2015-05-01T09:36:37-05:00 2014-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2013-07-01 560619359 GASTON MEMORIAL HOSPITAL INC GAST 7048342000 2525 COURT DRIVE PO BOX 1747 GASTONIA NC 280531747 DAVID O'CONNOR EVP, CFO 7048342000 2015-04-30 1 AMY BIBBY P00445891 8282542254 2013 2016-03-07 17:11:31Z CAROMONT REGIONAL MEDICAL CTR DAVID O'CONNOR 2525 COURT DRIVE PO BOX 1747 GASTONIA NC 280531747 424191094 0 X WWW.CAROMONT.ORG X 1945 NC TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. 14 9 3269 259 376650 100276 608905 440277 405334757 414500109 90192 98660 6249575 8902747 412283429 423941793 628195 1026120 0 0 173879833 170707984 0 0 0 206686229 211881223 381194257 383615327 31089172 40326466 350012184 372724775 304823821 316668651 45188363 56056124 TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. 0 0 358438679 1026120 414647704 CAROMONT REGIONAL MEDICAL CENTER PROVIDES INPATIENT, OUTPATIENT, EMERGENCY, SURGICAL, WELLNESS AND PREVENTIVE CARE SERVICES TO THE RESIDENTS OF GASTON COUNTY AND SURROUNDING AREAS AT ITS 435 BED ACUTE CARE FACILITY.PLEASE SEE SCHEDULE O FOR A CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS. 358438679 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 X 448 0 1 3269 1 1 1 0 0 0 0 0 0 0 0 0 X 14 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X DAVID O'CONNOR 7048342000 2525 COURT DRIVE GASTONIA NC 28054 MR H SPURGEON MACKIE JR CHAIR - 2013 1.00 1.00 X X 0 0 0 SHEILA S REILLY PHD CHAIR - 2014 1.00 1.00 X X 0 0 0 MR DONNIE LOFTIS VICE CHAIR - 2014 1.00 1.00 X X 0 0 0 MR W BARRY SMITH SECRETARY THROUGH 2013 1.00 1.00 X X 0 0 0 MS ANNETTE CARTER SECRETARY AS OF 2014 1.00 1.00 X X 0 7340 0 MR M VINCENT QUINN TREASURER 1.00 1.00 X X 0 0 0 MR JAMES R BEAM DIRECTOR 1.00 1.00 X 0 0 0 MR JAMES W BAILEY DIRECTOR 1.00 1.00 X 0 0 0 MR WILLIAM ANTHONY DIRECTOR 1.00 1.00 X 0 0 0 MR W MICHAEL DICKSON DIRECTOR 1.00 1.00 X 0 0 0 MRS MARY FRANCES FORRESTER DIRECTOR 1.00 1.00 X 0 0 0 DR CHARLES MEAKIN III DIRECTOR 1.00 1.00 X 0 0 0 MS SUSIE BROWN DIRECTOR THROUGH 2013 1.00 1.00 X 0 0 0 MR DAVID ALLEN SMITH DIRECTOR 1.00 1.00 X 0 0 0 MR R JASON WILLIAMS DIRECTOR 1.00 1.00 X 0 0 0 DR GE WARD ADCOCK III CHIEF-OF-STAFF 1.00 39.00 X 20000 272180 26803 DOUG LUCKETT CEO/PRESIDENT 40.00 10.00 X 712139 0 129918 DAVID O'CONNOR EVP/CFO/ASST. TREASURER 40.00 10.00 X 475002 0 98510 MARIA LONG EVP CHIEF LEGAL OFFICER/ASST. SECRETARY 40.00 10.00 X 381516 0 72932 KATHLEEN K BESSON EVP/COO 40.00 10.00 X 329336 0 74874 TODD DAVIS MD VP MEDICAL AFFAIRS 40.00 10.00 X 380097 0 71032 MICHAEL R JOHNSON VP CIO 40.00 10.00 X 330900 0 71226 W K HARWELL VP PATIENT CARE 40.00 10.00 X 305239 0 34104 ELIZABETH MCCRAW VP HUMAN RESOURCES 40.00 10.00 X 265947 0 60415 ANDREA K SERRA VP WELLNESS DEVELOPMENT 40.00 10.00 X 264048 0 51785 RANDALL L KELLEY FORMER OFFICER 0.00 X 690063 0 48062 JERRY LEVINE FORMER KEY EMPLOYEE 0.00 X 597216 0 35613 PENNY P COWDEN FORMER HIGHLY COMPENSATED 0.00 X 222507 0 13214 CRAIG A DUNKER FORMER HIGHLY COMPENSATED 0.00 X 188045 0 2368 STEVEN A RUBIN FORMER HIGHLY COMPENSATED 0.00 X 109009 0 175 5271064 279520 791031 124 1 1 0 MORRISONS MANAGEMENT SPECIALISTS 5801 PEACHTREE DRIVE ATLANTA GA 30342 FOOD SERVICES 4230542 ARAMARK HEALTHCARE 1101 MARKET STREET PHILADELPHIA PA 19107 BIOMED SERVICES 4005153 DUNN SOUTHEAST INC 6101 CARNEGIE BLVD STE 400 CHARLOTTE NC 28209 CONSTRUCTION 3836762 SHARED (SIEMENS) MEDICAL SOLUTIONS 51 VALLEY STREAM PARKWAY MALVERN PA 19355 INFORMATION SYSTEMS 2721452 MONTEITH CONSTRUCTION CORP 223 NORTH GRAHAM STREET STE 100 CHARLOTTE NC 28202 CONSTRUCTION 1807402 74 406982 33295 440277 PATIENT SERVICES REVENUE 621500 411831855 411831855 PREMIER PSHP INCOME 541900 2349001 2363022 -14021 ANCILLARY REVENUE 621500 319253 319253 414500109 259811 259811 2685 2125 161711 560 -161711 -161151 -161151 98043 85465 12578 12578 MEANINGFUL USE 621500 3644017 3644017 PHARMACY REVENUE 621500 2359882 2359882 CAFETERIA & VENDING INCOME 722210 2018627 2018627 867643 133574 390671 343398 8890169 423941793 414647704 376650 8477162 985567 985567 40553 40553 2274227 454845 1819382 135508050 122847672 12660378 6817430 6100975 716455 16211620 14507915 1703705 9896657 8856601 1040056 429669 429669 634949 634949 121604 121604 160914 160914 36035135 31977701 4057434 367729 96047 271682 2857681 1496767 1360914 641449 641449 9228504 9228504 131036 94913 36123 571715 304284 267431 8451179 8451179 23620785 23620785 3221709 3221709 UBI TAX 7268 7268 SUPPLIES 72911696 72911696 BAD DEBT 43014968 43014968 EQUIPMENT 4423388 4423388 5049845 4731492 318353 383615327 358438679 25176648 0 27684 677 44345810 52885169 2499 6668612 7251509 9382675 9145373 475878478 265194064 198570572 210684414 9490 10190 472338 1664300 2311646 2311646 88223357 88768998 350012184 372724775 40942536 47356576 201369253 195717418 62512032 73594657 304823821 316668651 X 45178875 56045938 9488 10186 45188363 56056124 350012184 372724775 X 40326466 562 -29459267 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 81033 0 1 79881 160914 0 PART II-B, LINE 1: ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $28,472 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. AN ADDITIONAL $51,409 IN LEGAL FEES WERE PAID FOR LOBBYING EXPENDITURES. 9488 1251 553 10186 8149 1500 962 1123 9488 6999 1500 221 571 8149 6513 966 480 6999 1.00000 0 0 2218480 2218480 258338072 127590035 130748037 1437153 755803 681350 186341598 136848226 49493372 27543175 27543175 210684414 PREPAID PENSION OBLIGATION 50143969 DEFERRED FINANCING COSTS 1871511 OTHER RECEIVABLES 4578967 457B PLAN ASSETS 7042331 DEFERRED CHARGE - INTEREST RATE SWAP 23495262 457F PLAN ASSETS 1636958 88768998 457B PLAN LIABILITY 7042331 ESTIMATED 3RD PARTY SETTLEMENTS 41420106 INTEREST RATE SWAP LIABILITY 23495262 457F PLAN LIABILITY 1636958 73594657 X 353586504 562 -70355851 -70355289 423941793 0 423941793 340600359 0 340600359 43014968 43014968 383615327 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR ONCOLOGY MEDICATIONS FOR INDIGENT PATIENTS. PART X, LINE 2: THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2014 AND 2013, RESPECTIVELY. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT -43,014,968. CHANGE IN VALUE OF INTEREST RATE SWAP -1,674,321. INTERCOMPANY TRANSFERS -25,666,562. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 43,014,968. 1 1 1 X 1 X 1 1 0 1 1 9562088 0 9562088 0.02810 57653495 46918229 10735266 0.03150 67215583 46918229 20297354 0.05960 1554228 8540 1545688 0.00450 3022483 215304 2807179 0.00820 70 1515337 706440 808897 0.00240 1343874 1343874 0.00390 70 7435922 930284 6505638 0.01900 70 74651505 47848513 26802992 0.07860 1211764 1211764 0.00360 1211764 1211764 0.00360 1 43014968 3461698 104168004 102498777 1669227 X 1 1 1 1 CAROMONT REGIONAL MEDICAL CENTER 2525 COURT DRIVE GASTONIA NC 28054 X X X 4 DIAGNOSTIC IMAGING CENTERS AND 6 OP SERIVCE CENTER CAROMONT REGIONAL MEDICAL CENTER 1 1 X X X X X X X X 12 1 0 1 X WWW.CAROMONTHEALTH.ORG X WWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMAN X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X 1 0 1 X 0 0 CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3: GASTON COUNTY COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY THE FOLLOWING PARTNERS: THE GASTON COUNTY HEALTH DEPT, GASTON TOGETHER, UNITED WAY OF GASTON COUNTY, AND CAROMONT HEALTH. DATA IN THIS ASSESSMENT IS DERIVED FROM THREE SOURCES: 1) GASTON COUNTY HEALTH DATA; 2) COUNTY HEALTH RANKINGS; 3) GASTON COUNTY QUALITY OF LIFE SURVEY, 2012. THE QUALITY OF LIFE SURVEY WAS CONDUCTED TO ASSESS THE OPINIONS OF GASTON COUNTY RESIDENTS REGARDING THEIR PERSONAL HEALTH. TO GET A COMPREHENSIVE PICTURE OF THESE OPINIONS, FOUR DIVERSE GROUPS WERE SURVEYED: COMMUNITY LEADERS, COMMUNITY RESIDENTS, HIGH SCHOOL STUDENTS, AND PERSONS LIVING IN LOW-INCOME AREAS THROUGHOUT THE COUNTY. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5D: OTHER WEBSITE'S FULL URL: HTTP://WWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMAN-SERVICES/PUBLIC-HEALTHDIVISION/COMMUNITY-HEALTH-DATA1) HOSPITAL'S FACEBOOK PAGE 2) PRESENTED FINDINGS TO COMMUNITY AT VARIOUS MEETINGS AT HOSPITAL IN JUNE, 2013 3) COPY IN GASTON COUNTY LIBRARY - HAD ADS PROMOTING THIS CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6I: MANY COMMUNITY ORGANIZATIONS INCLUDING GASTON COUNTY BOARD OF HEALTH AND CAROMONT HEALTH HAVE COMMITTED TO REDUCE THE INCIDENCE OF OBESITY IN GASTON COUNTY, TO PREVENT AND REDUCE THE INCIDENCE OF TOBACCO USE AND TO DEVELOP, IMPLEMENT, AND ADVOCATE FOR THE INTEGRATION OF BEHAVIORAL HEALTH RESOURCES INTO THESE INITIATIVES. THE EXISTING GASTON COMMUNITY HEALTHCARE COMMISSION STRUCTURE WILL BE THE VEHICLE FOR THIS WORK AND IS COMPOSED OF THE FOLLOWING 5 RESOURCE TEAMS: 1) HEALTHY BEHAVIORS; 2) PUBLIC POLICY AND ENVIRONMENT; 3) CLINICAL CARE; 4) MENTAL AND EMOTIONAL HEALTH; 5) MARKETING.A PILOT SITE, BETHLEHEM CHURCH, WEST CAMPUS, HAS BEEN IDENTIFIED. REPRESENTATIVES OF THE PILOT SITE AND THE RESOURCES TEAMS HAVE BEGUN COLLABORATING ON HEALTH INITIATIVES FOR THIS PILOT SITE. HOLY WELL, AN 8 WEEK HEALTHY BEHAVIORS INITIATIVE WITH A SPIRITUAL ASPECT HAS BEEN PROVIDED TO THIS POPULATION TWICE, WITH SUCCESS. THIS INITIATIVE WILL BE PROVIDED AGAIN IN FY'15. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7: THE NEEDS IDENTIFIED AND NOT ADDRESSED IN THIS WORK ARE: A) PREVENT ALCOHOL AND SUBSTANCE ABUSE; B) REDUCING TEEN PREGNANCY. PARTNERS HEALTH CARE IS A LOCAL PUBLIC AUTHORITY THAT MANAGES MENTAL HEALTH IN GASTON COUNTY AND GASTON COUNTY WORKS WITH THE ADOLOSCENT PREGNANCY PREVENTION CAMPAIGN OF NC. THESE NEEDS ARE BEING ADDRESSED BY THOSE GROUPS. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 14G: BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBALLY OR IN WRITING TO SCHEDULED PATIENTS PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16E: COLLECTION ACTIONS ARE TAKEN AFTER REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE PATIENT'S ELIGIBILITY FOR ASSISTANCE. PART I, LINE 3C: REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY:EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO (1) ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION. PART I, LINE 7: THE COSTING METHODOLOGY USED IS A COST ACCOUNTING SYSTEM. ALL PATIENT SEGMENTS ARE INCLUDED. THIS SYSTEM ASSIGNS DIRECT COSTS TO SUPPLIES, PROCEDURES, ROUTINE AND SPECIALTY ROOM RATES BASED ON THE DEPARTMENT OF ORIGINATION. FIXED COSTS ARE ALLOCATED BASED ON STATISTICAL BASIS. THESE COSTS ARE THEN AGGREGATED AT THE PATIENT LEVEL AND TABULATED BY PAYOR TYPE. NO COST TO CHARGE RATIOS WERE USED IN THE CALCULATIONS. PART I, LN 7 COL(F): 43,014,968 BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES PRIOR TO CALCULATING PERCENT OF TOTAL EXPENSE. PART I, LINE 6A: COMMUNITY BENEFIT REPORT: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT MADE AVAILABLE TO THE PUBLIC CONTAINS COMMUNITY BENEFITS FOR ALL RELATED ORGANIZATIONS TO THE HOSPITAL. PART I, LINE 7H: RESEARCH ACTIVITIES: CAROMONT HEALTH IS INVOLVED IN APPROXIMATELY 75 RESEARCH STUDIES, APPROXIMATELY FORTY PERCENT OF WHICH ARE CLINICAL TRIALS COOPERATIVE GROUP PROGRAM STUDIES SPONSORED BY THE NATIONAL CANCER INSTITUTE (NCI). CAROMONT HEALTH ALSO PARTICIPATES IN DRUG AND DEVICE STUDIES SPONSORED BY VARIOUS PHARMACEUTICAL, BIOTECHNOLOGY, AND DEVICE COMPANIES, AS WELL AS UNFUNDED NURSING AND PHARMACY RESEARCH STUDIES. PART II, COMMUNITY BUILDING ACTIVITIES: WORKFORCE DEVELOPMENT - CAROMONT HEALTH'S RECRUITMENT OF PHYSICIANS INTO THE FIVE COUNTIES THE SYSTEM SERVES IS DRIVEN BY THE CHANGING LANDSCAPE OF HEALTHCARE REFORM. THE SYSTEM RECRUITS BASED ON A MEDICAL STAFF DEVELOPMENT PLAN THAT IDENTIFIES COMMUNITY HEALTH CARE NEEDS FOR THE NEXT FIVE YEARS. THE SYSTEM'S GOAL IS TO BE PRO-ACTIVE AND ANTICIPATORY SO THAT THE HEALTHCARE NEEDS OF THE COMMUNITY ARE MET IN A QUALITY DRIVEN AND CONVENIENT MANNER. PART III, LINE 4: LINE 2: TOTAL CHARGES AND THE CHARGES WRITTEN OFF TO BAD DEBT WERE TABULATED AT THE PATIENT LEVEL AND ARE REPORTED AT THE AMOUNT CHARGED TO PATIENTS. ACCOUNTS ARE RESERVED AS BAD DEBT BASED ON AN ACCOUNTS RECEIVABLE AGING METHODOLOGY. WHEN ACCOUNTS ARE SENT TO A COLLECTION AGENCY, THEY ARE WRITTEN OFF THE ACCOUNTS RECEIVABLE SYSTEM. ANY SUBSEQUENT COLLECTIONS ON THE ACCOUNTS ARE POSTED AS RECOVERIES AND REDUCE THE EXPENSE. ALL UNINSURED PATIENTS RECEIVE A DISCOUNT ON THEIR BILL, WHICH IS RECORDED AS A CONTRACTUAL ADJUSTMENT. THE AMOUNT OF THE UNINSURED DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE. LINE 3: CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPARTMENT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING AND/OR APPLICATIONS FILED BY THE PATIENTS. IF NO MEANS TESTING IS DONE AND NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPARTMENT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY.LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. BAD DEBT EXPENSE IS REPORTED AS A DEDUCTION FROM PATIENT REVENUE. PART III, LINE 8: THE MEDICARE COST REPORT STANDARD COSTING METHODOLOGY WAS FOLLOWED WHEN FILING THE COST REPORT. THIS IS A STEP DOWN METHODOLOGY THAT APPLIES THE AVERAGE PATIENT COST TO MEDICARE PATIENTS. THE COST REPORT ALSO DOES NOT ALLOW HOSPITALS TO REPORT ALL OPERATING COSTS. BECAUSE OF THESE TWO ISSUES, THE MEDICARE COST REPORT METHODOLOGY UNDERSTATES THE TRUE COST OF TREATING MEDICARE PATIENTS. USING TOTAL COSTS FROM MEDICARE PATIENTS, THE HOSPITAL HAD AN ACTUAL MEDICARE SHORTFALL OF $13.4 MILLION. PART III, LINE 9B: THE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BELOW IS VERBIAGE FROM THE CHARITY POLICY:CAROMONT REGIONAL MEDICAL CENTER OFFERS MEDICAL SERVICES FREE OR AT A REDUCED RATE THROUGH THE CHARITY CARE PROGRAM. DETERMINATION OF FULL OR PARTIAL CHARITY CARE WILL BE BASED ON THE PATIENT'S INCOME, FAMILY SIZE, AND ASSETS. POTENTIAL ELIGIBILITY EXISTS ONLY AFTER REIMBURSEMENT EFFORTS FROM ALL OTHER THIRD PARTY RESOURCES, FEDERAL, STATE, AND LOCAL ASSISTANCE PROGRAMS HAVE BEEN EXHAUSTED. PART VI, LINE 2: CAROMONT HEALTH ESTABLISHES COMMUNITY PRIORITIES THROUGH A NUMBER OF MECHANISMS:- LEADERSHIP OPINIONS ARE SOUGHT TO HELP IDENTIFY NEEDED SERVICES IN THE COMMUNITY VIA PARTNERSHIPS WITH THE GASTON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, LOCAL NON-PROFIT ORGANIZATIONS FOCUSED ON HEALTH IMPROVEMENT IN OUR COMMUNITIES AND OTHER HEALTH-FOCUSED ENTITIES. CAROMONT HEALTH ALSO WORKS WITH COMMUNITY AGENCIES TO CONDUCT COMMUNITY NEEDS ASSESSMENTS AND QUALITY OF LIFE SURVEYS EVERY TWO TO THREE YEARS. - PATIENT SATISFACTION DATA IS ANALYZED TO DETERMINE WHERE AND/OR HOW SERVICES NEED TO BE IMPROVED.- SERVICE AREA DATA (VITAL STATISTICS, DEMOGRAPHICS AND UTILIZATION) ARE ANALYZED FOR TRENDS. THIS INFORMATION IS COORDINATED WITH PUBLIC HEALTH DATA TO DETERMINE VOIDS AND SERVICE AREA HEALTH PROBLEMS.- FINDINGS FROM COMMUNITY SURVEYS/REPORTS PUBLISHED BY OTHER ORGANIZATIONS (UNITED WAY, CHAMBER OF COMMERCE, PARTNERSHIP FOR CHILDREN, GASTON COUNTY, ETC.) ARE GATHERED AND REVIEWED FOR PERTINENCE TO COMMUNITY HEALTH PROBLEMS.- CAROMONT REGIONAL MEDICAL CENTER THROUGH THE GASTON COMMUNITY HEALTHCARE COMMISSION IN CONJUNCTION WITH THE GASTON COUNTY HEALTH DEPARTMENT CONDUCTS A COMMUNITY ASSESSMENT EVERY THREE YEARS. THE MOST RECENT STUDY CONCLUDED IN THE FALL OF 2012 AND WAS PUBLISHED IN JANUARY 2013. THIS ASSESSMENT GATHERS OPINIONS AND IS COMBINED WITH PUBLIC HEALTH DATA TO DETERMINE THE TOP FOUR COMMUNITY-WIDE HEALTH ISSUES. SERVICE AREA STRENGTHS, WEAKNESSES AND OPPORTUNITIES ARE USED AS A BASIS FOR ESTABLISHING COMMUNITY PRIORITIES. ALL THIS INFORMATION IS USED TO ESTABLISH ORGANIZATIONAL PRIORITIES, IDENTIFY AGENCIES AND ORGANIZATIONS TO BE INVOLVED IN RESOLVING COMMUNITY ISSUES, AND IMPLEMENT PROGRAMS TO RESOLVE IDENTIFIED ISSUES. GOALS, OBJECTIVES AND STRATEGIES ARE ESTABLISHED AND THE PROGRESS IS EVALUATED ON AN ANNUAL BASIS.- BOARD MEMBERS, SENIOR MANAGEMENT AND DEPARTMENT DIRECTORS ARE INVOLVED IN NUMEROUS ORGANIZATIONS. THROUGH THIS NETWORK OF RELATIONSHIPS, FURTHER INFORMATION ABOUT THE COMMUNITY AND THE NEEDS OF AREA RESIDENTS AND ORGANIZATIONS ARE USED IN THE DEVELOPMENT OF PROGRAMS AND SERVICES AVAILABLE THOUGH CAROMONT HEALTH. PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES THE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE IN SEVERAL WAYS. A CHARITY AND FINANCIAL SUMMARY IS ON OUR WEBSITE, BROCHURES ARE DISTRIBUTED IN THE EMERGENCY ROOM AND ALL OTHER REGISTRATION SITES. SPECIFICALLY TRAINED STAFF (FINANCIAL COUNSELORS AND BENEFIT ELIGIBILITY SPECIALISTS) PROACTIVELY MAKE CONTACT WITH PATIENTS PRIOR TO, AT TIME OF SERVICE, AND/OR AFTER DISCHARGE TO DISCUSS ELIGIBILITY FOR MEDICAID AND OTHER INSURANCE BENEFITS AND OFFER ASSISTANCE WITH APPLICATIONS. THE COMMUNICATION IS ATTEMPTED AS SOON AS POSSIBLE. WRITTEN COMMUNICATION IS MADE PRIOR TO COLLECTION AGENCY PLACEMENT. PART VI, LINE 4: GASTON COUNTY, LOCATED IN THE PIEDMONT REGION OF NORTH CAROLINA, IS THE ORGANIZATION'S PRIMARY MARKET. LINCOLN, CLEVELAND AND YORK COUNTY, AS WELL AS THE NORTHWEST PORTION OF MECKLENBURG COUNTY, IS THE HOSPITAL'S SECONDARY MARKET. THERE ARE NO OTHER ACUTE CARE HOSPITALS IN THE PRIMARY SERVICE AREA. ACCORDING TO THE U.S. CENSUS BUREAU, GASTON COUNTY HAD AN ESTIMATED POPULATION OF 209,420 (2013), A MEDIAN HOUSEHOLD INCOME OF $43,220 (2008-2012), AND 17% PERSONS BELOW POVERTY LEVEL (2008-2012). THE ETHIC/RACIAL DEMOGRAPHICS STATE THAT 80.5% OF THE POPULATION IDENTIFY THEMSELVES AS WHITE, 15.8% AS BLACK OR AFRICAN AMERICAN, 6.2% AS HISPANIC AND 1.4% AS ASIAN. DURING THE YEAR, 7.5% OF THE HOSPITAL'S GROSS CHARGES WERE FROM UNINSURED PATIENTS AND 15.2% FROM MEDICAID PATIENTS. PART VI, LINE 5: ACCOUNTABLE CARE ORGANIZATIONTHE INSTITUTE FOR HEALTHCARE IMPROVEMENT HAS ESTABLISHED A TRIO OF OBJECTIVES CALLED THE TRIPLE AIM, WHICH CAROMONT HEALTH HAS ADOPTED:1 IMPROVE THE HEALTH OF THE POPULATION2 ENHANCE THE PATIENT EXPERIENCE (QUALITY, ACCESS, RELIABILITY)3 CONTROL COSTSTHESE THREE OBJECTIVES ARE ALL CRITICAL COMPONENTS IN BEING WHAT IS KNOWN IN THE INDUSTRY AS AN ACCOUNTABLE CARE ORGANIZATION (ACO). IN OUR STEPS TOWARD BECOMING AN ACO, CAROMONT HEALTH HAS EXECUTED CHANGES THAT HAVE LEAD, AND WILL CONTINUE TO LEAD, TO BETTER COORDINATED CARE WITH BETTER OUTCOMES AT LOWER COSTS FOR PATIENTS. WE ALSO EMBRACE THE "MEDICAL HOME" CONCEPT, WHICH IS A NATIONAL INITIATIVE DESIGNED TO IMPROVE HEALTH CARE QUALITY. MEDICAL HOMES ARE PATIENT CENTERED, TEAM-BASED APPROACHES TO CARE THAT HAVE BEEN SHOWN TO REDUCE HOSPITAL ADMISSIONS AND DECREASE COSTS.COMMUNITY HEALTHOUR COMMUNITY HEALTH INITIATIVES ARE FOCUSED PRIMARILY ON DISEASE PREVENTION AND BETTER MANAGEMENT OF CHRONIC ILLNESSES. THAT INCLUDES WORKING WITH LOCAL EMPLOYERS ON INNOVATIVE PROGRAMS AND COLLABORATING WITH OUR HEALTH CARE NEIGHBORS, AS WELL AS WORKING TO MANAGE THIS ILLNESS WITH THE OUR OWN WORKFORCE. THROUGH INNOVATION AND A FOCUS ON COMMUNITY WELLNESS, CAROMONT HEALTH IS DETERMINED TO MAKE POSITIVE IMPACT ON HEALTH AND WELLNESS OF THE POPULATIONS WE SERVE. PATIENT CENTERED MEDICAL HOMETHE PATIENT-CENTERED MEDICAL HOME IS A HEALTH CARE SETTING THAT FACILITATES PARTNERSHIPS BETWEEN PATIENTS AND THEIR PERSONAL PHYSICIANS. THE PROGRAM PROVIDES MEDICAL PRACTICES WITH INFORMATION ABOUT ORGANIZING PATIENT-CENTERED CARE, WORKING IN TEAMS, AND COORDINATING AND TRACKING DURING THE CONTINUUM OF CARE. CURRENTLY, ALL PRIMARY CARE PRACTICES IN OUR SYSTEM ARE RECOGNIZED AS LEVEL 3 PATIENT-CENTERED MEDICAL HOMES BY THE NATIONAL COMMITTEE OF QUALITY ASSURANCE (NCQA) - THE HIGHEST RECOGNITION A CLINIC CAN OBTAIN.HEALTHNET GASTONHEALTHNET GASTON (HNG) IS A PROGRAM DESIGNED TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO LOW-INCOME, UNINSURED RESIDENTS OF GASTON COUNTY. ITS SERVICES INCLUDE: A MEDICAL HOME/PRIMARY CARE PHYSICIAN SERVICES, SPECIALTY PHYSICIAN SERVICES, MEDICATION ASSISTANCE, CASE MANAGEMENT/HEALTH COACHING ACTIVITIES, AND HOSPITAL SERVICES. HNG OPERATES THROUGH THE LEADERSHIP AND COLLABORATION OF ITS FOUR FOUNDING STRATEGIC PARTNERS, INCLUDING: CAROMONT REGIONAL MEDICAL CENTER, GASTON FAMILY HEALTH SERVICES, COMMUNITY HEALTH PARTNERS, GASTON COMMUNITY HEALTH COMMISSION. OTHER STRATEGIC PARTNERS INVOLVED WITH THIS INITIATIVE INCLUDE COMMUNITY PHYSICIANS, GASTON COUNTY DEPARTMENT OF SOCIAL SERVICES, GASTON COUNTY HEALTH DEPARTMENT, AND OTHER LOCAL LEADERS. COMMUNITY HEALTH IMPROVEMENT ADVOCACYCAROMONT HEALTH HAS SIGNIFICANTLY IMPACTED ITS COMMUNITY IN PROVIDING MANY DIFFERENT HEALTH IMPROVEMENT PROJECTS, GROUPS, EVENTS, EDUCATION PROGRAMS AND SPONSORSHIPS. IN FISCAL YEAR 2014, CAROMONT HEALTH INVESTED OVER $8 MILLION IN THE COMMUNITY THROUGH HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, COMMUNITY BENEFIT OPERATIONS, DONATIONS, AND IN-KIND DONATIONS OF GOOD AND SERVICES. OTHER EFFORTS TO PROMOTE HEALTH IN THE COMMUNITY ARE FACILIATED BY HAVING A MAJORITY OF THE ORAGANIZATION'S GOVERNING BOARD COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR MOST OR ALL DEPARTMENTS. THE ORGANIZATION APPLIES ITS SURPLUS OF FUNDS TO FURTHER ITS MISSION OF "PROVIDING EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE". THIS IS ACCOMPLISHED BY INVESTING IN NEW SERVICES, CAPITAL EQUIPMENT, INFORMATION TECHNOLOGY, RENOVATION OF THE PHYSICAL PLANT, PHYSICIAN ACQUISITIONS, ETC. PART VI, LINE 6: CAROMONT HEALTH IN GASTONIA, NORTH CAROLINA IS A REGIONAL, INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE SYSTEM. IT ENCOMPASSES GASTON MEMORIAL HOSPITAL (D.B.A. CAROMONT REGIONAL MEDICAL CENTER "CRMC") WITH 435-BEDS; COURTLAND TERRACE, A 96-BED SKILLED NURSING FACILITY; GASTON HOSPICE WHICH INCLUDES THE 12-BED ROBIN JOHNSON HOUSE INPATIENT FACILITY, AND CAROMONT MEDICAL GROUP, A NETWORK OF 45 PRIMARY AND SPECIALTY PHYSICIAN OFFICES. CAROMONT HEALTH'S VISION IS TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED PARTNER IN PROMOTING INDIVIDUAL HEALTH AND VIBRANT COMMUNITIES.CAROMONT HEALTH HAS 3 OFF-SITE IMAGING LOCATIONS, 2 SAME-DAY SURGERY CENTERS, 1 FREE-STANDING ENDOSCOPY CENTER, AND 1 OCCUPATIONAL MEDICINE CLINIC. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 GASTON FAMILY HEALTH SERVICES 991 WEST HUDSON BOULEVARD GASTONIA NC 28052 581958398 501(C)(3) 300000 FEDERALLY QUALIFIED HEALTHCARE CENTER OFFERING MEDICAL CARE TO LOW INCOME RESIDENTS MOUNT HOLLY COMMUNITY DEVELOPMENT FOUNDATION 1068 SOUTH MAIN STREET MOUNT HOLLY NC 28120 200738339 501(C)(3) 100000 COMMUNITY ASSISTANCE GASTON REGIONAL CHAMBER 601 W FRANKLIN BLVD GASTONIA NC 28053 560232990 501(C)(6) 97950 COMMUNITY ASSISTANCE GASTON TOGETHER PO BOX 817 GASTONIA NC 28053 562048064 501(C)(3) 75000 COMMUNITY ASSISTANCE GASTON COUNTY SCHOOLS 1351 BRADFORD HEIGHTS GASTONIA NC 28053 566001032 N/A 62241 COMMUNITY ASSISTANCE TOWN OF CRAMERTON 155 N MAIN ST CRAMERTON NC 28032 560891982 N/A 55000 COMMUNITY ASSISTANCE GASTON COLLEGE FOUNDATION 201 HIGHWAY 321 SOUTH DALLAS NC 28034 237079454 501(C)(3) 50000 COMMUNITY ASSISTANCE COMMUNITY FOUNDATION 1201 E GARRISON BLVD GASTONIA NC 28052 581340834 501(C)(3) 30000 COMMUNITY ASSISTANCE MONTCROSS AREA CHAMBER OF COMMERCE PO BOX 368 BELMONT NC 28012 560710166 501(C)(6) 20900 COMMUNITY ASSISTANCE GASTONIA GRIZZLIES PO BOX 177 GASTONIA NC 28053 421554288 N/A 20750 COMMUNITY ASSISTANCE HEART SOCIETY OF GASTON COUNTY 1201 EAST GARRISON BLVD GASTONIA NC 28052 561330921 501(C)(3) 19800 COMMUNITY ASSISTANCE HOLY ANGELS FOUNDATION 660 WILKINSON BLVD BELMONT NC 28012 561762654 501(C)(3) 15000 COMMUNITY ASSISTANCE MCADENVILLE FOUNDATION PO BOX 1939 MCADENVILLE NC 28101 560623961 501(C)(3) 15000 COMMUNITY ASSISTANCE NORTH CAROLINA MEDICAL SOCIETY ALLIANCE 3131 CHANNEL VIEW LANDING BELMONT NC 28012 561493811 501(C)(3) 13566 COMMUNITY ASSISTANCE AS ONE MINISTRIES 805 WEST AIRLINE AVENUE GASTONIA NC 28054 562180931 501(C)(3) 10000 COMMUNITY ASSISTANCE AUTEN-STOWE POST NO 144 AMERICAN LEGION 202 PARK DRIVE BELMONT NC 28012 566088269 501(C)(19) 10000 COMMUNITY ASSISTANCE BOYS & GIRLS CLUBS OF GREATER GASTON PO BOX 23 GASTONIA NC 28053 561419498 501(C)(3) 6000 COMMUNITY ASSISTANCE DALLAS HISTORIC COURTHOUSE FOUNDATION 306 W MAIN STREET DALLAS NC 28034 455094816 501(C)(3) 6000 COMMUNITY ASSISTANCE TWENTY SEVEN FOREVER FOUNDATION 2030 LINDA STREET GASTONIA NC 28054 461843123 N/A 5000 COMMUNITY ASSISTANCE BELMONT ABBEY COLLEGE PARTNERSHIP 100 BELMONT-MT HOLLY ROAD BELMONT NC 28012 560547498 501(C)(3) 5000 COMMUNITY ASSISTANCE CANCER SERVICES OF GASTON COUNTY 306 SOUTH COLUMBIA ST GASTONIA NC 28054 561164253 501(C)(3) 5000 COMMUNITY ASSISTANCE CHARLOTTE REGIONAL PARTNERSHIP 550 S CALDWELL STREET SUITE 760 CHARLOTTE NC 28202 581457132 501(C)(3) 5000 COMMUNITY ASSISTANCE GASTON COUNTY MEDICAL SOCIETY ALLIANCE 3729 EAGLEBROOK DRIVE GASTONIA NC 28056 561493811 501(C)(3) 5000 COMMUNITY ASSISTANCE THE GREAT 100 NC PO BOX 4875 GREENSBORO NC 27404 561705456 501(C)(3) 5000 COMMUNITY ASSISTANCE 9 15 GERTRUDE CLINTON HEALTH CAREERS SCHOLARSHIPS 27 40000 ONCOLOGY PHARMACY ASSISTANCE 10 553 PART I, LINE 2: OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED. SCHEDULE I, PART III THE PURPOSE OF THE GERTRUDE CLINTON HEALTH CAREERS SCHOLARSHIP IS TO ENCOURAGE MEDICAL AND HEALTH-RELATED PROFESSIONALS IN THE FIELD OF HUMAN SERVICES TO PRACTICE THEIR SPECIALTIES AT CAROMONT REGIONAL MEDICAL CENTER OR IN GASTON COUNTY. X X X X X 1 1 0 0 0 1 1 0 0 DR GE WARD ADCOCK III CHIEF-OF-STAFF 0 191263 20000 74027 0 6890 0 11491 0 15312 20000 298983 0 0 DOUG LUCKETT CEO/PRESIDENT 590205 0 121154 0 780 0 113546 0 16372 0 842057 0 0 0 DAVID O'CONNOR EVP/CFO/ASST. TREASURER 362570 0 111268 0 1164 0 82348 0 16162 0 573512 0 0 0 MARIA LONG EVP CHIEF LEGAL OFFICER/ASST. SECRET 294902 0 85720 0 894 0 70934 0 1998 0 454448 0 0 0 KATHLEEN K BESSON EVP/COO 258881 0 69784 0 671 0 59308 0 15566 0 404210 0 0 0 TODD DAVIS MD VP MEDICAL AFFAIRS 290216 0 89341 0 540 0 55236 0 15796 0 451129 0 0 0 MICHAEL R JOHNSON VP CIO 250804 0 78198 0 1898 0 56242 0 14984 0 402126 0 0 0 W K HARWELL VP PATIENT CARE 172745 0 74892 0 57602 0 29307 0 4797 0 339343 0 53114 0 ELIZABETH MCCRAW VP HUMAN RESOURCES 202734 0 62876 0 337 0 45045 0 15370 0 326362 0 0 0 ANDREA K SERRA VP WELLNESS DEVELOPMENT 203407 0 59737 0 904 0 43793 0 7992 0 315833 0 0 0 RANDALL L KELLEY FORMER OFFICER 347736 0 0 0 342327 0 43999 0 4063 0 738125 0 0 0 JERRY LEVINE FORMER KEY EMPLOYEE 243881 0 83569 0 269766 0 29274 0 6339 0 632829 0 0 0 PENNY P COWDEN FORMER HIGHLY COMPENSATED 95316 0 0 0 127191 0 8791 0 4423 0 235721 0 0 0 CRAIG A DUNKER FORMER HIGHLY COMPENSATED 56106 0 0 0 131939 0 1122 0 1246 0 190413 0 0 0 STEVEN A RUBIN FORMER HIGHLY COMPENSATED 0 0 0 0 109009 0 0 0 175 0 109184 0 0 0 PART I, LINE 3 THE CEO, CFO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY GASTON MEMORIAL HOSPITAL, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND FREE OF ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION LEAVES THE MEETING AND DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE DIRECTORS AND MANAGEMENT, UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. PART I, LINES 4A-B DURING THE YEAR THE ORGANIZATION PAID SEVERANCE PAYMENTS TO THE FORMER OFFICER AND KEY EMPLOYEES IDENTIFIED BELOW: RANDALL L. KELLEY, FORMER OFFICER $331,138 STEVEN A. RUBIN, FORMER KEY EMPLOYEE $109,009 CRAIG A. DUNKER, FORMER KEY EMPLOYEE $131,456 PENNY P. COWDEN, FORMER KEY EMPLOYEE $127,003 JERRY LEVINE, FORMER KEY EMPLOYEE $257,519 THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM THE FILING ORGANIZATION FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 69,504 MARIA LONG - 55,601 DOUG LUCKETT - 107,551 JERRY LEVINE - 20,569 RANDALL L. KELLEY - 37,456 W.K. HARWELL - 19,277 ANDREA K. SERRA - 29,459 KATHLEEN K. BESSON - 43,360 ELIZABETH MCCRAW - 31,007 TODD DAVIS, MD - 44,061 MICHAEL R. JOHNSON - 38,563 PENNY P. COWDEN - 7,313 THE FOLLOWING HIGHLY COMPENSATED EMPLOYEE RECEIVED A PAYOUT FROM A DEFERRED COMPENSATION PLAN BY THE FILING ORGANIZATION THAT IS TAXABLE IN THE CURRENT PERIOD: W.K. HARWELL - $53,114 THE PAYOUT LISTED ABOVE IS COMPRISED OF DEFERRED COMPENSATION REPORTED ON A PRIOR FORM 990. PART I, LINE 6 EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES AND FINANCIAL PERFORMANCE OF THE CONSOLIDATED SYSTEM. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HVF7 2003-01-23 120000000 SEE PART VI 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HG64 2008-01-31 118400000 SEE PART VI 0 0 0 A 1000000 123594002 5150936 1256069 3386000 91583288 22217709 2005 0 1 1 1 B 37420000 118649818 610174 917471 1553718 28952424 86616031 2009 1 0 1 1 A 0 0 1 1 1 1 0.00170 0.00000 0.00170 0 1 0.00110 0 1 B 0 0 1 1 1 1 0.00000 0.00010 0.00010 0 1 0.00000 0 1 A 0 0 0 1 1 1 MERRILL LYNCH CAPITAL SERVICES 31.600000000000 1 0 0 0 1 B 0 0 1 1 0 1 MERRILL LYNCH DERIVATIVE PRODUCTS 21.000000000000 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 03/18/2013 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 02/25/2013 SCHEDULE K SUPPLENTAL INFORMATION THREE 501(C)(3) ORGANIZATIONS WITHIN THE PARENT-SUBSIDIARY CONTROLLED GROUP BENEFIT FROM THE BONDS AS FOLLOWS: GASTON MEMORIAL HOSPITAL, INC. (56-0619359) CAROMONT HEALTH, INC. (58-1636959) CAROMONT HEALTH SERVICES, INC. (56-1455630) GASTON MEMORIAL HOSPITAL, INC. HOLDS THE LIABILITY FOR THE BONDS, PER AUDITED FINANCIAL STATEMENTS. SCHEDULE K, PART I, LINE A, COLUMN (C): THIS BOND ISSUE INCLUDES TWO CUSIPS MATURING ON THE SAME DATE: 65820HVG5 AND 65820HVF7. SCHEDULE K, PART I, COLUMN (F); DESCRIPTION OF PURPOSE: ISSUE A - THE SYSTEM USED THE PROCEEDS FROM THESE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO A NEW WOMEN'S CENTER AND PARKING DECK, RENOVATIONS TO EXISTING FACILITIES, AND EQUIPMENT. IN ADDITION, PROCEEDS WERE USED TO REFUND IN ADVANCE OF THEIR MATURITIES $17,000,000 IN PRINCIPAL AMOUNT OF THE SERIES 1998 HOSPITAL REVENUE BONDS, ISSUED ON AUGUST 27, 1998. ISSUE B - THE SYSTEM USED THE PROCEEDS FROM THE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO, THE RENOVATION OF CERTAIN FLOORS OF THE PATIENT TOWER, RENOVATION OF THE DAY OF SURGERY UNIT, INSTALLATION OF FIRE SPRINKLERS IN NON-SPRINKLED AREAS, AND THE UPGRADE OF LIFE SAFETY AND CRITICAL POWER. IN ADDITION, THE HOSPITAL USED THE PROCEEDS TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1995 REVENUE BONDS, ISSUED ON NOVEMBER 15, 1995, IN THE AMOUNT OF $41,210,000 AND TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1998 REVENUE BONDS, ISSUED ON AUGUST 27, 1998, IN THE AMOUNT OF $49,710,000. SCHEDULE K, PART II, LINE 3 COLUMN (A): LINE 3 COLUMN (A) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 3,594,002. SCHEDULE K, PART II, LINE 3 COLUMN (B): LINE 3 COLUMN (B) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 249,818. SCHEDULE K, PART II, LINE 11; OTHER SPENT PROCEEDS: OTHER SPENT PROCEEDS INCLUDE DEPOSITS MADE INTO A REFUNDING ESCROW ACCOUNT ALONG WITH INTEREST EARNED ON THE ACCOUNT, BOTH OF WHICH WERE SUBSEQUENTLY USED TO PAY PRINCIPLE AND INTEREST ON THE REFUNDED BONDS. SEE THE RESPONSE FOR PART I, COLUMN (F) FOR DETAILS. SCHEDULE K, PART IV, LINES 3 AND 4A, COLUMN (B): THE SERIES 2008 BONDS WERE ORIGINALLY ISSUED AS VARIABLE BONDS BEARING INTEREST AT WEEKLY RATES. CAROMONT HEALTH, INC. ENTERED INTO INTEREST SWAP AGREEMENTS TO HEDGE ITS INTEREST RISK WITH RESPECT TO A PORTION OF THE SERIES 2008 BONDS. ON SEPTEMBER 1, 2010, THE SERIES 2008 BONDS WERE CONVERTED TO FIXED INTEREST RATES TO MATURITY. HOWEVER, THE INTEREST RATE SWAPS WERE NOT TERMINATED IN CONNECTION WITH SUCH FIXED RATE CONVERSION AND REMAIN IN EFFECT. SCHEDULE K, PART IV, LINE 4C, COLUMN (B): THIS BOND ISSUE HAS TWO HEDGE TERMS: 11.0 YEARS AND 21.0 YEARS. GASTON REGIONAL CHAMBER OF COMMERCE A KEY EMPLOYEE OF THE ORGANIZATION IS A BOARD MEMBER OF THE CHAMBER 112890 VARIOUS PAYMENTS FOR MEMBERSHIP DUES, SPONSORSHIPS, AND EVENTS 0 FORM 990, PART III, LINE 4A STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: CAROMONT HEALTH IS A NOT-FOR-PROFIT HEALTH SYSTEM HEADQUARTERED IN GASTONIA, NC THAT PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES WITHIN FIVE COUNTIES AND TWO STATES. CAROMONT HEALTH EMPLOYS NEARLY 4,000 HEALTHCARE PROFESSIONALS WITH A MEDICAL STAFF MEMBERSHIP OF MORE THAN 450. CAROMONT REGIONAL MEDICAL CENTER, A MAGNET DESIGNATED 435-BED ACUTE CARE HOSPITAL, IS THE ANCHOR OF CAROMONT HEALTH AND FEATURES A STATE-OF-THE-ART CANCER CENTER, BIRTHPLACE AND NEONATAL INTENSIVE CARE UNIT, AS WELL AS A LEVEL III TRAUMA CENTER AND A COMPREHENSIVE SYSTEM OF CARE. AS AN INNOVATIVE LEADER IN HEALTH CARE, CAROMONT HEALTH HAS BEEN AWARDED MANY TOP HONORS IN 2014. SOME KEY ACHIEVEMENTS IN 2014 INCLUDE BEING NAMED A 100 TOP HOSPITAL BY BECKER'S HOSPITAL REVIEW AND A BEST REGIONAL HOSPITAL BY THE U. S. NEWS & WORLD REPORT. ADDITIONALLY, CAROMONT HEALTH WAS RECOGNIZED BY PREVENTION PARTNERS FOR OUR COMMITMENT TO PROVIDING COMPREHENSIVE WELLNESS PROGRAMS TO OUR EMPLOYEES, EARNING US THE HEALTHCARE IN EXCELLENCE AWARD. CAROMONT HEALTH'S MISSION IS TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE, AND WE STRIVE TO FULFILL THAT MISSION EVERY DAY. THIS REPORT IS INTENDED TO SHARE SOME OF THE MANY WAYS THAT CAROMONT HEALTH GIVES BACK TO OUR COMMUNITY. INTERNAL PROGRAMS AND COMMUNITY CARE CAROMONT HEALTH HAS PROVIDED HEALTH CARE TO RESIDENTS OF GASTONIA, GASTON COUNTY AND SURROUNDING COUNTIES FOR MORE THAN 70 YEARS. WHETHER IT IS THE LATEST TECHNOLOGY, CARE MODEL OR WELLNESS INITIATIVE, CAROMONT HEALTH IS CONSTANTLY LOOKING FOR WAYS TO IMPROVE AND PROVIDE OUR COMMUNITY THE BEST CARE POSSIBLE TO KEEP THEM HEALTHY FOR GENERATIONS TO COME. RESEARCH PROGRAMS CAROMONT HEALTH PARTICIPATED IN A NUMBER OF NATIONAL RESEARCH TRIALS AND PROGRAMS IN 2014. CAROMONT INVESTED $1.5 MILLION, $809,000 OF WHICH WAS UNREIMBURSED, IN THESE PROGRAMS FOR TREATMENTS, PROCEDURES, MEDICATIONS AND STAFF TIME. RESEARCH PROGRAMS ARE THE KEY TO INNOVATION AND ADVANCEMENT IN HEALTH CARE AND CAROMONT HEALTH IS DEDICATED TO SUPPORTING OUR MEDICAL PROFESSIONALS IN THE PURSUIT OF NEW TREATMENTS. PHYSICIAN RECRUITMENT & RETENTION CAROMONT BOASTS A ROBUST AND TALENTED MEDICAL STAFF OF MORE THAN 450 PHYSICIANS. MANY CAROMONT HEALTH PHYSICIANS, FROM A NUMBER OF DISCIPLINES, ARE RECOGNIZED REGIONALLY AND NATIONALLY FOR THEIR WORK AND ACHIEVEMENTS. CAROMONT HEALTH CONSISTENTLY SEEKS TO RECRUIT LEADERS IN THE FIELD OF MEDICINE AND INVESTS IN THE MEDICAL STAFF IN A NUMBER OF WAYS, INCLUDING ATTENDANCE AT INDUSTRY CONFERENCES AND OFFERING CONTINUING EDUCATION OPPORTUNITIES. IN 2014, CAROMONT INVESTED $804,374 TO RECRUIT, TRAIN AND RETAIN HIGHLY-SKILLED PHYSICIANS TO PROVIDE NATIONALLY-RECOGNIZED, HIGH-QUALITY CARE. UNREIMBURSED COSTS OF CARE IN 2014, CAROMONT HEALTH HAD $67.8 MILLION IN UNREIMBURSED HEALTH CARE COSTS. THIS AMOUNT COVERS ALL FORMS OF UNREIMBURSED CARE, INCLUDING MORE THAN $11.7 MILLION IN CHARITY CARE, $37.6 MILLION IN MEDICARE AND MEDICAID LOSSES, AND $18.5 IN BAD DEBT. CAROMONT PROVIDES CARE TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. THE CHARITY CARE AND BAD DEBT TOTALS REFLECT THE AMOUNT THAT IS NOT REIMBURSED, EITHER BY THE INABILITY OR CHOICE NOT TO PAY. THE MEDICARE AND MEDICAID LOSSES REFLECT THE COST OF CARE PROVIDED THAT WAS NOT PAID FOR BY EITHER THE APPLICABLE GOVERNMENT PROGRAM OR THE PATIENT. COMMUNITY HEALTH IMPROVEMENT INITIATIVES & INVESTMENTS CAROMONT HEALTH IS ACTIVE IN OUR COMMUNITY IN A NUMBER OF WAYS INCLUDING DONATIONS, INVESTMENTS AND VOLUNTEERISM. IN THE LAST FISCAL YEAR, CAROMONT INVESTED MORE THAN $3 MILLION IN OUR COMMUNITY THROUGH HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, DONATIONS, AND IN-KIND CONTRIBUTIONS OF GOODS AND SERVICES. IN FISCAL YEAR 2014, CAROMONT PROVIDED $300,000 TO GASTON FAMILY HEALTH SERVICES, A LOCAL FEDERALLY QUALIFIED HEALTHCARE CLINIC THAT PROVIDES HEALTHCARE, HEALTH EDUCATION, AND PREVENTIVE CARE SERVICES TO PATIENTS WITHOUT REGARDS TO THEIR ABILITY TO PAY. STUDENT EDUCATION CAROMONT HEALTH ALSO INVESTS HEAVILY IN THE FUTURE OF HEALTH CARE BY INVESTING IN THE EDUCATION OF LOCAL HEALTH CARE STUDENTS. IN 2014, CAROMONT INVESTED $3.8 MILLION TO COVER THE COSTS OF STUDENT ROTATIONS AND EDUCATION. THIS INCLUDES THE USE OF EQUIPMENT, STAFF AND INSTRUCTOR TIME, AND PROGRAM DEVELOPMENT FOR HIGH SCHOOL AND COLLEGE CURRICULA. SPONSORSHIPS & PARTNERSHIPS CAROMONT HEALTH IS ALWAYS SEEKING ACTIVE PARTNERS IN OUR JOURNEY TOWARD ACHIEVING BETTER COMMUNITY HEALTH. ONE OF THE WAYS WE IDENTIFY THESE PARTNERS IS THROUGH THE SPONSORSHIP PROGRAM. IN 2014 WE WERE PROUD TO PARTNER WITH SEVERAL ORGANIZATIONS, INCLUDING: BOYS & GIRLS CLUB OF GREATER GASTON, COMMUNITY FOUNDATION OF GASTON COUNTY, HEART SOCIETY OF GASTON COUNTY, HOLY ANGELS AND OTHERS. IN ADDITION TO THESE SPONSORED EVENTS, OUR WELLNESS DEPARTMENT IS ACTIVE WITH SEVERAL COMMUNITY ORGANIZATIONS TO IMPROVE THE HEALTH OF THE COUNTY. THESE ACTIVITIES TAKE THE FORM OF HEALTH FAIRS, LUNCH AND LEARNS, FAITH AND HEALTH MINISTRY, PHYSICIAN PRESENTATIONS AND COMMUNITY WELLNESS CHALLENGES. PATIENT ADVOCACY - ENROLLMENT ASSISTANCE CAROMONT REGIONAL MEDICAL CENTER HAS DEVELOPED A PROGRAM TO ASSIST UNINSURED AND UNDER-INSURED COMMUNITY MEMBERS WITH ENROLLMENT IN PUBLIC PROGRAMS. SEVERAL EMPLOYEES ASSIST INDIVIDUALS WITH ENROLLMENT IN MEDICAID, MEDICARE, NC HEALTH CHOICE, CRIME VICTIMS PROGRAMS, FOOD STAMPS, VOCATIONAL REHAB, PUBLIC HOUSING, PRESCRIPTION PROGRAMS, MEALS ON WHEELS AND ADULT SERVICES THROUGH DSS. THE TOTAL COST TO CAROMONT HEALTH FOR THIS PROGRAM IS $381,120. EMPLOYEE INVOLVEMENT & SUPPORT CAROMONT HEALTH EMPLOYEES ARE ALSO AMBASSADORS FOR OUR MESSAGE OF WELLNESS AND GOODWILL. IN 2014, OUR EMPLOYEES WERE A DRIVING FORCE IN RAISING FUNDS AND DONATIONS FOR SEVERAL CAUSES, INCLUDING: 2014 CAROMONT HEART WALK ON MAY 1, MORE THAN FOUR HUNDRED WALKERS GATHERED ON THE FRONT LAWN OF CAROMONT REGIONAL MEDICAL CENTER FOR THE 11TH ANNUAL HEART WALK. THE ONE-MILE WALK RAISED MORE THAN $17,500 FOR THE HEART SOCIETY OF GASTON COUNTY. UNITED WAY PACESETTER CAMPAIGN THE PACESETTER CAMPAIGN OFFERS OUR EMPLOYEES THE OPPORTUNITY TO SUPPORT MORE THAN 23 LOCAL ORGANIZATIONS WITH THE EASE OF A SINGLE DONATION. LAST FISCAL YEAR, CAROMONT HEALTH EMPLOYEES CONTRIBUTED NEARLY $160,000 TO THE UNITED WAY. COMMUNITY GROUPS AND INITIATIVES CAROMONT HEALTH EMPLOYEES ALSO CONTRIBUTE TIME TO SUPPORT LOCAL ORGANIZATIONS, THROUGH BOARD APPOINTMENTS AND VOLUNTEER OPPORTUNITIES. SEVERAL MEMBERS OF OUR LEADERSHIP TEAM SERVE ON LOCAL BOARDS AND WORK CLOSELY WITH PARTNER GROUPS, SUCH AS GASTON TOGETHER AND HEALTHNET GASTON, TO BETTER THE HEALTH OF GASTON COUNTY. THESE TIES TO THE COMMUNITY HELP US PAINT A CLEARER PICTURE OF THE RESIDENTS NEEDS, ALLOWING US TO TAILOR OUR PROGRAMS AND SERVICES TO BEST MEET THOSE NEEDS. FORM 990, PART VI, SECTION A, LINE 1B: BOARD MEMBER INDEPENDENCE: IN CALENDAR YEAR 2014, THE BOARD OF DIRECTORS OF CAROMONT HEALTH CONDUCTED A COMPREHENSIVE REVIEW OF BEST PRACTICES REGARDING INDEPENDENCE OF BOARD MEMBERS. THIS REVIEW RESULTED IN THE DEVELOPMENT OF A BOARD POLICY ON INDEPENDENCE OF BOARD MEMBERS. USING IRS REGULATIONS AND GUIDANCE, INDUSTRY BEST PRACTICES, GUIDANCE AND COMMENTARY APPLICABLE TO NON-PROFIT HEALTHCARE INSTITUTIONS, AND ADVICE OF COUNSEL, THE BOARD OF DIRECTORS DEVELOPED AND IMPLEMENTED A ROBUST POLICY THAT DEFINES INDEPENDENT AND NON-INDEPENDENT DIRECTORS AND CLASSIFIES DIRECTORS ON AN ANNUAL BASIS AS INDEPENDENT AND NON-INDEPENDENT. USING THE IRS REPORTING REQUIREMENTS AS A MINIMUM SET OF CRITERIA FOR DETERMINING THE INDEPENDENT STATUS OF BOARD MEMBERS, THE BOARD'S POLICY GOES BEYOND THE MINIMUM CRITERIA AND DEFINES ADDITIONAL CRITERIA THAT RENDER A BOARD MEMBER NON-INDEPENDENT. ONCE DETERMINED TO HAVE A DISQUALIFYING CONDITION THAT RENDERS THE MEMBER NON-INDEPENDENT, A BOARD MEMBER WHOSE DISQUALIFYING CONDITION HAS BEEN REMEDIED MAY ONLY BE RESTORED TO INDEPENDENT STATUS FOLLOWING A SPECIFIED TIME LIMIT DEFINED IN THE POLICY. IN REPORTING THE NUMBER OF INDEPENDENT DIRECTORS IN PART I, LINE 4 AND PART VI, SECTION A, LINE 1B, THE BOARD OF DIRECTORS HAS DETERMINED THAT IT WILL REPORT THE NUMBER DETERMINED BY ITS POLICY, RECOGNIZING THAT THIS MAY BE A STRICTER INTERPRETATION THAN THE IRS REQUIRES. IN SEATING BOARD COMMITTEES, SUCH AS THE EXECUTIVE COMPENSATION COMMITTEE AND THE AUDIT FINANCE AND INVESTMENT COMMITTEE, THE BOARD DETERMINES A DIRECTOR'S ELIGIBILITY TO SERVE ON THOSE COMMITTEES BASED ON APPLICATION OF THE BOARD'S DEFINITION OF INDEPENDENCE. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS DR. CHARLES MEAKIN, III AND MR. JAMES R. BEAM HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION SHALL BE CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL CONSIST OF FOURTEEN (14) MEMBERS, ALL OF WHOM SHALL BE THE MEMBERS OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC., AND ALL OF WHOM SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF CAROMONT HEALTH. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH EMPLOYEE AND DIRECTOR SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE INDIVIDUAL'S OBLIGATION TO IMMEDIATELY MAKE THE CORPORATE RESPONSIBILITY OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID INDIVIDUAL'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. QUESTIONNAIRES SUBMITTED BY DIRECTORS ARE REVIEWED ANNUALLY BY THE NOMINATING COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, CFO, COO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY CAROMONT REGIONAL MEDICAL CENTER, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND FREE OF ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION LEAVES THE MEETING AND DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE MANAGEMENT UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFER TO AFFILIATE -27,784,946. CHANGE IN VALUE OF INTEREST RATE SWAP -1,674,321. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM LAST YEAR. FORM 990, PART V AND PART VII COMMON PAYMASTER: THE FILING ORGANIZATION USES A RELATED ORGANIZATION FOR ITS PAYROLL FUNCTION. ALL W-2S ARE FILED BY THE COMMON PAYMASTER. HOWEVER, AMOUNTS PAID BY THE COMMON PAYMASTER ARE TREATED AS IF PAID DIRECTLY BY THE ORGANIZATION FOR WHICH SERVICES ARE PERFORMED. CAROMONT HEALTH INC 2525 COURT DRIVE GASTONIA NC 28054 581636959 MEDICAL SERVICES NC 501(C)(3) LINE 11B, II N/A 0 CAROMONT HEALTH SERVICES INC 2526 COURT DRIVE GASTONIA NC 28054 561455630 OUTPATIENT SERVICES NC 501(C)(3) LINE 3 CAROMONT HEALTH INC 0 GASTON MEMORIAL HOSPITAL FOUNDATION INC 2527 COURT DRIVE GASTONIA NC 28054 561479699 FOUNDATION NC 501(C)(3) LINE 9 CAROMONT HEALTH INC 0 CAROMONT MEDICAL GROUP INC 2528 COURT DRIVE GASTONIA NC 28054 561479712 MEDICAL GROUP NC 501(C)(3) LINE 9 CAROMONT HEALTH INC 0 HOSPICE OF GASTON COUNTY INC 2529 COURT DRIVE GASTONIA NC 28054 581341530 HOSPICE CARE NC 501(C)(3) LINE 7 CAROMONT HEALTH INC 0 GASTON EMERGENCY PHYSICIANS INC 2531 COURT DRIVE GASTONIA NC 28054 562209423 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11A, I CAROMONT HEALTH INC 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1