2015-08-14T09:01:22-05:00 2014-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2013-10-01 560603898 HARNETT HEALTH SYSTEM INC HARN 9108911000 800 TILGHMAN DRIVE DUNN NC 28334 DAN WEATHERLY PRESIDENT/CEO 9108911000 2015-08-13 1 JOHN NORMAN P01506766 7049985200 2013 2016-03-07 17:11:31Z BETSY JOHNSON REGIONAL HOSPITAL DAN WEATHERLY 800 TILGHMAN DRIVE DUNN NC 28334 74653723 0 X WWW.MYHARNETTHEALTH.ORG X 1937 NC PROVIDING MEDICAL CARE FOR PATIENTS OF THE HOSPITAL 12 11 1233 50 0 0 90004 117785 83707336 73915535 -5904 13422 949266 606981 84740702 74653723 0 0 0 0 57999564 60121150 0 0 0 51115528 49620047 109115092 109741197 -24374390 -35087474 131241890 171245857 119262535 197022590 11979355 -25776733 X HARNETT HEALTH IS DEDICATED TO PROVIDING QUALITY AND PERSONALIZED CARE WITH RESPECT AND COMPASSION. WE ARE COMMITTED TO MAKING A DIFFERENCE THROUGHOUT OUR COMMUNITIES WITH SERVICE EXCELLENCE. 0 0 96072301 73915535 THE HOSPITAL SERVED THE HARNETT COUNTY POPULATION AND REACHED INTO THE COUNTIES OF SAMPSON, JOHNSTON AND CUMBERLAND. THE HOSPITAL SERVED 27,651 INPATIENTS FOR FY14. THE HOSPITAL EXPERIENCED 663 DELIVERIES THE OUTPATIENTS SERVED WERE 61,723 EMERGENCY VISITS, 19,990 PHYSICAL THERAPY-OCCUPATIONAL THERAPY-SPEECH THERAPY VISITS AND ALL OTHER OUTPATIENT VISITS TOTALED 36,357 CARDIACREHAB, TREATED 133 PATIENTS AND SOME OF THE OUTCOMES WERE THE FOLLOWING - FERRANS AND POWERS SURVEY, OVERALL QUALITY OF LIFE IMPROVED 2 POINTS (GOAL IS 2-3 POINT INCREASE)- HEALTH AND FUNCTIONING SUB-SCORE IMPROVED 3 POINTS (GOAL IS 2-3 POINT INCREASE)EDUCATIONAL ASSESSMENT SCORE IMPROVED 1% B MEDICATION MANAGEMENT OF HARNETT COUNTY (BETSY JOHNSON REGIONAL HOSPITAL) ENCOUNTERED 100 NEW PATIENTS WITH A TOTAL OF 217 ACTIVE PARTICIPATES IN THE PROGRAM WE RECEIVED 696 MEDICATIONS WITH A TOTAL VALUE OF $480,920. OUTREACH PROGRAMS THE HOSPITAL ARE INVOLVED WITH TEENS AS PARENTS PROGRAM, WHICH COLLABORATES WITH TWO OTHER COUNTY AGENCIES, PROVIDES A HOME VISITATION PROGRAM AND THE CONTINUATION OF EDUCATION CLASSES ON CHILDBIRTH AND PARENTING THE PROGRAM ALSO PROVIDES HARNETT COUNTY TEEN PARENTS WITH OPPORTUNITIES TO DEVELOP SELF-RESPECT, PARENTING, AND DECISION-MAKING SKILLS WHILE CONTINUING THEIR EDUCATION TAP SERVED 30 TEENS THE REPEAT PREGNANCY RATE FOR TAP PARTICIPATES IS 3%, COMPARED TO THE COUNTY RATE OF 22% THE TAP PROGRAM PARTICIPANTS RECEIVED 195 HOURS OF GROUP INSTRUCTION INCLUDING THE FOLLOWING TOPICS 18.25 HOURS ACADEMIC SUPPORT, 119.75 HOURS OF COLLEGE PREPAREDNESS, 12.5 HOURS OF INDIVIDUAL COUNSELING AND 15.75 HOURS OF FAMILY COUNSELING, 133.5 HOURS OF LIFE SKILLS TRAINING, 321.25 HOURS OF IN HOME VISITATION. 3. HEALTH HARNETT PROGRAM OR "GO RED" IS A PROGRAM THAT PROMOTES HEALTHY EATING, WHICH LEADS TO A HEALTHY LIFESTYLE HARNETT HEALTH COLLABORATED WITH THE NC COOPERATIVE EXTENSION AND THE HARNETT COUNTY HEALTH DEPARTMENT THERE WERE A TOTAL OF 41 PARTICIPATES IN TWO PRESENTATIONS GIVEN BY THE HARNETT HEALTH CARDIAC REHAB DEPARTMENT AS WELL AS 2 SUPPORTING PHYSICIANS. OFFERED FREE EDUCATIONAL BROCHURES AND INFORMATION AT ALL EVENTS. WE PARTICIPATE IN PROJECT ACCESS OF JOHNSON/HARNETT COUNTY WHICH IS A PHYSICIAN LED VOLUNTEER INITIATIVE THAT GIVES LOWINCOME, UNINSURED COUNTY RESIDENTS ACCESS TO COMPREHENSIVE MEDICAL CARE PHYSICIANS AND COMMUNITY PARTNERS, LIKE HARNETT HEALTH, DONATE MEDICAL SERVICES WITHOUT RECEIVING REIMBURSEMENT OR COMPENSATION THE PROGRAM HAS ASSISTED 93 PATIENTS FOR THE LAST FISCAL YEAR THE HOSPITAL SERVED THE HARNETT COUNTY POPULATION AND REACHED INTO THE COUNTIES OF SAMPSON, JOHNSTON AND CUMBERLAND. THE HOSPITAL SERVED 27,651 INPATIENTS FOR FY14. THE HOSPITAL EXPERIENCED 663 DELIVERIES THE OUTPATIENTS SERVED WERE 61,723 EMERGENCY VISITS, 19,990 PHYSICAL THERAPY-OCCUPATIONAL THERAPY-SPEECH THERAPY VISITS AND ALL OTHER OUTPATIENT VISITS TOTALED 36,357 CARDIACREHAB, TREATED 133 PATIENTS AND SOME OF THE OUTCOMES WERE THE FOLLOWING - FERRANS AND POWERS SURVEY, OVERALL QUALITY OF LIFE IMPROVED 2 POINTS (GOAL IS 2-3 POINT INCREASE)- HEALTH AND FUNCTIONING SUB-SCORE IMPROVED 3 POINTS (GOAL IS 2-3 POINT INCREASE)EDUCATIONAL ASSESSMENT SCORE IMPROVED 1% B MEDICATION MANAGEMENT OF HARNETT COUNTY (BETSY JOHNSON REGIONAL HOSPITAL) ENCOUNTERED 154 NEW PATIENTS WITH A TOTAL OF 615 ACTIVE PARTICIPATES IN THE PROGRAM WE RECEIVED 1,968 MEDICATIONS WITH A TOTAL VALUE OF $1,029,689 C OUTREACH PROGRAMS THE HOSPITAL ARE INVOLVED WITH TEENS AS PARENTS PROGRAM, WHICH COLLABORATES WITH TWO OTHER COUNTY AGENCIES, PROVIDES A HOME VISITATION PROGRAM AND THE CONTINUATION OF EDUCATION CLASSES ON CHILDBIRTH AND PARENTING THE PROGRAM ALSO PROVIDES HARNETT COUNTY TEEN PARENTS WITH OPPORTUNITIES TO DEVELOP SELF-RESPECT, PARENTING, AND DECISION-MAKING SKILLS WHILE CONTINUING THEIR EDUCATION TAP SERVED 32 TEENS THE REPEAT PREGNANCY RATE FOR TAP PARTICIPATES IS 0%, COMPARED TO THE COUNTY RATE OF 17 9% THE TAP PROGRAM PARTICIPANTS RECEIVED 642 HOURS OF GROUP INSTRUCTION INCLUDING THE FOLLOWING TOPICS 22 HOURS ACADEMIC SUPPORT, 45 HOURS OF COLLEGE PREPAREDNESS, 72 HOURS OF COMMUNICATION SKILLS, 300 HOURS OF FAMILY NUTRITION AND PHYSICAL ACTIVITY, 48 HOURS OF INDOOR SAFETY, 60 HOURS OF INFANT/TODDLER PLAY 3 HEALTH HARNETT PROGRAM OR "GO RED" IS A PROGRAM THAT PROMOTES HEALTHY EATING, WHICH LEADS TO A HEALTHY LIFESTYLE HARNETT HEALTH COLLABORATED WITH THE NC COOPERATIVE EXTENSION AND THE HARNETT COUNTY HEALTH DEPARTMENT THERE WERE A TOTAL OF 103 PARTICIPATES IN TWO PRESENTATIONS GIVEN BY THE HARNETT HEALTH CARDIAC REHAB DEPARTMENT AS WELL AS THE SUPPORTING PHYSICIAN 4 WE PARTICIPATED IN THE HARNETT COUNTY SENIOR HEALTH FAIR AND WE ALSO HOSTED MULTIPLE FREE DIABETES SCREENINGS AND PARTICIPATES RECEIVED FREE EDUCATIONAL BROCHURES AND INFORMATION 5 WE PARTICIPATE IN PROJECT ACCESS OF JOHNSON/HARNETT COUNTY WHICH IS A PHYSICIAN LED VOLUNTEER INITIATIVE THAT GIVES LOWINCOME, UNINSURED COUNTY RESIDENTS ACCESS TO COMPREHENSIVE MEDICAL CARE PHYSICIANS AND COMMUNITY PARTNERS, LIKE HARNETT HEALTH, DONATE MEDICAL SERVICES WITHOUT RECEIVING REIMBURSEMENT OR COMPENSATION THE PROGRAM HAS ASSISTED 158 PATIENTS FOR THE LAST FISCAL YEAR 96072301 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 105 0 1233 1 0 0 0 0 0 0 0 0 0 0 X 12 11 1 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 0 1 1 0 X DEBORAH WHITTINGTON 9108921000 800 TILGHMAN DRIVE DUNN NC 28334 DR RON MADDOX PHARM D CHAIRMAN 4.00 X X 0 0 0 CORNELIA STEWART VICE-CHAIRMAN 2.00 X X 0 0 0 ERNEST ALPHIN TREASURER 2.00 X X 0 0 0 TEDDY BYRD SECRETARY 2.00 X X 0 0 0 WALTER T WEEKS JR ASSISTANT SEC. 2.00 X 0 0 0 JIM MCCORMICK TRUSTEE 2.00 X 0 0 0 BARBARA BETHEA MD TRUSTEE 2.00 X 0 0 0 WILEY POPE TRUSTEE 2.00 X 0 0 0 HEATHER H WILLIAMS TRUSTEE 2.00 X 0 0 0 H WEST LAWSON MD TRUSTEE 2.00 X 0 0 0 DEWEY BLALOCK TRUSTEE 2.00 X 0 0 0 BARBARA MCKOY TRUSTEE 2.00 X 0 0 0 FRANK STEWART TRUSTEE 2.00 X 0 0 0 KENNETH BRYAN PRESIDENT/CEO 40.00 X 460057 0 67427 ROBIN NICHOLS CFO 40.00 X 161745 0 0 VICKI ALLEN CNO/VP 40.00 X 182531 0 14062 WALLACE HORNE MD VP MED AFFAIRS 40.00 X 281775 0 8623 SONDRA DAVIS VP HR 40.00 X 146858 0 27716 LYNN LAMBERT CFO 40.00 X 273068 0 63370 MIKE JONES VP CENTRAL HOSPITAL AND SU 40.00 X 154167 0 20093 MICHAEL ZICH PHYSICIAN 40.00 X 311849 0 39328 BEVERLY YEARWOOD PHYSICIAN 40.00 X 199473 0 21689 BRAD BUTLER PHYSICIAN 40.00 X 172410 0 28398 VIDETTE COOPER PHYSICIAN 40.00 X 182411 0 16751 ASIF ZIA PHYSICIAN 40.00 X 179713 0 35251 2706057 0 342708 32 0 1 0 XTEND HEALTHCARE 500 W MAIN STREET SUITE 14 HENDERSONVILLE TN 37075 BILLING 1492254 AMSOL PO BOX 6633 HIGH POINT NC 27262 ANESTHIOLOGY 763774 BYERS DEAN & ASSOC 612 OFFICE PKWY SUITE A WESTERVILLE OH 43082 BILLING FOR PHY 591850 HTSG HOLDING LLC 5110 MARYLAND WAY SUITE 200 BRENTWOOD TN 37027 BILLING 537500 SOURCEHOW HEALTHCARE-LEXICODE PO BOX 142589 DRAWER 9059 IRVING TX 750142589 CODING 531130 26 117785 117785 NET PATIENT SERVICE REVENUE 621400 71022081 71022081 2893454 2893454 73915535 13422 13422 327943 0 327943 327943 327943 CAFETERIA SALES 900099 279038 279038 279038 74653723 74522516 0 13422 1935209 1644928 290281 51429944 43715452 7714492 4256278 3617836 638442 2499719 2124761 374958 1119178 1119178 370675 370675 101030 101030 532989 532989 88512 88512 1945212 1945212 2375786 2375786 190478 190478 5825427 5825427 8428815 8428815 624729 624729 MEDICAL SUPPLIES 7851549 7851549 CONTRACT SERVICES/ CONT 7750114 7750114 MAINT. & REPAIRS 3406084 3406084 DRUGS 2403880 2403880 6605589 3545749 3059840 109741197 96072301 13668896 0 2282814 314160 21085142 14813160 22066 932 3048290 2787557 563422 890411 149370524 60010539 97007895 89359985 1131189 1144849 6101072 61934803 131241890 171245857 23952402 41503732 848505 733949 18975918 21555000 72016792 72327937 3468918 60901972 119262535 197022590 X 10848166 -26921582 1131189 1144849 11979355 -25776733 131241890 171245857 -35087474 -2668614 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 14270 14270 0 PART II-B, LINE 1: THE HOSPITAL PAID ANNUAL DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND THE NORTH CAROLINA HOSPITAL ASSOCIATION. THE AMOUNT LISTED ABOVE REPRESENTS THE AMOUNT OF THE DUES PAID THAT WAS ATTRIBUTABLE TO LOBBYING. 1189620 1189620 91720937 23274509 68446428 55842762 36281803 19560959 617205 454227 162978 89359985 PREPAID PENSION COSTS 811424 ESTIMATED THIRD PARTY SETTLEMENTS 1666610 INTERCO 57573687 UNAMORTIZED LOSS ON EXTINGUISHMENT OF DEBT 1883082 61934803 ESTIMATED THIRD PARTY SETTLEMENTS 3328285 INTERCO 57573687 60901972 X PART X, LINE 2: THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. 1 1 X 1 X 1 X 1 1 1 0 1 1 2264550 2264550 0.02060 22688036 17972324 4715712 0.04300 380715 89572 291143 0.00270 25333301 18061896 7271405 0.06630 8342 8342 0.00010 42287 515 41772 0.00040 17236 9720 7516 0.00010 1940 1940 0.00000 69805 10235 59570 0.00060 25403106 18072131 7330975 0.06690 65933 65933 0.00060 65933 65933 0.00060 1 62440982 18370137 38667133 42585407 -3918274 X 1 1 2 1 BETSY JOHNSON REGIONAL HOSPITAL 800 TILGHMAN DRIVE DUNN NC 28835 X X X DISPROPORTIONATE SHARE HOSPITAL 2 CENTRAL HARNETT HOSPITAL 215 BRIGHTWATER DRIVE LILLINGTON NC 27546 X X X BETSY JOHNSON REGIONAL HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 0 CENTRAL HARNETT HOSPITAL 2 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 X 1 X X X X X 1 X 0 0 BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 3: IN 2012, FIRST CHOICE COMMUNITY HEALTH CENTERS (FCCHC), HARNETT HEALTH, AND THE HARNETT COUNTY PUBLIC HEALTH DEPARTMENT (HCPHD) BEGAN DISCUSSIONS AIMED AT DEVELOPING A SHARED CHNA. ALTHOUGH EACH ENTITY HAD A DIFFERENT TIMETABLE FOR ITS "NEXT" ASSESSMENT, SCHEDULES WERE ADJUSTED WITH THE GOAL OF COMPLETING A JOINT ASSESSMENT, DURING 2013, THAT COULD THEN BE SIMULTANEOUSLY USED BY ALL PARTNERS AND THE COMMUNITY. AN INVITATION TO PARTICIPATE IN THE CHNA PROCESS WAS EXTENDED TO CAMPBELL UNIVERSITY, GIVEN ITS ROLES IN THE COMMUNITY, ITS EXISTING PROGRAMS, AND THE OPENING OF ITS NEW MEDICAL SCHOOL IN AUGUST OF 2013. CAMPBELL UNIVERSITY ENTHUSIASTICALLY AGREED AND CAMPBELL'S DEPARTMENT OF PUBLIC HEALTH REPRESENTED THE UNIVERSITY.A WORK GROUP WAS FORMED WITH REPRESENTATIVES OF HARNETT HEALTH, HARNETT COUNTY PUBLIC HEALTH DEPARTMENT, CAMPBELL UNIVERSITY, AND FIRST CHOICE COMMUNITY HEALTH CENTERS TO UPDATE AND EXTEND THE AVAILABLE DATABASE AND SURVEY, ANALYZE FINDINGS, AND PREPARE THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR HARNETT COUNTY. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 3: BASED ON THE DATA FROM THE HARNETT COUNTY NEEDS ASSESSMENT WE REVIEW WHAT KEY ISSUES ARE ALIGNED WITH OUR MISSION. FROM THERE, WE DEVELOP PLANS ON WHICH STRATEGIES WILL HAVE THE MOST IMPACT ON OUR COMMUNITY. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 5D: THE HOSPITAL MADE THE CHNA AVAILABLE IN PRINT AT THE HEALTH DEPARTMENT. BETSY JOHNSON REGIONAL HOSPITAL PART V, SECTION B, LINE 7: BECAUSE THE HEALTH ASSESSMENT IS RELATIVELY NEW, WE HAVE BEEN WORKING ON STRATEGIES TO ADDRESS THE NEEDS ASSESSED. ONE NEED THAT WE HAVE ADDRESSED IS CHILDHOOD OBESITY BY IMPLEMENTING A CHILDHOOD OBESITY PROGRAM. WE WILL CONTINUE TO LOOK FOR WAYS TO ADDRESS THE OTHER NEEDS DETERMINED IN THE CHNA. CENTRAL HARNETT HOSPITAL PART V, SECTION B, LINE 7: BECAUSE THE HEALTH ASSESSMENT IS RELATIVELY NEW, WE HAVE BEEN WORKING ON STRATEGIES TO ADDRESS THE NEEDS ASSESSED. ONE NEED THAT WE HAVE ADDRESSED IS CHILDHOOD OBESITY BY IMPLEMENTING A CHILDHOOD OBESITY PROGRAM. WE WILL CONTINUE TO LOOK FOR WAYS TO ADDRESS THE OTHER NEEDS DETERMINED IN THE CHNA. 6 HARNETT HEALTH ANGIER MEDICAL SERVICES 185 RAWLS ROAD ANGIER NC 27501 PHYSICIAN PRACTICE HARNETT HEALTH LILLINGTON MEDICAL SERVIC 716 10TH STREET LILLINGTON NC 27546 PHYSICIAN PRACTICE HARNETT HEALTH DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE 700 DUNN NC 28335 PHYSICIAN PRACTICE HARNETT HEALTH HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE HARNETT HEALTH PREMIER PEDIATRICS 802 TILGHMAN DRIVE DUNN NC 28335 PHYSICIAN PRACTICE COATS MEDICAL SERVICES 25 N JOHNSON STREET COATS NC 27521 PHYSICIAN PRACTICE PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT IS PRESENTED AT GROSS CHARGES. PER THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS, THE ORGANIZATION ESTIMATES THAT SOME PORTION OF ITS BAD DEBT MAY QUALIFY FOR FINANCIAL ASSISTANCE DUE TO THE FACT THAT THE HOSPITAL DOES NOT HAVE 24 HOUR COVERAGE IN THE ED FOR FINANCIAL ASSISTANCE. ALSO, SOME PATIENTS TREATED REFUSE TO MEET AND DISCUSS FINANCIAL ASSISTANCE OPTIONS. THE ANDI REPORT WAS USED TO CALCULATE THE AMOUNT OF BAD DEBT THAT QUALIFIES FOR FINANCIAL ASSISTANCE. ANOTHER FACTOR CONTRIBUTING TO THE ESTIMATE OF BAD DEBT THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE IS THAT WE DO NOT VISIT OUR INSURED INPATIENTS THAT MAY HAVE HIGH DEDUCTIBLES OR CO-INSURANCES. IN FUTURE YEARS, THE ORGANIZATION PLANS TO IMPROVE CONSULTATION SESSIONS TO INLCUDE INSURED PATIENTS WITH POTENTIALLY HIGH DEDUCTIBLES OR CO-PAYMENTS. PART III, LINE 8: THE ORGANIZATION USES ITS ANDI REPORT TO COMPUTE PART III, LINES 5 AND 6. PART III, LINE 9B: ALL PATIENTS RECEIVE LETTERS AND/OR STATEMENTS REGARDING THEIR ACCOUNTS AND THEY ARE GIVEN 120 DAYS FROM THE BILL DATE TO MAKE SATISFACTORY PAYMENT ARRANGEMENTS OR TO APPLY FOR FINANCIAL ASSISTANCE BEFORE THE ACCOUNT GOES TO BAD DEBT STATUS. PATIENTS WHO APPLY FOR FINANCIAL ASSISTANCE MUST COMPLY WITH THE REQUIREMENTS OF THE APPLICATION TO AVOID THE ACCOUNT GOING INTO BAD DEBT STATUS. PATIENTS APPLYING FOR AID ARE PLACED IN A HOLD STATUS BY THE PALS TEAM TO AVOID COLLECTIONS. PATIENTS WHO HAVE MADE AN EFFORT TO COMPLETE AN APPLICATION OR WHO MAY NOT HAVE HAD AN OPPORTUNITY TO DISCUSS THEIR FINANCIAL SITUATION AND THEIR ACCOUNT GOES TO A COLLECTION STATUS ARE EVALUATED ON A CASE BY CASE BASIS TO DETERMINE IF THE ACCOUNT IS REMOVED FROM COLLECTIONS AND FINANCIAL ASSISTANCE IS PROVIDED. PART VI, LINE 2: BASED ON THE DATA FROM THE HARNETT COUNTY NEEDS ASSESSMENT WE REVIEW WHAT KEY ISSUES ARE ALIGNED WITH OUR MISSION. FROM THERE, WE DEVELOP PLANS ON WHICH STRATEGIES WILL HAVE THE MOST IMPACT ON OUR COMMUNITY. PART VI, LINE 3: THE HOSPITAL SYSTEM OFFERS FINANCIAL ASSISTANCE TO ANYONE BASED ON NEED AND ABILITY TO PAY. OUR PATIENT ACCOUNT LIAISONS WILL ASSIST PATIENTS IN APPLYING FOR FINANCIAL ASSISTANCE AND ANY OTHER FUNDING SOURCES THAT MAY BE AVAILABLE. PRE-SCREEING MAYBE CONDUCTED AT PRE-ADMISSION OR POINT OF SERVICE FOR ALL UNISURED OR UNDERINSURED PATIENTS THAT CAN NOT MEET THE DEPOSIT REQUIREMENTS; HOWEVER, ALL EMERGENT SERVICES ARE PROVIDED WITHOUT REGARD TO THE ABLITY TO PAY OR NOT. PART VI, LINE 4: HARNETT HEALTH SYSTEM, INC. IS LOCATED IN THE SOUTHEASTERN/MIDDLE SECTION OF HARNETT COUNTY NORTH CAROLINA. AS A RURAL HOSPITAL, WE ARE A KEY COMPONENT OF OUR STATE'S HEALTH CARE SAFETY NET BY TREATING EVERYONE WHO COMES THROUGH OUR DOORS. OUR PATIENT VOLUMES EXEMPLIFY OUR COMMITTMENT: % OF ADMISSIONS, MEDICARE 48.8%,MEDICAID 28.6%,MANAGED CARE 11%, SELF PAY 8%, TRICARE AND ALL OTHER 3.6%. THE HOSPITAL'S SERVICE AREA INCLUDED HARNETT AND A PORTION OF THREE NEIGHBORING COUNTIES, CUMBERLAND, JOHNSTON AND SAMPSON. AGRICULTURE AND CONSTRUCTION ARE THE LEADING INDUSTRIES OF OUR ECONOMIC STRUCTURE. THE TOP LARGEST EMPLOYER IN HARNETT COUNTY IS THE PUBLIC SCHOOL SYSTEM. PART VI, LINE 5: THE ROLE OF HARNETT HEALTH SYSTEM PLAYS IN THE COMMUNITY IS TO CARE FOR AND HEAL THE SICK AND INJURED, BUT EQUALLY IMPORTANT IS EDUCATING OUR COMMUNITY THE IMPORTANCE OF GOOD HEALTH AND WAYS TO IMPROVE THEIR LIFESTYLES. WE DEFINE OUR OBLIGATION BY HOLDING COMMUNITY EDUCATION AND WELLNESS CLASSES, PARTICIPATING IN ANNUAL COMMUNITY EVENTS, AND EDUCATING HIGH SCHOOL STUDENT ON THE MANY AREA OF EMPLOYMENT IN THE HEALTHCARE FIELD.WITH THE FEDERAL FUNDING AND STATE CUTS IN REIMBURSEMENT NO SURPLUS OF FUNDS TO PROVIDE MANY OF THE EXTRA ACTIVITIES THAT THE SYSTEM WOULD LIKE TO BE ABLE TO PROVIDE TO THE COMMUNITY. WE HAVE STILL MAINTAINED A COUPLE OF OUR COMMUNITY OUTREACH PROGRAM, "CHAMP", PROGRAM WHICH IS HOUSED IN THE ELEMENTARY SCHOOLS THROUGHOUT THE COUNTY, ASSIST CHILDREN WITH ASTHMA WHICH HAS CUT DOWN ON ABSENTEEISM. THE TEENS AS PARENTS PROGRAM, WORKS WITH TEENS WHO ARE PREGANANT OR HAVE HAD BABIES TO PROVIDE ADDITIONAL SUPPORT BY THE MEANS OF HOME BASED VISITS AND SUPPORT GROUP MEETINGS. EMPHASIS IS TO HAVE THE TEEN RETURN TO THE EDUCATION ARENA AND TO CONTINUE TO PROVIDE PARENTING SUPPORT AND HAVE HEALTHY BABIES. SOME OF OUR STAFF SERVES OR HAS SERVED ON LOCAL BOARDS WITHIN THE COMMUNITES INCLUDING THE NC COOPERATIVE EXTENSION ADVISORY BOARD, TEENS AS PARENTS EXECUTIVE AND ADVISORY BOARD,UNITED WAY BOARD AND VARIOUS OTHER CIVIC BOARDS. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NC X 0 1 X X 1 0 0 0 0 0 0 0 0 KENNETH BRYAN PRESIDENT/CEO 432370 0 13601 0 14086 0 20346 0 47081 0 527484 0 0 0 ROBIN NICHOLS CFO 147342 0 14403 0 0 0 0 0 0 0 161745 0 0 0 VICKI ALLEN CNO/VP 182531 0 0 0 0 0 4414 0 9648 0 196593 0 0 0 WALLACE HORNE MD VP MED AFFAIRS 281775 0 0 0 0 0 5658 0 2965 0 290398 0 0 0 SONDRA DAVIS VP HR 146858 0 0 0 0 0 3887 0 23829 0 174574 0 0 0 LYNN LAMBERT CFO 265246 0 7822 0 0 0 18840 0 44530 0 336438 0 0 0 MIKE JONES VP CENTRAL HOSPITAL AND SU 154167 0 0 0 0 0 3897 0 16196 0 174260 0 0 0 MICHAEL ZICH PHYSICIAN 311849 0 0 0 0 0 8016 0 31312 0 351177 0 0 0 BEVERLY YEARWOOD PHYSICIAN 199473 0 0 0 0 0 4750 0 16939 0 221162 0 0 0 BRAD BUTLER PHYSICIAN 172410 0 0 0 0 0 4521 0 23877 0 200808 0 0 0 VIDETTE COOPER PHYSICIAN 182411 0 0 0 0 0 4448 0 12303 0 199162 0 0 0 ASIF ZIA PHYSICIAN 179713 0 0 0 0 0 4750 0 30501 0 214964 0 0 0 PART I, LINE 2 INVOICE VALUE $0-25,000 REQUIRES DIRECTOR SIGNATURE, $25,000 AND GREATER REQUIRES DIRECTOR SIGNATURE AND A COSIGNATURE FROM A VP. PURCHASES OF PHARMACEUTICALS AND MEDICAL SUPPLIES HELD IN INVENTORY MAY BE PURCHASED UNDER THE SIGNATURE OF THE DEPT DIRECTOR WITHOUT REGARD TO THE ABOVE MENTIONED LIMITS. PART I, LINE 4 DURING THE YEAR, THE ORGANIZATION PAID ROBIN NICHOLS $80,138 IN SEVERANCE PAYMENTS. ALLISON TAYLOR FAMILY MEMBER OF BOARD MEMBER (HEATHER WILLIAMS) 101425 EMPLOYMENT COMPENSATION: ALLISON TAYLOR IS FAMILY MEMBER OF BOARD MEMBER HEATHER WILLIAMS. 0 FORM 990, PART VI, SECTION A, LINE 2 ALLISON TAYLOR WAS A DIRECTOR AND HER SISTER, HEATHER WILLIAMS, WAS ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 ON NOVEMBER 8, 2005, HARNETT HEALTH SYSTEM ENTERED INTO AN AGREEMENT WITH WAKEMED TO PROVIDE DAY-TO-DAY MANAGEMENT SERVICES, PRIMARILY A CHIEF EXECUTIVE OFFICER. THE AGREEMENT REQUIRES THE SYSTEM TO REIMBURSE WAKEMED FOR THE SALARY AND BENEFITS ASSOCIATED WITH THE CEO POSITION. IN ADDITION, WAKEMED RECEIVES A MANAGEMENT FEE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES OF THE ORGANIZATION IS COMPRISED OF THIRTEEN RESIDENTS OF HARNETT COUNTY, NC AND THE APPOINTED TRUSTEES SHALL SERVE A STAGGERED TERM FOR 1 TO 3 YEARS. SEVEN TRUSTEES OF THE ORGANIZATION ARE APPOINTED BY THE HARNETT COUNTY BOARD OF COMMISSIONERS, AND SHALL, AT ALL TIMES, INCLUDE AT LEAST ONE RESIDENT OF EACH OF THE FIVE COMMISSIONERS' DISTRICTS AND TWO OTHER PERSONS RESIDING IN HARNETT COUNTY. THE REMAINING SIX TRUSTEES ARE APPOINTED BY THE ORGANIZATION'S BOARD OF TRUSTEES AT ITS ANNUAL MEETING FROM NOMINEES THAT MEET RESIDENCY AND AGE REQUIREMENTS AS DEFINED IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. THE PROCESS THE ORGANIZATION USES TO REVIEW THE FORM 990 CONSISTS OF PROVIDING THE FORM 990 TO THE BOARD OF TRUSTEES BY ELECTRONIC COPY. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE LEADERSHIP OF THE BOARD OF TRUSTEES (THROUGHOUT THE YEAR IF NEEDED) AND ADMINISTERED TO ALL VOTING BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE SALARIES ARE DETERMINED BY A MARKET ANALYSIS INVOLVING COMPARABILITY DATA, INDUSTRY STANDARDS, AND LOCAL ECONOMICS. THE CEO'S SALARY IS A CONDITION OF THE MANAGEMENT AGREEMENT BETWEEN THE BOARD OF DIRECTORS AND WAKEMED (SEE THE RESPONSE TO LINE 3 ABOVE). THE BOARD HAS INDIRECT APPROVAL OVER THE COMPENSATION PAID TO THE CEO THROUGH THIS AGREEMENT, AND HAS APPROVAL OVER ANY ADDITIONAL AMOUNTS AND INCREASES. WAKEMED PREPARES A COMPENSATION STUDY FOR OFFICERS AND KEY EMPLOYEES EXCLUDING THE CEO AND MAKES THE RECOMMENDATIONS TO THE CEO OF HARNETT HEALTH SYSTEM. THOSE RECOMMENDATIONS, INCLUDING ANY AMOUNTS ALLOCATED FOR RAISES AND INCENTIVES, ARE INCLUDED IN THE ANNUAL BUDGET PROCESS WHICH IS APPROVED BY THE FINANCE COMMITIEE OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART XII, LINE 2C: THE ORGANIZATOIN HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. ANGIER MEDICAL SERVICES LLC 185 RAWLS ROAD ANGIER NC 27501 270906936 PHYSICIAN PRACTICE NC N/A LILLINGTON MEDICAL SERVICES LLC 716 S 10TH STREET LILLINGTON NC 27546 272944176 PHYSICIAN PRACTICE NC N/A HARNETT OBGYN 608 TILGHMAN DRIVE DUNN NC 28335 273320275 PHYSICIAN PRACTICE NC N/A DUNN MEDICAL SERVICES 700 TILGHMAN DRIVE DUNN NC 28335 273320115 PHYSICIAN PRACTICE NC N/A COATS MEDICAL SERVICES LLC 25 N JOHNSON STREET COATS NC 27521 462540799 PHYSICIAN PRACTICE NC N/A BETSY JOHNSON MEMORIAL HOSPITAL FOUNDATION 800 TILGHMAN DRIVE DUNN NC 28334 201929953 FUNDRAISING NC 501(C)(3) LINE 7 HARNETT HEALTH SYSTEM INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0