2016-04-26T12:50:22-05:00 2015-06-30 990 2014-07-01 540566029 NORTON COMMUNITY HOSPITAL INC NORT 2766799600 100 15TH STREET NW NORTON VA 24273 KEVIN MORRISON CFO 2766799600 2016-04-26 2014 2016-08-17 19:52:53Z MARK LEONARD 100 15TH STREET NW NORTON VA 24273 66755805 false X WWW.MOUNTAINSTATESHEALTH.COM/NCH X 1949 VA NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. 13 3 537 17 60502 47423 11240 149982 64087799 65110726 1265555 995576 26834 378428 65391428 66634712 86652 25350 0 34144220 34341990 0 0 29251782 27166307 63482654 61533647 1908774 5101065 90682634 96638270 36935287 39042998 53747347 57595272 X NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. false false 53481413 25350 65258556 NORTON COMMUNITY HOSPITAL (NCH) IN NORTON, VIRGINIA, IS A NOT-FOR-PROFIT, 129-BED ACUTE-CARE FACILITY SERVING SOUTHWEST VIRGINIA AND SOUTHEASTERN KENTUCKY SINCE 1949. NCH IS A SUBSIDIARY OF MOUNTAIN STATES HEALTH ALLIANCE. NCH IS THE SOLE OWNER OF DICKENSON COMMUNITY HOSPITAL, LOCATED IN CLINTWOOD, VIRGINIA. (CONT'D ON SCHEDULE O) (CONT'D) AS THE LARGEST HEALTHCARE FACILITY IN THE COALFIELD REGION, NCH PROVIDES A WIDE ARRAY OF SERVICES THROUGH HIGHLY TRAINED PHYSICIANS AND SUPPORT STAFF. NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. FOR THE YEAR ENDING JUNE 30, 2015, NCH RECORDED 12,477 INPATIENT ADMISSIONS, AND PROVIDED FOR 133,724 OUTPATIENT VISITS. THERE WERE 22,953 EMERGENCY VISITS, AND 12,304 HOME HEALTH VISITS. OUR HOSPITAL SAW SIGNIFICANT VOLUME INCREASES IN A NUMBER OF SERVICE LINES DURING FY15. FOR EXAMPLE, INPATIENT REHABILITATION OCCUPANCY INCREASED MORE THAN 8%, WHILE OUR SKILLED NURSING PATIENT DAYS INCREASED BY 15%. ENDOSCOPIES ROSE ALMOST 5%, THE EMERGENCY DEPARTMENT SAW VISITS INCREASE BY NEARLY 7%, OUTPATIENT REHAB PROCEDURES ROSE 18%, AND WE PERFORMED 22% MORE SLEEP STUDIES. NCH IS A MEMBER OF VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION AND IS ACCREDITED BY THE AMERICAN OSTEOPATHIC ASSOCIATION (AOA). OUR HOSPITAL WAS THE FIRST AOA ACCREDITED TEACHING FACILITY IN THE STATE OF VIRGINIA. NORTON COMMUNITY HOSPITAL OFFERS A FULL ARRAY OF PRIMARY CARE AND SPECIALTY SERVICES AS WELL AS SEVERAL AMENITIES THAT MAKE US THE HOSPITAL OF CHOICE FOR RESIDENTS IN OUR AREA. OUR TEAM APPROACH TO HEALTH CARE REFLECTS OUR COMMITMENT TO KEEPING OUR PATIENTS AT THE CENTER OF EVERYTHING WE DO. SEVERAL MAJOR PROJECTS WERE ANNOUNCED BY MOUNTAIN STATES HEALTH ALLIANCE LEADERSHIP THIS YEAR THAT WILL BROADEN AND ENHANCE KEY SERVICES AT NCH, INCLUDING A RENOVATED AND EXPANDED EMERGENCY ROOM AT THE HOSPITAL AND A NEW 39,000-SQUARE FOOT MEDICAL COMPLEX THAT WILL BE HOME TO KEY OUTPATIENT SERVICES LIKE REHABILITATION, OCCUPATIONAL MEDICINE, PHARMACY, SURGERY AND ORTHOPEDIC SERVICES, AS WELL AS A NEW WELLNESS CENTER. THESE PROJECTS ARE EXPECTED TO BE COMPLETED NEXT YEAR. RENOVATION AND EXPANSION OF THE EMERGENCY DEPARTMENT WILL INCLUDE SIX ADDITIONAL EXAM ROOMS AND A CENTRALIZED PROVIDER STATION THAT WILL IMPROVE COMMUNICATION, DEPARTMENT EFFICIENCY AND PATIENT FLOW. A NEW URGENT CARE OFFICE WILL WORK IN CONJUNCTION WITH THE ER BY PROVIDING A QUICK, CONVENIENT OPTION FOR PATIENTS WHOSE CONCERNS ARE NOT LIFE THREATENING. AMBULANCE BAYS WILL BE IMPROVED FOR BETTER ACCESS AND FASTER CARE. IN ADDITION, NCH WILL OFFER TELEMEDICINE SERVICES - CONNECTING PATIENTS AND PROVIDERS AT THE HOSPITAL WITH OTHER MSHA-AFFILIATED EXPERTS AT DIFFERENT FACILITIES, MOST NOTABLY NISWONGER CHILDREN'S HOSPITAL (NISWONGER). CHILDREN WHO VISIT THE ER AT NCH WILL HAVE DIRECT ACCESS TO THE PEDIATRIC EMERGENCY PHYSICIANS AT NISWONGER VIA TWO-WAY, LIVE VIDEO. THE NEW TELEMEDICINE SERVICE WILL OFFER A HIGHER LEVEL OF SPECIALTY CARE FOR PATIENTS WITHOUT THEM NEEDING TO TRAVEL OUTSIDE THE AREA. DURING THE YEAR, MSHA HOSPITALS, INCLUDING NCH, WENT THROUGH SURPRISE DRILLS TO TEST READINESS FOR POTENTIAL EBOLA PATIENTS, AND THE RESULTS WERE IMPRESSIVE. PARTNERS FROM THE VIRGINIA DEPARTMENT OF HEALTH SERVED AS EVALUATORS AT OUR VIRGINIA DRILLS. FOR SEVERAL MONTHS, OUR HOSPITALS PLACED AN INTENSE FOCUS ON TRAINING TO IDENTIFY AND ISOLATE A SUSPECTED EBOLA PATIENT. A PRIMARY GOAL WAS TO ENSURE THAT ASKING TRAVEL QUESTIONS AT THE POINT OF REGISTRATION WAS HARDWIRED INTO THE REGULAR REGISTRATION PROCESS. NCH RECEIVED NATIONAL RECOGNITION BY BECKER'S HOSPITAL REVIEW FOR HIGH QUALITY CARE OF PNEUMONIA PATIENTS AND BEING AMONG THE NATION'S 53 HOSPITALS WITH THE BEST OUTCOME FOR PNEUMONIA PATIENTS. USING DATA OBTAINED FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, BECKER'S IDENTIFIED 53 HOSPITALS IN THE U.S. WHOSE PNEUMONIA PATIENTS HAD A 30-DAY MORTALITY RATE AT OR BELOW 8.4, WHICH IS WELL BELOW THE NATIONAL AVERAGE OF 11.9. FOR THE SECOND YEAR IN A ROW, NCH PROVIDED 400 LUNCHES TO PATIENTS ATTENDING THE REMOTE AREA MEDICAL (RAM) EVENT IN LEE COUNTY. THE RAM EVENT TOOK PLACE OVER A TWO-DAY PERIOD OFFERING FREE DENTAL, VISION AND MEDICAL CARE TO THOSE IN NEED. NCH TEAM MEMBERS DISTRIBUTED THE FREE LUNCHES TO PATIENTS THE FIRST DAY OF THE RAM EVENT. NCH TAKES GREAT PRIDE IN TRAINING YOUNG PHYSICIANS FOR OUR RURAL, MEDICALLY UNDERSERVED AREA. THE RESIDENCY PROGRAM HAS RESULTED IN AN INCREASE IN QUALITY PRIMARY CARE FOR SOUTHWEST VIRGINIA AND THE SURROUNDING AREA AND THE GROWTH OF OUR HOSPITAL. NCH OFFERS THE BENEFITS OF RURAL LIVING WITH THE OPPORTUNITY TO TRAIN IN A MODERN AND PROGRESSIVE HOSPITAL. INTERNAL MEDICINE RESIDENTS ROTATE THROUGH ALL AREAS OF MEDICINE, FROM HEALTH MAINTENANCE TO CRITICAL CARE. THE RESIDENTS ASSIST OUR PHYSICIANS IN PROVIDING QUALITY HANDS-ON PATIENT CARE THROUGH OBSERVATION, EDUCATION AND BY PARTICIPATING IN GRAND ROUNDS. IN ADDITION TO THESE SERVICES WITHIN THE HOSPITAL SETTING, THE RESIDENTS ARE ALSO EXPOSED TO TREATING PATIENTS IN AN OFFICE SETTING AT THE COMMUNITY CLINIC (RESIDENT CONTINUITY CLINIC) IN WISE, VIRGINIA. INTERNAL MEDICINE RESIDENTS SPENT MORE THAN 54,000 HOURS AT NCH DURING FY15. OUR UNREIMBURSED COST FOR THIS RESIDENCY PROGRAM EXCEEDED 700,000. IN ADDITION TO INTERNAL MEDICINE RESIDENTS, NCH SERVES AS A CLINICAL TRAINING HOSPITAL FOR OTHER ALLIED HEALTH PROFESSION EDUCATION STUDENTS. WE HAVE DEDICATED STAFF THAT WORK WITH REGIONAL COLLEGES AND UNIVERSITIES TO COORDINATE THE PLACEMENT OF HEALTHCARE PROFESSIONAL STUDENTS AS PART OF STUDENTS' EDUCATIONAL CURRICULUM. IN ADDITION TO CLINICAL TRAINING, THE HEALTH CARE STUDENTS ENTERING OUR SYSTEM ARE REQUIRED TO HAVE ORIENTATION AND COMPUTER TRAINING. PARTICIPANTS RECEIVING CLINICAL EXPERIENCE AT NCH DURING FY15 INCLUDED 80 NURSING STUDENTS FROM VARIOUS COLLEGES, UNIVERSITIES AND PROGRAMS. THIS NURSING CLINICAL EXPERIENCE REQUIRED EXTENSIVE NCH NURSING STAFF INVOLVEMENT. THE CLINICAL SETTING AND HANDS-ON INSTRUCTION COST NCH 159,250. NCH PROVIDED A CLINICAL SETTING FOR ANOTHER 64 STUDENTS TRAINING IN HEALTH-RELATED PROGRAMS SUCH AS RADIOLOGY, PHARMACY, PHYSICAL THERAPY, EMT/PARAMEDIC AND OTHER ALLIED-HEALTH DISCIPLINES. THESE ADDITIONAL CLINICAL STUDENTS COST NCH 54,211. NCH PARTNERED WITH THE COMPANIES, FIRSTSOURCE SOLUTIONS USA AND ADVANCED PATIENT ADVOCACY, TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. DURING FY15, REPRESENTATIVES WERE AVAILABLE AT NCH TO ASSIST PATIENTS BY DETERMINING GOVERNMENTAL MEDICAL ASSISTANCE (MEDICAID OR TENNCARE) ELIGIBILITY, AND BY HELPING WITH THE APPLICATION PROCESS AND FOLLOW-UP. 514 PATIENTS WERE APPROVED FOR COVERAGE IN FY15. ONCE A PERSON IS APPROVED FOR MEDICAID OR TENNCARE THROUGH THE PROGRAM OFFERED THROUGH NCH, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. FIRSTSOURCE SOLUTIONS AND ADVANCED PATIENT ADVOCACY ARE COMPENSATED BY NCH. OUR COST FOR THIS PROGRAM WAS 78,786. NCH CONTINUED THE VALUE OPTIMIZATION SYSTEM (VOS) PROGRAM DURING FY15. VOS ALLOWS A TRANSFORMATION OF CARE BY PROVIDING TRAINING AND TOOLS TO REDUCE WASTE, MEET PATIENTS' EXPECTATIONS OF HIGH QUALITY AND EFFICIENT CARE, WHILE ACHIEVING OUTSTANDING OUTCOMES. THE PROGRAM IS STRUCTURED FOR CONTINUOUS MONITORING AND IMPROVEMENT. IDENTIFIED PROJECTS ARE REFERRED TO AS "STREAMS". IN FY15, NCH REDUCED PATIENTS' ARRIVAL TIME TO DOCTOR TIME FROM 20 MINUTES TO 13 MINUTES, A 35% REDUCTION IN A PATIENT'S WAIT TIME. A VALUE STREAM THAT FOCUSED ON INPATIENT CARE LOOKED AT MEDICATION RECONCILIATIONS. THIS PROJECT INCLUDED NURSES, PHYSICIANS, INTERNAL MEDICINE RESIDENTS, AND PHARMACY STAFF WITH THE GOAL TO REDUCE MEDICATION LIST ERRORS. A MEDICATION LIST, IN THIS CONTEXT, REFERS TO MEDICATIONS AND DOSAGES A PATIENT TAKES AT HOME. IF A PATIENT BEGINS THEIR HOSPITAL VISIT IN THE ED, THE ED NURSE IS RESPONSIBLE FOR MAKING HIS/HER BEST FAITH EFFORT TO OBTAIN A COMPLETE LIST OF CURRENT MEDICATIONS USED BY THE PATIENT. THE INFORMATION INCLUDES DRUG NAME, DOSAGE AND FREQUENCY, LAST DOSE TAKEN, AND REASON FOR THE MEDICATION. WHEN THE PATIENT IS TRANSFERRED FROM THE ED TO A NURSING FLOOR, THE FLOOR NURSE IS RESPONSIBLE FOR REVIEWING THE LIST AND CHECKING FOR MISSING INFORMATION OR NOTES. PHYSICIAN AND RESIDENTS ARE THE THIRD CHECKPOINT IN THE MEDICATION RECONCILIATION PROCESS. PHARMACY REVIEWS MEDICATION INFORMATION FOR EACH PATIENT DAILY AND ERRORS ARE BROUGHT TO THE ATTENTION OF MANAGERS SO THAT ADDITIONAL TRAINING MAY BE PROVIDED WHERE GAPS OR ERRORS ARE IDENTIFIED. THIS VERY STRUCTURED PROCESS RESULTED IN REDUCING ERRORS ON THE MEDICATION LIST BY OVER 85%. TO IMPROVE ACCESS TO PRIMARY CARE, NORTON COMMUNITY HOSPITAL, OPERATES A RESIDENCY CLINIC IN A RURAL, LOW-INCOME AREA. BECAUSE REIMBURSEMENT DOES NOT COVER THE OPERATING EXPENSES OF THE CLINIC, THE HOSPITAL SUBSIDIZES IT. DURING FY15, THE SUBSIDY WAS MORE THAN 53481413 true true false true false false false false false false true false false true true true false true false false false false false false false false true true true false true false false false false false false true false false false false false true true true true false false true 135 0 true 537 true true true false false false false false false false false false X 13 3 false false false false true true true true true false false true true true true true true true true false VA X KEVIN MORRISON 2764391011 100 15TH STREET NW NORTON VA 24273 MARVIN EICHORN MSHA EXEC. V 1.00 54.00 X 0 705370 42125 ANN FLEMING DIRECTOR 1.00 44.00 X 0 549839 22858 MATTHEW CUSANO MD DIRECTOR 39.50 0.50 X 358968 0 29393 JOHN DOYLE DIRECTOR 1.00 44.00 X 0 354549 55691 MONTY MCLAURIN VICE-CHAIR 1.00 44.00 X 0 351121 54334 SHANE HILTON MSHA WASH. C 1.00 44.00 X 0 348154 55626 TOM TULL DIRECTOR 1.00 44.00 X 0 146402 32163 ROBERT LEONARD SECRETARY/TR 1.00 1.00 X 23302 0 0 JAMES MANICURE DIRECTOR 1.00 1.00 X 17943 0 0 BUFORD STURGILL DIRECTOR 1.00 1.00 X 17512 0 0 CHARLES WARD CHAIR 1.00 0.50 X 15844 0 0 BILL WAMPLER DIRECTOR 1.00 0.50 X 8014 0 0 WILLIE PRICE-HARRIS DIRECTOR 1.00 0.50 X 7742 0 0 CHARLES SLEMP DIRECTOR 1.00 0.50 X 0 0 0 ERNIE WARD DIRECTOR 1.00 0.50 X 0 0 0 MARK LEONARD CEO 40.20 4.80 X 0 316295 47380 KEVIN MORRISON CFO 40.20 4.80 X 0 83936 7626 KENT VANBUECKEN MD PHYSICIAN 40.00 X 383830 0 22668 JAMES WILSON MD PHYSICIAN 40.00 X 356305 0 27455 BERNIE SERGENT MD PHYSICIAN 40.00 X 324575 0 29171 LATISHA HILTON MD PHYSICIAN 40.00 X 306475 0 8366 RUBYE WASHINGTON-MOORE MD PHYSICIAN 40.00 X 304402 0 27243 JOHN WRIGHT FORMER X 17775 0 0 STEPHEN SAWYER CFO IPMC CFO/FMR 45.00 X 0 165484 24048 2142687 3021150 486147 29 true true false WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN FEES 2126733 VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON VA 24212 ANESTHESIA SERV 922972 ARAMARK HEALTHCARE PO BOX 510467 NEW BERLIN WI 53151 DIETARY SERV. 760400 THOMPSON & LITTON INC 103 EAST MAIN STREET PO BOX 1307 WISE VA 24293 CONSULTING 508044 CROTHALL SERVICES EAST TN 955 CHESTERBROOK BLVD STE 300 WAYNE PA 19087 LINEN SERVICES 206046 10 106591 26812 16579 149982 PATIENT REVENUE 622110 64492117 64492117 WELLNESS PROGRAMS 622110 606663 606663 LABORATORY REVENUE 621500 11946 11946 65110726 497237 497237 677 677 184341 121093 63248 63248 48556 14692 416612 81050 416612 81050 497662 81050 416612 CAFETERIA & VENDING 722210 177120 177120 HQPAF ADMINISTRATION FEE 561000 66780 66780 REVENUE FROM PARENT 900099 52353 52353 18927 18927 315180 66634712 65246610 60502 1177618 X 25350 25350 854795 370479 484316 25569404 23539582 2029822 810269 761292 48977 5397381 4829275 568106 1710141 1643624 66517 227257 219045 8212 151746 151746 9510 9510 67476 67476 6937510 5707778 1229732 154701 5067 149634 794892 709205 85687 1631057 1604278 26779 1041972 919598 122374 264761 248892 15869 91784 90874 910 218449 218449 4126934 2863193 1263741 517777 131489 386288 MEDICAL SUPPLIES 7868566 7868566 MANAGEMENT FEES TO PARENT 1428852 591952 836900 REPAIRS & MAINTENANCE 1113364 1073902 39462 UBI TAXES 11847 11847 507852 277972 229880 61533647 53481413 8052234 0 X 4802630 5007854 9304073 9823180 1098013 949125 1266794 1492034 668366 602351 96658042 48345545 43402815 48312497 20031745 25232132 10108198 5219097 90682634 96638270 7431149 9452573 21242680 21095386 8261458 8495039 36935287 39042998 X 53594573 57473603 152774 121669 53747347 57595272 90682634 96638270 X 5101065 -101953 -1151187 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3382 false false false 3382 false SCHEDULE C, PART II-B, LINE 1 PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION THAT ARE ATTRIBUTABLE TO DIRECT LOBBYING. 2111034 2111034 48513880 18790774 29723106 282116 188424 93692 44560223 29026313 15533910 1190789 340034 850755 48312497 UNDER BOND INDENTURE AGREEMENTS 5219097 5219097 RETIREE BENEFITS PAYABLE 7840925 RESERVE FOR PROF LIABILITIES 599792 DUE TO AFFILIATES 54322 8495039 X SCHEDULE D, PAGE 3, PART X "THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2015 AND 2014. AT JUNE 30, 2015, TAX RETURNS FOR 2011 THROUGH 2014 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE." true true X true X true X true true false true true 719975 719975 0.01170 12946627 8032167 4914460 0.07990 13666602 8032167 5634435 0.09160 146513 146513 0.00240 2466333 1533358 932975 0.01520 5373133 4008414 1364719 0.02220 8028 8028 0.00010 7994007 5541772 2452235 0.03990 21660609 13573939 8086670 0.13140 true 7028655 5341777 14973650 14944188 29462 X true true 1 1 NORTON COMMUNITY HOSPITAL 100 15TH STREET NW NORTON VA 24273 MOUNTAINSTATESHEALTH.COM/NCH H 1879 X X X X NORTON COMMUNITY HOSPITAL 1 false false true X X X X X X X X 15 true true false true X MOUNTAINSTATESHEALTH.COM/NCH X true 16 false true false true X 200.000000000000 400.000000000000 X X X true true X X X true X MOUNTAINSTATESHEALTHCOM X MOUNTAINSTATESHEALTHCOM X X X X true X true X X X X true X false false FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 5 MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES, INCLUDING NCH. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 5 TO 18 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S PERCEIVED HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS, AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE FACILITY COMMUNITY BOARDS (SUCH AS NCH'S BOARD) WERE PRESENTED THIS INFORMATION AND SHARED THEIR THOUGHTS AS WELL ON THE HEALTH NEEDS TO PRIORITIZE. THE SPECIFIC NEEDS FOR EACH COUNTY WERE THEN ADDRESSED IN THE RESPECTIVE FACILITY IMPLEMENTATION PLAN WHICH WAS ADOPTED SEVERAL MONTHS LATER. FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 6A EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. NCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, JOHNSTON MEMORIAL HOSPITAL AND DICKENSON COMMUNITY HOSPITAL. FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 11 MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2015. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2014 AND 2015. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF NOVEMBER AND DECEMBER 2015. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. DUE TO LACK OF RESOURCES, SOME OF MSHA FACILITIES WERE UNABLE TO ADDRESS ISSUES THAT WERE IDENTIFIED. FACILITY 1, NORTON COMMUNITY HOSPITAL - PART V, LINE 22D UNINSURED PATIENTS RECEIVE A 66% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. ALLOWABLE AMOUNTS FOR INSURED PATIENTS ARE BASED ON THE NEGOIATED RATE WITH COMMERCIAL INSURANCE OR MEDICARE. PART I, LINE 6A - RELATED ORGANIZATION INFORMATION MSHA'S COMMUNITY BENEFIT REPORT COMPLETED IN FY15 INCLUDES NCH. MSHA IS NCH'S MAJORITY OWNER. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE COST TO CHARGE RATIO (WORKSHEET 2 "RATIO OF PATIENT CARE COST TO CHARGES") WAS USED TO CALCULATE LINE 7A FINANCIAL ASSISTANCE COST. OUR COST ACCOUNTING SYSTEM PROVIDED MEDICAID/TENNCARE LOSSES REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH AND OUR PHYSICIAN CLINICS. WE USED COST TO CHARGE RATIOS FOR HOME HEALTH AND OUR PHYSICIAN CLINICS BECAUSE THEIR DATA ARE NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS, WITH NO ADDITIONAL OVERHEAD INCLUDED IN THE COST. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF INTERNSHIPS (PRIMARILY INTERNAL MEDICINE RESIDENTS, NURSING, PHARMACY, AND THERAPY STUDENTS) WITH SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING AT A HOSPITAL AS PART OF THEIR EDUCATION AND TRAINING. DETAILED RECORDS ARE MAINTAINED FOR HOURS SPENT ON THESE RESIDENTS/STUDENT ACTIVITIES, THE NUMBER OF RESIDENTS/STUDENTS THAT ROTATE THROUGH OUR HOSPITAL, ETC. INFORMATION IS MAINTAINED FOR EACH HOSPITAL UNIT THAT PARTICIPATES. WE ONLY INCLUDE LABOR COSTS AND WE ONLY ASSUME A PERCENTAGE OF OUR TEAM MEMBERS' TIME IS DEVOTED TO THE STUDENTS. MEDICARE ALLOWABLE INDIRECT COSTS ARE INCLUDED FOR MEDICAL RESIDENTS AND MEDICARE REIMBURSEMENT RELATED TO RESIDENT TRAINING IS REPORTED AS AN OFFSET TO RESIDENT COSTS ON LINE 7F. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USE OUR COST ACCOUNTING SYSTEM. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND MEDICAID/TNCARE ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITAL THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE. FOR THE SERVICE LINES WE DO REPORT (SUCH AS NEONATOLOGY, REHABILITATION AND WOUND CARE), WE USED OUR COST ACCOUNTING SYSTEM SINCE THESE SERVICES HAVE ESTABLISHED, STANDARD FINANCIAL REPORTS. LINE 7G INCLUDES A 473,988 SUBSIDY OF A PHYSICIAN CLINIC OWNED AND OPERATED BY NCH. THE CLINIC IS LOCATED IN A RURAL, LOW-INCOME AREA. PART II - COMMUNITY BUILDING ACTIVITIES NCH LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER THEIR TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND MANAGING BOARDS OF LOCAL SERVICE AND NON-PROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. NCH, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. MOST OF THESE ORGANIZATIONS WORK TO IMPROVE THE LIVES OF COMMUNITY MEMBERS THAT HAVE LIMITED, OR NO, FINANCIAL RESOURCES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY SELF-PAY BALANCES INCLUDE ACCOUNTS AFTER PAYMENTS AND CONTRACTUAL ADJUSTMENTS (DISCOUNTS) HAVE BEEN POSTED FROM ALL THIRD-PARTY PAYERS- GENERALLY LEAVING THE PATIENT RESPONSIBLE FOR ANY REMAINING DEDUCTIBLE AND/OR CO-PAYMENT. OTHER SELF-PAY ACCOUNTS ARE FROM PATIENTS WITH NO INSURANCE OR OTHER THIRD-PARTY COVERAGE. ALL PATIENTS WITH NO FORM OF THIRD-PARTY PAYER COVERAGE RECEIVE A 66% CALCULATED DISCOUNT, AS REQUIRED BY TENNESSEE LAW. MSHA APPLIES TENNESSEE LAW TO OUR VIRGINIA HOSPITALS' PATIENT ACCOUNTS. AFTER THE NORMAL COLLECTION PROCESS HAS INDICATED AN ACCOUNT IS UNCOLLECTIBLE, NCH WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO GATHER HISTORICAL INFORMATION TO APPLY TO THE CURRENT BALANCE. IN OTHER WORDS, THE HOSPITAL EVALUATES PAST COLLECTION HISTORY ON ACCOUNTS WRITTEN OFF TO BAD DEBT AND APPLIES THE HISTORICAL UNPAID RATE TO THE CURRENT SELF-PAY ACCOUNTS RECEIVABLE BALANCE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE NCH'S PATIENT FINANCIAL SERVICES MANAGEMENT ESTIMATE THAT 76% OF BAD DEBT EXPENSE IS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. WE BASE THIS PERCENTAGE ON THE COMPOSITION OF BAD DEBTS ATTRIBUTABLE TO PEOPLE WITH NO FORM OF INSURANCE OR OTHER THIRD-PARTY COVERAGE, WHICH REPRESENTS THE MAJORITY OF BAD DEBT ACCOUNTS. WE ALSO ESTIMATE A MUCH SMALLER PERCENTAGE OF LIKELY CHARITY-ELIGIBLE ACCOUNTS TO PEOPLE WITH BALANCES AFTER INSURANCE/THIRD-PARTY COVERAGE HAS PAID (E.G. DEDUCTIBLES AND CO-PAYMENT BALANCES). IT IS IMPLAUSIBLE TO DETERMINE WITH EXACTITUDE THE AMOUNT OF NCH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETED FINANCIAL ASSESSMENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSISTANCE FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT MORE THAN 97% OF OUR PATIENTS WHO HAVE PROVIDED COMPLETED FINANCIAL ASSISTANCE FORMS HAVE BEEN APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE. WE HAVE MANY INSTANCES OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE ARE SURE WOULD QUALIFY FOR CHARITY CARE. ALTHOUGH HOSPITAL TEAM MEMBERS ENCOURAGE THESE INDIVIDUALS TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION, MANY WILL NOT DO SO. EVEN WHEN THESE INDIVIDUALS ARE TOLD WE FEEL SURE THEY DO QUALIFY FOR FULL OR PARTIAL ASSISTANCE, THEY STILL REFUSE TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE TEXT TO NCH'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE APPEARS ON PAGE 13 IN OUR MOST RECENT AUDITED FINANCIAL STATEMENTS (ATTACHED). PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE REPORTED USING NCH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS TRANSPORTATION OF A PATIENT AND COMFORT ITEMS TO INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS AND PHYSICIAN GUARANTEES ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED. ALSO, A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS SUCH AS THOSE NOTED ABOVE, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. WHILE WE AGREE THAT COSTS SUCH AS MARKETING TO ATTRACT PATIENTS AND LOBBYING ARE REASONABLE TO EXCLUDE, IT DOES NOT SEEM REASONABLE TO EXCLUDE RECRUITMENT OF PHYSICIANS AND BASIC ITEMS SUCH AS TELEVISIONS IN PATIENT ROOMS. AS A NOT-FOR-PROFIT ORGANIZATION, WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITY AND THE INDIVIDUAL WHILE MAINTAINING A HIGH LEVEL OF HEALTH CARE SERVICES WITHOUT LOSSES. SINCE LOSSES DO OCCUR THROUGH THE CMS SYSTEM OF REIMBURSEMENT, THESE LOSSES ARE A COST OF DOING BUSINESS FOR OUR COMMUNITY AND SHOULD BE CONSIDERED A COMMUNITY BENEFIT. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, NCH IS REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR OUR MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW OUR COST. THEREFORE, IT IS ONLY LOGICAL TO ALLOW HOSPITALS TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT. BY MAKING THIS CHANGE, NON-PROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES FINANCIALLY INJURIOUS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION: NCH HAS ESTABLISHED A STRONG COMMITMENT TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES WE SERVE. ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GENERAL GUIDELINES, WHILE ALLOWING FOR UNIQUE FINANCIAL CIRCUMSTANCES. NCH RECOGNIZES ITS OBLIGATION TO PROVIDE QUALITY HEALTHCARE TO THOSE WHO ARE UNABLE TO PAY. FINANCIAL ASSISTANCE ELIGIBILITY ENCOMPASSES A VARIETY OF PATIENTS, SUCH AS THOSE WITH MEDICAID ELIGIBILITY AFTER THE DATE OF SERVICE, PATIENTS THAT ARE DECEASED WITH NO ESTATE, MEDICAID ELIGIBLE ENCOUNTERS WHERE BENEFITS HAVE BEEN EXHAUSTED, ETC. OUR CHARITY GUIDELINES ARE BASED ON THE NATIONAL POVERTY GUIDELINES. HOWEVER, FINANCIAL ASSISTANCE IS NOT BASED SOLELY ON INCOME. UNIQUE FINANCIAL CIRCUMSTANCES ARE CONSIDERED, WHICH CAN CHANGE THE CATEGORY OF ELIGIBILITY. IN ADDITION, CHARITY DETERMINATION MAY BE RETROACTIVE FOR ALL DATES OF SERVICE. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED. PART VI, LINE 2 - NEEDS ASSESSMENT MSHA INCLUDED AMERICA'S HEALTH RANKINGS (AHR) IN ITS ASSESSMENT IN ORDER TO BETTER DEFINE THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. VIRGINIA RANKED 21ST AND TENNESSEE RANKED 43RD. HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE NCH IS LOCATED) CLOSELY RESEMBLES THE HEALTH RANKINGS FOR TENNESSEE. AMERICA'S HEALTH RANKINGS ARE BASED ON A SERIES OF MEASURES INCLUDING SEVERAL HEALTH OUTCOMES AND HEALTH FACTORS. A SURVEY WAS GIVEN TO 106 INDIVIDUALS REPRESENTING THE TEN COUNTIES IN WHICH MSHA OWNS A FACILITY. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH LEADERS, NON-PROFIT DIRECTORS, SCHOOL NURSES AND OFFICIALS, AND BUSINESS LEADERS. A SURVEY WAS GIVEN TO EACH INDIVIDUAL SEEKING FEEDBACK REGARDING AVAILABLE RESOURCES IN EACH AREA, THE PERCEIVED HEALTH STATUS, HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. THE MAJORITY OF RESPONSES SUGGESTED FOCUSING ON EDUCATION IN ORDER TO PROMOTE HEALTHY HABITS AND INCREASED ACCESS TO RESOURCES. OTHER RESPONSES INCLUDED: MAKE PHYSICAL EDUCATION A REQUIREMENT AS PART OF SCHOOL CURRICULUM, IMPROVE NATURAL TRAILS AND WALKWAYS, INCREASE COMMUNITY SUPPORT FOR SMOKE-FREE AREAS, PARTNER WITH LOCAL FARMER'S MARKETS, SHARE HEALTH INFORMATION BETWEEN PHARMACIES, NETWORK WITH SMALL BUSINESSES AND NON-PROFITS IN ORDER TO AVOID DUPLICATING RESOURCES, AND PROVIDE EARLY SCREENINGS FOR THE UNINSURED OR UNDERINSURED. OVERALL, THE COMMUNITY MEMBERS GAVE MSHA'S CORE SERVICE AREA A HEALTH STATUS RANKING OF 4.55 OUT OF 10 (1 BEING THE LOWEST, 10 BEING THE HIGHEST). AMONG THE 106 PARTICIPANTS, THE AREAS OF OBESITY, CANCER, HEART DISEASE, SMOKING, SUBSTANCE/PRESCRIPTION DRUG ABUSE, AND DIABETES WERE THE TOP HEALTH PRIORITIES IN OUR REGION. AHR REPORTS THAT VIRGINIA AND TENNESSEE BOTH SAW AN INCREASE IN DIABETES AND OBESITY WITHIN THE PAST TEN YEARS. VIRGINIA RANKS 25TH FOR CARDIOVASCULAR DEATHS, 23RD FOR CANCER DEATHS (31ST FOR SMOKING) AND 21ST FOR DIABETES. THE ROBERT WOOD JOHNSON FOUNDATION REPORTS 33% OF WISE COUNTY'S CITIZENS SMOKE COMPARED TO 18% IN THE STATE OF VIRGINIA. 32% OF OUR COUNTY'S ADULTS ARE CONSIDERED OBESE AND 38% ARE PHYSICALLY INACTIVE. WISE COUNTY'S HEALTH RANKING IS 129 OUT OF 133 STATEWIDE (1 BEING THE BEST AND 133 BEING THE WORST). PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE NCH PROVIDES COMMUNICATION OF FINANCIAL ASSISTANCE ON OUR WEBSITE AND ON POSTERS LOCATED IN PROMINENT AREAS OF THE HOSPITALS SUCH AS ADMITTING AND THE EMERGENCY DEPARTMENT. PRINTED EDUCATIONAL MATERIALS INCLUDING FINANCIAL ASSISTANCE CONTACT INFORMATION ARE ALSO PROVIDED IN EACH PATIENT'S REGISTRATION PAPERWORK. POSTERS AND REFERENCE MATERIALS ARE WRITTEN IN BOTH ENGLISH AND SPANISH. ADMITTING STAFF ARE TRAINED TO EDUCATE PATIENTS ON OUR FINANCIAL ASSISTANCE POLICY THESE COUNSELORS HELP UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDICAID/TENNCARE. NCH PARTNERED WITH THE COMPANIES FIRSTSOURCE SOLUTIONS USA AND ADVANCED PATIENT ADVOCACY TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. REPRESENTATIVES WERE AVAILABLE AT NCH TO ASSIST PATIENTS. THE REPRESENTATIVES WERE ABLE TO DETERMINE GOVERNMENTAL MEDICAL ASSISTANCE (MEDICAID OR TENNCARE) ELIGIBILITY, AND TO HELP WITH THE APPLICATION PROCESS AND FOLLOW-UP. ONCE A PERSON IS APPROVED FOR MEDICAID OR TENNCARE THROUGH THE PROGRAM OFFERED THROUGH NCH, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. 738 PATIENTS WERE APPROVED FOR GOVERNMENTAL ASSISTANCE DURING THE YEAR.FIRSTSOURCE AND ADVANCED PATIENT ADVOCACY ARE COMPENSATED BY NCH. DURING FY15, OUR COST FOR THIS PROGRAM WAS 78,786. PART VI, LINE 4 - COMMUNITY INFORMATION NCH IS LOCATED IN NORTON, WISE COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. SOUTHWEST VIRGINIA (SWVA) IS LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION AND HAS A HIGH RATE OF INDIVIDUALS WHO ARE UNINSURED. ACCORDING TO U.S. CENSUS BUREAU ESTIMATES, NORTON HAS A POPULATION OF APPROXIMATELY 4,031, WHILE WISE COUNTY'S POPULATION IS 39,935. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF WISE COUNTY IS 39.7 WHICH IS OLDER THAN THE MEDIAN AGE OF 37.6 IN VIRGINIA. THE BUREAU ESTIMATES WISE COUNTY MEDIAN HOUSEHOLD INCOME AT 37,357 COMPARED TO 62,792 FOR THE STATE OF VIRGINIA. 28% OF WISE COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 16% STATEWIDE. WISE COUNTY'S HEALTH OUTCOMES RANK 129 OUT OF 133 IN THE STATE. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH NCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. OPERATING SURPLUSES ARE INVESTED INTO IMPROVING TREATMENT OPTIONS FOR OUR PATIENTS THROUGH NEW TECHNOLOGIES, RECRUITING PHYSICIANS AND TRAINED STAFF IN SHORTAGE AREAS, AND IMPROVING OUR FACILITIES AND EQUIPMENT. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. THE MAJORITY OF NCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND ARE NOT EMPLOYED BY NCH. MANY OF OUR BOARD MEMBERS ARE NOT CONSIDERED INDEPENDENT, PER IRS FORM 990 INSTRUCTIONS. FOUR WERE EMPLOYED BY NCH'S MAJORITY OWNER, MSHA, AND WERE SERVING AS NCH BOARD MEMBERS ON THE LAST DAY OF THE FISCAL YEAR. FIVE MEMBERS ARE NOT CONSIDERED INDEPENDENT BECAUSE THEY HAD 1099 REPORTABLE COMPENSATION EXCEEDING 10,000 FOR HEALTH INSURANCE PAID BY NCH OR BECAUSE THEY HAD A FAMILY MEMBER EMPLOYED BY NCH (IN NON-MANAGERIAL POSITIONS). ANOTHER BOARD MEMBER IS NOT INDEPENDENT BECAUSE HE IS EMPLOYED BY AND RECEIVED COMPENSATION FROM NCH AS A PHYSICIAN. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY NCH. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM NCH IS A 129-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 13-MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. NCH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE. MSHA IS INTEGRATED BOTH VERTICALLY AND HORIZONTALLY AND IS THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. NCH SERVES AS THE COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM NCH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. IF NEED BE, PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS. MSHA HOSPITALS WORK CLOSELY WITH ONE ANOTHER TO SHARE EXPERTISE AND RESOURCES. FOR EXAMPLE, JOHNSTON MEMORIAL HOSPITAL (JMH) LOCATED IN ABINGDON, VIRGINIA ASSISTED NCH ESTABLISH A DIABETES CENTER. JMH'S CENTER HAS BEEN OPERATIONAL FOR MANY YEARS SO THE EXPERIENCED CLINICAL TEAM AT JMH PROVIDED VALUABLE INSIGHT THAT SAVED NCH TIME, MONEY, AND MISTAKES. PRIOR TO NCH'S DIABETES CENTER, MANY PATIENTS IN OUR AREA HAD TO TRAVEL ONE TO TWO HOURS FOR THIS TYPE OF CARE. THERE ARE MANY OTHER EXAMPLES OF SHARED EXPERTISE AND SERVICES BETWEEN MSHA FACILITIES - LABORATORY, CARDIAC SERVICES, ADMINISTRATIVE, ETC. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT VIRGINIA true UNIVERSITY OF VIRGINIA AT WISE 1 COLLEGE AVE WISE VA 24293 541638774 501C3 25000 ATHLETICS PROGRAM 1 SCHEDULE I, PAGE 1, PART I, LINE 2 OUR DONATION TO THE UNIVERSITY OF VIRGINIA AT WISE WAS MADE TO SUPPORT ATHLETICS PROGRAMS AT THE SCHOOL. WHILE ATHLETIC PROGRAMS PROVIDE ENTERTAINMENT, THESE PROGRAMS ALSO ENCOURAGE HEALTHY LIFESTYLES AND DISCIPLINE THROUGH TRAINING AND REQUIRING OBEYING RULES OF CONDUCT. MOST DONATION REQUESTS ARE MADE THROUGH AN APPLICATION PROCESS WHERE THE APPLICANT DESCRIBES HOW THE MONEY WILL BE USED, HOW IT BENEFITS THE COMMUNITY, HOW OUR DONATION WILL CORRELATE WITH HEALTH NEEDS IDENTIFIED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), AND THE AGREEMENT THAT THE DONEE WILL PROVIDE FOLLOW-UP OF HOW OUR DONATION WAS USED (WHO BENEFITED, ETC.). NOT ALL OF OUR DONATIONS ARE RESTRICTED TO OUR CHNA, BUT MANY ARE. MSHA'S SOCIAL RESPONSIBILITY COMMITTEE REVIEWS MOST DONATION REQUESTS TO DETERMINE WHICH REQUESTS MSHA, INCLUDING NCH, WILL FUND. THERE ARE MANY FACTORS THAT ARE CONSIDERED DURING THE REVIEW PROCESS BY THE COMMITTEE, SUCH AS OUR BUDGET CONSTRAINTS, IF THE APPLICANT HAS ALREADY RECEIVED A DONATION FROM A MSHA FACILITY, HOW THE REQUESTING ORGANIZATION FITS WITH OUR CNHA, ETC. X X false true false false false false false false false MARVIN EICHORN MSHA EXEC. VP/COO 513864 140426 51080 18788 23337 747495 ANN FLEMING DIRECTOR 319105 108007 122727 10125 12733 572697 39222 MATTHEW CUSANO MD DIRECTOR 302391 56096 481 7642 21751 388361 JOHN DOYLE DIRECTOR 287522 58179 8848 32472 23219 410240 MONTY MCLAURIN VICE-CHAIR 268960 61819 20342 29617 24717 405455 SHANE HILTON MSHA WASH. CO. CFO 287587 51843 8724 32472 23154 403780 TOM TULL DIRECTOR 128194 6550 11658 10968 21195 178565 MARK LEONARD CEO 239328 61237 15730 22220 25160 363675 KENT VANBUECKEN MD PHYSICIAN 360940 20000 2890 10782 11886 406498 JAMES WILSON MD PHYSICIAN 202200 153762 343 10781 16674 383760 BERNIE SERGENT MD PHYSICIAN 217405 86777 20393 7923 21248 353746 LATISHA HILTON MD PHYSICIAN 197225 76844 32406 7321 1045 314841 RUBYE WASHINGTON-MOORE MD PHYSICIAN 282998 21404 9267 17976 331645 JOHN WRIGHT FORMER 17775 17775 STEPHEN SAWYER CFO IPMC CFO/FMR NCH CFO 150118 6550 8816 6418 17630 189532 SCHEDULE J, PAGE 1, PART I, LINE 4 JOHN DOYLE 0 14,760 0 MONTY MCLAURIN 0 13,992 0 SHANE HILTON 0 14,760 0 MARK LEONARD 0 12,451 0 SCHEDULE J, PART III PART I, LINE 4B MONTY MCLAURIN, SHANE HILTON, MARK LEONARD, AND JOHN DOYLE PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE(MSHA). THE 457(F)PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON- OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24-MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. JAMIE FLEMING FAMILY MEMBER 34136 FAMILY MBR OF BD MBR false DEBBIE WARD FAMILY MEMBER 67756 FAMILY MBR OF BD MBR false SCHEDULE L, PART V BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: 1(A) NAME OF PERSON: JAMIE FLEMING 1(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF JAMES MANICURE, NORTON COMMUNITY HOSPITAL (NCH)BOARD MEMBER 1(D) DESCRIPTION OF TRANSACTION: JAMES MANICURE, BOARD MEMBER OF NCH, IS A FAMILY MEMBER OF JAMIE FLEMING, AN EMPLOYEE OF NCH. 2(A) NAME OF PERSON: DEBBIE WARD 2(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF ERNIE WARD, NORTON COMMUNITY HOSPITAL (NCH)BOARD MEMBER 2(D) DESCRIPTION OF TRANSACTION: ERNIE WARD, BOARD MEMBER OF NCH, IS A FAMILY MEMBER OF DEBBIE WARD, AN EMPLOYEE OF NCH. FORM 990 - ORGANIZATION'S MISSION NORTON COMMUNITY HOSPITAL (NCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. FORM 990, PAGE 2, PART III, LINE 4A (CONT'D) AS THE LARGEST HEALTHCARE FACILITY IN THE COALFIELD REGION, NCH PROVIDES A WIDE ARRAY OF SERVICES THROUGH HIGHLY TRAINED PHYSICIANS AND SUPPORT STAFF. NCH IS RECOGNIZED FOR ITS OUTSTANDING INPATIENT REHABILITATION SERVICES, AN OSTEOPATHIC INTERNAL MEDICINE RESIDENCY PROGRAM, BLACK LUNG TREATMENT SERVICES, HIGH-QUALITY IMAGING TECHNOLOGY, AND MANY OTHER SERVICE LINES. FOR THE YEAR ENDING JUNE 30, 2015, NCH RECORDED 12,477 INPATIENT ADMISSIONS, AND PROVIDED FOR 133,724 OUTPATIENT VISITS. THERE WERE 22,953 EMERGENCY VISITS, AND 12,304 HOME HEALTH VISITS. OUR HOSPITAL SAW SIGNIFICANT VOLUME INCREASES IN A NUMBER OF SERVICE LINES DURING FY15. FOR EXAMPLE, INPATIENT REHABILITATION OCCUPANCY INCREASED MORE THAN 8%, WHILE OUR SKILLED NURSING PATIENT DAYS INCREASED BY 15%. ENDOSCOPIES ROSE ALMOST 5%, THE EMERGENCY DEPARTMENT SAW VISITS INCREASE BY NEARLY 7%, OUTPATIENT REHAB PROCEDURES ROSE 18%, AND WE PERFORMED 22% MORE SLEEP STUDIES. NCH IS A MEMBER OF VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION AND IS ACCREDITED BY THE AMERICAN OSTEOPATHIC ASSOCIATION (AOA). OUR HOSPITAL WAS THE FIRST AOA ACCREDITED TEACHING FACILITY IN THE STATE OF VIRGINIA. NORTON COMMUNITY HOSPITAL OFFERS A FULL ARRAY OF PRIMARY CARE AND SPECIALTY SERVICES AS WELL AS SEVERAL AMENITIES THAT MAKE US THE HOSPITAL OF CHOICE FOR RESIDENTS IN OUR AREA. OUR TEAM APPROACH TO HEALTH CARE REFLECTS OUR COMMITMENT TO KEEPING OUR PATIENTS AT THE CENTER OF EVERYTHING WE DO. SEVERAL MAJOR PROJECTS WERE ANNOUNCED BY MOUNTAIN STATES HEALTH ALLIANCE LEADERSHIP THIS YEAR THAT WILL BROADEN AND ENHANCE KEY SERVICES AT NCH, INCLUDING A RENOVATED AND EXPANDED EMERGENCY ROOM AT THE HOSPITAL AND A NEW 39,000-SQUARE FOOT MEDICAL COMPLEX THAT WILL BE HOME TO KEY OUTPATIENT SERVICES LIKE REHABILITATION, OCCUPATIONAL MEDICINE, PHARMACY, SURGERY AND ORTHOPEDIC SERVICES, AS WELL AS A NEW WELLNESS CENTER. THESE PROJECTS ARE EXPECTED TO BE COMPLETED NEXT YEAR. RENOVATION AND EXPANSION OF THE EMERGENCY DEPARTMENT WILL INCLUDE SIX ADDITIONAL EXAM ROOMS AND A CENTRALIZED PROVIDER STATION THAT WILL IMPROVE COMMUNICATION, DEPARTMENT EFFICIENCY AND PATIENT FLOW. A NEW URGENT CARE OFFICE WILL WORK IN CONJUNCTION WITH THE ER BY PROVIDING A QUICK, CONVENIENT OPTION FOR PATIENTS WHOSE CONCERNS ARE NOT LIFE THREATENING. AMBULANCE BAYS WILL BE IMPROVED FOR BETTER ACCESS AND FASTER CARE. IN ADDITION, NCH WILL OFFER TELEMEDICINE SERVICES - CONNECTING PATIENTS AND PROVIDERS AT THE HOSPITAL WITH OTHER MSHA-AFFILIATED EXPERTS AT DIFFERENT FACILITIES, MOST NOTABLY NISWONGER CHILDREN'S HOSPITAL (NISWONGER). CHILDREN WHO VISIT THE ER AT NCH WILL HAVE DIRECT ACCESS TO THE PEDIATRIC EMERGENCY PHYSICIANS AT NISWONGER VIA TWO-WAY, LIVE VIDEO. THE NEW TELEMEDICINE SERVICE WILL OFFER A HIGHER LEVEL OF SPECIALTY CARE FOR PATIENTS WITHOUT THEM NEEDING TO TRAVEL OUTSIDE THE AREA. DURING THE YEAR, MSHA HOSPITALS, INCLUDING NCH, WENT THROUGH SURPRISE DRILLS TO TEST READINESS FOR POTENTIAL EBOLA PATIENTS, AND THE RESULTS WERE IMPRESSIVE. PARTNERS FROM THE VIRGINIA DEPARTMENT OF HEALTH SERVED AS EVALUATORS AT OUR VIRGINIA DRILLS. FOR SEVERAL MONTHS, OUR HOSPITALS PLACED AN INTENSE FOCUS ON TRAINING TO IDENTIFY AND ISOLATE A SUSPECTED EBOLA PATIENT. A PRIMARY GOAL WAS TO ENSURE THAT ASKING TRAVEL QUESTIONS AT THE POINT OF REGISTRATION WAS HARDWIRED INTO THE REGULAR REGISTRATION PROCESS. NCH RECEIVED NATIONAL RECOGNITION BY BECKER'S HOSPITAL REVIEW FOR HIGH QUALITY CARE OF PNEUMONIA PATIENTS AND BEING AMONG THE NATION'S 53 HOSPITALS WITH THE BEST OUTCOME FOR PNEUMONIA PATIENTS. USING DATA OBTAINED FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, BECKER'S IDENTIFIED 53 HOSPITALS IN THE U.S. WHOSE PNEUMONIA PATIENTS HAD A 30-DAY MORTALITY RATE AT OR BELOW 8.4, WHICH IS WELL BELOW THE NATIONAL AVERAGE OF 11.9. FOR THE SECOND YEAR IN A ROW, NCH PROVIDED 400 LUNCHES TO PATIENTS ATTENDING THE REMOTE AREA MEDICAL (RAM) EVENT IN LEE COUNTY. THE RAM EVENT TOOK PLACE OVER A TWO-DAY PERIOD OFFERING FREE DENTAL, VISION AND MEDICAL CARE TO THOSE IN NEED. NCH TEAM MEMBERS DISTRIBUTED THE FREE LUNCHES TO PATIENTS THE FIRST DAY OF THE RAM EVENT. NCH TAKES GREAT PRIDE IN TRAINING YOUNG PHYSICIANS FOR OUR RURAL, MEDICALLY UNDERSERVED AREA. THE RESIDENCY PROGRAM HAS RESULTED IN AN INCREASE IN QUALITY PRIMARY CARE FOR SOUTHWEST VIRGINIA AND THE SURROUNDING AREA AND THE GROWTH OF OUR HOSPITAL. NCH OFFERS THE BENEFITS OF RURAL LIVING WITH THE OPPORTUNITY TO TRAIN IN A MODERN AND PROGRESSIVE HOSPITAL. INTERNAL MEDICINE RESIDENTS ROTATE THROUGH ALL AREAS OF MEDICINE, FROM HEALTH MAINTENANCE TO CRITICAL CARE. THE RESIDENTS ASSIST OUR PHYSICIANS IN PROVIDING QUALITY HANDS-ON PATIENT CARE THROUGH OBSERVATION, EDUCATION AND BY PARTICIPATING IN GRAND ROUNDS. IN ADDITION TO THESE SERVICES WITHIN THE HOSPITAL SETTING, THE RESIDENTS ARE ALSO EXPOSED TO TREATING PATIENTS IN AN OFFICE SETTING AT THE COMMUNITY CLINIC (RESIDENT CONTINUITY CLINIC) IN WISE, VIRGINIA. INTERNAL MEDICINE RESIDENTS SPENT MORE THAN 54,000 HOURS AT NCH DURING FY15. OUR UNREIMBURSED COST FOR THIS RESIDENCY PROGRAM EXCEEDED 700,000. IN ADDITION TO INTERNAL MEDICINE RESIDENTS, NCH SERVES AS A CLINICAL TRAINING HOSPITAL FOR OTHER ALLIED HEALTH PROFESSION EDUCATION STUDENTS. WE HAVE DEDICATED STAFF THAT WORK WITH REGIONAL COLLEGES AND UNIVERSITIES TO COORDINATE THE PLACEMENT OF HEALTHCARE PROFESSIONAL STUDENTS AS PART OF STUDENTS' EDUCATIONAL CURRICULUM. IN ADDITION TO CLINICAL TRAINING, THE HEALTH CARE STUDENTS ENTERING OUR SYSTEM ARE REQUIRED TO HAVE ORIENTATION AND COMPUTER TRAINING. PARTICIPANTS RECEIVING CLINICAL EXPERIENCE AT NCH DURING FY15 INCLUDED 80 NURSING STUDENTS FROM VARIOUS COLLEGES, UNIVERSITIES AND PROGRAMS. THIS NURSING CLINICAL EXPERIENCE REQUIRED EXTENSIVE NCH NURSING STAFF INVOLVEMENT. THE CLINICAL SETTING AND HANDS-ON INSTRUCTION COST NCH 159,250. NCH PROVIDED A CLINICAL SETTING FOR ANOTHER 64 STUDENTS TRAINING IN HEALTH-RELATED PROGRAMS SUCH AS RADIOLOGY, PHARMACY, PHYSICAL THERAPY, EMT/PARAMEDIC AND OTHER ALLIED-HEALTH DISCIPLINES. THESE ADDITIONAL CLINICAL STUDENTS COST NCH 54,211. NCH PARTNERED WITH THE COMPANIES, FIRSTSOURCE SOLUTIONS USA AND ADVANCED PATIENT ADVOCACY, TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. DURING FY15, REPRESENTATIVES WERE AVAILABLE AT NCH TO ASSIST PATIENTS BY DETERMINING GOVERNMENTAL MEDICAL ASSISTANCE (MEDICAID OR TENNCARE) ELIGIBILITY, AND BY HELPING WITH THE APPLICATION PROCESS AND FOLLOW-UP. 514 PATIENTS WERE APPROVED FOR COVERAGE IN FY15. ONCE A PERSON IS APPROVED FOR MEDICAID OR TENNCARE THROUGH THE PROGRAM OFFERED THROUGH NCH, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. FIRSTSOURCE SOLUTIONS AND ADVANCED PATIENT ADVOCACY ARE COMPENSATED BY NCH. OUR COST FOR THIS PROGRAM WAS 78,786. NCH CONTINUED THE VALUE OPTIMIZATION SYSTEM (VOS) PROGRAM DURING FY15. VOS ALLOWS A TRANSFORMATION OF CARE BY PROVIDING TRAINING AND TOOLS TO REDUCE WASTE, MEET PATIENTS' EXPECTATIONS OF HIGH QUALITY AND EFFICIENT CARE, WHILE ACHIEVING OUTSTANDING OUTCOMES. THE PROGRAM IS STRUCTURED FOR CONTINUOUS MONITORING AND IMPROVEMENT. IDENTIFIED PROJECTS ARE REFERRED TO AS "STREAMS". IN FY15, NCH REDUCED PATIENTS' ARRIVAL TIME TO DOCTOR TIME FROM 20 MINUTES TO 13 MINUTES, A 35% REDUCTION IN A PATIENT'S WAIT TIME. A VALUE STREAM THAT FOCUSED ON INPATIENT CARE LOOKED AT MEDICATION RECONCILIATIONS. THIS PROJECT INCLUDED NURSES, PHYSICIANS, INTERNAL MEDICINE RESIDENTS, AND PHARMACY STAFF WITH THE GOAL TO REDUCE MEDICATION LIST ERRORS. A MEDICATION LIST, IN THIS CONTEXT, REFERS TO MEDICATIONS AND DOSAGES A PATIENT TAKES AT HOME. IF A PATIENT BEGINS THEIR HOSPITAL VISIT IN THE ED, THE ED NURSE IS RESPONSIBLE FOR MAKING HIS/HER BEST FAITH EFFORT TO OBTAIN A COMPLETE LIST OF CURRENT MEDICATIONS USED BY THE PATIENT. THE INFORMATION INCLUDES DRUG NAME, DOSAGE AND FREQUENCY, LAST DOSE TAKEN, AND REASON FOR THE MEDICATION. WHEN THE PATIENT IS TRANSFERRED FROM THE ED TO A NURSING FLOOR, THE FLOOR NURSE IS RESPONSIBLE FOR REVIEWING THE LIST AND CHECKING FOR MISSING INFORMATION OR NOTES. PHYSICIAN AND RESIDENTS ARE THE THIRD CHECKPOINT IN THE MEDICATION RECONCILIATION PROCESS. PHARMACY REVIEWS MEDICATION INFORMATION FOR EACH PATIENT DAILY AND ERRORS ARE BROUGHT TO THE ATTENTION OF MANAGERS SO THAT ADDITIONAL TRAINING MAY BE PROVIDED WHERE GAPS OR ERRORS ARE IDENTIFIED. THIS VERY STRUCTURED PROCESS RESULTED IN REDUCING ERRORS ON THE MEDICATION LIST BY OVER 85%. TO IMPROVE ACCESS TO PRIMARY CARE, NORTON COMMUNITY HOSPITAL, OPERATES A RESIDENCY CLINIC IN A RURAL, LOW-INCOME AREA. BECAUSE REIMBURSEMENT DOES NOT COVER THE OPERATING EXPENSES OF THE CLINIC, THE HOSPITAL SUBSIDIZES IT. DURING FY15, THE SUBSIDY WAS MORE THAN 470,000. NCH DONATED MEDICATIONS TO THE REMOTE AREA MEDICAL (RAM) WITH A COST OF JUST OVER 8,000. RAM PROVIDES FREE DENTAL, VISION, AND MEDICAL CARE TO ISOLATED, IMPOVERISHED, OR UNDERSERVED COMMUNITIES. US NEWS & WORLD REPORT RANKS NCH AS "BETTER THAN EXPECTED" FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND HEART FAILURE FO FORM 990, PAGE 6, PART VI, LINE 6 THE CORPORATION IS ORGANIZED AS A VIRGINIA, NON-STOCK, NON-PROFIT CORPORATION. MOUNTAIN STATES HEALTH ALLIANCE IS THE 50.1% MEMBER OF NORTON COMMUNITY HOSPITAL,INC. COMMUNITY HEALTHCARE FOUNDATION, INC. IS THE 49.9% MEMBER OF NORTON COMMUNITY HOSPITAL, INC. FORM 990, PAGE 6, PART VI, LINE 7A THERE ARE TWO CLASSES OF MEMBERS AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE NORTON COMMUNITY HOSPITAL CLASS IS ELECTED BY THE COMMUNITY HEALTHCARE FOUNDATION BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT. FORM 990, PAGE 6, PART VI, LINE 7B CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY, DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL. FORM 990, PAGE 6, PART VI, LINE 11B THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS. THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW. FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY, THE CORPORATE AUDIT AND COMPLIANCE DEPARTMENT OF MSHA FORWARDS THE CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO ALL MSHA MANAGEMENT TEAM MEMBERS AND BOARD MEMBERS, INCLUDING THOSE AT NCH. EMPLOYEES AND BOARD MEMBERS MUST NOTE ANY CONFLICTS OR ATTEST THEY HAVE "NONE", AND RETURN THE FORM TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION. FORM 990, PAGE 6, PART VI, LINE 15A THE COMPENSATION OF NCH'S CEO IS INITIALLY DETERMINED BY MOUNTAIN STATES HEALTH ALLIANCE'S HUMAN RESOURCE DEPARTMENT BASED ON MARKET DATA OF COMPARABLE POSITIONS IN SIMILAR SETTINGS. EXECUTIVE SALARIES ARE EVALUATED ON AN ANNUAL OR NEAR-ANNUAL BASIS. MSHA OFFERS AN INCENTIVE PLAN TO EXECUTIVES BASED ON TARGETED ACHIEVEMENT METRICS SET IN ADVANCE OF THE PAY YEAR. ESTABLISHED METRICS INCLUDE: COMMUNICATION WITH PATIENTS, PATIENT EVIDENCE BASED CARE SCORES AND PATIENT SAFETY, VALUE BASED PURCHASING, ETC. THESE SAME METRICS ARE USED FOR ALL MSHA EMPLOYEES WITHIN MSHA, WITH A SMALL NUMBER OF EXCEPTIONS FOR COMPANIES THAT DO NOT PROVIDE DIRECT PATIENT CARE. MSHA USES AN OUTSIDE AND INDEPENDENT COMPENSATION CONSULTING FIRM TO ESTABLISH REASONABLE COMPENSATION. FORM 990, PAGE 6, PART VI, LINE 15B COMPENSATION FOR NCH'S CFO IS ESTABLISHED THE SAME WAY AS THE CEO'S, DESCRIBED ABOVE (LINE 15A). FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY BASIS. FORM 990, PART IX, LINE 11G PHYSICIAN FEES 4,637,384 0 0 HYPERBARIC SERVICES 57,049 0 0 AMBULANCE FEES 45,671 0 0 LAB TESTS 190,226 0 0 LINEN & ENVIRONMENTAL SERV. 0 454,824 0 COLLECTION FEES 0 305,526 0 PATIENT RESOURCE MGMT. 0 80,419 0 TRANSCRIPTION 0 109,865 0 NUTRITIONAL SERVICES 310,027 0 0 ENGINEERING SERVICES 0 183,337 0 VARIOUS EXPENSES 467,421 95,761 0 FORM 990, PART X PART IV, LINE 24A AND PART X, LINE 20 - TAX EXEMPT BOND LIABILITY THE TAX EXEMPT BOND LIABILITY REFLECTS THE PORTION OF BONDS ISSUED BY MOUNTAIN STATES HEALTH ALLIANCE, NCH'S MAJORITY OWNER, ON BEHALF OF NCH FOR CAPITAL NEEDS. NCH PAYS ALL COSTS RELATED TO THIS PORTION OF THE BOND ISSUE. FORM 990, PART XI, LINE 9 CHANGE IN TEMP. RESTRICTED GRANTS -31,105 ELIMINATION OF INTERCOMPANY REC/PAY 2,635 PENSION & POST LIABILITY ADJUSTMENT -1,122,717 TOTAL TO FORM 990, PART XI, LINE 9 -1,151,187 NORTON COMMUNITY PHYSICIAN SVCS LLC 96 15TH ST NW NORTON VA 24273 260868690 MED. SERV. 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