGENT PATIENTS IN OUR EMERGENCY DEPARTMENT. WE ASSIST THE MEMBERS OF OUR MEDICAL STAFF IN RECRUITING NEW PHYSICIANS TO THE AREA. AS PART OF OUR ASSISTANCE PROGRAM, RECRUITED PHYSICIANS MUST AGREE TO SEE ALL PATIENTS, REGARDLESS OF INCOME LEVEL OR ABILITY TO PAY. RMC PROVIDES MANY COMMUNITY SERVICES IN THE FORM OF HEALTH EDUCATION, SCREENINGS AND SUPPORT GROUPS. OUR CANCER RESOURCE CENTER, PARISH NURSING PROGRAM, AND CONGREGATIONAL HEALTH OUTREACH ARE BUT A FEW OF OUR SERVICES TO OUR COMMUNITY THAT PROVIDE HIGHLY SKILLED STAFF TO PERFORM HEALTH SCREENINGS AND EDUCATION FREE OF CHARGE.A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE MEDICAL CENTER. THE ORGANIZATION OFFERS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED LOCAL PHYSICIANS IN ALL HOSPITAL DEPARTMENTS.THE FACILITY UTILIZES SURPLUS FUNDS PRIMARILY TO PURCHASE NEW AND REPLACEMENT MEDICAL EQUIPMENT AND TO PERFORM NEEDED RENOVATIONS ON ITS PLANT. OTHER USES OF SURPLUS FUNDS MIGHT INVOLVE FUNDING EDUCATIONAL OPPORTUNITIES FOR CLINICAL STAFF AND WHEN ALLOWED, MEMBERS OF ITS MEDICAL STAFF. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES AL 1 EAST ALABAMA EMERGENCY MEDICAL SERVICES PO BOX 700 LINCOLN AL 35096 630707345 501(C)(3) 9000 GENERAL ACTIVITY SPONSORSHIP ANNISTON CITY BOARD OF EDUCATION 4804 MCCLLELAN BLVD ANNISTON AL 36206 636000733 501(C)(3) 10000 GENERAL ACTIVITY SPONSORSHIP JACKSONVILLE STATE UNIVERSITY TICKET OFFICE 121 KENNAMER HALL JACKSONVILLE AL 36265 636001099 501(C)(3) 10000 GENERAL ACTIVITY SPONSORSHIP JACKSONVILLE STATE UNIVERSITY COLLEGE OF NURSING 700 PELHAM ROAD NORTH JACKSONVILLE AL 36265 636001099 501(C)(3) 4000 GENERAL ACTIVITY SPONSORSHIP 4 MEDICATION/MEDICAL SUPPLIES 123 20023 TRANSPORTATION 444 7142 AMBULANCE TRANSPORTS 16 11922 PREPAID CELL PHONE 1 55 SCHOLARSHIP AWARDS 55 271837 REHAB SERVICE 1 1560 SHELTER/HOUSING 1 20 PART I, LINE 2: THE ORGANIZATION HAS WRITTEN GUIDELINES FOR ORGANIZATIONS TO APPLY FOR COMMUNITY CONTRIBUTIONS (GRANTS). A DETAILED APPLICATION MUST BE COMPLETED AND APPROVED BY THE REVIEW COMMITTEE OF THE BOARD. A COPY OF THE APPLICATION IS AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINSITRATIVE OFFICE. X X X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 LOUIS BASS CEO 332000 0 13711 0 18000 0 0 0 0 0 363711 0 0 0 MARK NORTH CFO 184992 0 2192 0 15008 0 324 0 0 0 202516 0 0 0 JOSEPH WEAVER COO 216000 0 3127 0 24000 0 190 0 0 0 243317 0 0 0 TERRY M PHILLIS JR MD PHYSICIAN 600000 0 118594 0 36000 0 0 0 4088 0 758682 0 0 0 BARRY J BILLINGS MD PHYSICIAN 565000 0 79010 0 36000 0 0 0 4088 0 684098 0 0 0 MOHAMED JASSER MD PHYSICIAN 500004 0 131595 0 23000 0 0 0 3764 0 658363 0 0 0 FRANK H KIM MD PHYSICIAN 326519 0 0 0 45000 0 0 0 3764 0 375283 0 0 0 MASUMI YAMAMURO MD PHYSICIAN 452765 0 0 0 48000 0 0 0 3764 0 504529 0 0 0 J DAVID MCCORMACK CEO (THROUGH SEPT 14) 0 0 0 0 300000 0 0 0 0 0 300000 0 0 0 PART I, LINE 1A ALL TRAVEL EXPENSES FOR SPOUSES AND COMPANIONS, AS WELL AS TEMPORARY HOUSING ALLOWANCES PER EMPLOYMENT AGREEMENTS, ARE ADDED AS WAGES ON THE RECIPIENTS' FORM W-2 OR 1099-MISC. PART I, LINE 4A J. DAVID MCCORMACK RECIEVED A SEVERANCE PAYMENT IN THE AMOUNT OF $300,000 DURING CALENDAR YEAR 2015. RACHEL CALDWELL FAMILY MEMBER OF CORPORATE OFFICER 49980 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 JOHN FITE FAMILY MEMBER OF BOARD MEMBER 22238 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 MELANIE GRIZZARD FAMILY MEMBER OF BOARD MEMBER 66253 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 CHERI JOHNSON FAMILY MEMBER OF BOARD MEMBER 45178 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 WENDI OWSLEY FAMILY MEMBER OF BOARD MEMBER 33575 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPRISED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE SECRETARY OF THE BOARD, THE FINANCE COMMITTEE CHAIRPERSON, THE HUMAN RESOURCES COMMITTEE CHAIRPERSON, THE PHYSICAL FACILITIES AND PROPERTIES COMMITTEE CHAIRPERSON, THE COMPLIANCE COMMITTEE CHAIRPERSON, THE CHIEF OF THE MEDICAL STAFF, AND ONE AT-LARGE BOARD MEMBER. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION, EXCEPT AS SUCH AUTHORITY IS LIMITED OR RESERVED BY STATUTE OR IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE THOSE DULY APPOINTED UNDER THE PROVISIONS OF ORDINANCE NO. 74-0-13 ADOPTED BY THE COUNCIL OF THE CITY OF ANNISTON, AL, ON MAY 7, 1974. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD IS RESTRICTED FROM THE SALE OR DISPOSAL OF ANY PART OF THE REAL ESTATE USED IN CONNECTION WITH THE OPERATION OF THE MEDICAL CENTER OR THE TRANSFER OF THE OPERATION AND MANAGEMENT OF THE MEDICAL CENTER WITHOUT THE CONSENT OF THE GOVERNING BODY OF THE CITY OF ANNISTON, AL. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED INTERNALLY BY MANAGEMENT, AND FORWARDED TO THE MEMBERS OF THE BOARD OF DIRECTORS. AFTER THE RETURN WAS REVIEWED BY THE BOARD MEMBERS, IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO DISCLOSE ON AN ANNUAL BASIS ANY POTENTIAL CONFLICTS OF INTEREST PER THE ORGANIZATION'S OFFICIAL WRITTEN POLICY. A DISINTERESTED PARTY IS ASSIGNED TO INVESTIGATE ANY CONFLICTS THAT ARISE, AND AFFECTED BOARD MEMBERS ARE ADVISED OF THE PARTY'S DECISION. FORM 990, PART VI, SECTION B, LINE 15A THE CEO COMPENSATION PACKAGES ARE DETERMINED BY CONDUCTING SALARY SURVEYS FROM INDIVIDUAL HOSPITALS AS WELL AS UTILIZING SALARY INFORMATION AVAILABLE FROM INDEPENDENT SOURCES SUCH AS STATE HOSPITAL ASSOCIATIONS, INDEPENDENT COMPENSATION CONSULTANTS, AND PERIODICALS. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OVERSEES THE PROCESS AND DETERMINES THE COMPENSATION FOR THE CEO AFTER REVIEW AND CONSIDERATION OF ALL RELEVANT INFORMATION. THE CEO APPROVES COMPENSATION PACKAGES FOR ALL OTHER APPLICABLE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MEDICAL CENTER MEMORIAL FOUNDATION INC PO BOX 2208 ANNISTON AL 36202 630981593 EXEMPT ORG SUPPORT AL 501(C)(3) LINE 7 N/A 0 REGIONAL HEALTH SERVICES INC PO BOX 2208 ANNISTON AL 36202 630721572 EXEMPT ORG SUPPORT AL 501(C)(3) LINE 11A, I REGIONAL MEDICAL CENTER BOARD 1 REGIONAL HEALTH MANAGEMENT CORPORATION PO BOX 2345 ANNISTON AL 36202 630819576 MANAGEMENT AL N/A C 0 1 1 1 1 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1