2015-05-14T15:55:16-05:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 101 NORTH TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2013-07-01 560611546 CHATHAM HOSPITAL INC CHAT 9197994000 PO BOX 649 SILER CITY NC 27344 ROBERT ENDERS PRESIDENT 9197994000 2015-05-14 1 JOHN NORMAN P01506766 7049985200 2013 2016-02-25 16:41:14Z ROBERT ENDERS PO BOX 649 SILER CITY NC 27344 31119551 0 X WWW.CHATHAMHOSPITAL.ORG X 1939 NC PROVIDES SHORT-TERM MEDICAL CARE ON AN INPATIENT AND OUTPATIENT BASIS. 15 9 272 9 1123105 -127658 0 0 27795038 30661291 184396 158633 217180 299627 28196614 31119551 0 0 0 0 10817512 11373746 0 0 0 20028006 22571804 30845518 33945550 -2648904 -2825999 42721602 40409399 33296840 33966043 9424762 6443356 X TO PARTICIPATE IN AND PROMOTE THE PROVISION OF PATIENT CARE, FACILITATE THE EDUCATION OF PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, PROMOTE RESEARCH IN COLLABORATION WITH THE HEALTH SCIENCES SCHOOLS OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL, AND FACILITATE AND PROMOTE THE DELIVERY OF OTHER SERVICES DESIGNED TO PROMOTE THE HEALTH AND WELL-BEING OF THE CITIZENS OF NORTH CAROLINA. 0 0 25576139 29520175 CHATHAM HOSPITAL, INC. (THE "HOSPITAL") IS A PRIVATE, NOT-FOR-PROFIT HEALTH CARE ORGANIZATION LOCATED IN SILER CITY, NORTH CAROLINA. THE FACILITY IS A 25-BED CRITICAL ACCESS HOSPITAL. THE HOSPITAL HAS A 70-YEAR HISTORY OF PROVIDING QUALITY HEALTH SERVICES. THE HOSPITAL PROVIDES COMPREHENSIVE CARE, INCLUDING EMERGENCY, GENERAL SURGERY, INTENSIVE CARE, LAB, CT, MRI, NUCLEUR MEDICINE, PHARMACY, CARDIOPULMANARY, CARDIAC REHABILITATION, PHYSICAL THERAPY, AND DIABETES EDUCATION ON ITS CAMPUS. THE HOSPITAL REACHES BEYOND THE HOSPITAL SETTING TO PROVIDE DIABETES EDUCATION, PHYSICAL THERAPY, AND CARDIAC REHABILITATION IN TEMPORARY LEASED SPACE LOCATED IN SILER CITY NEAR THE MAIN HOSPITAL CAMPUS FOR A PORTION OF THE FISCAL YEAR. THE HOSPITAL CONTINUED ITS FOCUS ON QUALITY MEASURES FROM THE YEAR BEFORE WHICH RESULTED IN SIGNIFICANT IMPROVEMENTS. DURING 2012, CHATHAM HAD 1,695 ACUTE PATIENT DAYS AND AN AVERAGE LENGTH OF STAY OF 3.1 DAYS. THERE WERE 548 DISCHARGES AND 228 INPATIENT AND OUTPATIENT SURGERIES AS WELL AS 380 ENDOSCOPIC PROCEDURES. THERE WERE 14,565 EMERGENCY ROOM VISITS. 25576139 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 272 0 1 1 0 0 0 0 0 0 0 0 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X DAVID PAUGH 9197994000 PO BOX 649 SILER CITY NC 27344 MARY BECK DIRECTOR 2.00 58.00 X 0 312956 48532 LAURA CLAPP DIRECTOR 2.00 0.00 X 0 0 0 JAMES DAVIS MD DIRECTOR 2.00 0.00 X 0 0 0 ETTA FOUSHEE DIRECTOR 2.00 0.00 X 0 0 0 BARRY HAYES DIRECTOR 2.00 0.00 X 0 0 0 MEL HURSTON DIRECTOR 2.00 58.00 X 0 300333 47871 JOHN LEWIS DIRECTOR 2.00 58.00 X 0 529066 41605 TOD PETERSON DIRECTOR 2.00 0.00 X 0 0 0 WALTER PETTY DIRECTOR 2.00 0.00 X 0 0 0 PAUL POWELL DDS DIRECTOR 2.00 0.00 X 0 0 0 DONALD SPENCER MD DIRECTOR 2.00 58.00 X 0 369502 19959 DAVID STRONG DIRECTOR 2.00 58.00 X 0 1034493 275234 TIM WEINER MD DIRECTOR 2.00 0.00 X 0 0 0 BARRY WILKIE DIRECTOR 2.00 0.00 X 0 0 0 BOB ENDERS CEO 60.00 0.00 X X 0 211510 35188 TAMMY NEEDHAM CNO 60.00 0.00 X 0 132527 24576 DAVID PAUGH CFO 60.00 0.00 X 0 22143 4309 WILLIAM BOYD PHYSICIANS ASSISTANT 60.00 0.00 X 108476 0 10023 SHERLYNN POWELL DIRECTOR OF PHARMACY 60.00 0.00 X 130301 0 13484 LINDA ELLINGTON DIRECTOR OF COMPLIANCE 60.00 0.00 X 102638 0 2714 341415 2912530 523495 3 0 1 0 LABCORP 458 S MAIN ST BURLINGTON NC 27215 LABORATORY 836966 ALLIANCE HEALTH CARE 100 BAY VIEW CIRCLE NEWPORT BEACH CA 92660 MEDICAL EQUIPMENT 396896 ARAMARK CTS 10510 TWIN LAKES PARKWAY CHARLOTTE NC 28265 MEDICAL EQUIPMENT 186399 FIRST HEALTH OF THE CAROLINAS 155 MEMORIAL DRIVE PINEHURST NC 28374 MEDICAL EQUIPMENT 129273 RAO KOTHAPALLI MD PO BOX 767 SILER CITY NC 27344 PHYSICIAN 105567 5 PATIENT SERVICE REVENUE 621110 30463739 29340634 1123105 197552 197552 30661291 158633 158633 254577 0 254577 254577 254577 MISCELLANEOUS 624100 45050 45050 45050 31119551 29538186 1123105 458260 X 600431 600431 8608277 5850277 2758000 98030 62278 35752 1555818 899111 656707 511190 324758 186432 3375860 3375860 53186 53186 7389206 7198103 191103 9395 9395 2178707 1708155 470552 1839769 1839769 34826 13045 21781 18779 8567 10212 2427025 2427025 294055 294055 BAD DEBT EXPENSE 4792842 4792842 0 0 FOOD 158154 158154 0 0 33945550 25576139 8369411 0 2502 2802 5415437 4414921 2472670 4423868 266330 332040 141099 157323 41589227 16769510 27043705 24819717 5761357 6227050 1618502 31678 42721602 40409399 2924584 3290521 28353933 27529479 2018323 3146043 33296840 33966043 X 9424762 6443356 0 9424762 6443356 42721602 40409399 X -2825999 -155407 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 3031 3031 0 PART II-B, LINE 1: PART II- B, LINE 1, LOBBYING ACTIVITIES: THE AMOUNT ABOVE REPRESENTS A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 402081 402081 30454928 14999958 15454970 2488323 184051 2304272 8230250 1585501 6644749 13645 13645 24819717 INVESTMENTS 540683 F RESTRICTED ASSETS 5686367 F 6227050 26326709 -4792842 -4792842 31119551 0 31119551 29152708 0 29152708 4792842 4792842 33945550 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -4,792,842. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 4,792,842. 1 1 1 X 250.000000000000 0 1 1 1 0 1 1 1282469 1282469 0.04400 3644816 2901390 743426 0.02550 4927285 2901390 2025895 0.06950 2867 2867 0.00010 2867 2867 0.00010 4930152 2901390 2028762 0.06960 13256 13256 0.00050 13256 13256 0.00050 1 4774831 5514491 5550353 -35862 X 1 1 1 1 CHATHAM HOSPITAL 475 PROGRESS BLVD SILER CITY NC 27344 X X X X CHATHAM HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X WWW.CHATHAMHOSPITAL.ORG X X X X X X X 1 0 1 1 250.000000000000 0 1 X X X X X X X 1 1 X X X 1 X 1 X X X X 1 X 0 0 CHATHAM HOSPITAL PART V, SECTION B, LINE 20D: DISCOUNTS ARE AVAILABLE BASED ON MEANS TESTING AND PROMPT PAY ARRANGEMENTS. 1 CHATHAM HOSPITAL MEDICAL OFFICE BUILDING 163 MEDICAL PARK DRIVE SILER CITY NC 27344 CARDIAC REHABILITATION, DIABETES EDUCATION, PT/OT, AND OTHER ADMIN FUNCTIONS PART I, LINE 3C: CHARITY CARE IS AVAILABLE FOR NORTH CAROLINA RESIDENTS WHO HAVE A HOUSEHOLD INCOME AT OR LESS THAN 250% OF THE FEDERAL POVERTY GUIDELINES FOR THEIR FAMILY SIZE. A COMPLETE APPLICATION WITH SUPPORTING DOCUMENTATION OF INCOME IS PROVIDED FOR A FINAL DETERMINATION TO BE MADE. CHARITY CARE IS A BENEFIT WHERE 100% OF THE PATIENTS BALANCE WILL BE WRITTEN OFF EXCEPT FOR CERTAIN LIMITATIONS SUCH AS ELECTIVE, NON-MEDICALLY NECESSARY SERVICES AND THOSE BALANCES COVERED BY OTHER EXTERNAL FUNDING SOURCES.FPG IS USED FOR CHARITY CARE/FREE CARE. FOR SELF PAY, PROVIDE STRAIGHT 35% DISCOUNT ON CHARGES. PART I, LINE 6A: PART OF UNC HEALTH CARE SYSTEM REPORTING. PART I, LINE 7: AMOUNTS SHOWN IN PART I, LINE 7, COLUMN C WERE COMPUTED USING THE COST-TO-CHARGE RATIO WORKSHEET (WORKSHEET 2) FROM THE IRS INSTRUCTIONS FOR SCHEDULE H. PART I, LN 7 COL(F): THE HOSPITAL DOES NOT HAVE A PROCESS FOR ESTIMATING THE AMOUNT OF THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY. PART II, COMMUNITY BUILDING ACTIVITIES: CHATHAM HOSPITAL STRIVES TO IMPROVE EMERGENCY CARE FOR KIDS BY INCREASING MEDICATION SAFETY. ALSO, THE HOSPITAL HAS A DIABETES SELF-MANAGEMENT PROGRAM FOR INDIVIDUALS WITH DIABETES WITHIN THE COMMUNITY. CHATHAM HOSPITAL PARTICIPATES IN NUMEROUS COMMUNITY HEALTH FAIRS, PARTNERS WITH OTHER COMMUNITY LEADERS IN ADDRESSING HEALTH RELATED MATERS, PARTICIPATES IN COMMUNITY FUND RAISING EVENTS. PART III, LINE 2: SPECIFIC PATIENT BALANCES ARE WRITTEN OFF AT THE TIME THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 4: NET PATIENT SERVICE REVENUE IS RECORDED AT ESTABLISHED RATES WHEN SERVICES ARE PROVIDED WITH CONTRACTUAL ADJUSTMENTS, ESTIAMTED BAD DEBT EXPENSES, AND SERVCIES QUALIFYING AS CHARITY CARE DEDUCTED TO ARRIVE AT NET PATIENT SERVCIE REVENUE. CONTRACTUAL ADJUSTMENTS ARISE UNDER REIMBURSEMENT AGREEMENTS WITH CERTAIN INSURANCE CARRIERS, HEALTH MAINTENANCE ORGANIZATIONS AND PREFERRED PROVIDER ORGANIZATIONS, WHICH PROVIDE FOR PAYMENTS THAT GENERALLY LESS THAN ESTABLISHED BILLING RATES. SPECIFIC PATIENT BALANCES ARE WRITTEN OFF AT THE TIME THEY ARE DETERMINED TO BE UNCOLLECTIBLE. PART III, LINE 8: AS A CRITICAL ACCESS HOSPITAL, THE DIFFERENCE BETWEEN REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COST IS THE AMOUNT DUE FROM THE PATIENTS IN THE FORM OF CO-PAYMENTS, CO-INSURANCE AND DEDUCTIBLES. THE PATIENT AMOUNTS THAT ARE NOT COLLECTED END UP AS BAD DEBTS WHICH ARE PARTIALLY RECOVERABLE ON FUTURE COST REPORTS. PART III, LINE 9B: POLICY DOES CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE PART VI, LINE 2: LESS THAN 20% OF OUR COUNTYS RESIDENTS LIVE IN INCORPORATED TOWNS. THE COUNTY HAS ABOUT 85 RESIDENTS PER SQUARE MILE, WHICH REFLECTS ITS GENERALLY RURAL NATURE. A CRITICAL ACCESS HOSPITAL IS ESSENTIAL FOR A RURAL COMMUNITY SUCH AS THIS.CHATHAM HOSPITAL ADDRESSES THE COMMUNITY'S EMERGENCY HEALTH NEEDS BY PROVIDING AROUND-THE-CLOCK EMERGENCY SERVICES TO MORE THAN 1,000 PATIENTS EACH MONTH. OUR 5,500-SQUARE FOOT EMERGENCY ROOM IS NEWLY RENOVATED AND EQUIPPED WITH THE ADVANCED DIAGNOSTIC AND MONITORING EQUIPMENT REQUIRED TO DELIVER EXCELLENT CARE.CHATHAM HOSPITAL STRIVES TO IMPROVE EMERGENCY CARE FOR KIDS BY INCREASING MEDICATION SAFETY. ALSO, THE HOSPITAL HAS A DIABETES SELF-MANAGEMENT PROGRAM FOR INDIVIDUALS WITH DIABETES WITHIN THE COMMUNITY. PART VI, LINE 3: NOTICES OF PATIENT FINANCIAL PROGRAMS ARE POSTED IN SERVICE AREAS, AND BROCHURES ARE AVAILABLE DESCRIBING THE PROGRAMS AND PHONE NUMBERS FOR QUESTIONS OR TO REQUEST APPLICATIONS. FINANCIAL COUNSELORS ARE LOCATED IN SERVICE AREAS FOR DISCUSSIONS REGARDING FUNDING SOURCES, INCLUDING CHARITY CARE. AND, SELF PAY PATIENT ACCOUNTS ARE AUTOMATICALLY ROUTED TO MEDICAID ASSISTANCE COUNSELORS FOR REVIEW OF ELIGIBILITY POTENTIAL FOR MEDICAID. REGISTRATION COVERS THE CHARITY PROGRAM WITH PATIENTS DURING REGISTRATION AND GIVES CHARITY APPLICATIONS TO THOSE WHO DON'T HAVE INSURANCE OR WHO MEET CERTAIN CRITERIA. REGISTRATION ALSO INFORMS PATIENTS THAT PATIENT FINANCIAL SERVICES IS AVAILABLE TO PATIENTS WHO WISH TO DISCUSS PAYMENT OPTIONS. PART VI, LINE 4: POPULATION INFORMATION: THE OFFICIAL 2010 CENSUS PLACES OUR 2010 POPULATION AT 63,505, AN INCREASE OF 28.74% SINCE 2000. THE STATE AVERAGE GROWTH FOR THIS DECADE WAS 18.5%. LESS THAN 20% OF OUR COUNTY'S RESIDENTS LIVE IN INCORPORATED TOWNS. THE COUNTY HAS ABOUT 85 RESIDENTS PER SQUARE MILE, WHICH REFLECTS ITS GENERALLY RURAL NATURE. ETHNIC/RACIAL DIVERSITY: THE OVERALL, RACIAL/ETHNIC COMPOSITION OF CHATHAM COUNTY IS: 71% WHITE, 13% AFRICAN AMERICAN, 12% HISPANIC, 2% ASIAN AND 2% OTHER.AGE: THE 2009 ESTIMATED MEDIAN AGE FOR CHATHAM COUNTY RESIDENTS IS 42, UP FROM 38.7 IN 2007 AND ABOVE THE STATE AVERAGE. THE GREATEST PERCENTAGE OF OUR POPULATION (54%) IS IN THE RANGE OF 20 TO 60 YEARS OLD, AND 21.9% ARE AGE 60 OR OLDER. INCOME AND POVERTY: THE ESTIMATED MEDIAN HOUSEHOLD INCOME FOR CHATHAM COUNTY IN 2008 WAS $46,574, A SIGNIFICANT DROP FROM $51,794 IN 2007, BUT STILL RANKS US 8TH IN THE STATE PER CAPITA INCOME FOR 2008 WAS $43,894, WHICH RANKS THIRD OUT OF THE 100 COUNTIES. THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IN 2008 WAS ESTIMATED AT 10.3%, LOWER THAN THE STATE AVERAGE OF 14.6%, BUT STILL SIGNIFICANT. THIS POINTS OUT THE CHALLENGES OF A COUNTY WITH RESIDENTS AT EXTREME ENDS OF THE INCOME SPECTRUM. PART VI, LINE 5: CHATHAM HOSPITAL STRIVES TO FURTHER IT EXEMPT PURPOSES BY PARTNERING IN THE COMMUNITY TO ASSESS HEALTH NEEDS AND TO HELP DEVELOP STRATEGIES TO FULLFUL THOSE NEEDS. CHATHAM HOSPITAL IS WELL ENGAGED IN THE COMMUNITY THROUGH JOINT EFFORTS WITH OTHER ORGANIZATIONS, COMMUNITY OUTREACH THROUGH EDUCATION AND HEALTH FAIRS, DIRECTLY CONTRIBUTING TO FUNDRAISING EFFORTS, WORKING TO QUALIFY PATIENTS FOR EITHER INSURANCE OR CHARITY CARE AND IF NOT, PROVIDING DISCOUNTS TO HEALTH SERVICES. PART VI, LINE 6: CHATHAM HOSPITAL AND UNC HEALTH CARE ARE PARTNERING TO BRING NATIONALLY-RECOGNIZED HEALTH CARE TO CHATHAM COUNTY. OUR PARTNERSHIP MEANS YOU'LL CONTINUE TO HAVE ACCESS TO ADVANCED HEALTH CARE CLOSE TO HOME, WITH THE PERSONAL TOUCH YOU'VE COME TO EXPECT FROM US. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 X X X X X 0 1 0 0 0 1 1 0 0 MARY BECK DIRECTOR 0 268170 0 44786 0 0 0 43325 0 5207 0 361488 0 0 MEL HURSTON DIRECTOR 0 232625 0 39576 0 28132 0 42664 0 5207 0 348204 0 0 JOHN LEWIS DIRECTOR 0 482060 0 31903 0 15103 0 36398 0 5207 0 570671 0 0 DONALD SPENCER MD DIRECTOR 0 299396 0 41138 0 28968 0 14752 0 5207 0 389461 0 0 DAVID STRONG DIRECTOR 0 626252 0 157199 0 251042 0 263723 0 11511 0 1309727 0 229994 BOB ENDERS CEO 0 211510 0 0 0 0 0 29981 0 5207 0 246698 0 0 TAMMY NEEDHAM CNO 0 132421 0 0 0 106 0 19369 0 5207 0 157103 0 0 PART I, LINE 4B DURING THE CALENDAR YEAR 2013, DAVID STRONG PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED DISTRIBUTIONS TOTALING $229,994. HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $235,196. THE CURRENT YEAR EARNINGS ARE PAYABLE IN THE FUTURE. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657905ES0 2007-02-08 30540000 FHA INSURED MORTGAGE REVENUE BONDS 0 0 0 A 4015000 30540000 2303775 622810 329280 28221503 2008 1 0 1 1 A 0 0 0 0 0 0 1 A 1 0 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 6 SEE RESPONSE TO QUESTION 7A. FORM 990, PART VI, SECTION A, LINE 7A IN ADDITION TO SUCH POWERS AND RIGHTS AS ARE VESTED IN IT BY LAW, THE AMENDED AND RESTATED ARTICLES OF INCORPORATION OF THE CORPORATION OR THE AMENDED AND RESTATED BYLAWS, THE MEMBER ("UNCHCS") SHALL HAVE THE FOLLOWING POWERS: (A) THE POWER TO APPOINT THE CHAIRMAN OF THE BOARD, VICE CHAIRMAN, PRESIDENT, EXECUTIVE VICE PRESIDENTS, SECRETARY/TREASURER AND OTHER CORPORATE OFFICERS OF THE CORPORATION; (B) THE POWER TO APPOINT INDIVIDUAL MEMBERS OF THE CORPORATION'S BOARD OF TRUSTEES; (C) THE POWER TO ESTABLISH AND MAINTAIN QUALITY, SERVICE DELIVERY, AND FINANCIAL STANDARDS TO BE OBSERVED BY ALL MEMBERS OF UNCHCS, INCLUDING THE CORPORATION; (D) THE POWER TO ESTABLISH A SCHEDULE OF COST-BASED ASSESSMENTS PAYABLE BY PROVIDER COMPONENTS OF UNCHCS FOR THE SUPPORT OF THAT PORTION OF ITS OPERATING BUDGET ATTRIBUTABLE TO UNCHCS-WIDE ADMINISTRATION AND INITIATIVES AND REFLECTING OPERATING ENTITY PERFORMANCE; (E) THE POWER TO NEGOTIATE, DEVELOP, AND APPROVE ALL MANAGED CARE PRODUCTS AND CONTRACTS FOR THE CORPORATION; (F) THE POWER TO APPROVE (I) THE CORPORATION'S NAME, (II) CAPITAL AND OPERATING BUDGETS OF THE CORPORATION, AND (III) NON-BUDGETED MATERIAL EXPENDITURES OF THE CORPORATION (AS "MATERIAL" IS ESTABLISHED BY THE MEMBER FROM TIME TO TIME), PROVIDED THAT ONLY THE BOARD OF TRUSTEES SHALL HAVE THE AUTHORITY TO INITIATE A CHANGE IN THE NAME OF THE CORPORATION OF THE HOSPITAL, WHICH SHALL BE SUBJECT TO FINAL APPROVAL BY UNCHCS; AND (G) OTHER POWERS MUTUALLY AGREED TO BY UNCHCS AND THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B SEE RESPONSE TO QUESTION 7A. FORM 990, PART VI, SECTION B, LINE 11 FORM 990, PART VI, SECTION A,LINE 10: THE FORM 990 WAS REVIEWED PRIOR TO FILING BY THE PRESIDENT AND CFO OF THE HOSPITAL. IN ADDITION, IT WAS MADE AVAILABLE TO EVERY MEMBER OF THE GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY THE BOARD MEMBERS ANNUALLY TO BE REVIEWED BY THE HOSPITAL PRESIDENT. THE CHATHAM HOSPITAL CONFLICT OF INTEREST POLICY OUTLINES THE PROCESS TO BE FOLLOWED IN DETERMINING THE EXISTENCE OF A POTENTIAL CONFLICT, AND HOW TO ADDRESS THE SITUATION. FORM 990, PART VI, SECTION B, LINE 15 EFFECTIVE AUGUST 1, 2006, THE HOSPITAL ENETERED INTO A FIVE-YEAR CONTRACT WITH UNCH TO PROVIDE A CEO AND A CFO TO MANAGE THE DAY-TO-DAY OPERATIONS OF THE HOSPITAL. THE PRESIDENT OF CHATHAM HOSPITAL REPORTS MONTHLY TO THE PRESIDENT OF UNC HOSPITALS, DISCUSSING SURVEYS OF COMPENSATION DATA AND PLANNED RANGES OF SALARY OFFERS FOR EMPLOYEES OF CHATHAM. TARGET LEVELS ARE BASED ON LEVEL OF EDUCATION AND EXPERIENCE. WITH INPUT FROM THE MANAGEMENT OF UNC HOSPITALS, THE PRESIDENT OF CHATHAM HOSPITAL MAKES THE FINAL DECISION ON SALARIES, WITH THE EXCEPTION OF HIS/HER OWN, WHICH IS SET BY THE PRESIDENT OF UNCH WITH INPUT FROM THE UNC HOSPITALS MANAGEMENT TEAM. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE FORM 1023 AND RECENT COPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITON, RECENT COPIES OF FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART IX, LINE 11G PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 4,121,625. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,121,625. MOBILE IMAGING SERVICES: PROGRAM SERVICE EXPENSES 838,971. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 838,971. CONTRACTED SUPPORT FEES : PROGRAM SERVICE EXPENSES 1,134,789. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,134,789. MAINTENANCE FEES : PROGRAM SERVICE EXPENSES 119,362. MANAGEMENT AND GENERAL EXPENSES 191,103. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 310,465. ALL OTHER FEES : PROGRAM SERVICE EXPENSES 983,356. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 983,356. FORM 990, PART XI, LINE 9: CAPITAL CONTRIBUTED (TO) FROM SOLE MEMBER -155,407. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. UNIVERSITY OF NORTH CAROLINA HEALTHCARE SYSTEM 211 FRIDAY CENTER DRIVE CHAPEL HILL NC 27517 562206970 HEALTHCARE NC SECTION 115 0 REX HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 HEALTHCARE NC 501(C)(3) LINE 3 0 UNIVERSITY OF NORTH CAROLINA HOSPITALS 101 MANNING DRIVE CHAPEL HILL NC 27514 561118388 HEALTHCARE NC SECTION 115 0 REX HEALTHCARE INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509129 HEALTHCARE NC 501(C)(3) LINE 11A, I 0 REX HEALTHCARE FOUNDATION INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 566052117 HEALTHCARE NC 501(C)(3) LINE 11B, II 0 CALDWELL MEMORIAL HOSPITAL PO BOX 1890 LENOIR NC 28645 560554204 HEALTHCARE NC 501(C)(3) LINE 3 0 CALDWELL MEMORIAL HOSPITAL FOUNDATION INC PO BOX 1890 LENOIR NC 28645 581935514 SUPPORT OF CALDWELL MEMORIAL HOSPITAL NC 501(C)(3) LINE 7 0 HIGH POINT REGIONAL HEALTH 601 N ELM STREET HIGH POINT NC 27261 560532309 HEALTHCARE NC 501(C)(3) LINE 3 0 HIGH POINT REGIONAL HEALTH SERVICES INC 601 N ELM STREET HIGH POINT NC 27261 561497163 HEALTHCARE NC 501(C)(3) LINE 11B, II 0 HIGH POINT REGIONAL HEALTH SYSTEM FOUNDATION INC 601 N ELM STREET HIGH POINT NC 27261 272854711 SUPPORT HIGH POINT REGIONAL HEALTH NC 501(C)(3) LINE 11A, I 0 UNCPN 1600 PERIMETER PARK DRIVE STE 225 MORRISVILLE NC 27560 271081647 HEALTHCARE NC SECTION 115/501(C)(3 LINE 9 0 HIGH POINT SURGERY CENTER 600 NORTH LINDSAY STREET HIGH POINT NC 27260 561867005 HEALTHCARE NC N/A JRH VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 274092967 HEALTHCARE NC N/A REX HEALTH VENTURES I LP 4420 LAKE BOONE TRAIL RALEIGH NC 27607 371690478 HEALTHCARE NC N/A ORTHOPAEDIC SURGERY CENTER OF RALEIGH LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 271740526 HEALTHCARE NC N/A REX ENTERPRISES COMPANY INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 271740526 OPERATIONS SUPPORT NC N/A C 0 HIGH POINT HEALTHCARE VENTURES INC 601 N ELM STREET HIGH POINT NC 27261 561343468 HOLDING COMPANY NC N/A C 0 UNC PHYSICIANS NETWORK GROUP PRACTICES LLC 1600 PERIMETER PARK DRIVE MORRISVILLE NC 27560 461416986 HEALTHCARE NC N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 UNIVERSITY OF NORTH CAROLINA HEALTHCARE SYSTEM P 7816000 CASH UNCPN P 386000 CASH