2015-05-15T07:09:12-05:00 2014-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2013-07-01 636000090 REGIONAL MEDICAL CENTER BOARD REGI 2562355255 PO BOX 2208 ANNISTON AL 36202 LOUIS A BASS CEO 2562355255 2015-05-15 1 AMY BIBBY P00445891 8282542254 2013 2016-02-25 16:41:14Z NORTHEAST ALABAMA REGIONAL MEDICAL CTR J DAVID MCCORMACK PO BOX 2208 ANNISTON AL 36202 188996370 0 X WWW.RMCCARES.ORG X 1974 AL TO PROVIDE PERSONALIZED HEALTHCARE TO CITIZENS OF NORTHEAST ALABAMA 15 12 1791 225 216386 100210 53298 152467 162047970 183556366 2583966 2421686 115407 391049 164800641 186521568 291436 365589 0 0 67919126 70052067 0 0 0 97617642 113900621 165828204 184318277 -1027563 2203291 185319050 185023816 55780790 53846307 129538260 131177509 X THE BOARD'S MISSION IS PROVIDING STATE OF THE ART HEALTH CARE WITH INTEGRITY, TO THE PEOPLE WE SERVE. 0 0 172853447 365589 183339980 DURING THE YEAR ENDED JUNE 30, 2014, NORTHEAST ALABAMA REGIONAL MEDICAL CENTER HAD 12,290 ADULT AND PEDIATRIC INPATIENT ADMISSIONS, 1,350 NEWBORN ADMISSIONS AND SERVED PATIENTS THROUGH AMBULATORY CARE INCLUDING: 3,780 OBSERVATION PATIENTS, 42,687 EMERGENCY DEPARTMENT PATIENTS, 61,122 REFERRED OUTPATIENTS, 5,013 SAME DAY SURGERY PATIENTS. THE MEDICAL CENTER IS ALSO INVOLVED IN EDUCATION, RESEARCH, AND COMMUNITY BENEFIT ACTIVITIES DESIGNATED TO PROVIDE HEALTH AND WELLNESS. REGIONAL MEDICAL CENTER HOLDS DESIGNATIONS FOR THE FOLLOWING: BLUE CROSS CENTER OF DISTINCTION FOR CARDIAC CARE; IS THE ONLY HOSPITAL TO RECEIVE THE "BABY FRIENDLY" DESIGNATION FROM THE STATE OF ALABAMA; ASCR GOLD STANDARD AWARD (ALABAMA STATEWIDE CANCER REGISTRY).REGIONAL MEDICAL CENTER IS PROUD TO BE CATEGORIZED AS A TIER 1 HOSPITAL BY BLUE CROSS AND BLUE SHIELD OF ALABAMA. HOSPITALS DESIGNATED AS TIER 1 ARE RECOGNIZED AS HAVING ATTAINED THE HIGHEST LEVEL OF COMPLIANCE ACROSS THE FOLLOWING AREAS: QUALITY AWARENESS, PATIENT SAFETY AWARENESS, FINANCIAL AWARENESS, AND PATIENT SATISFACTION. 172853447 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 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 398 0 1 1791 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X X SUSAN MARNEY DIRECTOR - ACCOUNTING 2562355678 400 EAST TENTH STREET ANNISTON AL 36202 GREGORY J KERNION CHAIRMAN 1.00 X X 0 0 0 SANDRA FOX SUDDUTH VICE CHAIRMAN 1.00 1.00 X X 43 0 0 BILLY DON GRIZZARD SECRETARY 1.00 1.00 X X 0 0 0 JIMMIE THOMPSON BOARD MEMBER 1.00 X 0 0 0 JOHN E BLUE II BOARD MEMBER (THRU APRIL 1.00 X 89 0 0 FRED WILSON BOARD MEMBER 1.00 X 423 0 0 LARRY K DEASON BOARD MEMBER 1.00 X 0 0 0 ARTHUR F FITE III BOARD MEMBER 1.00 1.00 X 239 0 0 GEORGE CRAWFORD MD BOARD MEMBER 1.00 X 0 0 0 TRUDY D HARDEGREE BOARD MEMBER 1.00 1.00 X 0 0 0 W E WILLIAMS BOARD MEMBER 1.00 X 0 0 0 MICHAEL W KIMBERLY DRPH MPH HCLD BOARD MEMBER 1.00 X 0 0 0 JEFFREY A PARKER BOARD MEMBER (THRU SEPTEMBER) 1.00 X 0 0 0 ROHIT G PATEL MD CHIEF OF STAFF 1.00 X 18000 0 0 JAMES E ROBERTS BOARD MEMBER 1.00 1.00 X 5 0 0 ELLEN BASS BOARD MEMBER 1.00 X 0 0 0 GORDON HARDY MD VICE CHIEF OF STAFF (THRU 1.00 1.00 X 0 0 0 J DAVID MCCORMACK CEO 40.00 1.00 X 289900 0 28386 LOUIS BASS CFO 40.00 1.00 X 201099 0 32188 JOSEPH WEAVER COO 40.00 X 192288 0 25155 MASUMI YAMAMURO HIGHEST COMPENSATED EMPLOY 40.00 X 501250 0 25033 TERRY M PHILLIS JR HIGHEST COMPENSATED EMPLOY 40.00 X 710785 0 20025 BARRY J BILLINGS HIGHEST COMPENSATED EMPLOY 40.00 X 696306 0 20025 BERTHA SANCHEZ-VALDIVIESO HIGHEST COMPENSATED EMPLOY 40.00 X 260955 0 1129 ANOUAR BAKIR HIGHEST COMPENSATED EMPLOY 40.00 X 288184 0 3033 3159566 0 154974 39 0 1 0 ANESTHESIA SOLUTIONS OF ANNISTON LLC PO BOX 6633 HIGH POINT NC 27262 CRNA SERVICES 2611090 MORRISONS HEALTH CARE DIVISION PO BOX 102289 ATLANTA GA 303682289 MANAGEMENT OF FOOD SERVICE 1580394 INFOPARTNERS INC PO BOX 347747 PITTSBURGH PA 152514747 INFORMATION TECHNOLOGY 564185 MEDMANAGEMENT LLC 1500 URBAN CENTER DR STE 325 VESTAVIA HILLS AL 35242 PHYSICIAN ADVISORY SERVICES 492310 GREATER ALABAMA LITHOTPRIPSY PO BOX 847324 DALLAS TX 75284 PATIENT LITHOTRIPSY SERVICES 490771 26 250 7608 144609 4826 152467 NET PATIENT SERVICE 621400 174897538 174897538 MEDICAID DISP SHARE 900099 3463530 3463530 MEDICAID EHR PAYMENT 900099 3277280 3277280 PHARMACY REVENUE 900099 1131880 1131880 LONG TERM CARE HOSPITAL 621400 471884 471884 314254 97868 216386 183556366 2372489 2372489 1763178 9824 2437434 0 -674256 9824 -664432 -664432 86565 37368 49197 49197 49197 FOOD SERVICE & VENDING 722210 847653 847653 OTHER INCOME 900099 182903 182903 GIFT SHOP REVENUE 453220 24925 24925 1055481 186521568 183339980 216386 2812735 100280 100280 265309 265309 769016 256338 512678 139287 139287 55725546 51233067 4492479 3117682 2842149 275533 6274193 5719696 554497 4026343 3670505 355838 317054 317054 14892079 12665484 2226595 1067316 493694 573622 2398132 1290442 1107690 2918030 2918030 20043 14262 5781 157126 122003 35123 1442682 1442682 12395673 12395673 1125916 1125916 MEDICAL SUPPLIES 41954271 41954271 BAD DEBT 32801063 32801063 FOOD SERVICE EXPENSES 1309133 1309133 RECRUITMENT 824508 824508 277595 94163 183432 184318277 172853447 11464830 0 320543 347393 1293586 5500007 17544235 17669495 2015714 3145990 5316012 5000976 1540691 2101919 268684946 205024519 70787770 63660427 66081433 55864362 9006269 9006269 164000 164000 11248797 22562978 185319050 185023816 14946190 14737905 881786 704651 39306492 37839716 646322 564035 55780790 53846307 X 129528195 131167469 10065 10040 129538260 131177509 185319050 185023816 X 2203291 -361582 -202461 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20141 20141 0 PART II-B, LINE 1: A PORTION OF MEMBERSHIP DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE ALABAMA HOSPITAL ASSOCIATION (ALAHA) IS ALLOCATED TO LOBBYING ACTIVITIES PERFORMED FOR THE BENEFIT OF THOSE ORGANIZATIONS' MEMBER BODIES. IN 2013, 25.83% OF DUES TO THE AHA ($7,440) AND 23.65% OF DUES PAID TO THE ALAHA ($12,701) WERE ALLOCATED TO LOBBYING EFFORTS. 10065 -25 10040 10100 -35 10065 10160 -60 10100 10200 -40 10160 10212 -12 10200 1.00000 0 0 4015957 4015957 86112039 62566695 23545344 16451 8190 8261 174326852 139292662 35034190 4213647 3156972 1056675 63660427 OTHER ASSETS 10040 INTEREST RATE SWAP DEFERRED CHARGE 503922 INTEREST RECEIVABLE 3270 DUE FROM AFFILIATES 15484421 THIRD PARTY SETTLEMENTS 6561325 22562978 PROFESSIONAL LIABILITY SELF INSURANCE 512035 WORKER'S COMPENSATION LIABILITY 52000 564035 X 155791357 -361582 2437434 2075852 153715505 32806063 32806063 186521568 153949648 2437434 2437434 151512214 32806063 32806063 184318277 PART V, LINE 4: THE KNOX ENDOWMENT WAS ESTABLISHED IN THE 1940'S BY THE KNOX FAMILY TO PROVIDE MATERNITY CARE FOR INDIGENT HOSPITAL PATIENTS. INVESTMENT EARNINGS ON THE FUND ARE PUT TOWARDS INDIGENT MATERNITY PATIENTS ANNUALLY. THE HOSPITAL HAS DISCRETION TO USE THE FUNDS FOR MEDICAL EXPENSES BESIDES MATERNITY CARE IF NECESSARY. PART X, LINE 2: THE BOARD IS A POLITICAL SUBDIVISION AND THE AFFILIATE IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN 501(C)(3) OF THE INTERNAL REVENUE CODE; THEREFORE, NO PROVISION HAS BEEN RECORDED FOR INCOME TAXES FOR THESE ENTITIES. THE FILING ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2014 AND 2013. FISCAL YEARS ENDED ON OR AFTER JUNE 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES, GENERALLY FOR THREE YEARS AFTER THE RELATED TAX RETURNS WERE FILED. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE NET W/ REVENUES 2,437,434. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 32,801,063. GRANT EXPENSE IN REVENUES 5,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE NET W/ REVENUES 2,437,434. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 32,801,063. GRANT EXPENSE IN REVENUES 5,000. 1 1 1 X 1 X 1 1 1 0 1 1 6669057 6669057 0.03620 15067121 12387780 2679341 0.01450 21736178 12387780 9348398 0.05070 13545965 8394292 5151673 0.02790 59080 59080 0.00030 13605045 8394292 5210753 0.02820 35341223 20782072 14559151 0.07890 0 6465794 56618434 55519221 1099213 X 1 1 1 1 NORTHEAST ALABAMA REGIONAL MEDICAL CTR 400 EAST 10TH STREET ANNISTON AL 36207 X X X NORTHEAST ALABAMA REGIONAL MEDICAL CTR 1 1 X X X X X X X X X 12 1 0 1 X HTTP://WWW.RMCCARES.ORG/IMAGES/RMCA_CHNA_ X X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X X X 1 0 1 X 0 0 NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 3: RMC'S CHNA TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH. THE INTERVIEW PROCESS TOOK INTO ACCOUNT INPUT FROM PERSONS, BASED ON RECOMMENDATIONS FROM THE HOSPITAL'S MANAGEMENT TEAM, WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL INCLUDING HOSPITAL MANAGEMENT, HOSPITAL BOARD, HOSPITAL MEDICAL STAFF / COMMUNITY PHYSICIANS, LOCAL AGENCIES AND PROVIDERS, AND COMMUNITY LEADERS. COLLECTIVELY, THE COMMUNITY MEMBERS SURVEYED REPRESENT HUNDREDS OF YEARS OF LIVING EXPERIENCE IN THE PRIMARY SERVICE AREA OF THE HOSPITAL AND THEREFORE PROVIDE HIGH PROBABILITY THAT RESPONDENTS KNOW AND UNDERSTAND THE COMMUNITY DYNAMICS AND ISSUES OF THE PRIMARY SERVICE AREA. NORTHEAST ALABAMA REGIONAL MEDICAL CTR PART V, SECTION B, LINE 20D: THE ORGANIZATION CHARGES A % DISCOUNT OFF OF BILLED CHARGES BASED ON A SLIDING SCALE THAT IS TIED TO THE FEDERAL POVERTY GUIDELINES. THE ORGANIZATION PLANS TO MODIFY ITS EXISTING POLICY TO BETTER MEET THE REQUIREMENTS OF SECTION 501(R) AFTER IT HAS BEEN FINALIZED. 1 NORTHEAST AL REGIONAL MED CENTER PSYCH U 400 EAST 10TH STREET ANNISTON AL 36202 INPATIENT PSYCH UNIT PART I, LINE 3C: OUR ORGANIZATION PROVIDES A 30% DISCOUNT TO THE BILL FOR ALL SELF PAY (UNINSURED) PATIENTS. THIS ADJUSTMENT IS APPLIED TO THE BILL PRIOR TO STATEMENTS BEING MAILED TO THE PATIENT OR GUARANTOR. WE ALSO RETAIN ON A CONTRACTED BASIS VENDORS THAT ASSIST IN SCREENING PATIENTS FOR QUALIFICATION FOR FREE OR CHARITY CARE. THIS IS ACCOMPLISHED BY MEANS OF INTERVIEWS WITH THE PATIENT AS PART OF OUR NORMAL COLLECTION PROCESS. PART I, LN 7 COL(F): FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSE IN LINE 7, COLUMN (F), A BAD DEBT EXPENSE OF $32,801,063 HAS BEEN ADJUSTED FROM TOTAL EXPENSES PRESENTED ON FORM 990, PART XI, LINE 25. PART III, LINE 4: BAD DEBT EXPENSE AT COST WAS CALCULATED BY MULTIPLYING TOTAL BAD DEBT EXPENSE BY THE HOSPITAL'S COST TO CHARGE RATIO. THE COST TO CHARGE RATIO WAS CALCULATED USING WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS BY DIVIDING TOTAL OPERATING COSTS INTO TOTAL CHARGES. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE WAS DERIVED FROM THE MEDICARE COST REPORT. PART III, LINE 9B: THE CHARITY POLICY DOES NOT SPECIFICALLY ADDRESS COLLECTION PRACTICES. HOWEVER, ONCE A PERSON IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ALL COLLECTION ACTIVITY STOPS DUE TO THE FACT THAT THE ACCOUNTS ARE ADJUSTED TO A ZERO BALANCE. FOR THE INSTANCES WHERE THE PATIENT QUALIFIES FOR PARTIAL FINANCIAL ASSISTANCE, THE ACCOUNTS ARE ADJUSTED TO THE APPROPRIATE BALANCE AND THEN FOLLOW THE NORMAL COLLECITON SCHEDULES ESTABLISHED BY THE OUTSOURCED COLLECITON AGENCIES. PART VI, LINE 2: OUR ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF OUR COMMUNITY IN SEVERAL WAYS, WHICH INCLUDES THE COMPLETION OF A COMMUNITY HEALTH NEEDS ASSESEMENT ONCE EVERY THREE YEARS (WITH THE MOST RECENT ASSESSMENT COMPLETED IN DECEMBER 2012), AND THE COMPLETION OF AN ANNUAL UPDATE OF OUR MEDICAL STAFF DEVELOPMENT PLAN. THERE ARE SEVERAL COMPONENTS TO THIS PLAN, INCLUDING THE OVERALL POPULATION WITHIN OUR SERVICE AREA, THE AGE OF THE CURRENT MEMBERS OF OUR MEDICAL STAFF, AND PROJECTED PHYSICIAN NEEDS USING CALCULATIONS PROVIDED BY THE AMERICAN MEDICAL ASSOCIATION'S PHYSICIAN CHARACTERISTICS AND DISTRIBUTION IN THE U.S. PART VI, LINE 3: ALL PATIENT BILLS INCLUDE A STATEMENT THAT CHARITY CARE IS AVAILABLE TO QUALIFYING INDIVIDUALS, ALONG WITH INFORMATION ON HOW TO CONTACT PERSONNEL AT THE HOSPITAL IF THE PATIENT IS INTERESTED IN DETERMINING IF THEY QUALIFY FOR FINANCIAL ASSISTANCE. SIGNS ARE ALSO POSTED IN ALL REGISTRATION AREAS, AND INFORMATION ON OUR FINANCIAL ASSISTANCE POLICY IS ALSO PROVIDED ON THE HOSPITAL'S WEBSITE. PART VI, LINE 4: OUR SERVICE AREA IS COMPRISED OF APPROXIMATELY 200,000 PEOPLE RESIDING IN THE COUNTIES OF CALHOUN, CLEBURNE, CLAY, RANDOLPH AND TALLADEGA. ALL AGE GROUPS FROM NEWBORNS TO THE ELDERLY ARE SERVED. SERVICES INCLUDE MEDICAL/SURGICAL, INTENSIVE CARE, OBSTETRICS, PEDIATRICS, PSYCHIATRIC, CARDIOLOGY AND ONCOLOGY. ALL CITIZENS ARE SERVED REGARDLESS OF PAYER OR ABILITY TO PAY. WHILE RMC IS THE ONLY FULL SERVICE HOSPITAL IN THE SERVICE AREA, SMALLER HOSPITALS IN CALHOUN COUNTY INCLUDE STRINGFELLOW HOSPITAL AND JACKSONVILLE HOSPITAL. OTHER HOSPITALS IN OUR 5 COUNTY SERVICE AREA INCLUDE WEDOWEE HOSPITAL, CLAY COUNTY HOSPITAL IN CLAY COUNTY, AND CITIZENS HOSPITAL AND COOSA VALLEY MEDICAL CENTER IN TALLADEGA COUNTY. CLEBURNE AND RANDOLPH COUNTIES ARE CONSIDERED FEDERALLY DESIGNATED MEDICALLY UNDERSERVED FOR PRIMARY CARE, AND ALL COUNTIES ARE CONSIDERED UNDERSERVED FOR SPECIALTY PHYSICIANS. THE AREA ALSO QUALIFIES AS UNDERSERVED FOR PSYCHIATRIC SERVICES BY THE NATIONAL HEALTH SERVICE CORPS. PART VI, LINE 5: REGIONAL MEDICAL CENTER PROMOTES HEALTH WITHIN THE COMMUNITY WE SERVE IN A VARIETY OF WAYS. AS A NONPROFIT, WE PROVIDE SERVICES FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, AND WE SEE A VERY HIGH NUMBER OF UNINSURED, UNDERINSURED AND INDIGENT PATIENTS IN OUR EMERGENCY DEPARTMENT. WE ASSIST THE MEMBERS OF OUR MEDICAL STAFF IN RECRUITING NEW PHYSICIANS TO THE AREA. AS PART OF OUR ASSISTANCE PROGRAM, RECRUITED PHYSICIANS MUST AGREE TO SEE ALL PATIENTS, REGARDLESS OF INCOME LEVEL OR ABILITY TO PAY. RMC PROVIDES MANY COMMUNITY SERVICES IN THE FORM OF HEALTH EDUCATION, SCREENINGS AND SUPPORT GROUPS. OUR CANCER RESOURCE CENTER, PARISH NURSING PROGRAM, AND CONGREGATIONAL HEALTH OUTREACH ARE BUT A FEW OF OUR SERVICES TO OUR COMMUNITY THAT PROVIDE HIGHLY SKILLED STAFF TO PERFORM HEALTH SCREENINGS AND EDUCATION FREE OF CHARGE.A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE MEDICAL CENTER. THE ORGANIZATION OFFERS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED LOCAL PHYSICIANS IN ALL HOSPITAL DEPARTMENTS.THE FACILITY UTILIZES SURPLUS FUNDS PRIMARILY TO PURCHASE NEW AND REPLACEMENT MEDICAL EQUIPMENT AND TO PERFORM NEEDED RENOVATIONS ON ITS PLANT. OTHER USES OF SURPLUS FUNDS MIGHT INVOLVE FUNDING EDUCATIONAL OPPORTUNITIES FOR CLINICAL STAFF AND WHEN ALLOWED, MEMBERS OF ITS MEDICAL STAFF. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES AL 1 EAST ALABAMA EMERGENCY MEDICAL SERVICES PO BOX 700 LINCOLN AL 35096 630707345 501(C)(3) 21500 GENERAL ACTIVITY SPONSORSHIP NORTHEAST ALABAMA BICYCLE CLUB PO BOX 2414 ANNISTON AL 36202 300634903 501(C)(3) 5000 GENERAL ACTIVITY SPONSORSHIP MEDICAL CENTER MEMORIAL FOUNDATION PO BOX 2208 ANNISTON AL 36202 630981593 501(C)(3) 5000 GENERAL ACTIVITY SPONSORSHIP 3 MEDICATION/MEDICAL SUPPLIES 89 35742 TRANSPORTATION 18 494 AMBULANCE TRANSPORTS 6 1838 FOOD 7 41 SCHOLARSHIP AWARDS 37 227194 PART I, LINE 2: THE ORGANIZATION HAS WRITTEN GUIDELINES FOR ORGANIZATIONS TO APPLY FOR COMMUNITY CONTRIBUTIONS (GRANTS). A DETAILED APPLICATION MUST BE COMPLETED AND APPROVED BY THE REVIEW COMMITTEE OF THE BOARD. A COPY OF THE APPLICATION IS AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINSITRATIVE OFFICE. X X X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 J DAVID MCCORMACK CEO 275000 0 2115 0 12785 0 12750 0 15636 0 318286 0 0 0 LOUIS BASS CFO 190608 0 1531 0 8960 0 16616 0 15572 0 233287 0 0 0 JOSEPH WEAVER COO 177900 0 1423 0 12965 0 9500 0 15655 0 217443 0 0 0 MASUMI YAMAMURO HIGHEST COMPENSATED EMPLOY 501250 0 0 0 0 0 22000 0 3033 0 526283 0 0 0 TERRY M PHILLIS JR HIGHEST COMPENSATED EMPLOY 580184 0 130601 0 0 0 16992 0 3033 0 730810 0 0 0 BARRY J BILLINGS HIGHEST COMPENSATED EMPLOY 540184 0 156122 0 0 0 16992 0 3033 0 716331 0 0 0 BERTHA SANCHEZ-VALDIVIESO HIGHEST COMPENSATED EMPLOY 246455 0 14500 0 0 0 0 0 1129 0 262084 0 0 0 ANOUAR BAKIR HIGHEST COMPENSATED EMPLOY 264184 0 24000 0 0 0 0 0 3033 0 291217 0 0 0 PART I, LINE 1A ALL TRAVEL EXPENSES FOR SPOUSES AND COMPANIONS, AS WELL AS TEMPORARY HOUSING ALLOWANCES PER EMPLOYMENT AGREEMENTS, ARE ADDED AS WAGES ON THE RECIPIENTS' FORM W-2 OR 1099-MISC. RACHEL CALDWELL FAMILY MEMBER OF CORPORATE OFFICER 53151 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 JOHN FITE FAMILY MEMBER OF BOARD MEMBER 21315 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 MELANIE GRIZZARD FAMILY MEMBER OF BOARD MEMBER 64821 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPRISED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE SECRETARY OF THE BOARD, THE FINANCE COMMITTEE CHAIRPERSON, THE HUMAN RESOURCES COMMITTEE CHAIRPERSON, THE PHYSICAL FACILITIES AND PROPERTIES COMMITTEE CHAIRPERSON, THE COMPLIANCE COMMITTEE CHAIRPERSON, THE CHIEF OF THE MEDICAL STAFF, AND ONE AT-LARGE BOARD MEMBER. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION, EXCEPT AS SUCH AUTHORITY IS LIMITED OR RESERVED BY STATUTE OR IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE THOSE DULY APPOINTED UNDER THE PROVISIONS OF ORDINANCE NO. 74-0-13 ADOPTED BY THE COUNCIL OF THE CITY OF ANNISTON, AL, ON MAY 7, 1974. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD IS RESTRICTED FROM THE SALE OR DISPOSAL OF ANY PART OF THE REAL ESTATE USED IN CONNECTION WITH THE OPERATION OF THE MEDICAL CENTER OR THE TRANSFER OF THE OPERATION AND MANAGEMENT OF THE MEDICAL CENTER WITHOUT THE CONSENT OF THE GOVERNING BODY OF THE CITY OF ANNISTON, AL. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED INTERNALLY BY MANAGEMENT, AND FORWARDED TO THE MEMBERS OF THE BOARD OF DIRECTORS. AFTER THE RETURN WAS REVIEWED BY THE BOARD MEMBERS, IT WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO DISCLOSE ON AN ANNUAL BASIS ANY POTENTIAL CONFLICTS OF INTEREST PER THE ORGANIZATION'S OFFICIAL WRITTEN POLICY. A DISINTERESTED PARTY IS ASSIGNED TO INVESTIGATE ANY CONFLICTS THAT ARISE, AND AFFECTED BOARD MEMBERS ARE ADVISED OF THE PARTY'S DECISION. FORM 990, PART VI, SECTION B, LINE 15A THE CEO COMPENSATION PACKAGES ARE DETERMINED BY CONDUCTING SALARY SURVEYS FROM INDIVIDUAL HOSPITALS AS WELL AS UTILIZING SALARY INFORMATION AVAILABLE FROM INDEPENDENT SOURCES SUCH AS STATE HOSPITAL ASSOCIATIONS, INDEPENDENT COMPENSATION CONSULTANTS, AND PERIODICALS. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OVERSEES THE PROCESS AND DETERMINES THE COMPENSATION FOR THE CEO AFTER REVIEW AND CONSIDERATION OF ALL RELEVANT INFORMATION. THE CEO APPROVES COMPENSATION PACKAGES FOR ALL OTHER APPLICABLE EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 1023 AND 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 ONLINE 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 XI, LINE 9: REMOVAL OF BOND ISSUANCE COSTS DUE TO GASB 65 -202,461. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MEDICAL CENTER MEMORIAL FOUNDATION INC PO BOX 2208 ANNISTON AL 36202 630981593 EXEMPT ORG SUPPORT AL 501(C)(3) LINE 7 N/A 0 REGIONAL HEALTH SERVICES INC PO BOX 2208 ANNISTON AL 36202 630721572 EXEMPT ORG SUPPORT AL 501(C)(3) LINE 11A, I REGIONAL MEDICAL CENTER BOARD 1 REGIONAL HEALTH MANAGEMENT CORPORATION PO BOX 2345 ANNISTON AL 36202 630819576 MANAGEMENT AL N/A C 0 QHG OF JACKSONVILLE INC PO BOX 2208 ANNISTON AL 36202 621637909 HEALTHCARE AL REGIONAL MEDICAL CENTER BOARD C 22762479 11090623 1.00000 1 1 1 1 1 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 REGIONAL HEALTH SERVICES A 32355 CASH AND A/R REGIONAL HEALTH SERVICES D 729600 QHG OF JACKSONVILLE INC R 3444963