2016-08-12T12:41:08-05:00 2015-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-10-01 560529974 CHARLES A CANNON JR MEMORIAL HOSPITAL INC CHAR 8282624100 434 HOSPITAL DRIVE LINVILLE NC 28646 KEVIN B MAY CFO 8282624100 2016-08-12 1 AMY BIBBY P00445891 8282542254 2014 2016-09-27 15:27:22Z CHARLES MANTOOTH 434 HOSPITAL DRIVE LINVILLE NC 28646 25245082 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 12 221 75 0 0 977405 198644 20261110 24772302 96648 -169648 360672 269034 21695835 25070332 0 0 0 0 13220762 13805577 0 0 0 9231951 9762633 22452713 23568210 -756878 1502122 33166674 33724857 16894053 19592506 16272621 14132351 TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE CITIZENS OF AVERY COUNTY. 0 0 18195883 0 24772302 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, NEW LIFE CENTER, OUTPATIENT BEHAVIORAL HEALTH, REHABILITATION CENTER OFFERING PHYSICAL AND OCCUPATIONAL THERAPIES, SLEEP CENTER, AND CARDIOPULMONARY REHABILITATION ROUND OUT THE LIST OF SERVICES. 18195883 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 1 221 1 0 0 0 0 0 0 0 0 0 0 X 15 12 0 1 0 0 0 0 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 KENNETH WILCOX CHAIR 1.00 4.00 X X 0 0 0 JOHN BLACKBURN BOARD VICE CHAIR 1.00 4.00 X X 0 0 0 KEITH TESTER PAST CHAIR 1.00 4.00 X X 0 0 0 PAUL MILLER JR TRUSTEE 1.00 4.00 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 2.00 X 0 0 0 CHARLES BAKER MD TRUSTEE 1.00 41.00 X 0 244293 19303 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 1938 0 THOMAS DALE TRUSTEE 1.00 2.00 X 0 0 0 RICHARD SPARKS CEO ARHS 1.00 44.00 X 0 367274 138266 KEVIN MAY CFO ARHS 1.00 43.00 X 0 291279 28904 CHARLES MANTOOTH CEO CMH 1.00 41.00 X 0 234710 34115 CARMEN LACEY PRESIDENT, CMH 1.00 41.00 X 0 120451 24731 0 1259945 245319 0 0 1 0 0 198644 198644 PATIENT SERVICE REVENUE 621990 24361020 24361020 EHR MEANINGFUL USE 621990 411282 411282 24772302 5102 5102 120192 0 120192 120192 120192 174750 -174750 -174750 -174750 40098 0 40098 40098 CAFETERIA REVENUE 900099 89632 89632 MISCELLANEOUS REVENUE 900099 19112 19112 108744 25070332 24772302 0 99386 X 10823040 9246222 1576818 2339078 1984834 354244 643459 546010 97449 670 670 3195115 2815514 379601 1628 1628 420050 418927 1123 564816 3428 561388 17886 17339 547 2293 2293 267318 267318 1576734 601776 974958 238801 238801 DRUGS & MEDICAL SUPPLIE 1590525 1590525 CORP. ALLOCATIONS 946769 946769 EQUIPMENT RENTAL AND MA 458958 319448 139510 FOOD 181361 181361 299709 227777 71932 23568210 18195883 5372327 0 5300492 1853255 6662114 11155525 543235 553558 85394 90403 35382343 17979838 18163728 17402505 2411711 2669611 33166674 33724857 395392 656762 264234 7114345 7930930 9384316 10740580 16894053 19592506 X 15362806 13222536 909815 909815 16272621 14132351 33166674 33724857 X 1502122 -3642392 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1220002 1220002 21732128 10680116 11052012 4834077 2216351 2617726 7246839 4777236 2469603 349297 306135 43162 17402505 AUWIL 367091 INTEREST IN ARHF 2302520 2669611 DUE TO AFFILIATE 10350026 ESTIMATED THIRD-PARTY SETTLEMENTS -100000 MISCELLANEOUS 458894 CAPITAL LEASE OBLIGATION 31660 10740580 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, 2015. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2012, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. 1 1 1 X 1 X 1 1 1 0 1 1 340148 340148 0.01440 2938267 1657062 1281205 0.05440 3278415 1657062 1621353 0.06880 31464 31464 0.00130 36852 36852 0.00160 68316 68316 0.00290 3346731 1657062 1689669 0.07170 1 1638228 81911 10297805 10297805 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 12 1 1 0 1 X SEE SUPPLEMENTAL INFORMATION X 1 12 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 TASK FORCE INVOLVED CONSISTED OF PUBLIC HEALTH OFFICIALS, HOSPITAL STAFF, APPALACHIAN STATE UNIVERSITY, AND MENTAL HEALTH AND YOUTH ADVOCATES FOR THE COUNTY. COUNTY RESIDENTS WERE INFORMED OF THE ASSESSMENT THROUGH RADIO PUBLIC SERVICE ANNOUNCEMENTS, ADVERTISEMENTS ON AGENCY WEBSITES, AND WORD OF MOUTH. THE SURVEY WAS AVAILABLE ONLINE THROUGH SURVEY MONKEY, AND AT DESIGNATED COMMUNITY AGENCIES INCLUDING COUNTY HEALTH DEPARTMENTS, CHILDCARE CENTERS, COMMUNITY HEALTH CLINICS, AND OTHER HUMAN SERVICE AGENCIES. TELEPHONE INTERVIEWS WERE ALSO UTILIZED SURVEY RESPONDENTS REPRESENTED VARIOUS AGENCIES AND ORGANIZATIONS IN THE COMMUNITY. CHARLES A CANNON JR MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: THE HOSPITAL FACILITY CONDUCTED A CHNA WITH WATAGUA MEDICAL CENTER AND BLOWING ROCK HOSPITAL. 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/DIABETES/PROPER NUTRITION/CHRONIC DISEASE MANAGEMENTACCESS 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-2013.PDF PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CHARLES A CANNON JR MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: HTTPS://WWW.APPRHS.ORG/PATIENTS/FINANCIAL-ASSISTANCE 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. 0 1 0 0 0 0 0 0 0 CHARLES BAKER MD TRUSTEE 0 239553 0 0 0 4740 0 6523 0 12780 0 263596 0 0 RICHARD SPARKS CEO ARHS 0 363710 0 0 0 3564 0 130892 0 7374 0 505540 0 0 KEVIN MAY CFO ARHS 0 288957 0 0 0 2322 0 21530 0 7374 0 320183 0 0 CHARLES MANTOOTH CEO CMH 0 233988 0 0 0 722 0 19664 0 14451 0 268825 0 0 PART I, LINE 4B THE FOLLOWING PERSONS RECEIVED CURRENT YEAR DEFERRED COMPENSATION ACCRUALS FROM NON-QUALIFIED PLANS: - RICHARD SPARKS $113,773 - KEVIN MAY 6,866 - CHUCK MANTOOTH 5,824 - CARMEN LACY 2,850 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 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 REVIEW OF POLICY STATEMENT EACH YEAR. FORM 990, PART VI, SECTION B, LINE 15A INDEPENDENT COMPENSATION AND BENEFIT ANALYSIS WAS PERFORMED BY HLF REWARDS CONSULTING IN APRIL 2013. THE EXECUTIVE COMMITTEE (COMPENSATION COMMITTEE) REVIEWED THIS INFORMATION TO ESTABLISH APPROPRIATENESS OF TOTAL COMPENSATION, COMPLY WITH INTERMEDIATE SANCTION REGULATIONS, AND DETERMINE EXCUTIVE COMPENSATION FOR THE CEO POSITION. FORM 990, PART VI, SECTION C, LINE 19 PROVIDED UPON REQUEST. FORM 990, PART IX, LINE 11G PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 1,084,496. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,084,496. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 1,731,018. MANAGEMENT AND GENERAL EXPENSES 379,601. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,110,619. FORM 990, PART XI, LINE 9: TRANSFERS FROM AFFILIATE -3,642,392. FORM 990, PART XII, LINE 2C: THIS 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 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0