2016-08-15T11:27:05-05:00 2015-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2014-10-01 561484844 WAYNE MEMORIAL HOSPITAL INC WAYN 9197316142 PO BOX 8001 GOLDSBORO NC 27533 REBECCA CRAIG CFO 9197316142 2016-08-12 1 JOHN NORMAN P01506766 7049985200 2016-08-12 2014 2016-09-27 15:27:22Z J WILLIAM PAUGH PO BOX 8001 GOLDSBORO NC 27533 253808864 0 X WWW.WAYNEHEALTH.ORG X 1896 NC TO PROVIDE THE COMMUNITY QUALITY HEALTHCARE SERVICES. 12 11 1939 100 6920 0 805361 807299 228844116 247356207 3808066 4013824 0 1576620 233457543 253753950 117169 144430 0 0 106667563 113261126 0 0 0 115551505 119309287 222336237 232714843 11121306 21039107 285747411 297816262 134706133 151287887 151041278 146528375 THE MISSION OF WAYNE MEMORIAL HOSPITAL IS TO PROVIDE THE COMMUNITY QUALITY HEALTHCARE SERVICES THROUGH THE COMPASSIONATE HANDS OF WELL-TRAINED STAFF IN A TECHNOLOGICALLY ADVANCED, COST-EFFECTIVE MANNER. 0 0 220030851 144430 248925907 PROVIDING COMPASSIONATE PROGRESSIVE HEALTHCARE INCLUDING INPATIENT, OUTPATIENT, INTENSIVE CARE, AND EMERGENCY CARE. 220030851 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 116 0 1 1939 1 1 1 0 0 0 0 0 0 1 1 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X X REBECCA CRAIG CFO 9197316142 PO BOX 8001 GOLDSBORO NC 27533 R DANIEL BOWEN BOARD MEMBER 1.00 X 0 0 0 WILLIAM W BROADAWAY BOARD MEMBER 1.00 X 0 0 0 STEPHEN C LIES MD BOARD MEMBER 1.00 X 0 0 0 SUSAN H MCCALL BOARD MEMBER 1.00 X 0 0 0 RAY MCDONALD JR CHAIRMAN 1.00 X 0 0 0 JAMES C PARKER BOARD MEMBER 1.00 X 0 0 0 CHARLOTTE M WEAVER BOARD MEMBER 1.00 X 0 0 0 J WILLIAM PAUGH CEO 40.00 1.00 X X 847711 0 152067 C MUNROE BEST JR BOARD MEMBER 1.00 X 0 0 0 ARCHIE GURLEY III BOARD MEMBER 1.00 X 0 0 0 TERRY O JORDAN SR BOARD MEMBER 1.00 X 0 0 0 ROBERT WALKER JR BOARD MEMBER 1.00 X 0 0 0 BENJAMIN ESKRA MD BOARD MEMBER 1.00 X 0 0 0 REBECCA CRAIG CFO 40.00 1.00 X 244856 0 65224 THOMAS W BRADSHAW VP - OPERATIONS 40.00 1.00 X 272271 0 72052 RICHARD ROGERS VP - HR 40.00 1.00 X 190501 0 48431 SHIRLEY S HARKEY VP - NURSING SER 40.00 1.00 X 209982 0 56001 RICHARD BAZIK CRNA 40.00 X 214755 0 35291 AMY WILLOUGHBY CRNA 40.00 X 225091 0 37960 RICHARD MIDDLETON CRNA 40.00 X 207317 0 38128 DANIEL P BROCK CRNA 40.00 X 234019 0 18976 PHYLLIS HILL DIRECTOR 40.00 X 229041 0 51228 2875544 0 575358 60 0 1 0 SODEXO INC P O BOX 536922 ATLANTA GA 30353 CONTRACT MGMT 1067786 DIVERSIFIED CLINICAL 28525 NETWORK PLACE CHICAGO IL 60673 CONTRACT MGMT 866054 ARAMARK 24863 NETWORK PLACE CHICAGO IL 60673 CONTRACT MGMT 771656 DANIELS & DANIELS P O BOX 10337 GOLDSBORO NC 27532 CONSTRUCTION 648639 BILLIE BROCK 101 MCKAYLA LANE GOLDSBORO NC 27530 CONSTRUCTION 444163 18 807299 807299 PATIENT REVENUE 621110 239546958 239546958 7809249 7809249 247356207 4068738 4068738 54914 -54914 -54914 -54914 MRI INCOME 621500 1730311 1730311 PREMIER K-1 UBI 900099 6920 6920 LOSS ON REFINANCING 900099 -160611 -160611 1576620 253753950 248925907 6920 4013824 100000 100000 44430 44430 2875544 2875544 79164094 73414616 5749478 8321874 7531296 790578 17103729 15478875 1624854 5795885 5245276 550609 294515 294515 130780 130780 484712 219625 265087 4007189 4007189 3148060 2848995 299065 76621 71771 4850 353399 271035 82364 2074908 2074908 11320100 11303832 16268 613415 613415 MEDICAL SUPPLIES 37693174 37693174 BAD DEBT EXPENSE 21793068 21793068 PURCHASED SERVICES 9584847 9584847 PROFESSIONAL FEES 5275680 5275680 22458819 22458819 232714843 220030851 12683992 0 3975182 4289369 32150480 25339422 4879795 5498101 2052415 2360755 238525204 124962897 113886358 113562307 104042956 114968330 24760225 31797978 285747411 297816262 30844020 31005257 53379685 49720478 50482428 70562152 134706133 151287887 X 150047502 145407617 993776 1120758 151041278 146528375 285747411 297816262 X 21039107 -5380959 -20171051 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 19753 19753 0 PART II-B, LINE 1: A PORTION OF THE DUES THE HOSPITAL PAYS TO THE NORTH CAROLINA HOSPITAL ASSOCIATION ARE ATTRIBUTABLE TO LOBBYING ACTIVITIES. 1 0 132309065 58055020 74254045 106216139 66907877 39308262 113562307 INVESTMENTS 114968330 F 114968330 BOND ISSUANCE COSTS, NET 567984 INVESTMENT IN AFFILIATE 2666666 OTHER RECEIVABLES 4481768 DUE FROM AFFILIATE 22633089 LONG-TERM RECEIVABLES 1448471 31797978 OTHER LIABILITIES 15857957 MINIMUM PENSION LIABILITY 48705679 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 5572787 CAPITAL LEASE OBLIGATIONS 425729 70562152 X PART V, LINE 4: ALL ENDOWMENT FUNDS HELD BY WELLS FARGO ARE USED FOR THE CHARITABLE PURPOSES OF WAYNE MEMORIAL HOSPITAL. PART X, LINE 2: WAYNE MEMORIAL HOSPITAL ("WMH") IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. WMH ADOPTED THE PROVISIONS OF THE INCOME TAX STANDARD THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS. THIS GUIDANCE PRESCRIBES A RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THE ADOPTION OF THIS STANDARD HAD NO IMPACT ON WMH'S FINANCIAL STATEMENTS. 1 1 1 X 1 X 1 1 1 0 1 1 11653686 11653686 0.05010 6726519 6726519 0.02890 18380205 18380205 0.07900 2473384 2473384 0.01060 1917703 1917703 0.00820 713280 713280 0.00310 5104367 5104367 0.02190 23484572 23484572 0.10090 1 432321 432321 0.00190 800 1917703 1917703 0.00820 1 800 2350024 2350024 0.01010 1 X 1 1 1 WAYNE MRI LLC MRI 0.66700 0.33300 1 1 WAYNE MEMORIAL HOSPITAL INC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 X X X WAYNE MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 12 1 0 1 1 EXACT LINK IS: HTTP://WWW.WAYNEHEALTH.ORG/ABOUT/COMMUNITY-OUTREACH/REPORTS X HTTP://WWW.WAYNEGOV.COM/ARCHIVECENTER/VIEWFILE/ITEM/78 X 1 12 0 0 0 1 X 200.000000000000 350.000000000000 X X X X 1 1 X X X 1 X SEE PART VI X SEE PART VI X SEE PART VI X X X X X 1 0 X X X X 1 X 0 0 WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: THE CHNA WAS CONDUCTED IN CONJUCTION WITH WAYNE COUNTY DEPARTMENT OF HEALTH. THE CHNA TEAM ELICITED FEEDBACK FROM KEY STAKEHOLDER GROUPS BY CONDUCTING FOCUS GROUPS IN UNDER REPRESENTED GROUPS, AS WELL AS CONDUCTING A HEALTH OPINION SURVEY. THE HEALTH OPINION SURVEY WAS ADAPTED FROM THE COMMUNITY HEALTH ASSESSMENT GUDEBOOK, NC DIVISION OF PUBLIC HEALTH AND WAS SIMILAR TO THE 2012 SURVEY. MORE THAN 500 PEOPLE SUBMITTED THEIR OPINIONS.THE STAKEHOLDER GROUPS MET PERIODICALLY AND SCHEDULED EXTRA MEETINGS, IN EARLY 2016, TO COMPLETE THE PROCESS. SIX FOCUS GROUPS WERE HELD IN SPECIFIC LOCATIONS TO DISCOVER THE COMMUNITY MEMBER'S PERCEPTION AND SUGGESSTIONS FOR IMPROVING HEALTH WITHIN THE COMMUNITY. THERE WERE A TOTAL OF 53 FOCUS GROUP PARTICIPANTS. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 6B: REPRESENTATIVES FROM THE WAYNE COUNTY HEALTH DEPARTMENT, WAYNE MEMORIAL HOSPITAL, WAYNE COUNTY BOARD OF HEALTH, WATCH AND ECU COOPERATIVELY CONDUCTED THE COMMUNITY HEALTH ASSESSMENT. THE COLLABORATION IDENTIFIED THE TYPES AND SOURCES OF DATA TO BE COLLECTED, DETERMINED THE METHODS FOR COLLECTING INPUT FROM THE COMMUNITY AND KEY STAKEHOLDERS CONCERNING HEALTH RELATED ISSUES AS WELL AS COMMUNICATING THIS INFORMATION TO THE VARIOUS STAKEHOLDERS IN ORDER TO PRIORITIZE COMMUNITY HEALTH CONCERNS. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: FISCAL YEAR 2016 WAS A 9 MONTH SHORT YEAR ENDING JUNE 30, 2016. THE YEAR END WAS CHANGED TO ALIGN WITH THE FISCAL YEAR OF UNC HOSPITALS, THE ORGANIZATION'S MANAGING HOSPITAL. THE ORGANIZATION'S BOARD WILL ADOPT THE IMPLEMENTATION PLAN TO ADDRESS THE 2015 CHNA AT ITS SEPT 14, 2016 MEETING, WHICH IS WITHIN THE OLD 12-MONTH FISCAL YEAR TIMELINE THAT THE ORGANIZATION ALWAYS FOLLOWED IN ADOPTING CHNAS AND IMPLEMENTATION PLANS. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16I: ALL SELF PAY INPATIENTS RECEIVE VISITS FROM FINANCIAL COUNSELORS, AND THE CHARITY POLICY IS REVIEWD AT THAT TIME. SELF PAY OUTPATIENTS ARE SENT LETTERS OFFERING FINANCIAL ASSISTANCE. IF WE CAN IDENTIFY CHARITY STATUS AT TIME OF VISIT (BASED ON PATIENT) NO BILL IS SENT. WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 22D: UNISURED PATIENTS ARE BILLED THE SAME CHARGES AS INSURED PATIENTS. HOWEVER, A 16% DISCOUNT IS APPLIED FOR UNINSURED PATIENTS AND FOR PATIENTS WHO QUALIFY FOR CHARITY. THE REMAINING 84% IS ADJUSTED. PART V, SECTION B, LINE 16A, FAP WEBSITE HTTP://WWW.WAYNEHEALTH.ORG/PATIENTS/PATIENT-FINANCIAL-SERVICES/WAYNE-MEDICAL-ASSISTANCE-PROGRAM/ PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE HTTP://WWW.WAYNEHEALTH.ORG/WP-CONTENT/UPLOADS/2015/07/WMAP-APPLICATION-UPDATED-062014.PDF PART V, SECTION B, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE HTTP://WWW.WAYNEHEALTH.ORG/PATIENTS/PATIENT-FINANCIAL-SERVICES/WAYNE-MEDICAL-ASSISTANCE-PROGRAM/ PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16A WEBSITE: SEE PART VI WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16B WEBSITE: SEE PART VI WAYNE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 16C WEBSITE: SEE PART VI 3 WAYNE MRI LLC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 MRI GOLDSBORO WOUND CARE CENTER 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 WOUND CARE KINSTON WOUND CARE CENTER 204 AIRPORT ROAD KINSTON NC 28504 WOUND CARE PART I, LINE 3C: WAYNE MEMORIAL MANAGEMENT USES 200% OF FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR PATIENTS WHO PROVIDES INFOMRATION TO US. WE ALSO USE A PROPRIETARY CREDIT SCORING TOOL TO FURTHER DETERMINE ELIGIBILITY AND FOR NON-COMPLIANT PATIENTS. THIS PROPRIETARY TOOL USES ALGORITHMS, CONSUMER DATA, AND OTHER INFORMATION TO ASSIST WITH UNDERSTANDING PATIENT'S ABILITY TO PAY. 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): FOR PURPOSES OF CALCULATING THE COMMUNITY BENEFIT PERCENTAGE IN PART I, COLUMN (F), THE ORGANIZATION SUBTRACTED $21,818,418 (WHICH WAS REPORTED ON FORM 990, PART IX, LINE 25) AS BAD DEBT EXPENSE). PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL SURVEYS THE NEEDS OF THE MEDICAL COMMUNITY (PROVIDERS) TO ENABLE THE BOARD OF DIRECTORS TO ADOPT A MEDICAL STAFF DEVELOPMENT PLAN, FROM WHICH THEY DETERMINE RECRUITMENT TARGETS. IN THE CURRENT ENVIRONMENT, HOSPITALS ARE WORKING WITH MEDICAL STAFFS TO MEET THE NEED FOR PRIMARY CARE, AS WELL AS SPECIALTY CARE. THE HOSPITAL HAS PROVIDED SUPPORT IN THE FORM OF LOANS TO DOCTORS NEW TO THE AREA FOR THE FIRST YEAR OF PRACTICE, WHICH ARE FORGIVEN AS THESE PHYSICIANS STAY AND MEET COMMUNITY NEEDS.WAYNE MEMORIAL HOSPITALS EMPLOYS MORE THAN 700 REGISTERED NURSES, PLUS OTHER LICENSED HEALTH PROVIDERS (LAB TECHNOLOGISTS, IMAGING TECHNOLOGISTS, PHARMACISTS, PHARMACY TECHNOLOGISTS) TO CARE FOR RESIDENTS OF WAYNE COUNTY WHO NEED HOSPITAL SERVICES. IN SUPPORT OF THIS MISSION, THE HOSPITAL HAS CONTRIBUTED SCHOLARSHIP FUNDS TO ENABLE STUDENTS AT WAYNE COMMUNITY COLLEGE TO PURSUE DEGREES IN HEALTH SCIENCES. NURSES FROM WAYNE MEMORIAL ARE A VITAL PART OF SCHOOL-BASED HEALTH, AND ARE ALSO PART OF MANY LOCAL BUSINESSES WHICH SEE THE VALUE OF HAVING ON-SITE HEALTH EXPERTISE IN KEEPING THEIR EMPLOYEES PRODUCTIVE AND WELL. EDUCATING OUR LOCAL WORKFORCE IS A PRIORITY OF THIS HOSPITAL, IN TERMS OF CARE OF PATIENTS, AND CREATING A CULTURE OF WELLNESS WITHIN OUR COMMUNITY, BOTH AT SCHOOLS, IN BUSINESSES AND IN HOMES. PART III, LINE 4: THE HOSPITAL USES HISTORICAL COLLECTION EXPERIENCE AND A REVIEW OF CURRENT RECEIVABLES TO PROVIDE AN ESTIMATE OF THE ALLOWANCE FOR UNCOLLECTIBLES AND THE BAD DEBT EXPENSE. ACCOUNTS PAST DUE FOR MORE THAN 90 DAYS ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IF DEEMED UNCOLLECTIBLE, ACCOUNTS ARE REFERRED TO ONE OF TWO OUTSIDE COLLECTION AGENCIES UNLESS THE ACCOUNT IS BEING REVIEWED UNDER THE HOSPITAL'S CHARITY POLICY. THE HOSPITAL PROVIDES SERVICES TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS A RESULT, THE HOSPITAL HAS INCURRED LOSSES FROM BAD DEBT EXPENSE. THESE UNREIMBURSED SERVICES ARE CONSIDERED A COMMUNITY BENEFIT SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE BE UNMET. NOTE 2 ON PAGE 18 OF THE AUDITED FINANCIAL STATEMENTS DISCUSSES BAD DEBTS.PART III, SECTION A, LINE 2:THE AMOUNT ON LINE 2 WAS DERIVED BY TAKING THE BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS AND MULTIPLYING IT BY THE RATIO OF PATIENT CARE COST TO CHARGES DERIVED USING WORKSHEET 2 OF THE IRS INSTRUCTIONS FOR SCHEDULE H.PART III, SECTION A, LINE 3:THE HOSPITAL DOES NOT HAVE A PROCESS IN PLACE THAT ESTIMATES THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER A FINANCIAL ASSISTANCE POLICY. PART III, LINE 8: THE HOSPITAL PROVIDES SERVICES TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS A RESULT, THE HOSPITAL HAS INCURRED LOSSES BY SERVING MEDICARE PATIENTS. THE UNREIMBURSED SERVICES THE HOSPITAL PROVIDES TO PATIENTS COVERED BY MEDICARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE BE UNMET.PART III, SECTION B, LINE 8:THE COST TO CHARGE RATIO AS CALCULATED BY THE MOST RECENTLY FILED COST REPORT WAS USED TO DETERMINE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: OUR COLLECTION POLICY INDICATES OUR USE OF A CREDIT SCORING TOOL WHICH ASSISTS OUR COLLECTION STAFF IN THE IDENTIFICATION OF PATIENTS THAT QUALIFY FOR UNCOMPENSATED CARE. PART VI, LINE 2: WAYNE MEMORIAL HOSPITAL ROUTINELY CONDUCTS A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WITH THE WAYNE COUNTY HEALTH DEPARTMENT. IN 2015, A JOINT CHNA WAS BEGUN, WHICH CONCLUDED IN THE FALL OF 2015, AND WAS REPORTED TO THE COMMUNITY IN SUMMER 2016, PART OF THE HOSPITAL'S FYE 9/30/2016. AS PART OF THIS CHNA, AN ELECTRONIC AND PAPER SURVEY WAS CONDUCTED, WITH MORE THAN 500 RESPONSES. FOCUS GROUPS WERE CONVENED IN 6 DIFFERENT SETTINGS (DIVERSE IN GEOGRAPHY AND CULTURE) TO ADD MORE UNDERSTANDING. ACTIONS ARE BEING COORDINATED AND TAKEN BY KEY CONSTITUENTS FROM WAYNE COUNTY, IN PARTNERSHIP WITH THE WAYNE COUNTY HEALTH DEPARTMENT, THE CITY OF GOLDSBORO, THE HOSPITAL AND OTHER AGENCIES TO ENCOURAGE GOOD HEALTH COUNTY-WIDE.FINDINGS FROM THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT SHOWED SIGNIFICANT OVERLAP WITH THOSE FROM THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT. OBESITY CONTINUES TO BE THE SINGLE MORE PERVASIVE HEALTH ISSUE IN WAYNE COUNTY, FOLLOWED BY CHRONIC DISEASES. TOGETHER, THESE ARE TAKING A HEAVY TOLL ON WAYNE COUNTYS HEALTH. MORE THAN 12% OF WAYNE COUNTY ADULTS ARE DIAGNOSED WITH DIABETES. OBESITY HAS BEEN SHOWN TO CONTRIBUTE TO THE LEADING CAUSES OF DEATH INCLUDING HEART DISEASE, SOME CANCERS, AND DIABETES. THE PERCENTAGE OF OVERWEIGHT AND OBESE ADULTS IN WAYNE COUNTY HAS INCREASED TO MORE THAN 70% - MORE THAN 65,000 PEOPLE. IN RESPONSE TO THIS ISSUE, COMMUNITY PARTNERS HAVE COME TOGETHER TO FORM THE "HEALTHY WAYNE TASK FORCE", WHICH HAS PLACE HEALTHY LIVING AT ITS CENTER. ITS FIRST INITIATIVE, BEGUN IN THE SUMMER OF 2013, IS CALLED GOWAYNEGO. INITIAL EFFORTS HAVE BEEN TO CENTRALIZE COMMUNICATIONS TO LOCAL CITIZENS ABOUT THE IMPORTANCE OF INCREASING DAILY MOVEMENT, AND EDUCATING CITIZENS ABOUT FREE AND LOW-COST WAYS TO GET MORE ACTIVE IN WAYNE COUNTY. MORE THAN 3,000 T-SHIRTS WITH THE GOWAYNEGO LOGO HAVE BEEN DISTRIBUTED TO WAYNE COUNTY RESIDENTS, AND A WEBSITE HAS BEEN SET UP TO ENCOURAGE GETTING ROUTINE EXERCISE. PARTNERS IN THE HEALTHY WAYNE TASK FORCE INCLUDE WAYNE COUNTY HEALTH DEPARTMENT, WAYNE HEALTH FOUNDATION (DBA WATCH), GOLDSBORO FAMILY YMCA, CITY OF GOLDSBORO PARKS & RECREATION DEPARTMENT, UNITED WAY OF WAYNE COUNTY, SEYMOUR JOHNSON AIR FORCE BASE, GOLDSBORO PEDIATRICS, PARTNERSHIP FOR CHILDREN OF WAYNE COUNTY, WAYNE INITIATIVE FOR SCHOOL HEALTH, AND OTHERS. HEALTH LITERACY AND MENTAL HEALTH WERE THE OTHER MOST SIGNIFICANT ISSUES COMING OUT OF THE 2015 COMMUNITY HEALTH ASSESSMENT. A SUMMARY OF ALL INITIATIVES SELECTED, RESOURCES, USED, AND EVALUATION OF RESULTS IS INCLUDED AT WWW.WAYNEHEALTH.ORG.HEALTH LITERACY IS AN ISSUE IN RURAL AREAS LIKE EASTERN NORTH CAROLINA. IN WAYNE COUNTY, 10% OF ADULTS ARE NON-READERS, AND 26% STRUGGLE WITH BASIC LITERACY. WAYNE MEMORIAL HOSPITAL HAS A TEAM OF NURSES AND TRAINERS WORKING TO INCORPORATE MORE UNDERSTANDABLE DISCHARGE INSTRUCTIONS FOR PATIENTS AND FAMILIES, TO REDUCE THE NUMBERS OF PATIENTS WHO MUST RETURN TO THE HOSPITAL SOON AFTER DISCHARGE FOR PROBLEMS THAT MIGHT NOT HAVE ARISEN IF THERE WERE BETTER UNDERSTANDING OF FOLLOW UP CARE. THIS TEAM IS USING RESOURCES DEVELOPED FROM AROUND THE COUNTRY TO TRY TO GET IMPROVED RESULTS (LOWER READMISSIONS). WITH RESPECT TO TEACHING READING SKILLS, IN WAYNE COUNTY, LITERACY CONNECTIONS OF WAYNE COUNTY IS A NON-PROFIT AGENCY CREATED TO IMPROVE ADULT LITERACY. LITERACY CONNECTIONS PROVIDES FREE, CONFIDENTIAL, ONE-ON-ONE TUTORING FOR ADULTS TO IMPROVE THEIR READING SKILLS. IT IS SUPPORTED BY WAYNE COUNTY GOVERNMENT, AND UNITED WAY OF WAYNE COUNTY. IN SCHOOLS, WAYNE MEMORIAL PROVIDES AN AWARD-WINNING QUARTERLY "KIDS PAGE" TO EACH ELEMENTARY STUDENT TO ENCOURAGE HEALTH LITERACY. MENTAL HEALTH IS AN ISSUE THAT CONTINUES TO IMPACT HEALTH CARE IN OUR COMMUNITY, OUR STATE AND THE ENTIRE COUNTRY. IN RECOGNITION OF THE SPECIAL NEEDS OF PATIENTS WITH BEHAVIORAL HEALTH ISSUES, THE HOSPITAL DESIGNED ITS NEW EMERGENCY DEPARTMENT (OPENED IN 2012) TO ENABLE SEPARATION OF PATIENTS WITH MENTAL ISSUES FROM PATIENTS WITH PHYSICAL HEALTH ISSUES. THE OBJECTIVE WAS TO GIVE THESE PATIENTS AN AREA WHERE THEY CAN BE CARED FOR IN A CALM CONTROLLED ENVIRONMENT, WHERE THEY AND THOSE THAT ARE CARING FOR THEM CAN BE SAFE. IN ADDITION, THE HOSPITAL'S PARENT ORGANIZATION, WAYNE HEALTH CORPORATION, RECOGNIZING THE NEED TO REPLACE PSYCHIATRISTS WHO WERE APPROACHING RETIREMENT, RECRUITED THREE ADDITIONAL PSYCHIATRISTS, EMPLOYED BY HOSPITAL'S SISTER ORGANIZATION, WAYNE HEALTH PHYSICIANS, TO SEE PATIENTS IN OFFICES AS OUTPATIENTS, PLUS TREAT PATIENTS ADMITTED TO THE INPATIENT UNIT. A SUMMARY OF ALL INITIATIVE SELECTED, RESOURCES USED, AND EVALUATION OF RESULTS IS INCLUDED AT WWW.WAYNEHEALTH.ORG. PART VI, LINE 3: WE HAVE FINANCIAL COUNSELORS THAT ASSIST WHILE THEY ARE PATIENTS. WE ALSO SEND FINANCIAL ASSISTANCE LETTERS TO PATIENTS THAT WE ARE UNABLE TO SEE WHILE THEY ARE IN-HOUSE. WE ALSO PROVIDE INFORMATIONAL PAMPHLETS AND HAVE INFORMATION AVAILABLE ON THE HOSPITAL WEBSITE. PART VI, LINE 4: WAYNE MEMORIAL HOSPITAL SERVES PRIMARILY WAYNE COUNTY,NORTH CAROLINA, WITH AN ESTIMATED POPULATION WAS 124,000 IN 2015, ACCORDING TO THE US CENSUS QUICKFACTS. THE POPULATION IS SLIGHTLY YOUNGER THAN THE AVERAGE IN NORTH CAROLINA, LIKELY DUE TO THE PRESENCE OF SEYMOUR JOHNSON AIR FORCE BASE, WITH ABOUT 6,000 ACTIVE DUTY AND RESERVISTS PLUS THEIR FAMILIES. AVERAGE HOUSEHOLD INCOME IN WAYNE COUNTY IS LOWER, AT $41,172, THAN NORTH CAROLINA'S AVERAGE OF $46,693. CHILDREN LIVING IN POVERTY IN WAYNE COUNTY, (AVERAGE 2010-2014) IS HIGHER, AT 35%, COMPARED TO NORTH CAROLINA'S AVERAGE OF 26%. WAYNE COUNTY'S POPULATION IS 51.1% WHITE, 32% BLACK, AND 11.2% HISPANIC. THE COUNTY IS LARGE, AT 553 SQUARE MILES, AND IT IS THE 4TH LARGEST AGRICULTURAL PRODUCER IN THE STATE. POVERTY IMPACTS ACCESS TO CARE, WITH EMERGENCY DEPARTMENT USE HIGHER IN AREAS WITH HIGHER PROVERTY, AND SHORTER LIVES ON AVERAGE. PART VI, LINE 5: WAYNE MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF, WHICH MEANS THAT ANY PHYSICIAN WHO MEETS QUALITY STANDARDS SET BY A COMMITTEE OF THE HOSPITAL (WHICH INCLUDES BOARD MEMBERS) IS WELCOME TO JOIN THE STAFF, IN RETURN FOR CERTAIN RESPONSIBILITIES RELATED TO PROVIDING CARE TO PATIENTS SEEN IN THE EMERGENCY DEPARTMENT WHO NEED INPATIENT CARE. THE BOARD OF DIRECTORS IS COMPRISED ON 12 CITIZENS OF WAYNE COUNTY, INCLUDING THE CEO, WHO ARE CHARGED WITH ENSURING THAT QUALITY, EFFICIENT CARE IS PROVIDED AT THE HOSPITAL, AND FOR ENSURING PLANNING, WITH COMMUNITY PARTNERS, FOR FUTURE HEALTH NEEDS. PART VI, LINE 6: AS THE PROVIDER OF CARE WITHIN THE COMMUNITY WITH THE MOST DIVERSE AND SOPHISTICATED EQUIPMENT, THE BOARD, MANAGEMENT AND STAFF OF WAYNE MEMORIAL HOSPITAL SEES ITS ROLE AS BOTH COORDINATOR OF CARE FOR THOSE WHO ARE THE SICKEST IN OUR COMMUNITY AS WELL AS PROMOTER OF HEALTHY LIVING FOR ALL RESIDENTS, IN COORDINATION WITH OUR PARTNERS IN HEALTH THROUGHOUT WAYNE COUNTY. THE HOSPITAL HAS TWO PRIMARY AFFILIATES THAT ARE INTEGRAL TO COMMUNITY HEALTH. ONE IS WAYNE HEALTH FOUNDATION,DBA "WATCH", WHICH HAS OPERATED A MOBILE VAN FOR UNINSURED SINCE THE 1990'S, ADDED TWO FIXED CLINICS SINCE 2009, AND WHOSE OTHER PRIMARY FOCUS HAS BEEN ADDRESSING COMMUNITY NEEDS IDENTIFIED IN FREQUENT HEALTH NEEDS ASSESSMENTS SINCE THAT TIME. THE SECOND SISTER CORPORATION, WAYNE HEALTH PHYSICIANS, WAS ORGANIZED IN 2009 TO HELP MEET THE NEEDS FOR PRIMARY AND SPECIALTY PHYSICIAN CARE IN WAYNE COUNTY. THIS WAS IN RESPONSE TO NATIONAL TRENDS THAT SHOWED PHYSICIANS SEEKING EMPLOYMENT IN SYSTEM ENVIRONMENTS TO ALLOW THEM MORE FOCUS ON PATIENT CARE, AND LESS ON THE BUSINESS ASPECTS OF MEDICAL PRACTICES. THIS COMPANY IS PROVIDING AN AVENUE TO WORK TOWARD LOWER OVERALL HEALTH CARE COSTS THROUGH BETTER COORDINATION OF CARE, WITH THE OBJECTIVE OF PROVIDING SERVICES TO PATIENTS IN THE LOWEST COST SETTING. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 THE FOUNDATION OF WAYNE COMMUNITY COLLEGE PO BOX 8002 GOLDSBORO NC 27533 561556512 501(C)(3) 100000 NURSING SCHOLARSHIPS 1 EDUCATIONAL SCHOLARSHIPS 32 44430 ADDITIONAL COURSE STUDY PART I, LINE 2: WAYNE MEMORIAL HOSPITAL, INC. MAKES GRANTS TO SUPPORT THE ACTIVITIES OF ITS RELATED ORGANIZATIONS AND TO PROMOTE GOOD COMMUNITY RELATIONS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 J WILLIAM PAUGH CEO 544834 0 76847 0 226030 0 94745 0 57322 0 999778 0 0 0 REBECCA CRAIG CFO 232336 0 11617 0 903 0 47590 0 17634 0 310080 0 0 0 THOMAS W BRADSHAW VP - OPERATIONS 258398 0 12920 0 953 0 36718 0 35334 0 344323 0 0 0 RICHARD ROGERS VP - HR 173514 0 6940 0 10047 0 18142 0 30289 0 238932 0 0 0 SHIRLEY S HARKEY VP - NURSING SER 200824 0 10041 0 -883 0 38870 0 17131 0 265983 0 0 0 RICHARD BAZIK CRNA 214755 0 0 0 0 0 20402 0 14889 0 250046 0 0 0 AMY WILLOUGHBY CRNA 225091 0 0 0 0 0 21384 0 16576 0 263051 0 0 0 RICHARD MIDDLETON CRNA 207317 0 0 0 0 0 6472 0 31656 0 245445 0 0 0 DANIEL P BROCK CRNA 234019 0 0 0 0 0 7015 0 11961 0 252995 0 0 0 PHYLLIS HILL DIRECTOR 229041 0 0 0 0 0 21759 0 29469 0 280269 0 0 0 PART I, LINE 1A LESS THAN $300 PAID ANNUALLY. PART I, LINE 1B CERTAIN DUES AND FEES AND COMPANION TRAVEL ARE REIMBURSED BY THE ORGANIZATION. PART I, LINE 4B J. WILLIAM PAUGH PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AND RECEIVED $100,093 IN PAYMENTS FROM THE PLAN DURING THE YEAR. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HB93 2009-03-19 35720000 REFUND PRIOR BONDS 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2015-07-21 17455000 0 0 0 A 3705000 35720000 400705 219295 35100000 2009 1 0 1 1 B 17455000 1 0 1 1 A 0 0 1 1 0 0.03990 0.03990 0 0 1 B 0 1 1 1 0 0.02590 0.02590 0 0 1 A 0 0 0 0 1 1 WELLS FARGO 21.000000000000 0 0 0 0 0 B 0 0 1 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF FORM 990 IS MADE AVAILABLE TO THE GOVERNING BODY FOR REVIEW BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL PERSONNEL ARE RESPONSIBLE FOR ADHERING TO THE CORPORATE COMPLIANCE PLAN. THIS PLAN REQUIRES PERSONNEL TO DISCLOSE CONFLICTS AS THEY ARISE. VOTING MEMBERS OF THE GOVERNING BODY ARE RECUSED FROM VOTING WHEN A CONFLICT ARISES. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS REVIEWED AGAINST COMPARABILITY DATA AND APPROVED BY THE BOARD. WRITTEN COMPENSATION AGREEMENTS ARE KEPT UP-TO-DATE. OFFICER AND KEY EMPLOYEE COMPENSATION IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE CORPORATE COMPLIANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE. ADDITIONALLY, THE AUDITED FINANCIAL STATEMENTS ARE AVAILABLE ON WWW.DACBOND.COM AND WWW.GUIDESTAR.ORG. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -680,317. CHANGE IN MINIMUM PENSION LIABILITY -17,367,299. CHANGE IN VALUE OF DERIVATIVE FINANCIAL INSTRUMENT -2,116,515. DISTRIBUTIONS FROM MEMBERS PREMIER K-1 UBI NOT REFLECTED IN AUDIT REPORT -6,920. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. AMERICAN MANAGEMENT ASSOCIATES LLC 2719 GRAVES DRIVE GOLDSBORO NC 27534 561622637 COLLECTIONS NC 972763 926771 N/A WAYNE HEALTH FOUNDATION INC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 581881912 SUPPORT NC 501(C)(3) LINE 9 N/A 0 WAYNE HEALTH CORPORATION PO BOX 8001 GOLDSBORO NC 27534 561479733 HEALTHCARE NC 501(C)(3) LINE 11A, I N/A 0 WAYNE HEALTH PHYSICIANS 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 264291056 HEALTHCARE NC 501(C)(3) LINE 9 N/A 0 WAYNE MRI LLC 2700 WAYNE MEMORIAL DRIVE GOLDSBORO NC 27533 342043934 MRI SERVICES NC N/A RELATED 0 1 0.66670 WAYNE HEALTH ENTERPRISES INC PO BOX 8001 GOLDSBORO NC 27533 561622624 NC WAYNE MEMORIAL HOSPITAL INC C -3338 400563 1.00000 1 WAYNE HEALTH PROPERTIES PO BOX 8001 GOLDSBORO NC 27533 561756076 NC WAYNE HEALTH ENTERPRISES C 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 1 WAYNE HEALTH CORPORATION K ACTUAL CASH TRANSFER WAYNE HEALTH PHYSICIANS D ACTUAL CASH TRANSFER