2016-08-01T16:45:37-05:00 2015-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2014-10-01 560603898 HARNETT HEALTH SYSTEM INC HARN 9108927161 PO BOX 1707 DUNN NC 28335 KEVIN JACKSON PRESIDENT/CEO 9108927161 2016-07-20 1 JOHN NORMAN P01506766 7049985200 2016-07-07 2014 2016-12-15 16:53:06Z BETSY JOHNSON REGIONAL HOSPITAL KEVIN JACKSON PO BOX 1707 DUNN NC 28335 92903855 0 X WWW.MYHARNETTHEALTH.ORG X 1937 NC PROVIDING MEDICAL CARE FOR PATIENTS OF THE HOSPITAL 13 12 1189 50 0 0 117785 118827 73915535 92029103 13422 17874 606981 738051 74653723 92903855 0 0 0 0 60121150 52854176 0 0 0 49620047 46093967 109741197 98948143 -35087474 -6044288 171245857 183081424 197022590 212334624 -25776733 -29253200 X HARNETT HEALTH IS DEDICATED TO PROVIDING QUALITY AND PERSONALIZED CARE WITH RESPECT AND COMPASSION. WE ARE COMMITTED TO MAKING A DIFFERENCE THROUGHOUT OUR COMMUNITIES WITH SERVICE EXCELLENCE. 0 0 85100189 92370359 THE HOSPITAL SERVED THE HARNETT COUNTY POPULATION AND REACHED INTO THE COUNTIES OF SAMPSON, JOHNSTON AND CUMBERLAND. THE HOSPITAL SERVED 26,307 INPATIENTS FOR FY15. THE HOSPITAL EXPERIENCED 599 DELIVERIES. THE OUTPATIENTS SERVED WERE 65,105 EMERGENCY VISITS, 18,957 PHYSICAL THERAPY-OCCUPATIONAL THERAPY-SPEECH THERAPY VISITS AND ALL OTHER OUTPATIENT VISITS TOTALED 32,355. CARDIACREHAB TREATED 113 PATIENTS AND SOME OF THE OUTCOMES WERE THE FOLLOWING - FERRANS AND POWERS SURVEY, OVERALL QUALITY OF LIFE IMPROVED 2 POINTS (GOAL IS 2-3 POINT INCREASE), HEALTH AND FUNCTIONING SUB-SCORE IMPROVED 3 POINTS (GOAL IS 2-3 POINT INCREASE), EDUCATIONAL ASSESSMENT SCORE IMPROVED 2%. MEDICATION MANAGEMENT OF HARNETT COUNTY (BETSY JOHNSON REGIONAL HOSPITAL) ENCOUNTERED 37 NEW PATIENTS WITH A TOTAL OF 214 ACTIVE PARTICIPANTS IN THE PROGRAM. WE RECEIVED 561 MEDICATIONS WITH A TOTAL VALUE OF $461,932. OUTREACH PROGRAMS THE HOSPITAL ARE INVOLVED WITH INCLUDE THE FOLLOWING: TEENS AS PARENTS PROGRAM, WHICH COLLABORATES WITH TWO OTHER COUNTY AGENCIES, PROVIDES A HOME VISITATION PROGRAM AND THE CONTINUATION OF EDUCATION CLASSES ON CHILDBIRTH AND PARENTING. THE PROGRAM ALSO PROVIDES HARNETT COUNTY TEEN PARENTS WITH OPPORTUNITIES TO DEVELOP SELF-RESPECT, PARENTING, AND DECISION-MAKING SKILLS WHILE CONTINUING THEIR EDUCATION. TAP SERVED 30 TEENS. THE REPEAT PREGNANCY RATE FOR TAP PARTICIPANTS IS 3%, COMPARED TO THE COUNTY RATE OF 22%. THE TAP PROGRAM PARTICIPANTS RECEIVED 117.5 HOURS OF GROUP INSTRUCTION, INCLUDING THE FOLLOWING TOPICS: 13.25 HOURS ACADEMIC SUPPORT, 136 HOURS OF COLLEGE PREPAREDNESS, 9.5 HOURS OF INDIVIDUAL COUNSELING AND 8.5 HOURS OF FAMILY COUNSELING, 81.5 HOURS OF LIFE SKILLS TRAINING, AND 262.25 HOURS OF IN HOME VISITATION. HEALTH HARNETT PROGRAM OR "GO RED" IS A PROGRAM THAT PROMOTES HEALTHY EATING, WHICH LEADS TO A HEALTHY LIFESTYLE. HARNETT HEALTH COLLABORATED WITH THE NC COOPERATIVE EXTENSION AND THE HARNETT COUNTY HEALTH DEPARTMENT. THERE WERE A TOTAL OF 93 PARTICIPANTS IN TWO PRESENTATIONS GIVEN BY THE HARNETT HEALTH CARDIAC REHAB DEPARTMENT, AS WELL AS 2 SUPPORTING PHYSICIANS. OFFERED FREE EDUCATIONAL BROCHURES AND INFORMATION AT ALL EVENTS. WE PARTICIPATE IN PROJECT ACCESS OF JOHNSON/HARNETT COUNTY, WHICH IS A PHYSICIAN LED VOLUNTEER INITIATIVE THAT GIVES LOWINCOME, UNINSURED COUNTY RESIDENTS ACCESS TO COMPREHENSIVE MEDICAL CARE PHYSICIANS AND COMMUNITY PARTNERS, LIKE HARNETT HEALTH, DONATE MEDICAL SERVICES WITHOUT RECEIVING REIMBURSEMENT OR COMPENSATION. THE PROGRAM HAS ASSISTED 104 PATIENTS FOR THE LAST FISCAL YEAR. 85100189 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 95 0 1189 1 0 0 0 0 0 0 0 0 0 0 X 13 12 1 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 0 1 1 0 X DEBORAH WHITTINGTON 9108921000 800 TILGHMAN DRIVE DUNN NC 28334 DR RON MADDOX PHARM D CHAIRMAN 4.00 X X 0 0 0 CORNELIA STEWART CHAIRMAN 2.00 X X 0 0 0 ERNEST ALPHIN TREASURER 2.00 X X 0 0 0 TEDDY BYRD VICE-CHAIRMAN 2.00 X X 0 0 0 WALTER T WEEKS JR SECRETARY 2.00 X X 0 0 0 JIM MCCORMICK TRUSTEE 2.00 X 0 0 0 BARBARA BETHEA MD TRUSTEE 2.00 X 0 0 0 WILEY POPE TRUSTEE 2.00 X 0 0 0 HEATHER H WILLIAMS TRUSTEE 2.00 X 0 0 0 H WEST LAWSON MD TRUSTEE 2.00 X 0 0 0 DEWEY BLALOCK TRUSTEE 2.00 X 0 0 0 BARBARA MCKOY TRUSTEE 2.00 X 0 0 0 FRANK STEWART TRUSTEE 2.00 X 0 0 0 MIKE NAGOWSKI TRUSTEE 2.00 X 0 0 0 KENNETH BRYAN PRESIDENT/CEO (10/2014) 40.00 X 460057 0 67427 DANIEL WEATHERLY PRESIDENT (11/2014-9/2015) 55.00 X 229228 0 5536 ROBIN NICHOLS CFO 40.00 X 161745 0 0 LYNN LAMBERT CFO 40.00 X 273068 0 63370 VICKI ALLEN CNO/VP (10/2014-12/2014) 40.00 X 200403 0 14146 SONDRA DAVIS VP HR 40.00 X 152007 0 24177 MIKE JONES VP CENTRAL HOSPITAL AND SU 40.00 X 151315 0 22190 MICHAEL ZICH PHYSICIAN 40.00 X 308728 0 31188 BEVERLY YEARWOOD PHYSICIAN 40.00 X 196781 0 21169 BRAD BUTLER PHYSICIAN 40.00 X 172410 0 30403 ASIF ZIA PHYSICIAN 40.00 X 183142 0 21943 JODI MILLER PHYSICIAN 40.00 X 174434 0 19531 2663318 0 321080 33 0 1 0 WYRICK ROBBINS YATES & PONTON 4101 LAKE BOONE TRAIL SUITE 300 RALEIGH NC 27607 LEGAL 912789 AMSOL PO BOX 6633 HIGH POINT NC 27262 ANESTHIOLOGY 869345 KPMG LLP 5 CHESTNUT RIDGE ROAD MONTVALE NJ 07645 PATIENT BILLING 795000 BYERS DEAN & ASSOC 612 OFFICE PKWY SUITE A WESTERVILLE OH 43082 BILLING FOR PHY 652689 DIVERSIFIED CLINICAL SERVICES PO BOX 551187 JACKSONVILLE FL 32255 WOUND CARE 575336 17 118827 118827 NET PATIENT SERVICE REVENUE 621400 90916849 90916849 1112254 1112254 92029103 17874 17874 341256 0 341256 341256 341256 CAFETERIA SALES 900099 396795 0 396795 396795 92903855 92370359 0 414669 1476508 1476508 43376527 38125080 5251447 5066248 4306311 759937 2934893 2494659 440234 1817866 1817866 1016542 1016542 147849 147849 335503 335503 39796 39796 1648285 1648285 2302003 2302003 105084 105084 3688412 3688412 7941931 7941931 811607 811607 CONTRACT SERVICES/ CONT 7646270 7646270 MEDICAL SUPPLIES 7083799 7083799 MAINT. & REPAIRS 4187684 4187684 DRUGS 2583057 2583057 4738279 1800708 2937571 98948143 85100189 13847954 0 314160 2255949 14813160 10996264 932 3473 2787557 2019048 890411 838549 145353879 63589501 89359985 81764378 1144849 4065353 61934803 81138410 171245857 183081424 41503732 32676412 733949 830102 21555000 20965000 72327937 71615946 60901972 86247164 197022590 212334624 X -26921582 -33789789 1144849 4536589 -25776733 -29253200 171245857 183081424 -6044288 2567821 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1189620 1189620 91745490 26317086 65428404 51759181 36814744 14944437 659588 457671 201917 81764378 PREPAID PENSION COSTS 4080446 INTERCO 75294882 UNAMORTIZED LOSS ON EXTINGUISHMENT OF DEBT 1763082 81138410 ESTIMATED THIRD PARTY SETTLEMENTS 10419898 INTERCO 75294882 DUE TO HHS FOUNDATION 64797 DEFERRED INFLOWS OF RESOURCES (PENSION RELATED) 467587 86247164 X PART X, LINE 2: THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. 1 1 X 1 X 1 X 1 1 1 0 1 1 5928696 5928696 0.05990 20944391 20975126 -30735 0.00000 217888 0 217888 0.00220 27090975 20975126 6115849 0.06210 2242 2242 0.00000 40190 40190 0.00040 22506 10068 12438 0.00010 1900 1900 0.00000 66838 10068 56770 0.00050 27157813 20985194 6172619 0.06260 60178 60178 0.00060 60178 60178 0.00060 1 13832724 4149817 38337773 38300947 36826 X 1 1 2 1 BETSY JOHNSON REGIONAL HOSPITAL 800 TILGHMAN DRIVE DUNN NC 28835 X X X DISPROPORTIONATE SHARE HOSPITAL 2 CENTRAL HARNETT HOSPITAL 215 BRIGHTWATER DRIVE LILLINGTON NC 27546 X X X BETSY JOHNSON REGIONAL HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTP://MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ X X 1 12 1 HTTP://MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES/ X X 0 0 X X X X 1 X 0 0 CENTRAL HARNETT HOSPITAL 2 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTP://MYHARNETTHEALTH.ORG/COMMUNITY-NEEDS/ X X 1 12 0 0 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES/ X X 0 0 X X X X 1 X 0 0 BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 5: IN 2012, FIRST CHOICE COMMUNITY HEALTH CENTERS (FCCHC), HARNETT HEALTH, AND THE HARNETT COUNTY PUBLIC HEALTH DEPARTMENT (HCPHD) BEGAN DISCUSSIONS AIMED AT DEVELOPING A SHARED CHNA. ALTHOUGH EACH ENTITY HAD A DIFFERENT TIMETABLE FOR ITS "NEXT" ASSESSMENT, SCHEDULES WERE ADJUSTED WITH THE GOAL OF COMPLETING A JOINT ASSESSMENT, DURING 2013, THAT COULD THEN BE SIMULTANEOUSLY USED BY ALL PARTNERS AND THE COMMUNITY. AN INVITATION TO PARTICIPATE IN THE CHNA PROCESS WAS EXTENDED TO CAMPBELL UNIVERSITY, GIVEN ITS ROLES IN THE COMMUNITY, ITS EXISTING PROGRAMS, AND THE OPENING OF ITS NEW MEDICAL SCHOOL IN AUGUST OF 2013. CAMPBELL UNIVERSITY ENTHUSIASTICALLY AGREED AND CAMPBELL'S DEPARTMENT OF PUBLIC HEALTH REPRESENTED THE UNIVERSITY.A WORK GROUP WAS FORMED WITH REPRESENTATIVES OF HARNETT HEALTH, HARNETT COUNTY PUBLIC HEALTH DEPARTMENT, CAMPBELL UNIVERSITY, AND FIRST CHOICE COMMUNITY HEALTH CENTERS TO UPDATE AND EXTEND THE AVAILABLE DATABASE AND SURVEY, ANALYZE FINDINGS, AND PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR HARNETT COUNTY. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 5: BASED ON THE DATA FROM THE HARNETT COUNTY NEEDS ASSESSMENT WE REVIEW WHAT KEY ISSUES ARE ALIGNED WITH OUR MISSION. FROM THERE, WE DEVELOP PLANS ON WHICH STRATEGIES WILL HAVE THE MOST IMPACT ON OUR COMMUNITY. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 7D: THE HOSPITAL MADE THE CHNA AVAILABLE IN PRINT AT THE HEALTH DEPARTMENT. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 11: BECAUSE THE HEALTH ASSESSMENT IS RELATIVELY NEW, WE HAVE BEEN WORKING ON STRATEGIES TO ADDRESS THE NEEDS ASSESSED. ONE NEED THAT WE HAVE ADDRESSED IS CHILDHOOD OBESITY BY IMPLEMENTING A CHILDHOOD OBESITY PROGRAM. WE WILL CONTINUE TO LOOK FOR WAYS TO ADDRESS THE OTHER NEEDS DETERMINED IN THE CHNA. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 11: BECAUSE THE HEALTH ASSESSMENT IS RELATIVELY NEW, WE HAVE BEEN WORKING ON STRATEGIES TO ADDRESS THE NEEDS ASSESSED. ONE NEED THAT WE HAVE ADDRESSED IS CHILDHOOD OBESITY BY IMPLEMENTING A CHILDHOOD OBESITY PROGRAM. WE WILL CONTINUE TO LOOK FOR WAYS TO ADDRESS THE OTHER NEEDS DETERMINED IN THE CHNA. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES/ CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTP://MYHARNETTHEALTH.ORG/FINANCIAL-SERVICES/ 6 HARNETT HEALTH ANGIER MEDICAL SERVICES 185 RAWLS ROAD ANGIER NC 27501 PHYSICIAN PRACTICE HARNETT HEALTH LILLINGTON MEDICAL SERVIC 716 10TH STREET LILLINGTON NC 27546 PHYSICIAN PRACTICE HARNETT HEALTH DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE 700 DUNN NC 28335 PHYSICIAN PRACTICE HARNETT HEALTH HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE HARNETT HEALTH PREMIER PEDIATRICS 802 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE COATS MEDICAL SERVICES 25 N JOHNSON STREET COATS NC 27521 PHYSICIAN PRACTICE PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT IS PRESENTED AT GROSS CHARGES. PER THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS, THE ORGANIZATION ESTIMATES THAT SOME PORTION OF ITS BAD DEBT MAY QUALIFY FOR FINANCIAL ASSISTANCE DUE TO THE FACT THAT THE HOSPITAL DOES NOT HAVE 24 HOUR COVERAGE IN THE ED FOR FINANCIAL ASSISTANCE. ALSO, SOME PATIENTS TREATED REFUSE TO MEET AND DISCUSS FINANCIAL ASSISTANCE OPTIONS. THE ANDI REPORT WAS USED TO CALCULATE THE AMOUNT OF BAD DEBT THAT QUALIFIES FOR FINANCIAL ASSISTANCE. ANOTHER FACTOR CONTRIBUTING TO THE ESTIMATE OF BAD DEBT THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE IS THAT WE DO NOT VISIT OUR INSURED INPATIENTS THAT MAY HAVE HIGH DEDUCTIBLES OR CO-INSURANCES. IN FUTURE YEARS, THE ORGANIZATION PLANS TO IMPROVE CONSULTATION SESSIONS TO INLCUDE INSURED PATIENTS WITH POTENTIALLY HIGH DEDUCTIBLES OR CO-PAYMENTS. PART III, LINE 8: THE ORGANIZATION USES ITS ANDI REPORT TO COMPUTE PART III, LINES 5 AND 6. PART III, LINE 9B: ALL PATIENTS RECEIVE LETTERS AND/OR STATEMENTS REGARDING THEIR ACCOUNTS AND THEY ARE GIVEN 120 DAYS FROM THE BILL DATE TO MAKE SATISFACTORY PAYMENT ARRANGEMENTS OR TO APPLY FOR FINANCIAL ASSISTANCE BEFORE THE ACCOUNT GOES TO BAD DEBT STATUS. PATIENTS WHO APPLY FOR FINANCIAL ASSISTANCE MUST COMPLY WITH THE REQUIREMENTS OF THE APPLICATION TO AVOID THE ACCOUNT GOING INTO BAD DEBT STATUS. PATIENTS APPLYING FOR AID ARE PLACED IN A HOLD STATUS BY THE PALS TEAM TO AVOID COLLECTIONS. PATIENTS WHO HAVE MADE AN EFFORT TO COMPLETE AN APPLICATION OR WHO MAY NOT HAVE HAD AN OPPORTUNITY TO DISCUSS THEIR FINANCIAL SITUATION AND THEIR ACCOUNT GOES TO A COLLECTION STATUS ARE EVALUATED ON A CASE BY CASE BASIS TO DETERMINE IF THE ACCOUNT IS REMOVED FROM COLLECTIONS AND FINANCIAL ASSISTANCE IS PROVIDED. PART VI, LINE 2: BASED ON THE DATA FROM THE HARNETT COUNTY NEEDS ASSESSMENT WE REVIEW WHAT KEY ISSUES ARE ALIGNED WITH OUR MISSION. FROM THERE, WE DEVELOP PLANS ON WHICH STRATEGIES WILL HAVE THE MOST IMPACT ON OUR COMMUNITY. PART VI, LINE 3: THE HOSPITAL SYSTEM OFFERS FINANCIAL ASSISTANCE TO ANYONE BASED ON NEED AND ABILITY TO PAY. OUR PATIENT ACCOUNT LIAISONS WILL ASSIST PATIENTS IN APPLYING FOR FINANCIAL ASSISTANCE AND ANY OTHER FUNDING SOURCES THAT MAY BE AVAILABLE. PRE-SCREEING MAYBE CONDUCTED AT PRE-ADMISSION OR POINT OF SERVICE FOR ALL UNISURED OR UNDERINSURED PATIENTS THAT CAN NOT MEET THE DEPOSIT REQUIREMENTS; HOWEVER, ALL EMERGENT SERVICES ARE PROVIDED WITHOUT REGARD TO THE ABLITY TO PAY OR NOT. PART VI, LINE 4: HARNETT HEALTH SYSTEM, INC. IS LOCATED IN THE SOUTHEASTERN/MIDDLE SECTION OF HARNETT COUNTY NORTH CAROLINA. AS A RURAL HOSPITAL, WE ARE A KEY COMPONENT OF OUR STATE'S HEALTH CARE SAFETY NET BY TREATING EVERYONE WHO COMES THROUGH OUR DOORS. OUR PATIENT VOLUMES EXEMPLIFY OUR COMMITTMENT: % OF ADMISSIONS, MEDICARE 48.8%,MEDICAID 28.6%,MANAGED CARE 11%, SELF PAY 8%, TRICARE AND ALL OTHER 3.6%. THE HOSPITAL'S SERVICE AREA INCLUDED HARNETT AND A PORTION OF THREE NEIGHBORING COUNTIES, CUMBERLAND, JOHNSTON AND SAMPSON. AGRICULTURE AND CONSTRUCTION ARE THE LEADING INDUSTRIES OF OUR ECONOMIC STRUCTURE. THE TOP LARGEST EMPLOYER IN HARNETT COUNTY IS THE PUBLIC SCHOOL SYSTEM. PART VI, LINE 5: THE ROLE OF HARNETT HEALTH SYSTEM PLAYS IN THE COMMUNITY IS TO CARE FOR AND HEAL THE SICK AND INJURED, BUT EQUALLY IMPORTANT IS EDUCATING OUR COMMUNITY THE IMPORTANCE OF GOOD HEALTH AND WAYS TO IMPROVE THEIR LIFESTYLES. WE DEFINE OUR OBLIGATION BY HOLDING COMMUNITY EDUCATION AND WELLNESS CLASSES, PARTICIPATING IN ANNUAL COMMUNITY EVENTS, AND EDUCATING HIGH SCHOOL STUDENT ON THE MANY AREA OF EMPLOYMENT IN THE HEALTHCARE FIELD.WITH THE FEDERAL FUNDING AND STATE CUTS IN REIMBURSEMENT NO SURPLUS OF FUNDS TO PROVIDE MANY OF THE EXTRA ACTIVITIES THAT THE SYSTEM WOULD LIKE TO BE ABLE TO PROVIDE TO THE COMMUNITY. WE HAVE STILL MAINTAINED A COUPLE OF OUR COMMUNITY OUTREACH PROGRAM, "CHAMP", PROGRAM WHICH IS HOUSED IN THE ELEMENTARY SCHOOLS THROUGHOUT THE COUNTY, ASSIST CHILDREN WITH ASTHMA WHICH HAS CUT DOWN ON ABSENTEEISM. THE TEENS AS PARENTS PROGRAM, WORKS WITH TEENS WHO ARE PREGANANT OR HAVE HAD BABIES TO PROVIDE ADDITIONAL SUPPORT BY THE MEANS OF HOME BASED VISITS AND SUPPORT GROUP MEETINGS. EMPHASIS IS TO HAVE THE TEEN RETURN TO THE EDUCATION ARENA AND TO CONTINUE TO PROVIDE PARENTING SUPPORT AND HAVE HEALTHY BABIES. SOME OF OUR STAFF SERVES OR HAS SERVED ON LOCAL BOARDS WITHIN THE COMMUNITES INCLUDING THE NC COOPERATIVE EXTENSION ADVISORY BOARD, TEENS AS PARENTS EXECUTIVE AND ADVISORY BOARD,UNITED WAY BOARD AND VARIOUS OTHER CIVIC BOARDS. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NC X 0 1 X X 1 0 0 0 0 0 0 0 0 KENNETH BRYAN PRESIDENT/CEO (10/2014) 432370 0 13601 0 14086 0 20346 0 47081 0 527484 0 0 0 DANIEL WEATHERLY PRESIDENT (11/2014-9/2015) 197076 0 31544 0 608 0 3397 0 2139 0 234764 0 0 0 ROBIN NICHOLS CFO 147342 0 14403 0 0 0 0 0 0 0 161745 0 0 0 LYNN LAMBERT CFO 265246 0 7822 0 0 0 18840 0 44530 0 336438 0 0 0 VICKI ALLEN CNO/VP (10/2014-12/2014) 200403 0 0 0 0 0 4446 0 9700 0 214549 0 0 0 SONDRA DAVIS VP HR 152007 0 0 0 0 0 3324 0 20853 0 176184 0 0 0 MIKE JONES VP CENTRAL HOSPITAL AND SU 151315 0 0 0 0 0 3916 0 18274 0 173505 0 0 0 MICHAEL ZICH PHYSICIAN 308728 0 0 0 0 0 6500 0 24688 0 339916 0 0 0 BEVERLY YEARWOOD PHYSICIAN 196781 0 0 0 0 0 5081 0 16088 0 217950 0 0 0 BRAD BUTLER PHYSICIAN 172410 0 0 0 0 0 4609 0 25794 0 202813 0 0 0 ASIF ZIA PHYSICIAN 183142 0 0 0 0 0 4775 0 17168 0 205085 0 0 0 JODI MILLER PHYSICIAN 174434 0 0 0 0 0 3260 0 16271 0 193965 0 0 0 PART I, LINE 4A DURING THE YEAR, ROBIN NICHOLS RECEIVED SEVERANCE PAYMENTS OF $160,817. PART I, LINE 2 INVOICE VALUE $0-25,000 REQUIRES DIRECTOR SIGNATURE, $25,000 AND GREATER REQUIRES DIRECTOR SIGNATURE AND A COSIGNATURE FROM A VP. PURCHASES OF PHARMACEUTICALS AND MEDICAL SUPPLIES HELD IN INVENTORY MAY BE PURCHASED UNDER THE SIGNATURE OF THE DEPT DIRECTOR WITHOUT REGARD TO THE ABOVE MENTIONED LIMITS. ALLISON TAYLOR FAMILY MEMBER OF BOARD MEMBER (HEATHER WILLIAMS) 104504 EMPLOYMENT COMPENSATION: ALLISON TAYLOR IS FAMILY MEMBER OF BOARD MEMBER HEATHER WILLIAMS. 0 FORM 990, PART VI, SECTION A, LINE 2 ALLISON TAYLOR WAS A DIRECTOR AND HER SISTER, HEATHER WILLIAMS, WAS ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 ON NOVEMBER 8, 2005, HARNETT HEALTH SYSTEM ENTERED INTO AN AGREEMENT WITH WAKEMED TO PROVIDE DAY-TO-DAY MANAGEMENT SERVICES, PRIMARILY A CHIEF EXECUTIVE OFFICER. THE AGREEMENT REQUIRES THE SYSTEM TO REIMBURSE WAKEMED FOR THE SALARY AND BENEFITS ASSOCIATED WITH THE CEO POSITION. IN ADDITION, WAKEMED RECEIVES A MANAGEMENT FEE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES OF THE ORGANIZATION IS COMPRISED OF THIRTEEN RESIDENTS OF HARNETT COUNTY, NC AND THE APPOINTED TRUSTEES SHALL SERVE A STAGGERED TERM FOR 1 TO 3 YEARS. SEVEN TRUSTEES OF THE ORGANIZATION ARE APPOINTED BY THE HARNETT COUNTY BOARD OF COMMISSIONERS, AND SHALL, AT ALL TIMES, INCLUDE AT LEAST ONE RESIDENT OF EACH OF THE FIVE COMMISSIONERS' DISTRICTS AND TWO OTHER PERSONS RESIDING IN HARNETT COUNTY. THE REMAINING SIX TRUSTEES ARE APPOINTED BY THE ORGANIZATION'S BOARD OF TRUSTEES AT ITS ANNUAL MEETING FROM NOMINEES THAT MEET RESIDENCY AND AGE REQUIREMENTS AS DEFINED IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO SUBMISSION, THE 990 WILL BE MADE AVAILABLE UPON REQUEST FOR BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE LEADERSHIP OF THE BOARD OF TRUSTEES (THROUGHOUT THE YEAR IF NEEDED) AND ADMINISTERED TO ALL VOTING BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE SALARIES ARE DETERMINED BY A MARKET ANALYSIS INVOLVING COMPARABILITY DATA, INDUSTRY STANDARDS, AND LOCAL ECONOMICS. THE CEO'S SALARY IS A CONDITION OF THE MANAGEMENT AGREEMENT BETWEEN THE BOARD OF DIRECTORS AND WAKEMED (SEE THE RESPONSE TO LINE 3 ABOVE). THE BOARD HAS INDIRECT APPROVAL OVER THE COMPENSATION PAID TO THE CEO THROUGH THIS AGREEMENT, AND HAS APPROVAL OVER ANY ADDITIONAL AMOUNTS AND INCREASES. WAKEMED PREPARES A COMPENSATION STUDY FOR OFFICERS AND KEY EMPLOYEES EXCLUDING THE CEO AND MAKES THE RECOMMENDATIONS TO THE CEO OF HARNETT HEALTH SYSTEM. THOSE RECOMMENDATIONS, INCLUDING ANY AMOUNTS ALLOCATED FOR RAISES AND INCENTIVES, ARE INCLUDED IN THE ANNUAL BUDGET PROCESS WHICH IS APPROVED BY THE FINANCE COMMITIEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF 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 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 XII, LINE 2C: THE ORGANIZATOIN HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. ANGIER MEDICAL SERVICES LLC 185 RAWLS ROAD ANGIER NC 27501 270906936 PHYSICIAN PRACTICE NC N/A LILLINGTON MEDICAL SERVICES LLC 716 S 10TH STREET LILLINGTON NC 27546 272944176 PHYSICIAN PRACTICE NC N/A HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 273320275 PHYSICIAN PRACTICE NC N/A DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE DUNN NC 28335 273320115 PHYSICIAN PRACTICE NC N/A COATS MEDICAL SERVICES LLC 25 N JOHNSON STREET COATS NC 27521 462540799 PHYSICIAN PRACTICE NC N/A BETSY JOHNSON MEMORIAL HOSPITAL FOUNDATION 800 TILGHMAN DRIVE DUNN NC 28334 201929953 FUNDRAISING NC 501(C)(3) LINE 7 HARNETT HEALTH SYSTEM INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0