2017-08-11T16:13:00-05:00 2016-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2015-10-01 560529974 CHARLES A CANNON JR MEMORIAL HOSPITAL INC CHAR 8282624100 434 hospital drive LINVILLE NC 28646 kevin b may CFO 8282624100 2017-08-11 1 Amy Bibby P00445891 8282542254 2017-08-09 2015 2021-01-29 14:40:06Z CHARLES MANTOOTH 434 hospital drive LINVILLE NC 28646 21690225 0 X WWW.APPRHS.ORG X 1957 NC TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE CITIZENS OF AVERY COUNTY. 15 12 210 68 0 0 198644 430545 24772302 20834754 -169648 11982 269034 412944 25070332 21690225 0 0 0 0 13805577 12847102 0 0 0 9762633 9790409 23568210 22637511 1502122 -947286 33724857 24022388 19592506 10221544 14132351 13800844 X To provide health care services to enhance the quality of life for the citizens of avery county. 0 1 17679527 20834754 Charles A. Cannon, Jr. Memorial Hospital in Linville is a 25-bed acute care hospital with a 10-bed inpatient behavioral health unit. The full-service emergency department, imaging department, laboratory, outpatient behavioral health, rehabilitation center offering physical and occupational therapies, and cardiopulmonary rehabilitation round out the list of services. 17679527 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 210 1 0 0 0 0 0 0 0 0 0 0 X 15 12 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X kevin b may 8282624100 336 DEERFIELD ROAD boone NC 28607 JOHN BLACKBURN CHAIR 1.00 4.00 X X 0 0 0 KENNETH WILCOX VICE CHAIR 1.00 4.00 X X 0 0 0 PAUL MILLER JR TRUSTEE 1.00 3.00 X 0 0 0 joe miller TRUSTEE 1.00 4.00 X 0 0 0 SUSAN ROGGENKAMP TRUSTEE 1.00 3.00 X 0 0 0 sam adams TRUSTEE 1.00 3.00 X 0 0 0 CHARLES BAKER MD TRUSTEE 1.00 41.00 X 0 250053 20679 jack howard TRUSTEE 1.00 2.00 X 0 0 0 pattie tennille TRUSTEE 1.00 3.00 X 0 0 0 jan winkler TRUSTEE 1.00 2.00 X 0 0 0 KIM MILLER TRUSTEE 1.00 2.00 X 0 0 0 JAMES HODGES COUNTY COMMISSION REPRESEN 1.00 2.00 X 0 0 0 PAUL DAGHER MD TRUSTEE 1.00 2.00 X 0 4000 0 THOMAS DALE TRUSTEE 1.00 2.00 X 0 0 0 KENT TARBUTTON TRUSTEE 1.00 2.00 X 0 0 0 richard sparks ceo arhs 1.00 44.00 X 0 1952765 24824 kevin may cfo arhs 1.00 44.00 X 0 322328 23803 CHARLES MANTOOTH CEO CMH 1.00 41.00 X 0 244042 26201 CARMEN LACEY PRESIDENT, CMH 1.00 41.00 X 0 134682 22802 0 2907870 118309 0 0 1 0 0 430545 430545 PATIENT SERVICE REVENUE 621990 20834754 20834754 20834754 8556 8556 198816 0 198816 198816 198816 3426 0 3426 3426 3426 37230 0 37230 37230 CAFETERIA REVENUE 900099 154079 154079 MISCELLANEOUS REVENUE 900099 22819 22819 176898 21690225 20834754 0 424926 X 10291347 8841799 1449548 1929410 1647716 281694 626345 587482 38863 2713 2713 3616649 3249530 367119 1662 1662 427574 426836 738 531474 3295 528179 23777 22629 1148 2197 2197 284496 284496 1639530 642935 996595 127046 127046 Drugs & Medical Supplie 1391103 1391103 Corp. Allocations 797227 797227 Equipment rental and ma 438394 303327 135067 Food 197685 197685 308882 234285 74597 22637511 17679527 4957984 0 1853255 508857 11155525 2359136 553558 586353 90403 123911 36276427 19352419 17402505 16924008 2669611 3520123 33724857 24022388 656762 301922 264234 104596 7930930 7265644 10740580 2549382 19592506 10221544 X 13222536 12891029 909815 909815 14132351 13800844 33724857 24022388 X -947286 615779 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1220002 1220002 22258565 11434539 10824026 4963571 2542603 2420968 7528332 5121104 2407228 305957 254173 51784 16924008 ASSETS USE WHICH IS LIMITED 367275 Interest in ARHF 2918299 ESTIMATED THIRD-PARTY SETTLEMENTS 225000 DUE FROM AFFILIATES 9549 3520123 Due to affiliate 2128600 Miscellaneous 394298 Capital lease obligation 26484 2549382 X Part X, Line 2: ARHS and the companies for which it serves as sole member are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal and state income taxes on related income. Accordingly, no provision for income taxes has been made in the accompanying combined financial statements. The System has determined it does not have any material unrecognized tax benefits or obligations as of September 30, 2016. 1 1 1 X 1 X 1 1 1 0 1 1 355773 355773 0.01570 2670471 1571220 1099251 0.04860 3026244 1571220 1455024 0.06430 44185 44185 0.00200 44185 44185 0.00200 3070429 1571220 1499209 0.06630 1 1776974 88849 10254141 10254141 X 1 1 1 APPALACHIAN REGIONAL HEALTHCARE SYSTEM SOLE MEMBER OF CHARLES A. CANNON JR., MEMORIAL HOSPITAL, INC. 1.00000 1 1 charles a cannon jr memorial hospital 434 hospital drive linville NC 28646 X X X X CHARLES A CANNON JR MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 15 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X 1 15 0 0 0 1 X 200.000000000000 300.000000000000 X X X 1 1 X X 1 X https://www.apprhs.org/patients/financial-assistance X X 1 X 0 X X X 1 X 0 0 CHARLES A CANNON JR MEMORIAL HOSPITAL Part V, Section B, Line 5: THE CHNA UTILIZED COMMUNITY HEALTH OPINIONS SURVEYS AND COMMUNITY HEALTH LEADERSHIP SURVEYS FOR REQUIRED COMMUNITY INPUT. THE COMMUNITY HEALTH OPINIONS SURVEY WAS DEVELOPED TO MIRROR QUESTIONS THAT IDENTIFIED COMMUNITY STRENGTHS, IMPORTANT HEALTH PROBLEMS, AND HEALTH BEHAVIORS OF RESIDENTS. QUESTIONS WERE MODELED AFTER THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS. 800 ENGLISH AND 200 SPANISH SURVEYS WERE PRINTED AND DISTRIBUTED TO THE COMMUNITY. IN ADDITION, AN ELECTRONIC VERSION OF THE SURVEY WAS DEVELOPED USING SURVEY MONKEY. CHARLES A CANNON JR MEMORIAL HOSPITAL Part V, Section B, Line 6a: THE HOSPITAL FACILITY CONDUCTED A CHNA WITH WATAGUA MEDICAL CENTER. CHARLES A CANNON JR MEMORIAL HOSPITAL Part V, Section B, Line 6b: THE HOSPITAL FACILITY CONDUCTED THE CHNA WITH APPALACHIAN DISTRICT HEALTH DEPARTMENT, TOE RIVER HEALTH DISTRICT, AND HIGH COUNTRY VISION COUNCIL. CHARLES A CANNON JR MEMORIAL HOSPITAL Part V, Section B, Line 11: THE ORGANIZATION'S IMPLEMENTATION STRATEGY DESCRIBES HOW THE FACILITY IS ADDRESSING THE FOLLOWING NEEDS:ACCESS TO PRIMARY HEALTHCARE SERVICESOBESITY, CHRONIC DISEASE, AND PROPER NUTRITIONACCESS TO MENTAL HEALTH SERVICESTHE ORGANIZATION IS NOT ADDRESSING SUBSTANCE ABUSE/SUICIDE, POVERTY, LACK OF YOUTH ACTIVITIES, DENTAL CARE, AND CHILD ABUSE BECAUSE THESE HEALTH NEEDS ARE ALREADY BEING ADDRESSED IN THE COMMUNITY. CHARLES A CANNON JR MEMORIAL HOSPITAL Part V, Section B, Line 16i: INCLUDED IN THE ADMISSION PACKET THAT PATIENTS RECEIVE. PATIENT FINANCIAL ADVOCATE AT THE HOSPITALS VISIT SELF-PAY PATIENTS AND MAKE THEM AWARE OF AVAILABLE FINANCIAL ASSISTANCE. CHARLES A CANNON JR MEMORIAL HOSPITAL Part V, Section B, Line 22d: AVERAGE OF ALL COMMERCIAL PAYERS. COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY URL https://www.apprhs.org/guides/Community-Health-Needs-Assessment-2016.pdf Part III, Line 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENT'S EVALUATION OF THE ACCOUNTS RECEIVABLE. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE. Part III, Line 9b: CHARITY WRITE-OFFS ARE SEGREGATED FROM NORMAL BAD DEBTS THROUGH A SEPARATE TRANSACTION CODE. FAMILY INCOME BELOW 175% OF FPG ARE ELIGIBLE FOR 100% WRITE-OFF. PARTIAL WRITE-OFF IS AVAILABLE BETWEEN FAMILY INCOME BETWEEN 200% AND 300% OF FPG. Part VI, Line 2: THE HOSPITAL FACILITY RECENTLY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY. PLEASE SEE WEBSITE https://www.apprhs.org/guides/Community-Health-Needs-Assessment-2016.pdf Part VI, Line 3: PATIENTS ARE EDUCATED ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE FINANCIAL ASSISTANCE POLICY(FAP). DURING PRE-REGISTRATION AND REGISTRATION, PATIENTS CAN BE INTERVIEWED BY A PATIENT FINANCIAL ADVOCATE TO DETERMINE WHETHER THE PATIENT HAS A NEED FOR FINANCIAL ASSISTANCE OR POTENTIAL ELIGIBILITY UNDER GOVERNMENT PROGRAMS. Part VI, Line 4: THE COMMUNITY CONSISTS OF ASHE, AVERY, AND WATAUGA COUNTIES. A POPULATION OF APPROXIMATELY 98,000 PEOPLE IN NORTHWESTERN NORTH CAROLINA. PLEASE READ THE RECENT COMMUNITY HEALTH NEEDS ASSESSMENT FOR AN IN-DEPTH LOOK AT THE DEMOGRAPHICS BY USING WEBSITE https://www.apprhs.org/guides/Community-Health-Needs-Assessment-2016.pdf Part VI, Line 5: Appalachian Regional Healthcare System (ARHS) stays committed to promoting health in the High Country, enhancing quality of life and simply "making life better." The healthcare system offers a variety of health education programs, prevention programs, and health screenings to encourage healthy lifestyles for residents and visitors. In addition to partnering with local health departments to conduct health needs assessments, ARHS hosts annual health fairs in our primary service area, Watauga and Avery Counties. We also attempt to address the needs of low income, uninsured residents through two programs - Appalachian Healthcare Project and the Latino Health Program.Appalachian Healthcare Project is a collaborative effort among the medical community to provide healthcare for low income, uninsured residents of Watauga and Avery Counties. The project enrolls persons who meet program guidelines and coordinates health care on the individual's behalf. Coordination of health care includes: managing referrals to specialists, helping patients get access to medications, and patient case management. Medical providers donate much needed care to individuals who qualify.The Latino Health Program of Appalachian Regional Healthcare System seeks to improve the health and well-being of Latinos in Watauga and Avery counties through increased access to care, health education, and other enabling services.Appalachian Healthcare Project and the Latino Health Program provide more than $2.5 million worth of medical assistance to approximately 400 low income, uninsured residents annually. 0 1 0 0 0 0 0 0 0 CHARLES BAKER MD TRUSTEE 0 244813 0 500 0 4740 0 7735 0 12944 0 270732 0 0 richard sparks ceo arhs 0 474795 0 0 0 1477970 0 16950 0 7874 0 1977589 0 0 kevin may cfo arhs 0 311106 0 500 0 10722 0 15929 0 7874 0 346131 0 0 CHARLES MANTOOTH CEO CMH 0 234407 0 500 0 9135 0 12652 0 13549 0 270243 0 0 CARMEN LACEY PRESIDENT, CMH 0 133042 0 500 0 1140 0 7351 0 15451 0 157484 0 0 Part I, Line 4b THE FOLLOWING PERSON RECEIVED A 457(F) DISTRIBUTION: RICHARD SPARKS - $1,471,342 THE 457F PLAN VESTS 10 YEARS FROM DATE OF HIRE WITH THE OPTION TO DEFER IN 5 YEAR INCREMENTS. DURING 2015, MR. SPARKS REACHED THE VESTING TERMS OF THE PLAN, THEREFORE $1,471,342 WAS INCLUDED AS REPORTABLE COMPENSATION ON THE FORM W-2. THIS AMOUNT IS REPORTED ON SCHEDULE J, PART III, COLUMN B(III). Form 990, Part III, line 3 THE ORGANIZATION CEASED OPERATIONS OF THE OBSTETRICS SERVICES DURING FISCAL YEAR 2016. Form 990, Part VI, Section A, line 1 The Executive Committee shall consist of the Chairman of the Board of Trustees, the Vice Chairman of the Board of Trustees, the immediate past Chairman of the Board of Trustees (if still a member of the Board of Trustees), and three (3) other Trustees. The Chairman shall appoint the members of the Executive Committee and shall serve as its Chairman. In the absence of a quorum of the entire Board of Trustees, the Executive Committee or a majority thereof shall have full authority to act in all matters relating to Cannon Memorial Hospital business, including, but not limited to all things deemed necessary and expedient in the governance, management, and control of the business and affairs of the Corporation, including matters relating to executive compensation, and shall have and exercise the power and authority of the Board of Trustees to transact all regular business of the Corporation when the Board of Trustees is not in session, except as prohibited in Article V, Section 3 herein. Further, the Executive Committee or a majority thereof shall have full authority to act on behalf of Cannon Memorial Hospital at any called or special meeting. When the Executive Committee exercises the power and authority of the Board of Trustees, such action is subject to ratification by the Board of Trustees. Form 990, Part VI, Section A, line 3 Parent company, Appalachian Regional Health Care System (ARHS) oversees CMH operations. Also note that salaries and other common expenses incurred by arhs are allocated appropriately to CMH. Payments to vendors are paid through ARHS and all 1099s are issued through ARHS. Form 990, Part VI, Section A, line 6 THE SOLE MEMBER IS APPALACHIAN REGIONAL HEALTHCARE SYSTEM. Form 990, Part VI, Section A, line 7a THE TRUSTEES OF THE SOLE MEMBER SHALL ALSO SERVE AS THE TRUSTEES OF THE FILING ORGANIZATION. Form 990, Part VI, Section B, line 11 The svp/cfo and the vice president of finance review the 990 and then it is made available to the board upon completion. Form 990, Part VI, Section B, line 12c THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. Form 990, Part VI, Section B, line 15a Integrated Healthcare Strategies (IHS) conducted an independent compensation and benefit analysis for the CEO of ARHS. Comparative data was used in this analysis from national and regional peer groups (health system's with comparable net revenue, structure, & organizational complexity. Benchmark data included IHS & Sullivan Cotter. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST. Form 990, Part IX, line 11g Professional fees : Program service expenses 1,458,068. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,458,068. Contract labor : Program service expenses 1,791,462. Management and general expenses 367,119. Fundraising expenses 0. Total expenses 2,158,581. Form 990, Part XI, line 9: Transfers from affiliate 615,779. Form 990, Part XII, Line 2c: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. appalachian regional healthcare system po box 2600 boone NC 28607 201067022 parent company NC 501(c)(3) Line 11b, II 0 blowing rock hospital inc po box 148 blowing rock NC 28605 560513181 post acute care and rehabilitation center NC 501(c)(3) Line 3 appalachian regional healthcare system inc 1 watauga medical center inc 336 deerfield rd boone NC 28607 560510824 hospital NC 501(c)(3) Line 3 appalachian regional healthcare system inc 1 appalachian regional healthcare foundation 336 deerfield rd boone NC 28607 204625618 philanthropic organization for the system NC 501(c)(3) Line 7 appalachian regional healthcare system inc 1 appalachian regional medical associates inc po box 2600 boone NC 28607 205755130 employment alternative to both new and established physician practices NC 501(c)(3) Line 9 appalachian regional healthcare system inc 1 ARHS PROPERTIES INC 336 deerfield rd boone NC 28607 203470765 hold future purchase of non-profit land acquisitions NC 501(c)(3) Line 11b, II appalachian regional healthcare system inc 1 SLOOP MEDICAL OFFICE PLAZA CONDOMINIUM ASSOCIATION 434 HOSPITAL DRIVE LINVILLE NC 28646 593761777 RENTAL NC APPALACHIAN REGIONAL HEALTHCARE SYSTEM C 192681 219891 0.59920 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0