2016-08-09T07:22:04-05:00 2015-09-30 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2014-10-01 562112733 The Outer Banks Hospital Inc OUTE 2528475129 2100 Stantonsburg Road Greenville NC 27835 David Hughes Secretary and Treasurer 2528475129 2016-08-02 1 Wayne Harder P00294296 3126343400 2014 2016-09-27 15:27:22Z Ronald Sloan 2100 Stantonsburg Road Greenville NC 27835 67010297 0 X www.theouterbankshospital.com X 2002 NC To provide a wide range of quality services to the residents and visitors of the Outer Banks. 10 9 400 50 0 0 224339 0 67810517 65514841 94905 213143 1071002 1282313 69200763 67010297 0 0 0 0 19883888 19056579 0 0 0 36286804 39236134 56170692 58292713 13030071 8717584 67059177 65385247 7450328 6780987 59608849 58604260 To enhance the quality of life for the people and communities we serve, touch and support. 0 0 40063738 52647518 Outpatient and emergency services;Provided emergency services to 22,109 patients 24 hours a day for 365 days. Provided outpatient diagnostic and therapeutic services to 17,830 patients. Performed 2,098 outpatient surgical procedures. 9552979 12867323 Inpatient Services:Provided inpatient care 24 hours a day for 365 days to 1,580 patients. Delivered 379 babies. Performed 306 inpatient surgical procedures. 49616717 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 400 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 0 0 0 1 1 0 X X Todd Warlitner 2528475129 2100 Stantonsburg Road Greenville NC 27835 Dr Ernest W Larkin MD Chairman 2.00 X 0 0 0 Steve Rodriquez Vice Chairman 2.00 X 0 0 0 Peter Bastone Board Director 2.00 X 0 0 0 Stuart Bell Board Director 2.00 X 0 0 0 Susanne Fearing Board Director 2.00 X 0 0 0 Arthur H Keeney III Board Director 2.00 6.00 X 0 0 0 Jody Midgette Board Director 2.00 X 0 0 0 Dr Christine Petzing MD Board Director 2.00 X 0 0 0 Roger Robertson Board Director 2.00 46.00 X 0 441646 116650 Terry Wheeler Board Director 2.00 X 0 0 0 Ronald Sloan President of Outer Banks Hospital 40.00 X 237991 0 75769 Todd Warlitner VP of Business Operations 40.00 X 150481 0 61993 Judy Bruno VP of Clinical Operations 40.00 X 144775 0 56620 Patrick Heins Interim Chief Nursing Officer 40.00 X 143271 0 29292 Gary Hunter Anesthesiologist 40.00 X 437812 0 45341 Steven McLawhorn Oncology Physicist at TOBH, Inc. 40.00 X 176606 0 34125 Monte Thompson Director of Pharmacy 40.00 X 159094 0 25187 Mary Terrell Parnell Pharmacist 40.00 X 130601 0 36690 Mary Mosely Pharmacist 40.00 X 114140 0 41809 1694771 441646 523476 15 0 1 0 SE Emergency Physicians PO Box 634850 Cincinnati OH 45263 Contract Employees 407404 Shiftwise PO Box 70870 St Paul MN 55170 Staff Management 356169 GE Healthcare PO Box 640200 Pittsburgh PA 15264 Equipment Training 355023 Aviation Anesthesia Association Inc 158 Battlefield Court Manteo NC 27954 Equipment Service/Repair 326513 Frank X Biondi PO Box 1464 Nags Heah NC 27959 Physician Services 286280 11 Outpatient Revenue 621110 52647518 52647518 Inpatient Revenue 621110 12867323 12867323 65514841 95613 95613 524593 0 524593 524593 524593 117530 0 117530 117530 117530 I/C Environmental Services 900099 216986 216986 Employee Pharmacy 900099 211371 211371 Cafeteria Meals 722210 92411 92411 236952 236952 757720 67010297 65514841 0 1495456 565412 565412 14747915 14010519 737396 41452 39379 2073 2637626 2505745 131881 1064174 1010965 53209 10208446 8166757 2041689 10088 10088 57870 57870 4460117 3568094 892023 313510 250808 62702 614356 552920 61436 209820 41964 167856 1787805 1430244 357561 152141 121713 30428 17354 17354 2425414 2425414 49319 9864 39455 Patient Supplies 10330879 8264703 2066176 Bad Debt Expense 6900782 6900782 Repairs 1584228 316846 1267382 114005 114005 58292713 49616717 8675996 0 4293494 2238407 8517728 9196868 1412585 1347980 260558 139022 50755414 29389803 18872175 21365611 28607066 28658213 5095571 2439146 67059177 65385247 6632058 5966608 818270 814379 7450328 6780987 X 59608849 58604260 59608849 58604260 67059177 65385247 X 8717584 -9722173 X 0 1 X 1 0 X 1694182 1694182 29751609 18388384 11363225 15367054 11001419 4365635 3942569 3942569 21365611 Due to Third Party Payors 494379 Reserve for Professional Liability Losses 320000 814379 X Part X, Line 2: The Outer Banks Hospital, Inc. has been determined to qualify as a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code. The Outer Banks Hospital, Inc. has reviewed its tax positions for all open years and has concluded that no material liabilities exist as of September 30, 2015 and 2014. The Outer Banks Hospital, Inc. files tax returns with the U.S. federal and State of North Carolina jurisdictions. With few exceptions, The Outer Banks Hospital, Inc. is no longer subject to U.S. federal examinations by tax authorities for years before 2012. 1 1 X 1 X 1 X 1 1 0 0 1831171 1831171 0.03140 1831171 1831171 0.03140 14 3874 1001197 1001197 0.01720 3 22 26636 26636 0.00050 3 12531 181445 181445 0.00310 20 16427 1209278 1209278 0.02080 20 16427 3040449 3040449 0.05220 1 14093 14093 0.00020 1 9203 9203 0.00020 1 6041 6041 0.00010 1 482 16713 16713 0.00030 4 482 46050 46050 0.00080 1 2820715 0 14547856 19617678 -5069822 X 1 1 1 The Outer Banks Hospital Medical Office Building LLC Provision of Space for Providing Health Care 1.00000 0.00000 0.00000 2 Outer Banks Professional Services LLC Provision of Primary and Urgent Health Care 1.00000 0.00000 0.00000 1 1 The Outer Banks Hospital Inc 4800 South Croatan Highway Nags Head NC 27959 X X X The Outer Banks Hospital Inc 1 0 0 1 X X X X X X X X 12 1 0 0 1 X See Schedule H, Part V, Section C X X 1 12 0 0 0 1 X 200.000000000000 200.000000000000 X X 1 1 X X X 1 X X 1 X 0 X X X X 1 X 0 0 The Outer Banks Hospital, Inc. Part V, Section B, Line 5: The CHNA document is the culmination of a partnership between the Dare County Department of Public Health (DCDPH) and The Outer Banks Hospital (TOBH). In communities where there is an active Healthy Carolinians coalition, the CHNA partnership also usually includes that entity. Healthy Carolinians is "a network of public-private partnerships across North Carolina that shares the common goal of helping all North Carolinians to be healthy." The members of local coalitions are representatives of the agencies and organizations that serve the health and human service needs of the local population, as well as representatives from businesses, communities of faith, schools and civic groups. In Dare County, the local Healthy Carolinians coalition is Healthy Carolinians of the Outer Banks (HCOB). The community health assessment, which is both a process and a document, investigates and describes the current health status of the community, what has changed since the last assessment, and what still needs to change to improve the health of the community. The process involves the collection and analysis of a large range of data, including demographic, socioeconomic and health statistics, environmental data, and professional and public opinion. The document is a summary of all the available evidence and serves as a resource until the next assessment. The completed CHNA serves as the basis for prioritizing the community's health needs, and culminates in planning to meet those needs. The Outer Banks Hospital, Inc. Part V, Section B, Line 7d: The CHNA is available at: https://www.vidanthealth.com/uploadedFiles/UHSEastMain/UHS_East/CHNA_reports/TOBH%20CHNA%202013.pdf The Outer Banks Hospital, Inc. Part V, Section B, Line 11: Certain community needs may not be fully documented or addressed in the Community Health Needs Assessment. These needs are generally those which other organizations share an overlap with The Outer Banks Hospital. TOBH is not equipped to handle all needs and has prioritized those that it can fully address. The Outer Banks Hospital, Inc. Part V, Section B, Line 16i: The full policy is not available on the facility website. In lieu of the policy, a concise summary is provided with pertinent details and phone numbers for additional information. Part I, Line 6a: In addition to the Community Benefit Report for TOBH, information regarding this entity is found in the annual report for University Health Systems of Eastern Carolina d/b/a Vidant Health. Part I, Line 7: Costs were calculated using the estimated cost to charge ratio from The North Carolina Hospital Association's Advocacy Needs Data Initiative which is the standard for reporting community benefits in North Carolina. Part II, Community Building Activities: The community building activities of The Outer Banks Hospital involve services that are otherwise not provided by other organizations in the patient area. Part III, Line 2: In connection with the Presumptive Eligibility consideration of the Affordable Care Act, The Outer Banks Hospital does not reflect any bad debt in connection with FAP-eligible patients. These patients are presumed to be part of the Medicaid population and afforded coverage as such. Part III, Line 4: The financial statements of The Outer Banks Hospital are presented on a consolidated basis as part of the consolidated financial statements of Vidant Health; the text of the footnote from page 21 is presented below:Patient Accounts Receivable:Patient Accounts Receivable are reported net of estimated allowances for contractual adjustments and allowances for bad debts. Estimated allowances for bad debts are approximately $117.5 million and $134.7 million as of September 30, 2015 and 2014, respectively. Part III, Line 8: The shortfall of Medicare revenue to Medicare was calculated according to the cost to charge ratio. Allowable costs of care should be considered community benefit because in the area served by TOBH, there are no other providers available to provide the required services. Therefore, the care would become a government obligation and is treated as a community benefit provided by TOBH. Part III, Line 9b: Recommended patient accounts will continue to go through the accounts receivable billing cycle as normal. When the account reaches the customer service/collections manager, financial counseling supervisor or patient accounts supervisor, based on the information given, a decision will be made whether to proceed with collection or refer the account for approval of charity care. The process will occur as follows: I. Financial counselors will try to locate third party payors. If not eligible for any third party coverage (including charities), they may, based upon the financial information received, recommend the patient for charity care. II. Patient counselors will review for any third party payors and verify employment and assets. A charity care application will need to be completed along with tax return, pay stubs, social security award letter and other financial information as may be required. III. The patient accounts supervisor, financial counseling supervisor or customer service/collections manager, based upon account balance and the information given, will make a decision whether to proceed with collection or refer the patient account for approval for charity care.Presumptive eligibility for charity care - there are occasions in which a patient may appear eligible for a charity care discount, but there is no financial assistance information available to support financial aid. A. Some patients are presumed to be eligible for charity care discounts on the basis of individual life circumstances (e.g., homelessness, patients with no income, bankruptcy, deceased patients with no estate or spouse, etc). B. Through the assistance of a third party vendor and certain algorithms, in conjuction with our charity policy guidelines, all accounts, prior to outside collection agency referral, will be tested for presumptive charity. C. The accounts deemed charity will be adjusted and the remaining accounts will be referred to an outside collection agency. D. Once the agency has had the accounts for six months and has deemed them uncollectible, the accounts with balances of $1,200 or greater will remain with the agency and be kept on the patient's credit file. E. The accounts returned to the hospital will be placed in a unique financial class and will not be pursued for collections. Part VI, Line 2: The organization assesses community need in conjunction with the state affiliated county health departments and other local health care organizations. See also Schedule H, Part V, Section B, lines 1-7. Part VI, Line 3: Information is available on the organization's website and at registration for patients. In addition, face-to-face financial counseling is available to patients and their families in the central business office. Part VI, Line 4: See Schedule O, Part III Part VI, Line 5: See Schedule O, Part III Part VI, Line 6: See Schedule O, Part III Part VI, Line 7, Reports Filed With States NC X X X X 0 0 0 0 0 0 0 0 0 Roger Robertson Board Director 0 391637 0 47720 0 2289 0 77285 0 39365 0 558296 0 0 Ronald Sloan President of Outer Banks Hospital 204248 0 33743 0 0 0 33661 0 42108 0 313760 0 0 0 Todd Warlitner VP of Business Operations 139786 0 10695 0 0 0 16076 0 45917 0 212474 0 0 0 Judy Bruno VP of Clinical Operations 134172 0 10603 0 0 0 15395 0 41225 0 201395 0 0 0 Patrick Heins Interim Chief Nursing Officer 134479 0 8792 0 0 0 14476 0 14816 0 172563 0 0 0 Gary Hunter Anesthesiologist 425812 0 12000 0 0 0 0 0 45341 0 483153 0 0 0 Steven McLawhorn Oncology Physicist at TOBH, Inc. 175106 0 1500 0 0 0 0 0 34125 0 210731 0 0 0 Monte Thompson Director of Pharmacy 157594 0 1500 0 0 0 0 0 25187 0 184281 0 0 0 Mary Terrell Parnell Pharmacist 129601 0 1000 0 0 0 0 0 36690 0 167291 0 0 0 Mary Mosely Pharmacist 112640 0 1500 0 0 0 0 0 41809 0 155949 0 0 0 Part I, Line 3 The Top Management Official is the President who is an employee of TOBH. The compensation is determined by the Compensation and Benefits Committee of the Vidant Health Board using comparative data from like organizations and input from consultants. This process is performed every two years, the last year being 2015. It will be performed again in fiscal year 2017. Compensation of other officers and key employees is also determined by the Compensation and Benefits Committee of the VH Board using comparative data from like organizations and input from consultants. This process is performed every two years, the last year being 2015. It will be performed again in fiscal year 2017. All compensation discussions and actions are documented and approved in the minutes of the Committee. Part I, Line 4 As of January 1, 2013, the supplemental nonqualified retirement plan was frozen and no further amounts have accrued to its benefit. In lieu of the SERP, the comprehensive defined benefit pension plan will provide an equivalent benefit. The increase in the value of such plans is reflected in the sum of Part II, Column (C). Form 990, Part VI, Section A, line 6 According to the organization's amended and restated bylaws, Article II, the Organization has two members, East Carolina Health and Chesapeake Hospital Authority. Form 990, Part VI, Section A, line 7a The members elect the Board of Directors. Form 990, Part VI, Section A, line 7b The following actions shall not be taken without unanimous consent of the members: possess property, invest funds, additional capital contributions, admit members, merger or dissolution, amendment, certificate of need litigation, sale of assets, and business of the Corporation. Form 990, Part VI, Section B, line 11 Form 990 is made available to Board Members by posting to a Board Member's website. Any Board Member who does not have the ability to access the return in this manner will receive a copy via electronic or regular mail. The return is also reviewed by the Chief Financial Officer, Chief General Counsel and the Chief Audit and Compliance Officer of University Health Systems prior to filing. Form 990, Part VI, Section B, line 12 All Officers, Board Members and Key Employees are required to complete a yearly comprehensive conflict of interest questionnaire. These responses are reviewed by legal counsel and any potential or actual conflicts are brought to the Board for disposition. Board Members are instructed to report any potential conflicts arising during the year for review. Board Members are required to recuse themselves from voting on issues in which they are deemed to have a conflict. Form 990, Part VI, Section B, line 15 The Top Management Official is the President who is an employee of The Outer Banks Hospital, Inc. The compensation is determined by the Compensation and Benefits Committee of the Vidant Health Board using comparative data from like organizations and input from consultants. This process is performed every two years, the last year being 2015. It will be performed again in fiscal year 2017. Compensation of other officers and key employees is also determined by the Compensation and Benefits Committee of the VH Board using comparative data from like organizations and input from consultants. This process is performed every two years, the last year being 2015. It will be performed again in fiscal year 2017. All compensation discussions and actions are documented and approved in the minutes of the Committee. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request for the same period of disclosure as set forth in IRC Section 6104(d). Form 990, Part XI, line 9: Change in Bond Accounting -9,722,173. Outer Banks Professional Services LLC 604 Amanda Street Manteo NC 27954 270484506 Family Practice NC -377288 720379 The Outer Banks Hospital Outer Banks Medical Office Building LLC 4810 South Croatan Highway Nags Head NC 27959 161740979 Medical Office Building NC -741110 3781398 The Outer Banks Hospital University Health Systems of Eastern Carolina (DBA Vidant Health) 2100 Stantonsburg Road Greenville NC 27835 562141073 Healthcare NC 501(c)(3) Line 11c, III-FI N/A 0 Pitt County Memorial Hospital Inc (DBA Vidant Medical Center) 2100 Stantonsburg Road Greenville NC 27835 560585243 Hospital NC 501(c)(3) Line 3 Vidant Health 0 Surgicenter Services of Pitt Inc 102 Bethesda Drive Greenville NC 27835 561690553 Healthcare NC 501(c)(3) Line 11b, II Vidant Medical Center 0 East Carolina Health Inc (DBA Vidant Community Hospitals - Central) 2100 Stantonsburg Road Greenville NC 27835 562003393 Hospital NC 501(c)(3) Line 3 Vidant Health 0 East Carolina Health-Bertie (DBA Vidant Bertie Hospital) 2100 Stantonsburg Road Greenville NC 27835 562072002 Hospital NC 501(c)(3) Line 3 Vidant Health 0 East Carolina Health-Chowan (DBA Vidant Chowan Hospital) 2100 Stantonsburg Road Greenville NC 27835 562101090 Hospital NC 501(c)(3) Line 3 Vidant Health 0 East Carolina Health-Heritage (DBA Vidant Edgecombe Hospital) 2100 Stantonsburg Road Greenville NC 27835 562093700 Hospital NC 501(c)(3) Line 3 Vidant Health 0 East Carolina Health-Beaufort (DBA Vidant Beaufort Hospital) 2100 Stantonsburg Road Greenville NC 27835 452436270 Hospital NC 501(c)(3) Line 3 Vidant Health 0 Duplin General Hospital (DBA Vidant Duplin Hospital) 2100 Stantonsburg Road Greenville NC 27835 566011594 Hospital NC 501(c)(3) Line 3 Vidant Health 0 East Carolina Health Inc (DBA Vidant Roanoke-Chowan Hospital) 2100 Stantonsburg Road Greenville NC 27835 264634725 Hospital NC 501(c)(3) Line 3 Vidant Health 0 Pungo District Hospital Corporation (DBA Vidant Pungo Hospital) 2100 Stantonsburg Road Greenville NC 27835 560518757 Hospital NC 501(c)(3) Line 3 Vidant Health 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0