2017-08-15T08:09:37-05:00 2016-09-30 990 2015-10-01 566000064 ANGEL MEDICAL CENTER INC ANGE 8285248411 PO BOX 1209 FRANKLIN NC 28744 LENA COCHRAN REGIONAL DIRECTOR - FINANCE 8285248411 2017-08-14 2015 2021-01-29 14:40:06Z LENA COCHRAN PO BOX 1209 FRANKLIN NC 28744 62229484 0 X MISSION-HEALTH.ORG/MEMBER-HOSPITALS.PHP X 1933 NC PROVISION OF HEALTHCARE SERVICES 16 11 482 108 0 0 186222 195094 58395937 61562961 -61417 -193401 165898 0 58686640 61564654 4500 3168 0 0 31350014 21487396 0 0 77254 25641624 36873151 56996138 58363715 1690502 3200939 38287323 37823794 17762801 14098333 20524522 23725461 DEDICATED PROFESSIONALS PROVIDING COMPASSIONATE HEALTHCARE TO ALL. 0 0 54515939 3168 61562961 THE ORGANIZATION PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES TO PEOPLE IN ITS SERVICE AREA REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE ORGANIZATION, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES. THE ORGANIZATION FURTHER RECOGNIZES THAT ITS MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND EDUCATION. TO THIS END, THE ORGANIZATION PROVIDES FREE CARE, SUBSIDIZED CARE, AND CARE AT BELOW COST TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. HEALTHCARE ACTIVITIES AND SCREENINGS, PROGRAMS AND EDUCATION TO SUPPORT THE COMMUNITY'S HEALTH ARE ALSO PROVIDED EACH YEAR. 54515939 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 1 0 0 0 1 0 0 482 1 0 0 0 0 0 0 0 0 0 0 X 16 11 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X FINANCE DEPARTMENT 8282577063 400 RIDGEFIELD CT SUITE 100 ASHEVILLE NC 28806 KEN STONEBRAKER CHAIRPERSON 1.00 X X 0 0 0 CONNIE HAIRE TREASURER 1.00 X X 0 0 0 JANE C KIMSEY VICE-CHAIRPERSON 1.00 X X 0 0 0 JOHNNY MIRA-KNIPPEL SECRETARY 1.00 X X 0 0 0 CHARLES BARRIER MD BOARD MEMBER 1.00 X 0 0 0 DAVID FRANKS MD BOARD MEMBER 40.00 X 0 245346 10937 CHUCK TRENTHAM MD BOARD MEMBER 40.00 X 168069 0 0 JANET J GREENE BOARD MEMBER 1.00 X 0 0 0 JOSEPH COLLINS BOARD MEMBER 1.00 X 0 0 0 GEORGE RENFRO BOARD MEMBER 1.00 X 0 0 0 ROBERT BEDNAREK BOARD MEMBER 1.00 59.00 X 0 322366 33182 JAN UNGER BOARD MEMBER 1.00 X 0 0 0 LADSON GADDY-DUBAC MD BOARD MEMBER 40.00 X 54957 209680 13995 KATHY GUYETTE BOARD MEMBER 1.00 59.00 X 0 543135 79029 DALE WEST BOARD MEMBER 1.00 X 0 0 0 KEN MURPHY BOARD MEMBER 1.00 X 0 0 0 MARK NAKAGAWA REG DIR - FIN UNTIL MAR 2016 25.00 25.00 X 0 164022 29932 SHEILA PRICE CHIEF NURSING OFFICER 50.00 X 158348 0 5376 LENA COCHRAN REG DIR - FIN BEG DEC 2015 20.00 20.00 X 0 12564 608 KAREN GORBY CNO BEG AUG 2016 50.00 X 0 0 0 AMOS HADDOCK MD PHYSICIAN 40.00 X 0 395172 32378 GILBERTO ROBLES MD PHYSICIAN 40.00 X 124682 328044 28796 TRAVIS PETRICEK MD PHYSICIAN 40.00 X 125239 274587 15042 LAURA VERDE MD PHYSICIAN 40.00 X 0 388892 26625 MICHAEL KEGAN MD PHYSICIAN 40.00 X 0 434876 31848 JAMES BROSS FORMER CEO 0.00 0.00 X 0 341426 14585 631295 3660110 322333 9 1 1 0 JOHNSON CONTROLS INC 430 ROPER MOUNTAIN ROAD SUITE J GREENVILLE SC 29615 EQUIPMENT MAINTENANCE SERVICES 106241 1 82044 31805 81245 195094 NET PATIENT SERVICES REVENUE 900099 59438656 59438656 OTHER OPERATING REVENUE 900099 2124305 2124305 61562961 22904 22904 438312 438312 0 10213 226518 -216305 -216305 -216305 61564654 61562961 0 -193401 X 3168 3168 494819 395855 98964 17057341 15181033 1828107 48201 224590 199885 24705 2373211 2112158 254347 6706 1337435 1190317 147118 687179 584102 103077 22770 22770 12713 12713 15642922 15435710 207212 72682 72099 583 503840 443379 60078 383 654985 261994 392991 2346687 2090825 234669 21193 99867 88881 10798 188 36573 36573 117869 117869 2521772 2521772 303632 258087 45545 PHARMACEUTICALS 8119538 8119538 MEDICAL SUPPLIES 4183820 4183820 REPAIRS AND MAINTENANCE 227569 193434 34135 1318733 1134112 184621 58363715 54515939 3770522 77254 2024244 1537388 286031 185741 24704 11115806 11055621 293440 293440 1510417 1582389 124010 46249 30566372 7468110 22703526 23098262 229849 0 38287323 37823794 5055800 3779493 4113125 2716684 8570000 0 23876 0 0 7602156 17762801 14098333 X 20382940 23588624 141582 136837 20524522 23725461 38287323 37823794 3200939 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3480000 3480000 13297483 3342927 9954556 3317396 423541 2893855 7965986 3032076 4933910 2505507 669566 1835941 23098262 INTERCOMPANY NOTE PAYABLE - MISSION HEALTH SYSTEM 7145000 INTERCOMPANY LIABILITIES 457156 7602156 X PART X, LINE 2: THE ORGANIZATION IS INCLUDED IN MISSION HEALTH SYSTEM'S CONSOLIDATED AUDIT WHICH APPLIES THE PROVISIONS OF FASB ASC TOPIC 740, INCOME TAXES (ASC 740), IN ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. ASC 740 PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS CURRENTLY NO IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740. 1 1 1 X 1 X 1 1 1 0 1 1 2144796 2144796 0.03670 7777265 7651605 125660 0.00220 9922061 7651605 2270456 0.03890 122365 122365 0.00210 528220 528220 0.00910 2286 2286 0.00000 652871 652871 0.01120 10574932 7651605 2923327 0.05010 300 300 0.00000 300 300 1 3603324 16120 22982905 22160151 822754 X 1 1 1 1 ANGEL MEDICAL CENTER INC 120 RIVERVIEW STREET FRANKLIN NC 28734 WWW.ANGELMED.ORG H0034 X X X ANGEL MEDICAL CENTER INC 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X SEE PART VI X SEE PART VI X 1 13 1 SEE PART VI 0 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X HTTPS://WWW.MISSION-HEALTH.ORG/FINANCIAL-ASSISTANCE.PHP X X X X X 1 X 0 X X X 1 X 0 0 ANGEL MEDICAL CENTER, INC. PART V, SECTION B, LINE 5: IN THE RANDOM-SAMPLE SURVEY THAT WAS ADMINISTERED IN OUR COUNTY AS PART OF THIS REGIONAL COMMUNITY HEALTH ASSESSMENT, APPROXIMATELY 200 COMMUNITY MEMBERS COMPLETED A QUESTIONNAIRE REGARDING THEIR HEALTH STATUS, HEALTH BEHAVIORS, INTERACTIONS WITH CLINICAL CARE SERVICES, SUPPORT FOR CERTAIN HEALTH-RELATED POLICIES, AND FACTORS THAT IMPACT THEIR QUALITY OF LIFE. IN ADDITION, IN OUR COUNTY, COMMUNITY MEMBERS AND PARTNERS WERE INVOLVED IN: - A COLLECTION AND REVIEW OF KEY HEALTH STATISTICS, COMPARING MACON COUNTY RESULTS WITH PEER COUNTIES AND NC RESULTS. IN ADDITION, TRENDS IN MACON COUNTY RESULTS WERE REVIEWED. - A QUANTITATIVE RESEARCH STUDY OF RESIDENTS, SELECTED AT RANDOM, AND INTERVIEWED USING A COMPREHENSIVE HEALTH QUESTIONNAIRE. - A SERIES OF COMMUNITY FOCUS GROUPS. THESE DISCUSSION GROUPS CONSISTED OF MACON RESIDENTS REPRESENTING IMPORTANT COMMUNITY PERSPECTIVES, SUCH AS SENIOR CITIZENS, STUDENTS, THE LATINO COMMUNITY, HIGHLANDS RESIDENTS, AND PRIVATE BUSINESSES. - INTERVIEWS WITH SELECTED COMMUNITY LEADERS WITH PERSPECTIVES ON HEALTH. ANGEL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6A: REGIONAL PARTNERSHIP:ANGEL MEDICAL CENTER'S COLLABORATIVE COMMUNITY HEALTH IMPROVEMENT EFFORT IS ALSO SUPPORTED BY A COMPREHENSIVE PARTNERSHIP WITH OTHER REGIONAL HOSPITALS AND LOCAL HEALTH DEPARTMENTS. THIS INITIATIVE, KNOWN AS WNC HEALTHY IMPACT, REPRESENTS 16 COUNTIES ACROSS THE WESTERN NORTH CAROLINAREGION WORKING COLLABORATIVELY TO IMPROVE COMMUNITY HEALTH. INFORMATION ABOUT THIS INNOVATIVE REGIONAL COLLABORATION, COUNTY-WIDE COMMUNITY HEALTH ASSESSMENTS, AND OVERALL REGIONAL FINDINGS, ARE MADE WIDELY AVAILABLE TO THE PUBLIC AT WWW.WNCHEALTHYIMPACT.COM. ANGEL MEDICAL CENTER, INC. PART V, SECTION B, LINE 6B: MACON COUNTY DEPARTMENT OF PUBLIC HEALTH ANGEL MEDICAL CENTER, INC. PART V, SECTION B, LINE 22D: THE ORGANIZATION USED THE LOOK-BACK METHOD IN DETERMINING AGB FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE IT PROVIDES TO A FAP-ELIGIBLE INDIVIDUAL. THE AGB PERCENTAGE WAS BE CALCULATED ANNUALLY BY DIVIDING THE SUM OF ALL CLAIMS FOR EMERGENCY AND MEDICALLY NECESSARY CARE THAT HAVE BEEN PAID IN FULL DURING A PRIOR 12-MONTH PERIOD BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. CLAIMS PAID INCLUDE CLAIMS PAID BY BOTH MEDICARE FEE-FOR-SERVICE AND ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYERS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY MEDICARE BENEFICIARIES OR INSURED INDIVIDUALS IN THE FORM OF CO-PAYMENTS, CO-INSURANCE OR DEDUCTIBLES. 11 1 - ANGEL URGENT CARE 195 FRANKLIN PLAZA DRIVE FRANKLIN NC 28734 RURAL HEALTH CLINIC 2 - ANGEL PHYSICIAN PRACTICES MEDICAL PARK DRIVE FRANKLIN NC 28734 PHYSICIAN CLINIC 3 - MISSION WOMEN'S CARE SYLVA 111 CENTRAL ST SYLVA NC 28779 PHYSICIAN CLINIC 4 - CARDIAC REHAB AT ANGEL MEDICAL CENTER 55 MEDICAL PARK DR FRANKLIN NC 28734 REHABILITATION 5 - ANGEL ORTHOPAEDICS 56 MEDICAL PARK DR FRANKLIN NC 28734 ORTHOPAEDICS 6 - ANGEL PEDIATRICS 56 MEDICAL PARK DR FRANKLIN NC 28734 PEDIATRICS 7 - ANGEL SURGICAL ASSOCIATES 121 RIVERVIEW ST FRANKLIN NC 28734 OUTPATIENT 8 - ANGEL PRIMARY CARE 190 RIVERVIEW ST FRANKLIN NC 28734 PHYSICIAN CLINIC 9 - ANGEL REHAB CENTER 834 DEPOT ST FRANKLIN NC 28734 REHABILITATION 10 - COUMADIN CLINIC 834 DEPOT ST FRANKLIN NC 28734 OUTPATIENT 11 - ANGEL INFUSION CENTER 834 DEPOT ST FRANKLIN NC 28734 INFUSION PART I, LINE 7: THE NCHA ANDI REPORTS WERE USED WHICH ARE BASED ON THE IRS GUIDELINES TO DERIVE A COST-TO-CHARGE RATIO USED IN THE CALCULATION OF COMMUNITY BENEFIT EXPENSE AT COST. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT: AMC IS VERY INVOLVED WITH HEALTH PROMOTION IN THE SURROUNDING AREA. IN 2016, VOLUNTEERS FROM AMC SERVED ON BOARDS AND COMMITTEES THAT HELP IMPROVE THE OVERALL HEALTH IN MACON COUNTY. ORGANIZATIONS SERVED INCLUDED THOSE HELPING BATTERED WOMEN AND CHILDREN, MENTAL HEALTH PROVIDERS, AND THE MACON COUNTY PUBLIC HEALTH DEPARTMENT. AMC ALSO ORGANIZES MULTIPLE BLOOD DRIVES EACH YEAR AND CONTINUES TO BE A RED CROSS DONOR SITE. COALITION BUILDING: ANGEL MEDICAL CENTER HAS AN ACTIVE COMMUNITY RELATIONS BOARD THAT MEETS REGULARLY TO DISCUSS THE HOSPITAL AND ITS RELATIONSHIP TO THE COMMUNITY. EMPLOYEES PARTICIPATE IN VARIOUS POLICY COUNCILS IN THE COUNTY SUCH AS MACON PROGRAM FOR PROGRESS THAT ADDRESSES THE NEEDS OF UNDERPRIVILEGED CHILDREN. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: REPRESENTATIVES FROM PUBLIC RELATIONS AND COMMUNITY EDUCATION ON PLANNING BOARDS AND COMMITTEES MEET TO PROMOTE HEALTHY LIVING IN MACON COUNTY. SUCH PROGRAMS INCLUDE LIGHTEN UP FOR LIFE, COMMUNITY HEALTH PLANNING AND AN AMERICAN CANCER SOCIETY STUDY, ALL OF THESE PROMOTE A HEALTHIER LIFESTYLE TO HELP PREVENT POTENTIAL HEALTH PROBLEMS IN HIGH RISK INDIVIDUALS. WORKFORCE DEVELOPMENT: VOLUNTEERS FROM NURSING AND ALLIED HEALTH DEPARTMENTS PARTICIPATE ANNUALLY IN A PROGRAM WITH THE LOCAL HIGH SCHOOL AND COMMUNITY COLLEGE THAT ALLOWS STUDENTS FROM HEALTH OCCUPATIONS CLASSES TO OBSERVE AND LEARN FROM ACTUAL EXPERIENCE RATHER THAN JUST CLASS ROOM ACTIVITIES. PART III, LINE 2: THE ORGANIZATION USES A COST TO CHARGE RATIO TO ESTIMATE BAD DEBT. PART III, LINE 3: THE ORGANIZATION USES THE COST TO CHARGE RATIO APPLIED TO BAD DEBTS RECLASSIFIED TO CHARITY CARE AS OF THE MOST RECENT DATE AVAILABLE AFTER YEAR END. PART III, LINE 4: THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR MISSION HEALTH SYSTEM. THE COST OF THE ORGANIZATION'S BAD DEBT IS INCLUDED IN TOTAL COST OF UNCOLLECTIBLE ACCOUNTS REPORTED ON THESE AUDITED FINANCIALS. PART III, LINE 8: PER THE INSTRUCTIONS, THE MEDICARE COST REPORT IS THE BASIS FOR CALCULATING THE COSTS USING ALLOWABLE COSTS RELATED TO THE REVENUE REPORTED. PART III, LINE 9B: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND OTHER CHARITY CARE ARE NOTIFIED USING THE PROCESS DESCRIBED IN THE EDUCATION OF PATIENTS' ELIGIBILITY IN PART VI, ON LINE 3. PART VI, LINE 2: ANGEL MEDICAL CENTER PARTICIPATES IN A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EVERY THREE YEARS, WITHT HE MOST RECENT ASSESSMENT COMPLETED IN 2015. PART VI, LINE 3: THE CURRENT INDIGENT CARE POLICY IS POSTED AT THE REGISTRATION AREAS. PATIENTS ARE ENCOURAGED TO SPEAK WITH A PATIENT COUNSELOR TO SEEK FINANCIAL ASSISTANCE. PART VI, LINE 4: ANGEL MEDICAL CENTER SERVES MACON COUNTY, NC WITH A POPULATION OF APPROXIMATELY 32,600, 23.8% OF WHICH ARE OVER THE AGE 65, 21.3% OF WHICH ARE BELOW POVERTY LEVEL AND 6.1% OF WHICH ARE UNEMPLOYED. THE AVERAGE ANNUAL HOUSEHOLD INCOME IS ALMOST $38,000. THE ETHNIC DEMOGRAPHICS OF THE AREA INCLUDE 6.6% HISPANIC POPULATION, 1.3% AFRICAN AMERICAN POPULATION AND OTHER MINORITY POPULATIONS TOTALING 4.9%. THESE STATISTICS ARE ACCORDING TO THE US CENSUS BUREAU AND THE EMPLOYMENT SECURITIES COMMISSION OF NC. PART VI, LINE 5: SEE PROGRAM SERVICES ACCOMPLISHMENTS ON PAGE 2 OF THE 990. PART VI, LINE 6: ANGEL MEDICAL CENTER IS PART OF AN AFFILIATED HEALTH CARE SYSTEM WITH THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES DESCRIBED BELOW IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.MISSION HEALTH SYSTEM, INC. IS THE PARENT ORGANIZATION FOR THE CHARITABLE ORGANIZATIONS OF MISSION HOSPITAL, INC.; MISSION HEALTH SYSTEM FOUNDATION, INC.; MISSION MEDICAL ASSOCIATES, INC.; BLUE RIDGE REGIONAL HOSPITAL, INC.; THE MCDOWELL HOSPITAL, INC.; ANGEL MEDICAL CENTER, INC.; TRANSYLVANIA COMMUNITY HOSPITAL, INC.; HIGHLANDS-CASHIERS HOSPITAL, INC. AND COMMUNITY CAREPARTNERS, INC.THE SYSTEM'S MISSION IS TO OPERATE AN INTEGRATED HEALTH CARE SYSTEM FOR THE BENEFIT OF THE RESIDENTS OF WESTERN NORTH CAROLINA.MISSION HOSPITAL, INC. IS A REGIONAL INTEGRATED HEALTH FACILITY PROVIDING SUPERIOR CARE AND SERVICE TO PATIENTS AND THEIR FAMILIES THROUGH A FULL CONTINUUM OF INTEGRATED SERVICES, EDUCATION, AND RESEARCH. IT SERVES AS A TRAUMA CENTER TO PEOPLE OF WESTERN NORTH CAROLINA AND THE SURROUNDING COUNTIES. MISSION MEDICAL ASSOCIATES' MISSION IS TO PROVIDE PHYSICIAN SERVICES IN PREDOMINANTLY RURAL AREAS THAT ARE INSUFFICIENTLY SERVED, THEREBY IMPROVING THE HEALTH CARE OF THE GENERAL PUBLIC. IN MANY CASES THIS INVOLVES RECRUITING AND PLACING PRIMARY CARE PHYSICIANS, AS WELL AS PEDIATRIC AND ADULT SPECIALTY SERVICES CLOSE TO WHERE PEOPLE LIVE AND WORK.BLUE RIDGE REGIONAL HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MITCHELL, YANCEY AND SURROUNDING COUNTIES.THE MCDOWELL HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MCDOWELL AND THE SURROUNDING COUNTIES.MISSION HEALTH SYSTEM FOUNDATION, INC. SUPPORTS THE MISSION AND PROGRAMS OF MISSION HOSPITAL, INC. AND MISSION HEALTH SYSTEM, INC. AND OF OTHER ORGANIZATIONS THAT ARE TAX EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND WORKS TO BENEFIT THE COMMUNITY AND REGION SERVED BY THE ENTITIES LISTED ABOVE.TRANSYLVANIA COMMUNITY HOSPITAL, INC. SERVES AS A COMMUNITY HOSPITAL IN TRANSYLVANIA AND SURROUNDING COUNTIES.HIGHLANDS-CASHIERS HOSPITAL, INC. SERVES AS A COMMUNITY HOSPITAL FOR JACKSON AND MACON AND SURROUNDING COUNTIES.COMMUNITY CAREPARTNERS, INC. OPERATES AN INPATIENT FACILITY FOR ACUTE REHABILITATION LOCATED IN ASHEVILLE, NORTH CAROLINA, AND PROVIDES A WIDE VARIETY OF POST-ACUTE CARE SERVICES TO RESIDENTS OF WESTERN NORTH CAROLINA, INCLUDING REHABILITATION, HOME HEALTH, ADULT CARE, AND HOSPICE AND PALLIATIVE CARE.MSJHS AND CCP JOINT DEVELOPMENT COMPANY DBA ASHEVILLE SPECIALTY HOSPITAL OPERATES AN INPATIENT FACILITY FOR LONG-TERM ACUTE CARE. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 1 0 0 0 0 0 0 0 DAVID FRANKS MD BOARD MEMBER 0 242991 0 162 0 2193 0 1056 0 9881 0 256283 0 0 CHUCK TRENTHAM MD BOARD MEMBER 168069 0 0 0 0 0 0 0 0 0 168069 0 0 0 ROBERT BEDNAREK BOARD MEMBER 0 242967 0 0 0 79399 0 9960 0 23222 0 355548 0 30791 LADSON GADDY-DUBAC MD BOARD MEMBER 44690 204592 0 162 10267 4926 1356 5250 1421 5968 57734 220898 0 0 KATHY GUYETTE BOARD MEMBER 0 360580 0 142400 0 40155 0 66890 0 12139 0 622164 0 34027 MARK NAKAGAWA REG DIR - FIN UNTIL MAR 2016 0 138610 0 24270 0 1142 0 5940 0 23992 0 193954 0 0 SHEILA PRICE CHIEF NURSING OFFICER 54284 0 0 0 104064 0 1639 0 3737 0 163724 0 0 0 AMOS HADDOCK MD PHYSICIAN 0 373260 0 16853 0 5059 0 15900 0 16478 0 427550 0 0 GILBERTO ROBLES MD PHYSICIAN 90515 324905 0 162 34167 2977 1343 5640 4101 17712 130126 351396 0 0 TRAVIS PETRICEK MD PHYSICIAN 68674 274192 0 162 56565 233 1343 5640 1568 6491 128150 286718 0 0 LAURA VERDE MD PHYSICIAN 0 370927 0 16853 0 1112 0 10600 0 16025 0 415517 0 0 MICHAEL KEGAN MD PHYSICIAN 0 365438 0 16853 0 52585 0 15181 0 16667 0 466724 0 0 JAMES BROSS FORMER CEO 0 144353 0 44591 0 152482 0 5700 0 8885 0 356011 87670 87670 PART I, LINE 3 COMPENSATION FOR OFFICERS AND EXECUTIVES ARE SET BY MISSION HEALTH SYSTEM. SEE SCHEDULE O FOR ADDITIONAL DETAIL. PART I, LINES 4A-B OFFICERS AS WELL AS KEY EMPLOYEES AND TOP FIVE HIGHEST COMPENSATED EMPLOYEES WHO RECEIVED SEVERANCE PAYMENTS. JIM BROSS $63,692 OFFICERS AS WELL AS KEY EMPLOYEES AND TOP FIVE HIGHEST COMPENSATED EMPLOYEES WHO PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH CONTRIBUTION AMOUNTS. KATHY GUYETTE $53,640 JIM BROSS $16,540 OFFICERS AS WELL AS KEY EMPLOYEES AND TOP FIVE HIGHEST COMPENSATED EMPLOYEES WHO RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. KATHY GUYETTE $34,027 JIM BROSS $87,670 ROBERT BEDNAREK $30,791 FORM 990, PART VI, SECTION A, LINE 7A MISSION HEALTH SYSTEM, INC. A NORTH CAROLINA NONPROFIT CORPORATION, HAS THE RIGHT TO APPOINT UP TO SEVEN MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE FOLLOWING RIGHTS WITH RESPECT TO THE CORPORATION (A) APPROVAL OF THE GOVERNING INSTRUMENTS OF THE CORPORATION, (B) APPROVAL OF THE MISSION, VISION, AND VALUES STATEMENT, (C) ELECTION AND REMOVAL OF THE BOARD OF DIRECTORS, (D) APPROVAL OF THE PLEDGE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, THE PURCHASE OR SALE OF PROPERTY, AND LONG-TERM BORROWING, (E) APPROVAL OF DISSOLUTION, MERGER, SALE, OR CONSOLIDATION, (F) APPROVAL OF THE FORMATION AND GOVERNANCE OF NEW CORPORATIONS, PARTNERSHIPS, OR JOINT VENTURES (ABOVE FINANCIAL AND OTHER LIMITS), (G) APPROVAL OF THE CAPITAL AND OPERATING BUDGET, (H) APPROVAL OF THE CONSOLIDATION, MATERIAL EXPANSION, OR ELIMINATION OF ANY CLINICAL SERVICE, (I) APPROVAL OF THE ELECTION OF THE PRESIDENT/CEO, (J) THE OPTION TO REMOVE THE PRESIDENT/CEO. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION PROVIDES DATA TO THE SENIOR TREASURY ANALYST OF MISSION HEALTH SYSTEM, INC. THE 990 IS PREPARED AND REVIEWED BY MANAGEMENT PRIOR TO THE REVIEW BY THE ORGANIZATION'S BOARD OF DIRECTORS. AFTER REVIEW BY THE BOARD, AND REVISIONS FOR ANY CLARIFICATIONS OR CORRECTIONS, THE FULL COPY OF THE 990 IS PROVIDED TO THE BOARD PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS CIRCULATES A CONFLICT OF INTEREST POLICY ANNUALLY, REQUIRING ALL VOTING BOARD MEMBERS TO REVIEW, SIGN, AND RETURN. MEMBERS PRESENTING A POTENTIAL CONFLICT OF INTEREST RECUSE THEMSELVES BEFORE ANY DISCUSSION OR VOTE ON A TOPIC THAT INCLUDES AN INTERESTED PARTY OR TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 A RELATED ORGANIZATION DRAWS WAGE COMPARISON DATA FROM OUTSIDE EXECUTIVE COMPENSATION CONSULTANTS TO ENSURE COMPENSATION LEVELS ARE AT FAIR MARKET VALUE THE HUMAN RESOURCES AND COMPENSATION COMMITTEE OF THE RELATED ORGANIZATION(COMMITTEE) REVIEWS THIS DATA AND RECOMMENDS TO THE BOARD OF THE RELATED ORGANIZATION ANY REVISIONS TO THE OVERALL PHILOSOPHY AND POLICY TO GUIDE THE DETERMINATION OF COMPENSATION AND BENEFIT PACKAGES FOR EXECUTIVES WHICH INCLUDES THE CEO, THE CFO, AND PRESIDENT AS WELL AS ALL OTHER EXECUTIVES, WHICH WOULD INCLUDE ALL KEY EMPLOYEES. THE COMMITTEE KEEPS AND DISTRIBUTES MINUTES OF ALL ITS MEETINGS TO ITS MEMBERS. ITEMS OF A SENSITIVE NATURE ARE REFERENCED IN THE MINUTES WITH DETAILED, SUPPORTING DOCUMENTATION RETAINED ON FILE. THE COMMITTEE ALSO DISCLOSES ANY POTENTIAL CONFLICTS OF INTEREST SITUATIONS TO THE COMMITTEE CHAIRMAN THAT MAY AFFECT THEIR INDEPENDENT DIRECTORS' STATUS AS SOON AS THEY ARISE, AND MAINTAINS COMPLETE DOCUMENTATION OF ALL MATTERS DISCUSSED BY THE COMMITTEE. THE COMMITTEE OBTAINS EDUCATION AND TRAINING TO EXERCISE ALL RESPONSIBILITIES EFFECTIVELY AND KEEPS ABREAST OF SIGNIFICANT DEVELOPMENTS IN EXECUTIVE COMPENSATION PRACTICES AND REGULATIONS, AND ENSURES THAT ALL ASPECTS OF MISSION HEALTH SYSTEM AND HOSPITAL EXECUTIVE COMPENSATION ADHERE TO ALL RELEVANT REGULATORY REQUIREMENTS, AND REVIEWS THE COMMITTEE CHARTER ANNUALLY REVISES AS APPROPRIATE AND CONDUCTS AN ANNUAL EVALUATION OF THE COMMITTEE'S PERFORMANCE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ANGEL MEDICAL CENTER'S FY 2015 AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THIS RETURN. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 12,406,749. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,406,749. INTERCOMPANY FEES: PROGRAM SERVICE EXPENSES 1,806,774. MANAGEMENT AND GENERAL EXPENSES 123,602. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,930,376. OTHER FEES: PROGRAM SERVICE EXPENSES 678,029. MANAGEMENT AND GENERAL EXPENSES 46,384. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 724,413. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 544,158. MANAGEMENT AND GENERAL EXPENSES 37,226. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 581,384. 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