2016-08-09T11:35:17-05:00 2015-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-10-01 560642846 HUGH CHATHAM MEMORIAL HOSPITAL INC HUGH 3365277000 180 PARKWOOD DR ELKIN NC 28621 DONALD E TRIPPEL CFO 3365277000 2016-07-28 1 AMY BIBBY P00445891 8282542254 2014 2016-09-27 15:27:22Z DONALD E TRIPPEL 180 PARKWOOD DR ELKIN NC 28621 141531983 0 X WWW.HUGHCHATHAM.ORG X 1930 NC TO PROVIDE BIRTHING AND ACUTE CARE SERVICES IN ADDITION TO SKILLED NURSING, RETIREMENT COMMUNITY, HOME HEALTH, AND HOSPICE SERVICES PRIMARILY TO THE RESIDENTS OF AND SURROUNDING COUNTIES TO SURRY COUNTY, NORTH CAROLINA. 16 14 928 85 0 0 51200 2333978 91818549 103909698 14688971 6089452 1408416 1204857 107967136 113537985 182058 23064 0 0 41295790 46104534 0 0 67456 56013215 57210414 97491063 103338012 10476073 10199973 208018399 211923747 88302120 90698008 119716279 121225739 X TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. 0 0 95410142 23064 103909698 HUGH CHATHAM MEMORIAL HOSPITAL (HCMH) IS A NOT-FOR-PROFIT HOSPITAL LOCATED IN ELKIN, SURRY COUNTY, NORTH CAROLINA. IT IS THE SIXTH LARGEST EMPLOYER IN SURRY COUNTY AND IS RANKED AMONG TOP HOSPITALS NATIONWIDE FOR QUALITY BY THE JOINT COMMISSION. HCMH CARES FOR PATIENTS IN THE YADKIN VALLEY REGION IN NORTH CAROLINA, AND ALSO FOR THOSE WHO CHOOSE TO COME TO US FOR CARE FROM SEVERAL COUNTIES IN VIRGINIA, INCLUDING CARROLL, GRAYSON AND PATRICK COUNTIES. HCMH IS FOCUSED ON PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT SERVICE AND A REMARKABLE WORK ENVIRONMENT FOR OUR STAFF. DURING THE FISCAL YEAR, HCMH WAS NAMED "BEST PLACE TO WORK" BY THE TRIAD BUSINESS JOURNAL, BASED LARGELY ON A RANDOM SAMPLE OF 200 EMPLOYEES' RESPONSES TO A SURVEY THAT MEASURED 10 EMPLOYEE ENGAGEMENT CATEGORIES. HCMH HAS NEARLY 800 EMPLOYEES IN ALL.THE HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITIES IN THE YADKIN VALLEY REGION OF NORTH CAROLINA, ONE PERSON AT A TIME. IT OFFERS A FULL CONTINUUM OF EMERGENCY, MEDICAL, SURGICAL, REHABILITATIVE AND BEHAVIORAL HEALTH SERVICES. TOP PROGRAMS INCLUDE CANCER SERVICES, CARDIOLOGY, GENERAL SURGERY, GASTROENTEROLOGY, IMAGING, NEUROLOGY, OBSTETRICS AND GYNECOLOGY, ORTHOPEDIC AND SPORTS MEDICINE, PULMONOLOGY AND REHABILITATION SERVICES. THE HOSPITAL ALSO HAS A CERTIFIED PRIMARY STROKE CENTER THAT HAS GOLD PLUS LEVEL DISTINCTION FROM THE AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION - THE ONLY HOSPITAL IN REGION CERTIFIED AT THAT LEVEL. OUR COMMITMENT TO EXCELLENCE IN PATIENT CARE CONTINUED DURING THE YEAR. FOR EXAMPLE, HCMH EARNED "MOST WIRED" HOSPITAL STATUS AS ONE OF THE NATION'S HEALTH LEADERS IN INFORMATION TECHNOLOGY AND ALSO ACHIEVED STAGE 6 OF 7 FOR ELECTRONIC MEDICAL RECORD ADOPTION ACCORDING TO THE HEALTHCARE INFORMATION AND MANAGEMENT SYSTEM SOCIETY (HIMSS) PUTTING HCMH IN THE TOP 22 PERCENT OF ALL U.S. HOSPITALS IN THAT CATEGORY. DURING THE FISCAL YEAR, HCMH ADDED TO ITS ALREADY STRONG FOCUS ON PATIENT SAFETY BY LAUNCHING A MULTI-STRATEGY "GOING FOR ZERO" PATIENT SAFETY INITIATIVE GUIDED BY A VISION STATEMENT ENCOURAGING ALL EMPLOYEES AND MEDICAL STAFF TO, "IMAGINE PLACE WHERE COMMUNICATION IS CLEAR, EVERYONE CARES AND PATIENTS ARE ALWAYS SAFE." EDUCATION WAS PROVIDED TO STAFF IN THE USE OF BEST PRACTICE SAFETY COMMUNICATION METHODS SUCH AS CUS AND SBARQ AND A CULTURE OF COMMUNICATING OPENLY ABOUT NEAR MISSES AND "GREAT CATCHES" WAS CREATIVELY ENCOURAGED AND FACILITATED.AS ANOTHER PATIENT SAFETY STRATEGY, HCMH CONTINUED TO USE BIOMETRIC TECHNOLOGY THAT USES IRIS RECOGNITION TO IDENTIFY PATIENTS. THIS TECHNOLOGY IS PART OF THE ADMISSIONS PROCESS AND IMPROVES SAFETY BY ACCURATELY IDENTIFYING PATIENTS AND LIMITING DUPLICATE MEDICAL RECORDS. IT ALSO HELPS TO ELIMINATE IDENTITY THEFT AT THE POINT OF SERVICE.FISCAL YEAR 2015 HIGHLIGHTS:DURING THE YEAR, HCMH HANDLED MORE THAN 29,300 EMERGENCY ROOM VISITS; 17,131 HOME HEALTH VISITS; AND MORE THAN 99,000 PATIENT VISITS TO ITS MEDICAL GROUP PRIMARY AND SPECIALTY CARE PRACTICES. THE HOSPITAL ALSO HANDLED MORE THAN 50,000 OUTPATIENT IMAGING VISITS; 7,888 RADIATION ONCOLOGY PROCEDURES AND MORE THAN 4,300 INPATIENT ADMISSIONS. EXPANDING ACCESS TO PRIMARY, SPECIALTY AND HOME HEALTH CARE:TO HELP PATIENTS AND LOCAL COMMUNITIES TO GET BETTER AND STAY HEALTHY, HCMH EXPANDED ACCESS TO MEDICAL CARE BY OPENING AN EXPRESS CARE FACILITY IN ELKIN, NC, AND AN URGENT CARE CLINIC IN JONESVILLE, NC THAT INCLUDES X-RAY AND LABORATORY SERVICES. THE JONESVILLE FACILITY ALSO PROVIDES OCCUPATIONAL HEALTH SERVICES AND HAS A MEETING ROOM AVAILABLE TO COMMUNITY GROUPS FOR THEIR USE. OTHER NEW DEVELOPMENTS TO MEET THE COMMUNITY'S HEALTH CARE NEEDS INCLUDED HCMH ADDING TWO NEW FAMILY MEDICINE CLINICS IN WILKES COUNTY, NORTH CAROLINA. IN ADDITION, FIVE HCMH PRIMARY CARE PRACTICES EARNED CERTIFICATION AS PATIENT-CENTERED MEDICAL HOMES.FURTHER ENHANCING ACCESS TO CONVENIENT, PATIENT-CENTERED CARE, HCMH LAUNCHED A FREE NURSE ADVICE LINE, 336-527-CARE AVAILABLE TO THE PUBLIC AROUND-THE-CLOCK, SEVEN DAYS A WEEK, TO ANSWER MEDICAL QUESTIONS.THE EXPAND ACCESS TO SPECIALTY CARE, HCMH OPENED HUGH CHATHAM NEUROLOGY AS A REGIONAL DESTINATION FOR NEUROLOGIC AND STROKE CARE AND FOR DIAGNOSING AND TREATING HEADACHES, ALZHEIMER'S DISEASE AND PARKINSON'S DISEASE. HCMH ALSO ESTABLISHED A BEHAVIORAL HEALTH PRACTICE TO MEET THE REGION'S GROWING NEED FOR MENTAL HEALTH, COUNSELING AND SUBSTANCE ABUSE ADDICTION SUPPORT SERVICES INCLUDING PERSONALIZED TREATMENT PLANS AND MEDICATION MANAGEMENT.HCMH ALSO ESTABLISHED A HOME HEALTH PRACTICE, YADKIN VALLEY HOME HEALTH, TO SERVE HOMEBOUND PATIENTS IN SURRY, ALLEGHANY, WILKES AND YADKIN COUNTIES. THESE COUNTIES HAVE HIGH PERCENTAGES OF THE POPULATION WHO ARE ELDERLY, LOW-INCOME AND WHO LIVE IN RURAL AREAS OR SMALL TOWNS WHERE TRANSPORTATION TO MEDICAL CARE CAN BE DIFFICULT BECAUSE OF A LACK OF PUBLIC TRANSPORTATION OR MOUNTAINOUS ROADS THAT CAN BE HARD FOR ILL, ELDERLY PATIENTS AND THEIR CAREGIVERS TO NAVIGATE. REHABILITATION AND WELLNESS SERVICES DELIVERED THE COMMUNITY INCLUDED STROKE SCREENINGS AND THE ADDITION OF NEW LAND- AND WATER-BASED EXERCISE CLASSES AT THE HCMH AQUATIC AND WELLNESS CENTER INCLUDING TAI CHI FOR ARTHRITIS AND YOGA CLASSES.HCMH ALSO CONTINUED TO OWN AND MANAGE PARKWOOD PLACE SENIOR INDEPENDENT LIVING APARTMENTS IN ELKIN, NORTH CAROLINA. AMENITIES AND SERVICES ARE DESIGNED TO GIVE RESIDENTS A SAFE, COMFORTABLE APARTMENT LIVING ENVIRONMENT THAT IS ALSO AFFORDABLE. ACTIVITIES INCLUDED SPONSORSHIP OF A FREE HEALTH FAIR AT YADKIN VALLEY SENIOR CENTER IN JONESVILLE.PROVIDING HEALTH EDUCATION, SCREENINGS AND SUPPORT TO PATIENTS AND COMMUNITIES:DURING THE YEAR, THE HOSPITAL DID MANY COMMUNITY OUTREACH ACTIVITIES. ONE EXAMPLE WAS PROVIDING BASELINE CONCUSSION SCREENINGS FOR ATHLETES FROM THREE HIGH SCHOOLS (ELKIN, STARMOUNT AND SURRY CENTRAL) IN A VARIETY OF SPORTS INCLUDING BASKETBALL, CHEERLEADING, FOOTBALL, SOCCER AND TENNIS. A TOTAL OF 162 BASELINE AND POST-INJURY SCREENINGS WERE PROVIDED TO 154 STUDENTS. IN ADDITION, DR. JONATHAN SNYDER AND JOHN ORTA, DPT SERVED ON THE SIDELINES TO ASSIST WITH FIRST AID AND TO ASSESS INJURIES FOR EVERY FOOTBALL GAME AT ELKIN HIGH SCHOOL. 95410142 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 80 0 1 928 1 0 0 0 0 0 0 0 0 0 0 X 16 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X CHERYL PARDUE 3365277595 PO BOX 560 ELKIN NC 28621 BOB MIDKIFF CHAIRMAN 1.00 X X 0 0 0 TERRY DARNELL VICE CHAIRMAN 1.00 X X 0 0 0 DAVID CLINE TREASURER 1.00 X X 0 0 0 CAROL JERNIGAN SECRETARY 1.00 X X 0 0 0 DONNA THOMPSON ASST. SECRETARY/ASST. TREA 1.00 1.00 X X 0 0 0 DOMINICK CARBONE MD CHIEF OF STAFF 40.00 1.00 X 736296 0 19927 PHIL HARRIS BOARD MEMBER 1.00 X 0 0 0 ERCEL CARTER BOARD MEMBER 1.00 X 0 0 0 JAMES FREEMAN BOARD MEMBER 1.00 X 0 0 0 JL LOWE JR BOARD MEMBER 1.00 X 0 0 0 ALAN PAYNE BOARD MEMBER 1.00 1.00 X 0 0 0 MIKE STANLEY BOARD MEMBER 1.00 X 0 0 0 BARBARA MYERS BOARD MEMBER 1.00 X 0 0 0 KEVIN AUSTIN BOARD MEMBER 1.00 X 0 0 0 BOB BALL BOARD MEMBER 1.00 X 0 0 0 ALVARO CASTILLEJO MD BOARD MEMBER 1.00 X 0 0 0 PAUL HAMMES CEO 40.00 2.00 X 300000 0 23597 DONALD TRIPPEL CFO 40.00 X 180957 0 9055 MARY BLACKBURN CPO 40.00 X 158246 0 12837 SARBA KUNDU MD PHYSICIAN 40.00 X 467977 0 12476 ANDREW LEE MD PHYSICIAN 40.00 X 454174 0 19474 JONATHAN SNYDER MD PHYSICIAN 40.00 X 531830 0 20258 MURUGANANTHAN SUBBIAH MD PHYSICIAN 40.00 X 378179 0 17981 PRAG GUPTA MD PHYSICIAN 40.00 X 379157 0 12078 3586816 0 147683 42 0 1 0 SODEXO INC PO BOX 536922 ATLANTA GA 30353 DIETARY & HOUSEKEEPING SERVICES 2599037 HORIZON CSA LLC 265 PITT ROAD MOORESVILLE NC 28115 EQUIPMENT MAINTENANCE 1945258 CARDINAL HEALTH PO BOX 905867 CHARLOTTE NC 28290 PATIENT & HOSPITAL SUPPLIES 1716321 GARANCO INC PO BOX 100 PILOT MOUNTAIN NC 27041 CONSTRUCTION SERVICES 1654063 CARDINAL DISTRIBUTION PHARMACY 25025 NETWORK PLACE CHICAGO IL 60673 PHARMACY SUPPLIES & MEDICATIONS 1568901 67 2333978 2333978 PATIENT CARE SERVICES 621400 102961879 102961879 OTHER OPERATING REVENUE 621400 735312 735312 EHR MEANINGFUL USE REVENUE 621400 149559 149559 NET HOSPICE INVESTMENT 623000 62948 62948 103909698 1964075 1964075 1395165 334637 1060528 1060528 1060528 31781915 2823 27658704 657 4123211 2166 4125377 4125377 CAFETERIA & VENDING 722210 144329 144329 144329 113537985 103909698 0 7294309 X 23064 23064 1337558 334390 949457 53711 60006 60006 35324720 33818223 1506497 604872 563466 40520 886 6448461 6007041 431973 9447 2328917 2169494 156011 3412 432147 432147 145784 145784 120285 120285 504636 504636 13414011 11578991 1835020 598254 20102 578152 8520843 8112696 408147 1547527 1547527 285888 258449 27439 3057647 3057647 6913608 6913608 1065125 1065125 BAD DEBT EXPENSE 12730298 12730298 MEDICAL SUPPLIES 3927548 3927548 PROVIDER TAX 2673112 2673112 RECRUITMENT 374240 374240 899461 549355 350106 103338012 95410142 7860414 67456 10212540 15449307 2990 6240 7914767 8007196 1300862 1023037 2644962 2832295 149440925 79673848 72552722 69767077 106000758 107958746 4350905 4618417 3037893 2261432 208018399 211923747 8474731 9946335 69825000 68995000 10002389 11756673 88302120 90698008 X 117894899 118259751 1821380 2965988 119716279 121225739 208018399 211923747 X 10199973 -2389217 -6301296 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 11586 11586 0 PART II-B, LINE 1: PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS TO LEGISLATIVE BODIES ON BEHALF OF THEIR MEMBERSHIP BASES. EACH YEAR, A PORTION OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ENDEAVORS. FOR THE CURRENT YEAR, THE PORTION OF DUES PAID ALLOCATED TO LOBBYING IS APPROXIMATELY $ 11,600. 2546331 2546331 87933941 31765803 56168138 9127906 6978536 2149370 48897995 40929509 7968486 934752 934752 69767077 INTEREST PAYABLE 746689 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 4618710 PHYSICIAN GUARANTEE 371064 INTEREST RATE SWAP 5944493 RESIDENT TRUST FUNDS 75717 11756673 X 89570587 -2389217 617538 -1771679 91342266 504636 21691083 22195719 113537985 88061127 334637 334637 87726490 504636 15106886 15611522 103338012 PART X, LINE 2: THE HOSPITAL, FOUNDATION, AND AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE HOSPITAL HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2015. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: JOINT VENTURE INCOME FROM ACCOUNT WITH SWAP 282,901. DIRECT RENTAL EXPENSE 334,637. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SWAP AGREEMENT 2,444,923. BAD DEBT EXPENSE NET WITH REVENUES 12,730,298. RECOGNIZED LOSSES ON IMPAIRMENTS 4,139,274. GRANTS/CONTRIBUTIONS TO FOUNDATION 2,376,588. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT RENTAL EXPENSES 334,637. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET WITH REVENUES 12,730,298. GRANTS/CONTRIBUTIONS TO FOUNDATION 2,376,588. 1 1 X 1 X 1 X 1 1 1 0 1 1 1337991 1337991 0.01480 12992733 10729381 2263352 0.02500 14330724 10729381 3601343 0.03980 15772 15772 0.00020 225826 225826 0.00250 617748 617748 0.00680 859346 859346 0.00950 15190070 10729381 4460689 0.04930 17 4328 17 4328 1 3913294 1369653 75542218 75620270 -78052 X 1 0 1 1 HUGH CHATHAM MEMORIAL HOSPITAL 180 PARKWOOD DRIVE ELKIN NC 28621 X X X DISPROPORTIONATE SHARE HOSPITAL HUGH CHATHAM MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X SEE DISCLOSURE X 1 12 1 SEE DISCLOSURE 0 0 1 X 150.000000000000 200.000000000000 X X X X X 1 1 X X X X 1 X SEE DISCLOSURE X SEE DISCLOSURE X SEE DISCLOSURE X X X X X 1 0 X 1 X 0 0 HUGH CHATHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: EXPERTS IN THE FIELD OF PUBLIC HEALTH, HOSPICE CARE, NURSES, PHYSICIANS, CASE MANAGEMENT, EDUCATION, AND PHILANTHROPY WERE CHOSEN FOR THE FOCUS GROUP. THE FOCUS GROUPS WERE DESIGNED AROUND THE KEY ISSUES THAT EMERGED FROM THE MEETINGS. HUGH CHATHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: HUGH CHATHAM MEMORIAL HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN OUR COMMUNITY, WITH A SPECIAL FOCUS ON THE UNDERSERVED. AS SUCH, COMMUNITY BENEFIT PLANNING IS INTEGRATED INTO OUR HOPSITAL'S ANNUAL PLANNING AND BUDGETING PROCESSES TO ENSURE WE CONTINUE TO EFFECTIVELY SUPPORT COMMUNITY BENEFITS. PART V, SECTION B, LINE 7A: HTTP://WWW.HUGHCHATHAM.ORG/ABOUT/COMMUNITY-HEALTH/ PART V, SECTION B, LINE 10A: HTTP://WWW.HUGHCHATHAM.ORG/ABOUT/COMMUNITY-HEALTH/ PART V, SECTION B, LINE 16A: HTTP://WWW.HUGHCHATHAM.ORG/PATIENTS/FINANCIAL-ASSISTANCE/ PART V, SECTION B, LINE 16B: HTTP://WWW.HUGHCHATHAM.ORG/PATIENTS/FINANCIAL-ASSISTANCE/ PART V, SECTION B, LINE 16C: HTTP://WWW.HUGHCHATHAM.ORG/PATIENTS/FINANCIAL-ASSISTANCE/ PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY HUGH CHATHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: SEE DISCLOSURE HUGH CHATHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: SEE DISCLOSURE HUGH CHATHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: SEE DISCLOSURE 20 HUGH CHATHAM NURSING CENTER 700 JOHNSON RIDGE ROAD ELKIN NC 28621 NURSING FACILITY YADKIN VALLEY HOME HEALTH 213 WINSTON ROAD JONESVILLE NC 28642 HOME HEALTH YADKIN VALLEY ADULT MEDICINE 500 CHATHAM MEDICAL PARK ELKIN NC 28621 PHYSICIANS OFFICES CLINGMAN MEDICAL CENTER 3369 CLINGMAN ROAD RONDA NC 28670 PHYSICIANS OFFICES YADKIN VALLEY UROLOGY 200 JOHNSON RIDGE MEDICAL PARK ELKIN NC 28621 PHYSICIANS OFFICES HUGH CHATHAM FAMILY MEDICINE JONESVILLE 112 N SWAIM STREET JONESVILLE NC 28642 PHYSICIANS OFFICES YADKIN VALLEY GASTROENTEROLOGY 201 WEST MAIN STREET ELKIN NC 28621 PHYSICIANS OFFICES G I CLINIC 201 WEST MAIN STREET ELKIN NC 28621 PHYSICIANS OFFICES YADKIN VALLEY DERMATOLOGY 690 PARKWOOD MEDICAL PARK ELKIN NC 28621 PHYSICIANS OFFICES HUGH CHATHAM NEUROLOGY 100 CHATHAM MEDICAL PARK ELKIN NC 28621 PHYSICIANS OFFICES HUGH CHATHAM FAMILY MEDICINE ELKIN 101 CLAREMONT MEDICAL PARK ELKIN NC 28621 PHYSICIANS OFFICES HUGH CHATHAM SURGICAL 201 B CLAREMONT MEDICAL PARK ELKIN NC 28621 PHYSICIANS OFFICES TRI COUNTY ORTHOPEDIC & SPORTS MEDICINE 400 JOHNSON RIDGE RD ELKIN NC 28621 PHYSICIANS OFFICES HUGH CHATHAM BEHAVORIAL 690 PARKWOOD MEDICAL PARK ELKIN NC 28621 PHYSICIANS OFFICES YADKIN VALLEY PULMONARY 180 PARKWOOD DRIVE ELKIN NC 28621 PHYSICIANS OFFICES HUGH CHATHAM FAMILY MEDICINE BOOMER 156 BOOMER COMMUNITY CENTER RD BOOMER NC 28606 PHYSICIANS OFFICES HUGH CHATHAM FAMILY MEDICINE MT VIEW 5229 ROCK CREEK RD MT VIEW NC 28602 PHYSICIANS OFFICES EXPRESS CARE NORTH BRIDGE STREET ELKIN NC 28621 PROCEDURE CLINIC HUGH CHATHAM PODIATRIC MEDICINE AND SURG 150 CHATHAM MEDICAL PARK MT VIEW NC 28621 PHYSICIANS OFFICES HUGH CHATHAM WOMEN'S CENTER 150 PARKWOOD DRIVE MT VIEW NC 28621 PHYSICIANS OFFICES PART I, LINE 7: THE ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM WAS USED TO COMPUTE A COST-TO-CHARGES RATIO THAT WAS USED TO CALCULATE COSTS USED IN PART I, LINE 7. PART I, LN 7 COL(F): THE TOTAL EXPENSE AMOUNT LISTED ON FORM 990, PART IX, LINE 26 CONTAINS BAD DEBT EXPENSE OF $12,730,298 THAT WAS REMOVED FOR THE PURPOSE OF CALCULATING TOTAL CHARITY CARE PERCENTAGE ON LINE 7, COLUMN (F). PART I, LINE 6A: THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS FILED THROUGH THE MEDICAL CARE COMMISSION OF NORTH CAROLINA. PART II, COMMUNITY BUILDING ACTIVITIES: HUGH CHATHAM MEMORIAL HOSPITAL PROVIDES ALL LOCAL SCHOOLS WITH FREE HAND SANITIZERS WITH FLU PREVENTION BROCHURES EVERY FALL AND SUNCREEN WITH MELANOMA AWARENESS BROCHURES EVERY SPRING. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE GROSS BAD DEBT EXPENSE PER AUDITED FINANCIAL STATEMENTS REDUCED TO COST USING AN INTERNALLY COMPUTED COST-TO-CHARGES RATIO FROM THE ORGANIZATION'S COST ACCOUNTING SYSTEMS.DUE TO THE FACT THAT APPROXIMATELY 30% OF THE SURROUNDING COMMUNITY'S RESIDENTS ARE CONSIDERED TO BE LIVING BELOW THE POVERTY LINE, IN COMBINATION WITH THE FACT THAT THE UNEMPLOYMENT PERCENTAGE FOR THE AREA IS APPROXIMATELY 12.7%, THE ORGANIZATION FEELS THAT APPROXIMATELY 35% OF BAD DEBT IS AN APPROPRIATE ESTIMATION OF THE AMOUNT OF BAD DEBT THAT MAY CONSTITUTE A COMMUNITY BENEFIT. PART III, LINE 8: AN INTERNAL COST-TO-CHARGE RATIO WAS USED TO COMPUTE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6. PART III, LINE 9B: HCMH MAKES EVERY EFFORT TO EVALUATE PATIENTS PRIOR TO PLACEMENT WITH A COLLECTIONS AGENCY TO SEE IF THEY ARE QUALIFIED FOR MEDICAID OR HOSPITAL CHARITY CARE. WE HAVE AN IN-HOUSE EMPLOYEE DESIGNATED TO ASSISTING PATIENTS ELIGIBLE FOR MEDICAID AND/OR FINANCIAL ASSISTANCE. AT THE POINT OF THE PATIENT NOT BEING ELIGIBLE AND FAILURE TO RESPOND FOR OUR PAYMENT PLAN OPTIONS, THE ACCOUNT IS PLACED WITH A COLLECTION AGENCY AND THE AGENCY MAKES AN EFFORT FOR 30 DAYS PRIOR TO PLACING ON THE CREDIT SCORE, TO OBTAIN PAYMENT. PART VI, LINE 2: THE ORGANIZATION TRACKS THE RESULTS OF HEALTH SCREENINGS PROVIDED THROUGH ITS QUARTERLY HEALTH FAIRS AND LOOKS FOR TRENDS. THESE SCREENINGS PROVIDE INSIGHT INTO FURTHER MEDICAL NEEDS OF THE COMMUNITY MEMBERS. THE FAIRS ARE HELD QUARTERLY AND ARE ATTENDED BY HUNDREDS OF PEOPLE WHO ARE OFFERED VARIOUS HEALTH SCREENINGS. THE ORGANIZATION ALSO SUBSCRIBES TO NATIONAL AFFILIATED ORGANIZATIONS THAT PROVIDE DATA ON REGIONAL HEALTH NEEDS. THE LAST COUPLE OF YEARS OUR FOCUS HAS BEEN ON STROKE EDUCATION, WITH STROKE CERTIFICATION FOR OUR FACILITY. VARIOUS HEALTH FAIRS FOR SPECIFIC GROUPS, SUCH AS "KIDSFEST, HEARTFEST, AND SCREENINGS SPECIFICALLY HELD FOR OUR EMPLOYEES. WE SPONSER SUPPORT GROUPS, LUNCH AND LEARN SESSIONS FOR THE COMMUNITY ALSOTHE ORGANIZATION TRACKS THE RESULTS OF HEALTH SCREENINGS PROVIDED THROUGH ITS QUARTERLY HEALTH FAIRS AND LOOKS FOR TRENDS. THESE SCREENINGS PROVIDE INSIGHT INTO FURTHER MEDICAL NEEDS OF THE COMMUNITY MEMBERS. THE FAIRS ARE HELD QUARTERLY AND ARE ATTENDED BY HUNDREDS OF PEOPLE WHO ARE OFFERED VARIOUS HEALTH SCREENINGS. THE ORGANIZATION ALSO SUBSCRIBES TO NATIONAL AFFILIATED ORGANIZATIONS THAT PROVIDE DATA ON REGIONAL HEALTH NEEDS. THE LAST COUPLE OF YEARS OUR FOCUS HAS BEEN ON STROKE EDUCATION, WITH STROKE CERTIFICATION FOR OUR FACILITY. VARIOUS HEALTH FAIRS FOR SPECIFIC GROUPS, SUCH AS "KIDSFEST, HEARTFEST, AND SCREENINGS SPECIFICALLY HELD FOR OUR EMPLOYEES. ALSO, WE SPONSER SUPPORT GROUPS, LUNCH AND LEARN SESSIONS FOR THE COMMUNITY. PART VI, LINE 3: FINANCIAL ASSISTANCE EDUCATION IS MADE AVAILABLE AT ADMISSION AND ON THE WEBSITE. AT REGISTRATION THERE ARE BROCHURES WITH FINANCIAL ASSISTANCE INFORMATION MADE AVAILABLE. SIGNAGE IS LOCATED THROUGHOUT THE FACILITY TO INFORM AND EDUCATE THE PUBLIC OF THEIR FINANCIAL RIGHTS. HUGH CHATHAM MEMORIAL HOSPITAL OFFERS A LANGUAGE LINE FOR THE NON-ENGLISH SPEAKING COMMUNITY AND PHONETREE ASSISTANCE WHERE NEEDED. PART VI, LINE 4: THE PRIMARY SERVICE AREA OF THE HOSPITAL INCLUDES NINE ZIP CODES--ROUGHLY A FIFTEEN MILE DIAMETER AROUND ELKIN, NC. THE SECONDARY SERVICE AREA INCLUDES AN ADDITIONAL FIVE ZIP CODES WIDENING THE DIAMETER TO THIRTY MILES AROUND ELKIN. BOTH OF THESE MARKETS INCLUDE PART, BUT NOT ALL, OF THE NORTH CAROLINA COUNTIES OF WILKES, ALLEGHANY, YADKIN, AND SURRY. SOUTHERN VIRGINIA COUNTIES OF GRAYSON, PATRICK, AND CARROLL ARE ALSO INCLUDED. THESE AREAS HAVE BEEN SEVERELY AFFECTED BY THE ECONOMIC CLIMATE OF THE PAST YEAR. THE AREA CURRENTLY HAS AN UNEMPLOYMENT PERCENTAGE OF 12.7%. DOBSON, NC, WHICH IS IN THE CENTER OF SURRY COUNTY, IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. HUGH CHATHAM IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA. PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OF ITS DEPARTMENTS.HCMH OFFERS A WIDE VARIEY OF SERVICES TO OUR COMMUNITY, SUCH AS WOMEN'S HEALTH EDUCATION SEMINARS,INFANT AND CHILD CPR CLASSES, LAMAZE AND CHILDBIRTH CLASSES, CARDIAC REHABILITATION, AND VARIOUS PATIENT EDUCATIONAL PROGRAMS. THE HOSPITAL PARTICIPATES IN AND HOSTS MANY COMMUNITY HEALTH SCREENINGS AND IMMUNIZATIONS, CANCER SCREENINGS (PROSTATE, BREAST, SKIN, AND COLON), AS WELL AS SCREENINGS IN THE FOLLOWING AREAS: CHOLESTEROL/GLUCOSE, BLOOD PRESSURE, HEART RATE,OXYGEN SATURATION, WEIGHT AND BODY MASS INDEX ASSESSMENT, FALLS ASSESSMENT, BONE DENSITY TESTING, TETANUS AND FLU CLINICS. THE EMPLOYEES AT HCMH ARE COMMITTED TO THE AREA'S NEEDS. COMMITTMENT IS DEMONSTRATED THROUGH PARTICIPATION IN THE FOLLOWING: THE STOP HUNGER FOOD DRIVE, MARCH OF DIMES, UNITED WAY, TRI C MINISTRIES, SUSAN G. KOMEN WALKATHONS, SPECIAL OLYMPICS, THE AMERICAN CANCER SOCIETY, THE NATIONAL MS SOCIETY, AND A LOCAL ORGANIZATION TRIAD FIRST IN FAMILIES THAT HELPS CHILDREN IN NEED.HCMH IS COMMITTED TO THE PROMOTION OF HEALTH, OUTREACH, AND SUPPORT GROUPS. THE HOSPITAL SPONSORS THE FOLLOWING:CANCER HEART AND SOUL, LOOK GOOD FEEL BETTER CANCER SUPPORT, HOSPICE GRIEF CAMP FOR CHILDREN, BEREAVEMENT AND THE GRIEF PROCESS, STROKE SUPPORT, AMPUTEE SUPPORT, ALZHEIMER'S SUPPORT, CPR FOR INDUSTRY, DAY CARE WORKERS, AND LIFEGUARDS, SENIOR FITNESS CLASSES, AND CARDIAC REHABILITATION CLASSES. HCMH ALSO HOLDS "LUNCH AND LEARNS" WHICH ARE OFFERED TO THE COMMUNITY PROMOTING DIFFERENT TOPICS OF HEALTH RELATED INTEREST.THE HOSPITAL ALSO SPONSORS THE GRACE CLINIC WHICH IS A LOCAL FREE CLINIC WHICH OPERATES ON DONATED SERVICES AND SUPPLIES. PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 X X X X 0 0 0 0 0 1 0 0 0 DOMINICK CARBONE MD CHIEF OF STAFF 499910 0 236386 0 0 0 9061 0 10866 0 756223 0 0 0 PAUL HAMMES CEO 275000 0 25000 0 0 0 8566 0 15031 0 323597 0 0 0 DONALD TRIPPEL CFO 170957 0 10000 0 0 0 4493 0 4562 0 190012 0 0 0 MARY BLACKBURN CPO 148246 0 10000 0 0 0 3943 0 8894 0 171083 0 0 0 SARBA KUNDU MD PHYSICIAN 431309 0 36668 0 0 0 398 0 12078 0 480453 0 0 0 ANDREW LEE MD PHYSICIAN 274298 0 179876 0 0 0 7539 0 11935 0 473648 0 0 0 JONATHAN SNYDER MD PHYSICIAN 456073 0 75757 0 0 0 8180 0 12078 0 552088 0 0 0 MURUGANANTHAN SUBBIAH MD PHYSICIAN 240294 0 137885 0 0 0 6261 0 11720 0 396160 0 0 0 PRAG GUPTA MD PHYSICIAN 323273 0 55884 0 0 0 0 0 12078 0 391235 0 0 0 PART I, LINE 6 THE PHYSICIANS IN CHARGE OF THE UROLOGY PRACTICE, GASTROENTEROLOGY PRACTICE, AND CLINGMAN CLINIC ARE ELIGIBLE TO RECEIVE A PORTION OF THE NET PROFIT FROM THEIR PRACTICE. ANY PROFITS RESULTING FROM PHYSICIANS' PROFESSIONAL SERVICES AFTER ALL THE PRACTICE AND PHYSICIAN EXPENSES, SHALL BE SHARED. THE PHYSICIANS RECEIVE UP TO AN 85% ALLOCATION WITH THE REMAINDER GOING TO THE EMPLOYER. THE HOSPITALIST BONUS IS BASED ON PERFORMANCE GOALS AND MAY BE UP TO AS MUCH AS 20% OF THEIR SALARY. ANOTHER PHYSICIAN IN CHARGE OF THE HOSPITALIST GROUP IS ELIGIBLE TO RECEIVE UP TO 20% OF THEIR BASE SALARY DEPENDING ON PERFORMANCE MEASURES OF THE HOSPITALIST GROUP. AMOUNTS PAID OUT TO INDIVIDUALS LISTED ON PART VII OF THE FORM 990 FOR 2014 WERE: DOMINICK CARBONE, MD $236,386 JONATHAN SNYDER, MD 75,757 ANDREW LEE, MD 179,876 SARBA KUNDA, MD 36,668 MURUGANANTHAN SUBBIAH, MD 37,885 PRAG GUPTA, MD 55,884 FORM 990, PART VII, SECTION A, LINE 1: COMPENSATION FROM AN UNRELATED ORGANIZATION: CEO PAUL HAMES IS COMPENSATED BY AN OUTSIDE MANAGEMENT COMPANY, ALLIANT MANAGEMENT GROUP. THE COMPENSATION PAID BY THE UNRELATED ORGANIZATION IS INCLUDED ON FORM 990, PART VII, SECTION A, LINE 1. THE DETAILS ARE AS FOLLOWS: PAUL HAMES: $ 300,000 A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657902F31 2003-04-23 39673032 REFUNDING, NEW STRUCTURES, EQUIPMENT 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65821DAF8 2008-09-24 45455000 NEW STRUCTURES, EQUIPMENT 1 0 0 A 13240000 41151940 2658335 529906 1878294 21551473 11100000 2005 1 0 1 1 B 3220000 42235000 46276755 3493414 435743 513249 42448072 2010 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 1 0.13870 1 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 1 1 WELLS FARGO 30.000000000000 1 0 0 0 0 A 0 B 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 06/13/2013 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 08/28/2013 SCH K, PART II, LINE 11, COLUMN A THE OTHER SPENT PROCEEDS OF $11,100,000 WERE USED TO CURRENTLY REFUND PRIOR BONDS ISSUED ON 05-08-1996. LAURA OAKS FAMILY MEMBER OF BOARD MEMBER BOB MIDKIFF 60006 COMPENSATION AS AN EMPLOYEE OF THE ORGANIZATION 0 FORM 990, PART III, LINE 4A THROUGHOUT THE YEAR, TO TEACH PEOPLE TO RECOGNIZE STROKE WARNING SIGNS THAT OFTEN COME ON SUDDENLY, HCMH EDUCATED THE PUBLIC ABOUT AN ACRONYM CALLED F.A.S.T. - FACE DROOPING, ARM WEAKNESS, SPEECH DIFFICULTY AND TIME TO CALL 9-1-1. MORE THAN TWO MILLION MARKETING IMPRESSIONS WERE GENERATED FOR PUBLIC EDUCATION ABOUT THESE SIGNS AND SYMPTOMS. HCMH ALSO SUPPORTED COMMUNITY ORGANIZATIONS SUCH AS PROJECT LAZARUS SURRY COALITION BY ALLOWING THE GROUP TO MEET AT THE HOSPITAL AND BY PROVIDING HOSPITAL STAFF AS PARTICIPANTS. IT ALSO PROVIDED HANDS-ONLY CPR AND AED USE INSTRUCTION TO MEMBERS OF THE YADKIN VALLEY ROTARY. THE HOSPITAL ALSO SUBSIDIZED LABORATORY AND IMAGING EXPENSES FOR GRACE CLINIC OF THE YADKIN VALLEY, A FREE CLINIC LOCATED IN ELKIN, NORTH CAROLINA THAT SEES PATIENTS AGES 18 TO 64 WITH NO MEDICAL INSURANCE AND WHO FALL UNDER THE INCOME AT OR LESS THAN 200 PERCENT OF THE FEDERAL POVERTY LEVEL. A FREE, MONTHLY SERIES OF CLASSES TAUGHT BY A REGISTERED DIETITIAN AND CERTIFIED DIABETES EDUCATOR WERE HELD AT THE HOSPITAL TO EDUCATE ADULTS ABOUT HOW TO KEEP DIABETES IN CONTROL. CLASSES LASTED 90 MINUTES AND MORE THAN 100 PEOPLE ATTENDED. SUPPORT FOR CANCER PATIENTS INCLUDED MASTECTOMY FITTERS GOING TO PATIENT'S HOMES AFTER SURGERY FOR A PROSTHESIS FITTING. THEY PROVIDE A "SOFTIE AND PILLOW FOR THE PATIENT'S COMFORT DURING THE RECOVERY PERIOD UNTIL THE PROSTHESIS IS READY FOR FITTING. HCMH ALSO CONTINUED TO OFFER "LOOK GOOD FEEL BETTER" A FREE NATIONAL PUBLIC SERVICE PROGRAM THAT HELPS WOMEN UNDERGOING CANCER TREATMENT LEARN TO COPE WITH THEIR APPEARANCE AND WITH SIDE EFFECTS OF TREATMENT. A LICENSED COSMETOLOGIST VOLUNTEER TEACHES WOMEN HOW TO ENHANCE THEIR APPEARANCE AND MATERIALS ARE PROVIDED AT NO CHARGE. OTHER WOMEN'S SERVICES COMMUNITY OUTREACH INCLUDED BIRTHING CLASSES AND BREASTFEEDING EDUCATION. DURING THE FISCAL YEAR, HCMH RECEIVED SEVERAL CERTIFICATIONS, AWARDS AND RANKINGS THAT DEMONSTRATE THE HOSPITAL'S CONTINUED BENEFIT TO THE COMMUNITY: - HCMH RANKED FIRST AMONG ALL ACUTE-CARE HOSPITALS IN NORTH CAROLINA FOR THE QUALITY OF OUR PATIENT CARE, INCLUDING CLINICAL PROCESSES OF CARE, PATIENT EXPERIENCE AND PATIENT OUTCOMES, BASED ON HOSPITAL TOTAL PERFORMANCE SCORES UNDER MEDICARE'S FISCAL YEAR 2014 VALUE-BASED PURCHASING PROGRAM, ACCORDING TO HOSPITAL COMPARE DATA FROM WWW.MEDICARE.GOV - FOR A THIRD YEAR, HCMH RECEIVED A 2015 WOMEN'S CHOICE AWARD AS ONE OF AMERICA'S TOP 100 HOSPITALS FOR PATIENT EXPERIENCE AND WAS ALSO RECOGNIZED AMONG AMERICA'S BEST STROKE CENTERS. - THE AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION RECOGNIZED HCMH FOR "GOLD PLUS" LEVEL PERFORMANCE BY THE HOSPITAL ACHIEVING AT LEAST 24 CONSECUTIVE MONTHS OF 85% OR HIGHER ADHERENCE TO ALL GET WITH THE GUIDELINES STROKE PERFORMANCE ACHIEVEMENT INDICATORS. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE IMMEDIATE PAST CHAIRMAN AND ONE (1) OR MORE ADDITIONAL MEMBERS WHO WILL BE NOMINATED BY THE CHAIRMAN FOR THE ELECTION BY THE BOARD OF TRUSTEES. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. THE EXECUTIVE COMMITTEE SHALL ALSO ANNUALLY REVIEW THE PERFORMANCE, COMPENSATION AND TERMS OF EMPLOYEMENT OF THE CHIEF EXECUTIVE OFFICER AND MAKE RECOMMENDATIONS TO THE BOARD CONCERNING COMPENSATION AND TERMS OF THE EMPLOYMENT OF THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL ENTERED INTO A MANAGEMENT AGREEMENT IN JUNE 2006 WITH ALLIANT, AN UNRELATED CORPORATION WHEREBY THE MANAGEMENT COMPANY WILL PERFORM MANAGEMENT AND ADMINISTRATION SERVICES ON A DAY-TO-DAY BASIS AND PROVIDE A CHIEF EXECUTIVE OFFICER. THE AGREEMENT CALLS FOR A BASE MANAGEMENT FEE OF APPROXIMATELY $220,000 IN THE FIRST YEAR WITH ANNUAL INCREASES TO APPROXIMATE THE INCREASE IN CONSUMER PRICE INDEX. IN ADDITION TO THE ANNUAL FEE, THE HOSPITAL IS REQUIRED TO PAY THE SALARIES, BONUSES AGREED UPON BY THE BOARD, AND ALL FRINGE BENEFITS OF THE MANAGEMENT COMPANY'S KEY PERSONNEL WHO PERFORM THE ADMINISTRATIVE DUTIES. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH SUPERVISION AND ASSISTANCE BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DELIVERED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL. THE RETURN WAS THEN PRESENTED AT A SCHEDULED MEETING OF THE BOARD OF DIRECTORS BY A REPRESENTATIVE OF THE ACCOUNTING FIRM, AND EACH VOTING MEMBER OF THE BOARD WAS PROVIDED A COPY FOR DISCUSSION AND QUESTIONS. FOLLOWING THE MEETING AND A PERIOD OF TIME FOR COMMENT, THE RETURN WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL VOTING BOARD MEMBERS ARE PRESENTED WITH THE GOVERNANCE POLICIES CONCERNING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. UPON REVIEW AND DISCUSSION CONCERNING RELATIONSHIPS WITH THE ORGANIZATION, ITS AFFILIATES, OR AMONGST EACH OTHER, THE BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE POLICY STATEMENT TO THE ADMINISTRATION. THESE STATEMENTS ARE REVIEWED BY THE BOARD CHAIR AND ARE PRESENTED TO THE AUDITORS DURING THE ANNUAL AUDIT. FORM 990, PART VI, SECTION B, LINE 15 A REPRESENTATIVE FROM ALLIANT, THE OUTSIDE MANAGEMENT COMPANY, MEETS WITH THE BOARD TO REVIEW AND APPROVE SALARIES FOR THE CEO AND OTHER OFFICERS. THE SALARIES OF THE TOP EXECUTIVE AND OTHER MEMBERS OF THE ADMINISTRATIVE DEPARTMENT ARE DETERMINED IN THE CONTRACT NEGOTIATIONS. A REVIEW OF ALL SALARIES, TOP TO BOTTOM, WAS DONE THROUGH THE ADMINISTRATIVE TEAM. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. 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 IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 5,330,907. MANAGEMENT AND GENERAL EXPENSES 1,309,003. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,639,910. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,741,334. MANAGEMENT AND GENERAL EXPENSES 325,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,066,334. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 3,277,576. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,277,576. CENTRALIZED BILLING: PROGRAM SERVICE EXPENSES 778,953. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 778,953. OTHER FEES: PROGRAM SERVICE EXPENSES 450,221. MANAGEMENT AND GENERAL EXPENSES 201,017. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 651,238. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SWAP AGREEMENT -2,444,923. RECOGNIZED LOSSES ON IMPAIRMENTS -4,139,274. JV INCOME FROM ACCOUNT WITH SWAP 282,901. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC 180 PARKWOOD DRIVE ELKIN NC 28621 562049537 FUNDRAISING NC 501(C)(3) LINE 11A, I HUGH CHATHAM MEMORIAL HOSPITAL 1 HUGH CHATHAM MEMORIAL HOSPITAL AUXILIARY 180 PARKWOOD DRIVE ELKIN NC 28621 561199949 THRIFT/GIFT SHOP NC 501(C)(3) LINE 11A, I HUGH CHATHAM MEMORIAL HOSPITAL 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC C 2333978 CASH