2016-05-16T15:50:24-05:00 2015-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-07-01 636000090 REGIONAL MEDICAL CENTER BOARD REGI 2562355255 PO BOX 2208 ANNISTON AL 36202 LOUIS A BASS CEO 2562355255 2016-05-16 1 AMY BIBBY P00445891 8282542254 2014 2016-08-17 19:52:53Z LOUIS A BASS PO BOX 2208 ANNISTON AL 36202 210217235 0 X WWW.RMCCARES.ORG X 1974 AL TO PROVIDE PERSONALIZED HEALTHCARE TO CITIZENS OF NORTHEAST ALABAMA 15 12 1787 215 172430 85216 152467 220965 183556366 204128393 2421686 2575323 391049 602599 186521568 207527280 365589 381566 0 0 70052067 80874273 0 0 0 113900621 122015592 184318277 203271431 2203291 4255849 185023816 178194081 53846307 53575083 131177509 124618998 X THE BOARD'S MISSION IS PROVIDING STATE OF THE ART HEALTH CARE WITH INTEGRITY, TO THE PEOPLE WE SERVE. 0 0 187875945 381566 203955963 DURING THE YEAR ENDED JUNE 30, 2015, NORTHEAST ALABAMA REGIONAL MEDICAL CENTER AND JACKSONVILLE MEDICAL CENTER HAD 13,337 ADULT AND PEDIATRIC INPATIENT ADMISSIONS, 1,756 NEWBORN ADMISSIONS AND SERVED PATIENTS THROUGH AMBULATORY CARE INCLUDING: 3,712 OBSERVATION PATIENTS, 55,853 EMERGENCY DEPARTMENT PATIENTS, 64,330 REFERRED OUTPATIENTS, 6,895 SAME DAY SURGERY PATIENTS. THE MEDICAL CENTER IS ALSO INVOLVED IN EDUCATION, RESEARCH, AND COMMUNITY BENEFIT ACTIVITIES DESIGNATED TO PROVIDE HEALTH AND WELLNESS. REGIONAL MEDICAL CENTER HOLDS DESIGNATIONS FOR THE FOLLOWING: BLUE CROSS CENTER OF DISTINCTION FOR CARDIAC CARE; IS THE ONLY HOSPITAL TO RECEIVE THE "BABY FRIENDLY" DESIGNATION FROM THE STATE OF ALABAMA; ASCR GOLD STANDARD AWARD (ALABAMA STATEWIDE CANCER REGISTRY).REGIONAL MEDICAL CENTER IS PROUD TO BE CATEGORIZED AS A TIER 1 HOSPITAL BY BLUE CROSS AND BLUE SHIELD OF ALABAMA. HOSPITALS DESIGNATED AS TIER 1 ARE RECOGNIZED AS HAVING ATTAINED THE HIGHEST LEVEL OF COMPLIANCE ACROSS THE FOLLOWING AREAS: QUALITY AWARENESS, PATIENT SAFETY AWARENESS, FINANCIAL AWARENESS, AND PATIENT SATISFACTION. 187875945 1 1 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 379 0 1 1787 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X X SUSAN MARNEY DIRECTOR - ACCOUNT 2562355678 400 EAST TENTH STREET ANNISTON AL 36202 GREGORY J KERNION CHAIRMAN (THROUGH MAY 15) 1.00 X X 0 0 0 BILLY DON GRIZZARD CHAIRMAN (BEGAN JUN 15) 1.00 X X 0 0 0 JAMES E ROBERTS VICE CHAIRMAN 1.00 1.00 X X 122 0 0 ARTHUR F FITE III SECRETARY 1.00 1.00 X X 100 0 0 SANDRA FOX SUDDUTH BOARD MEMBER 1.00 1.00 X X 50 0 0 JIMMIE THOMPSON BOARD MEMBER 1.00 X 0 0 0 FRED WILSON BOARD MEMBER 1.00 1.00 X 125 0 0 GEORGE CRAWFORD MD BOARD MEMBER 1.00 X 0 0 0 TRUDY D HARDEGREE BOARD MEMBER 1.00 1.00 X 0 0 0 W E WILLIAMS BOARD MEMBER 1.00 X 100 0 0 MICHAEL W KIMBERLY DRPH MPH HCLD BOARD MEMBER (THROUGH MAY 15) 1.00 X 75 0 0 BRIAN JOHNSON BOARD MEMBER (BEGAN SEP 14) 1.00 X 0 0 0 ELLEN BASS BOARD MEMBER 1.00 X 100 0 0 PAULA WATKINS BOARD MEMBER (BEGAN JUN 15) 1.00 X 0 0 0 BUD OWSLEY BOARD MEMBER (BEGAN JUN 15) 1.00 X 0 0 0 GORDON HARDY MD CHIEF OF STAFF 1.00 X 100 0 0 ROHIT G PATEL MD CHIEF OF STAFF (THROUGH SEPT 14) 1.00 X 18500 0 0 BLANE BATEMAN VICE CHIEF OF STAFF (OCT 14 - SEPT 15) 1.00 X 0 0 0 LARRY DEASON BOARD MEMBER (THROUGH SEPT 14) 1.00 X 1070 0 0 J DAVID MCCORMACK CEO (THROUGH SEPT 14) 50.00 1.00 X 325155 0 14291 LOUIS BASS CEO (APP.DEC 14) /CFO (THRGH DEC 14) 50.00 1.00 X 201699 0 20099 MARK NORTH CFO (APPOINTED DEC 14) 50.00 X 138824 0 18619 JOSEPH WEAVER COO 50.00 X 192288 0 25317 TERRY M PHILLIS JR MD PHYSICIAN 50.00 X 772377 0 21073 BARRY J BILLINGS MD PHYSICIAN 50.00 X 655596 0 21081 MOHAMED JASSER MD PHYSICIAN 50.00 X 460542 0 23593 FRANK H KIM MD PHYSICIAN 50.00 X 357712 0 20374 MASUMI YAMAMURO MD PHYSICIAN 50.00 X 464765 0 24781 3589300 0 189228 41 0 1 0 ANESTHESIA SOLUTIONS OF ANNISTON LLC PO BOX 6633 HIGH POINT NC 27262 CRNA SERVICES 2737150 MORRISONS HEALTH CARE DIVISION PO BOX 102289 ATLANTA GA 303682289 MANAGEMENT OF FOOD SERVICE 1629356 HEALTHCARE MANAGEMENT PARTNERS LLC 9001 W 110TH STREET SUITE 260 OVERLAND PARK KS 66211 ADMINISTRATIVE MANAGEMENT CONSULTING 957344 ALIGN MD 624 28TH STREET NORTH BIRMINGHAM AL 35203 EMERGENCY DEPT PHYSICIAN SERVICES 684000 ASSISTMED INC 15303 VENTURA BLVD SUITE 900 SHERMAN OAKS CA 94103 TRANSCRIPTION SERVICES 437280 29 10563 210402 220965 NET PATIENT SERVICE 621400 195373680 195373680 MEDICAID DISP SHARE 900099 4662461 4662461 EHR PAYMENT 900099 1737068 1737068 PHARMACY REVENUE 900099 1026785 1026785 OTHER PROGRAMS 900099 808503 636073 172430 519896 519896 204128393 2407735 2407735 1933851 9824 2432359 0 -498508 9824 -488684 -488684 425184 257596 167588 167588 167588 FOOD SERVICE & VENDING 722210 959161 959161 OTHER INCOME 900099 104093 104093 GIFT SHOP REVENUE 453220 28029 28029 1091283 207527280 203955963 172430 3177922 78396 78396 303170 303170 765211 255070 510141 136340 136340 70159157 64186425 5972732 4445582 4034846 410736 5367983 4872025 495958 733218 733218 20650 20650 19485209 16291413 3193796 23666 23666 2656765 1857281 799484 3089382 1496233 1593149 4240690 4240125 565 56682 41973 14709 175940 136558 39382 1340517 1340517 12448324 12448324 1191052 1183612 7440 UNRELATED BUSINESS INCO 13000 13000 MEDICAL SUPPLIES 43783211 43783211 BAD DEBT 29556580 29556580 FOOD SERVICE EXPENSES 1474795 1474795 1725911 135385 1590526 203271431 187875945 15395486 0 347393 921383 5500007 7459294 17669495 19441165 3145990 1975251 5000976 5702127 2101919 2296408 283208010 217337608 63660427 65870402 55864362 56730185 9006269 9006269 164000 164000 22562978 8627597 185023816 178194081 14737905 14695273 704651 963721 37839716 36754545 564035 1161544 53846307 53575083 X 131167469 124608958 10040 10040 131177509 124618998 185023816 178194081 X 4255849 -762421 -10051939 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 25999 25999 0 PART II-B, LINE 1: A PORTION OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE ALABAMA HOSPITAL ASSOCIATION (ALAHA) IS ALLOCATED TO LOBBYING ACTIVITIES PERFORMED FOR THE BENEFIT OF THOSE ORGANIZATIONS' MEMBER BODIES. IN 2014, 22.80% OF DUES TO THE AHA ($7,124) AND 20.93% OF DUES PAID TO THE ALAHA ($18,875) WERE ALLOCATED TO LOBBYING EFFORTS. 10040 10040 10065 -25 10040 10100 -35 10065 10160 -60 10100 10200 -40 10160 1.00000 0 0 4678957 4678957 91314656 65651920 25662736 4472409 3343317 1129092 182175787 148342371 33833416 566201 566201 65870402 INVESTMENT IN QHG OF JACKSONVILLE 9006269 C 9006269 PROFESSIONAL LIABILITY SELF INSURANCE 495938 WORKER'S COMPENSATION LIABILITY 104000 PENSION DEFERRALS 561606 1161544 X 178226196 -762421 2432359 1669938 176556258 30971022 30971022 207527280 174732768 2432359 2432359 172300409 30971022 30971022 203271431 PART V, LINE 4: THE KNOX ENDOWMENT WAS ESTABLISHED IN THE 1940'S BY THE KNOX FAMILY TO PROVIDE MATERNITY CARE FOR INDIGENT HOSPITAL PATIENTS. INVESTMENT EARNINGS ON THE FUND ARE PUT TOWARDS INDIGENT MATERNITY PATIENTS ANNUALLY. THE HOSPITAL HAS DISCRETION TO USE THE FUNDS FOR MEDICAL EXPENSES BESIDES MATERNITY CARE IF NECESSARY. PART X, LINE 2: THE BOARD IS A POLITICAL SUBDIVISION AND THE AFFILIATE IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN 501(C)(3) OF THE INTERNAL REVENUE CODE; THEREFORE, NO PROVISION HAS BEEN RECORDED FOR INCOME TAXES FOR THESE ENTITIES. THE FILING ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2015 AND 2014. FISCAL YEARS ENDED ON OR AFTER JUNE 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES, GENERALLY FOR THREE YEARS AFTER THE RELATED TAX RETURNS WERE FILED. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE NET W/ REVENUES 2,432,359. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 29,556,580. EXPENSES NET W/REVENUES 1,414,442. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE NET W/ REVENUES 2,432,359. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 29,556,580. EXPENSES NET W/REVENUES 1,414,442. 1 1 1 X 1 X 1 1 1 0 1 1 7895260 7895260 0.04340 18611248 17058683 1552565 0.00850 26506508 17058683 9447825 0.05190 251566 251566 0.00140 12082007 8870926 3211081 0.01760 82686 82686 0.00050 12416259 8870926 3545333 0.01950 38922767 25929609 12993158 0.07140 0 3626461 56640539 58539090 -1898551 X 1 1 2 1 NORTHEAST ALABAMA REGIONAL MEDICAL CTR 400 EAST 10TH STREET ANNISTON AL 36207 X X X 2 REGIONAL MEDICAL CENTER - JACKSONVILLE 1701 PELHAM ROAD JACKSONVILLE AL 36265 X X X NORTHEAST ALABAMA REGIONAL MEDICAL CTR 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X WWW.RMCCARES.ORG X 0 0 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.RMCCARES.ORG X X X X X 1 0 X X 1 X 0 0 REGIONAL MEDICAL CENTER JACKSONVILLE 2 0 1 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X WWW.RMCCARES.ORG X X X X X 1 0 X X 1 X 0 0 NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 5: RMC'S CHNA TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE INTERVIEW PROCESS TOOK INTO ACCOUNT INPUT FROM PERSONS, BASED ON RECOMMENDATIONS FROM THE HOSPITAL'S MANAGEMENT TEAM, WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL INCLUDING HOSPITAL MANAGEMENT, HOSPITAL BOARD, HOSPITAL MEDICAL STAFF / COMMUNITY PHYSICIANS, LOCAL AGENCIES AND PROVIDERS, AND COMMUNITY LEADERS. COLLECTIVELY, THE COMMUNITY MEMBERS SURVEYED REPRESENT HUNDREDS OF YEARS OF LIVING EXPERIENCE IN THE PRIMARY SERVICE AREA OF THE HOSPITAL AND THEREFORE PROVIDE HIGH PROBABILITY THAT RESPONDENTS KNOW AND UNDERSTAND THE COMMUNITY DYNAMICS AND ISSUES OF THE PRIMARY SERVICE AREA. REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 2: THE ORGANIZATION PURCHASED THE HOSPITAL FACILITY OPERATED AS RMC JACKSONVILLE DURING THE YEAR. NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 11: THE ORGANIZATION PRIORITIZED THE HEALTH NEEDS ADDRESSED BASED ON FIVE CONSIDERATIONS: 1) CONSISTENCY WITH THE ORGANIZATION'S MISSION, 2) QUALITY CONSIDERATIONS, 3)GOVERNANCE AND ORGANIZATION STRUCTURE ISSUES, 4)FINANCIAL OPERATIONS IMPACTS, 5)AND RISK. NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 22D: THE ORGANIZATION CHARGES A % DISCOUNT OFF OF BILLED CHARGES BASED ON A SLIDING SCALE THAT IS TIED TO THE FEDERAL POVERTY GUIDELINES. THE ORGANIZATION PLANS TO MODIFY ITS EXISTING POLICY TO BETTER MEET THE REQUIREMENTS OF SECTION 501(R) AFTER IT HAS BEEN FINALIZED. REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 22D: THE ORGANIZATION CHARGES A % DISCOUNT OFF OF BILLED CHARGES BASED ON A SLIDING SCALE THAT IS TIED TO THE FEDERAL POVERTY GUIDELINES. THE ORGANIZATION PLANS TO MODIFY ITS EXISTING POLICY TO BETTER MEET THE REQUIREMENTS OF SECTION 501(R) AFTER IT HAS BEEN FINALIZED. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 16A WEBSITE: WWW.RMCCARES.ORG REGIONAL MEDICAL CENTER JACKSONVILLE PART V, SECTION B, LINE 16A WEBSITE: WWW.RMCCARES.ORG 1 NORTHEAST AL REGIONAL MED CENTER PSYCH U 400 EAST 10TH STREET ANNISTON AL 36202 INPATIENT PSYCH UNIT PART I, LINE 3C: OUR ORGANIZATION PROVIDES A 60% DISCOUNT TO THE BILL FOR ALL SELF PAY (UNINSURED) PATIENTS. THIS ADJUSTMENT IS APPLIED TO THE BILL PRIOR TO STATEMENTS BEING MAILED TO THE PATIENT OR GUARANTOR. WE ALSO RETAIN ON A CONTRACTED BASIS VENDORS THAT ASSIST IN SCREENING PATIENTS FOR QUALIFICATION FOR FREE OR CHARITY CARE. THIS IS ACCOMPLISHED BY MEANS OF INTERVIEWS WITH THE PATIENT AS PART OF OUR NORMAL COLLECTION PROCESS. PART I, LN 7 COL(F): FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSE IN LINE 7, COLUMN (F), A BAD DEBT EXPENSE OF $29,556,580 HAS BEEN ADJUSTED FROM TOTAL EXPENSES PRESENTED ON FORM 990, PART X, LINE 25. PART III, LINE 4: BAD DEBT EXPENSE AT COST WAS CALCULATED BY MULTIPLYING TOTAL BAD DEBT EXPENSE BY THE HOSPITAL'S COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS BY DIVIDING TOTAL OPERATING COSTS INTO TOTAL CHARGES. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE WAS DERIVED FROM THE MEDICARE COST REPORT. PART III, LINE 9B: THE CHARITY POLICY DOES NOT SPECIFICALLY ADDRESS COLLECTION PRACTICES. HOWEVER, ONCE A PERSON IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ALL COLLECTION ACTIVITY STOPS DUE TO THE FACT THAT THE ACCOUNTS ARE ADJUSTED TO A ZERO BALANCE. FOR THE INSTANCES WHERE THE PATIENT QUALIFIES FOR PARTIAL FINANCIAL ASSISTANCE, THE ACCOUNTS ARE ADJUSTED TO THE APPROPRIATE BALANCE AND THEN FOLLOW THE NORMAL COLLECTION SCHEDULES ESTABLISHED BY THE OUTSOURCED COLLECTION AGENCIES. PART VI, LINE 2: OUR ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF OUR COMMUNITY IN SEVERAL WAYS, WHICH INCLUDES THE COMPLETION OF A COMMUNITY HEALTH NEEDS ASSESEMENT ONCE EVERY THREE YEARS (WITH THE MOST RECENT ASSESSMENT COMPLETED IN TAX YEAR 2012), AND THE COMPLETION OF AN ANNUAL UPDATE OF OUR MEDICAL STAFF DEVELOPMENT PLAN. THERE ARE SEVERAL COMPONENTS TO THIS PLAN, INCLUDING THE OVERALL POPULATION WITHIN OUR SERVICE AREA, THE AGE OF THE CURRENT MEMBERS OF OUR MEDICAL STAFF, AND PROJECTED PHYSICIAN NEEDS USING CALCULATIONS PROVIDED BY THE AMERICAN MEDICAL ASSOCIATION'S PHYSICIAN CHARACTERISTICS AND DISTRIBUTION IN THE U.S. PART VI, LINE 3: ALL PATIENT BILLS INCLUDE A STATEMENT THAT CHARITY CARE IS AVAILABLE TO QUALIFYING INDIVIDUALS, ALONG WITH INFORMATION ON HOW TO CONTACT PERSONNEL AT THE HOSPITAL IF THE PATIENT IS INTERESTED IN DETERMINING IF THEY QUALIFY FOR FINANCIAL ASSISTANCE. SIGNS ARE ALSO POSTED IN ALL REGISTRATION AREAS, AND INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY IS ALSO PROVIDED ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: OUR SERVICE AREA IS COMPRISED OF APPROXIMATELY 200,000 PEOPLE RESIDING IN THE COUNTIES OF CALHOUN, CLEBURNE, CLAY, RANDOLPH AND TALLADEGA. ALL AGE GROUPS FROM NEWBORNS TO THE ELDERLY ARE SERVED. SERVICES INCLUDE MEDICAL/SURGICAL, INTENSIVE CARE, OBSTETRICS, PEDIATRICS, PSYCHIATRIC, CARDIOLOGY AND ONCOLOGY. ALL CITIZENS ARE SERVED REGARDLESS OF PAYER OR ABILITY TO PAY. WHILE RMC ANNISTON IS THE ONLY FULL SERVICE HOSPITAL IN THE SERVICE AREA, SMALLER HOSPITALS IN CALHOUN COUNTY INCLUDE STRINGFELLOW HOSPITAL AND RMC JACKSONVILLE. OTHER HOSPITALS IN OUR 5 COUNTY SERVICE AREA INCLUDE WEDOWEE HOSPITAL, CLAY COUNTY HOSPITAL IN CLAY COUNTY, AND CITIZENS HOSPITAL AND COOSA VALLEY MEDICAL CENTER IN TALLADEGA COUNTY. CLEBURNE AND RANDOLPH COUNTIES ARE CONSIDERED FEDERALLY DESIGNATED MEDICALLY UNDERSERVED FOR PRIMARY CARE, AND ALL COUNTIES ARE CONSIDERED UNDERSERVED FOR SPECIALTY PHYSICIANS. THE AREA ALSO QUALIFIES AS UNDERSERVED FOR PSYCHIATRIC SERVICES BY THE NATIONAL HEALTH SERVICE CORPS. PART VI, LINE 5: REGIONAL MEDICAL CENTER PROMOTES HEALTH WITHIN THE COMMUNITY WE SERVE IN A VARIETY OF WAYS. AS A NONPROFIT, WE PROVIDE SERVICES FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, AND WE SEE A VERY HIGH NUMBER OF UNINSURED, UNDERINSURED AND INDIGENT PATIENTS IN OUR EMERGENCY DEPARTMENT. WE ASSIST THE MEMBERS OF OUR MEDICAL STAFF IN RECRUITING NEW PHYSICIANS TO THE AREA. AS PART OF OUR ASSISTANCE PROGRAM, RECRUITED PHYSICIANS MUST AGREE TO SEE ALL PATIENTS, REGARDLESS OF INCOME LEVEL OR ABILITY TO PAY. RMC PROVIDES MANY COMMUNITY SERVICES IN THE FORM OF HEALTH EDUCATION, SCREENINGS AND SUPPORT GROUPS. OUR CANCER RESOURCE CENTER, PARISH NURSING PROGRAM, AND CONGREGATIONAL HEALTH OUTREACH ARE BUT A FEW OF OUR SERVICES TO OUR COMMUNITY THAT PROVIDE HIGHLY SKILLED STAFF TO PERFORM HEALTH SCREENINGS AND EDUCATION FREE OF CHARGE.A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE MEDICAL CENTER. THE ORGANIZATION OFFERS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED LOCAL PHYSICIANS IN ALL HOSPITAL DEPARTMENTS.THE FACILITY UTILIZES SURPLUS FUNDS PRIMARILY TO PURCHASE NEW AND REPLACEMENT MEDICAL EQUIPMENT AND TO PERFORM NEEDED RENOVATIONS ON ITS PLANT. OTHER USES OF SURPLUS FUNDS MIGHT INVOLVE FUNDING EDUCATIONAL OPPORTUNITIES FOR CLINICAL STAFF AND WHEN ALLOWED, MEMBERS OF ITS MEDICAL STAFF. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES AL 1 EAST ALABAMA EMERGENCY MEDICAL SERVICES PO BOX 700 LINCOLN AL 35096 630707345 501(C)(3) 15000 GENERAL ACTIVITY SPONSORSHIP UNITED WAY OF CALHOUN COUNTY PO BOX 1122 ANNISTON AL 36202 630350957 501(C)(3) 6250 GENERAL ACTIVITY SPONSORSHIP 2 MEDICATION/MEDICAL SUPPLIES 105 26368 TRANSPORTATION 303 4887 AMBULANCE TRANSPORTS 13 7432 FOOD 4 19 SCHOLARSHIP AWARDS 52 258566 REHAB SERVICE 1 5498 SHELTER/HOUSING 3 400 PART I, LINE 2: THE ORGANIZATION HAS WRITTEN GUIDELINES FOR ORGANIZATIONS TO APPLY FOR COMMUNITY CONTRIBUTIONS (GRANTS). A DETAILED APPLICATION MUST BE COMPLETED AND APPROVED BY THE REVIEW COMMITTEE OF THE BOARD. A COPY OF THE APPLICATION IS AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINSITRATIVE OFFICE. X X X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 J DAVID MCCORMACK CEO (THROUGH SEPT 14) 239744 0 0 0 85411 0 0 0 14291 0 339446 0 0 0 LOUIS BASS CEO (APP.DEC 14) /CFO (THRGH DEC 14) 190608 0 1531 0 9560 0 9000 0 11099 0 221798 0 0 0 MARK NORTH CFO (APPOINTED DEC 14) 129681 0 1058 0 8085 0 8080 0 10539 0 157443 0 0 0 JOSEPH WEAVER COO 177900 0 1423 0 12965 0 14400 0 10917 0 217605 0 0 0 TERRY M PHILLIS JR MD PHYSICIAN 545016 0 192377 0 34984 0 17492 0 3581 0 793450 0 0 0 BARRY J BILLINGS MD PHYSICIAN 505184 0 115412 0 35000 0 17500 0 3581 0 676677 0 0 0 MOHAMED JASSER MD PHYSICIAN 405517 0 0 0 55025 0 20012 0 3581 0 484135 0 0 0 FRANK H KIM MD PHYSICIAN 320462 0 20000 0 17250 0 17250 0 3124 0 378086 0 0 0 MASUMI YAMAMURO MD PHYSICIAN 460365 0 0 0 4400 0 21200 0 3581 0 489546 0 0 0 PART I, LINE 1A ALL TRAVEL EXPENSES FOR SPOUSES AND COMPANIONS, AS WELL AS TEMPORARY HOUSING ALLOWANCES PER EMPLOYMENT AGREEMENTS, ARE ADDED AS WAGES ON THE RECIPIENTS' FORM W-2 OR 1099-MISC. PART I, LINE 4A J. DAVID MCCORMACK RECIEVED A SEVERANCE PAYMENT IN THE AMOUNT OF $75,000 DURING CALENDAR YEAR 2014. RACHEL CALDWELL FAMILY MEMBER OF CORPORATE OFFICER 51089 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 JOHN FITE FAMILY MEMBER OF BOARD MEMBER 23274 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 MELANIE GRIZZARD FAMILY MEMBER OF BOARD MEMBER 61977 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPRISED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE SECRETARY OF THE BOARD, THE FINANCE COMMITTEE CHAIRPERSON, THE HUMAN RESOURCES COMMITTEE CHAIRPERSON, THE PHYSICAL FACILITIES AND PROPERTIES COMMITTEE CHAIRPERSON, THE COMPLIANCE COMMITTEE CHAIRPERSON, THE CHIEF OF THE MEDICAL STAFF, AND ONE AT-LARGE BOARD MEMBER. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION, EXCEPT AS SUCH AUTHORITY IS LIMITED OR RESERVED BY STATUTE OR IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION IS DOING BUSINESS AS RMC JACKSONVILLE FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE THOSE DULY APPOINTED UNDER THE PROVISIONS OF ORDINANCE NO. 74-0-13 ADOPTED BY THE COUNCIL OF THE CITY OF ANNISTON, AL, ON MAY 7, 1974. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD IS RESTRICTED FROM THE SALE OR DISPOSAL OF ANY PART OF THE REAL ESTATE USED IN CONNECTION WITH THE OPERATION OF THE MEDICAL CENTER OR THE TRANSFER OF THE OPERATION AND MANAGEMENT OF THE MEDICAL CENTER WITHOUT THE CONSENT OF THE GOVERNING BODY OF THE CITY OF ANNISTON, AL. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED INTERNALLY BY MANAGEMENT, AND FORWARDED TO THE MEMBERS OF THE BOARD OF DIRECTORS. AFTER THE RETURN WAS REVIEWED BY THE BOARD MEMBERS, IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO DISCLOSE ON AN ANNUAL BASIS ANY POTENTIAL CONFLICTS OF INTEREST PER THE ORGANIZATION'S OFFICIAL WRITTEN POLICY. A DISINTERESTED PARTY IS ASSIGNED TO INVESTIGATE ANY CONFLICTS THAT ARISE, AND AFFECTED BOARD MEMBERS ARE ADVISED OF THE PARTY'S DECISION. FORM 990, PART VI, SECTION B, LINE 15A THE CEO COMPENSATION PACKAGES ARE DETERMINED BY CONDUCTING SALARY SURVEYS FROM INDIVIDUAL HOSPITALS AS WELL AS UTILIZING SALARY INFORMATION AVAILABLE FROM INDEPENDENT SOURCES SUCH AS STATE HOSPITAL ASSOCIATIONS, INDEPENDENT COMPENSATION CONSULTANTS, AND PERIODICALS. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OVERSEES THE PROCESS AND DETERMINES THE COMPENSATION FOR THE CEO AFTER REVIEW AND CONSIDERATION OF ALL RELEVANT INFORMATION. THE CEO APPROVES COMPENSATION PACKAGES FOR ALL OTHER APPLICABLE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART XI, LINE 9: ADJUSTMENT TO PENSION LIABILITY -7,034,391. TRANSFER OF EQUITY -3,017,548. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MEDICAL CENTER MEMORIAL FOUNDATION INC PO BOX 2208 ANNISTON AL 36202 630981593 EXEMPT ORG SUPPORT AL 501(C)(3) LINE 7 N/A 0 REGIONAL HEALTH SERVICES INC PO BOX 2208 ANNISTON AL 36202 630721572 EXEMPT ORG SUPPORT AL 501(C)(3) LINE 11A, I REGIONAL MEDICAL CENTER BOARD 1 REGIONAL HEALTH MANAGEMENT CORPORATION PO BOX 2345 ANNISTON AL 36202 630819576 MANAGEMENT AL N/A C 0 QHG OF JACKSONVILLE INC PO BOX 2208 ANNISTON AL 36202 621637909 HEALTHCARE AL REGIONAL MEDICAL CENTER BOARD C 6733064 1.00000 1 1 1 1 1 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 REGIONAL MEDICAL CENTER FOUNDATION O 97553 QHG OF JACKSONVILLE INC S -3676087 REGIONAL MEDICAL CENTER FOUNDATION Q 55896