2015-05-19T14:54:16-05:00 2014-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2013-10-01 560529974 CHARLES A CANNON JR MEMORIAL HOSPITAL INC CHAR 8282624119 434 HOSPITAL DRIVE LINVILLE NC 28646 KEVIN B MAY CFO 8282624119 2015-05-19 AMY BIBBY P00445891 8282542254 2013 2016-02-25 16:41:14Z KEVIN B MAY 434 HOSPITAL DRIVE LINVILLE NC 28646 21791178 0 X WWW.APPRHS.ORG X 1957 NC TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE. 15 11 0 78 0 0 642397 977405 21189610 20261110 5835 96648 300459 360672 22138301 21695835 0 0 0 0 13352629 13220762 0 0 0 8887694 9231951 22240323 22452713 -102022 -756878 27668729 33166674 10165298 16894053 17503431 16272621 TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE. 0 0 17212314 20563942 CHARLES A. CANNON, JR. MEMORIAL HOSPITAL IN LINVILLE IS A 25-BED ACUTE CARE HOSPITAL WITH A 10-BED INPATIENT BEHAVIORAL HEALTH UNIT. THE FULL-SERVICE EMERGENCY DEPARTMENT, IMAGING DEPARTMENT, LABORATORY, NEW LIFE CENTER, OUTPATIENT BEHAVIORAL HEALTH, REHABILITATION CENTER OFFERING PHYSICAL AND OCCUPATIONAL THERAPIES, SLEEP CENTER, AND CARDIOPULMONARY REHABILITATION ROUND OUT THE LIST OF SERVICES. 17212314 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 11 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN B MAY 8282624100 336 DEERFIELD ROAD BOONE NC 28607 PAUL MILLER JR TRUSTEE 1.00 X 0 0 0 JOHN BLACKBURN BOARD VICE CHAIR 1.00 X X 0 0 0 JOE MILLER TRUSTEE 1.00 X 0 0 0 SUSAN ROGGENKAMP TRUSTEE 1.00 X 0 0 0 KENNETH WILCOX PAST CHAIR 1.00 X 0 0 0 KEITH TESTER BOARD CHAIR 1.00 X X 0 0 0 SAM ADAMS TRUSTEE 1.00 X 0 0 0 CHARLES BAKER MD TRUSTEE 1.00 40.00 X 0 244153 12116 JACK HOWARD TRUSTEE 1.00 X 0 0 0 PATTIE TENNILLE TRUSTEE 1.00 X 0 0 0 JAN WINKLER TRUSTEE 1.00 X 0 0 0 KIM MILLER TRUSTEE 1.00 X 0 0 0 NATHAN MILLER COUNTY COMMISSION REPRESENTATIVE 1.00 X 0 0 0 MARK MURREY MD TRUSTEE 1.00 X 0 8700 0 THOMAS DALE TRUSTEE 1.00 X 0 0 0 RICHARD SPARKS CEO ARHS 1.00 40.00 X 0 461195 168690 KEVIN MAY CFO ARHS 1.00 40.00 X 0 277512 27450 CHARLES MANTOOTH CEO CMH 40.00 X 0 237823 31828 CARMEN LACEY PRESIDENT, CMH 40.00 X 0 116110 22022 0 1345493 262106 0 0 1 0 0 977405 977405 PATIENT SERVICE REVENUE 621990 24433620 24433620 PROVISION FOR BAD DEBT 621990 -4172510 -4172510 20261110 6541 6541 212725 0 212725 212725 212725 185450 95343 90107 90107 90107 CAFETERIA REVENUE 900099 78573 78573 MISCELLANEOUS REVENUE 900099 69374 69374 147947 21695835 20563942 0 154488 X 10136794 8664371 1472423 2425453 2073141 352312 658515 624132 34383 2602134 2266791 335343 874 874 455935 449858 6077 764171 196464 567707 24422 24200 222 2233 2233 273352 273352 1504695 628543 876152 166819 166819 DRUGS & MEDICAL SUPPLIE 1594064 1594064 CORP. ALLOCATIONS 1127910 1127910 EQUIPMENT RENTAL AND MA 432440 290397 142043 MINOR EQUIPMENT 95681 95681 187221 134746 52475 22452713 17212314 5240399 0 1205553 5300492 5487423 6662114 502536 543235 72762 85394 38597090 20433362 17464582 18163728 2935873 2411711 27668729 33166674 306622 395392 7434575 7114345 2424101 9384316 10165298 16894053 X 16593616 15362806 909815 909815 17503431 16272621 27668729 33166674 X -756878 -473932 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1220002 1220002 22086854 10242709 11844145 4253151 2087361 2165790 11037083 8103292 2933791 18163728 AUWIL 366908 INTEREST IN ARHF 2044803 2411711 DUE TO AFFILIATE 10164099 ESTIMATED THIRD-PARTY SETTLEMENTS -1240783 MISCELLANEOUS 461000 9384316 X PART X, LINE 2: ARHS AND THE COMPANIES FOR WHICH IT SERVES AS SOLE MEMBER ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS. THE SYSTEM HAS DETERMINED IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2014. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2011, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. 1 1 1 X 1 X 1 1 1 0 1 1 355428 355428 0.01580 3073095 1573249 1499846 0.06680 3428523 1573249 1855274 0.08260 24753 24753 0.00110 956934 776262 180672 0.00800 24779 24779 0.00110 1006466 776262 230204 0.01020 4434989 2349511 2085478 0.09280 1 1721151 86058 11395480 11395480 X 1 1 1 APPALACHIAN REGIONAL HEALTHCARE SYSTEM SOLE MEMBER OF CHARLES A. CANNON JR., MEMORIAL HOSPITAL, INC. 1.00000 1 1 CHARLES A CANNON JR MEMORIAL HOSPITAL 434 HOSPITAL DRIVE LINVILLE NC 28646 X X X X CHARLES A CANNON JR MEMORIAL HOSPITAL 1 1 X X X X X X X X 12 1 0 1 X SEE SUPPLEMENTAL INFORMATION X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X 1 1 X X X X 1 0 1 X 0 0 CHARLES A CANNON JR MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: THE TASK FORCE INVOLVED CONSISTED OF PUBLIC HEALTH OFFICIALS, HOSPITAL STAFF, APPALACHIAN STATE UNIVERSITY, AND MENTAL HEALTH AND YOUTH ADVOCATES FOR THE COUNTY. COUNTY RESIDENTS WERE INFORMED OF THE ASSESSMENT THROUGH RADIO PUBLIC SERVICE ANNOUNCEMENTS, ADVERTISEMENTS ON AGENCY WEBSITES, AND WORD OF MOUTH. THE SURVEY WAS AVAILABLE ONLINE THROUGH SURVEY MONKEY, AND AT DESIGNATED COMMUNITY AGENCIES INCLUDING COUNTY HEALTH DEPARTMENTS, CHILDCARE CENTERS, COMMUNITY HEALTH CLINICS, AND OTHER HUMAN SERVICE AGENCIES. TELEPHONE INTERVIEWS WERE ALSO UTILIZED SURVEY RESPONDENTS REPRESENTED VARIOUS AGENCIES AND ORGANIZATIONS IN THE COMMUNITY. CHARLES A CANNON JR MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: INCLUDED IN THE ADMISSION PACKET THAT PATIENTS RECEIVE. PATIENT FINANCIAL ADVOCATE AT THE HOSPITALS VISIT SELF-PAY PATIENTS AND MAKE THEM AWARE OF AVAILABLE FINANCIAL ASSISTANCE. CHARLES A CANNON JR MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: AVERAGE OF ALL COMMERCIAL PAYERS. SCH H, PART V, SECTION B, LINE 5A HTTPS://APPRHS.ORG/IMAGES/STORIES/ADMIN/CHNA_9.2013.PDF PART III, LINE 2: FOR PURPOSES OF THE COMMUNITY BENEFIT CALCULATION, BAD DEBT EXPENSE PER THE FINANCIAL STATEMENTS WAS GROSSED UP USING A NET REALIZED REVENUE PERCENTAGE AND THEN APPLIED AGAINST A COST TO CHARGE RATIO. PART III, LINE 3: WE ESTIMATE 5% OF CHARITY COSTS FAIRLY ESTIMATE AMOUNTS INCLUDED AS BAD DEBT THAT WOULD BE ELIGIBLE FOR CHARITY CARE BUT FAILED TO APPLY. PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENT'S EVALUATION OF THE ACCOUNTS RECEIVABLE. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE. PART III, LINE 9B: CHARITY WRITE-OFFS ARE SEGREGATED FROM NORMAL BAD DEBTS THROUGH A SEPARATE TRANSACTION CODE. FAMILY INCOME BELOW 175% OF FPG ARE ELIGIBLE FOR 100% WRITE-OFF. PARTIAL WRITE-OFF IS AVAILABLE BETWEEN FAMILY INCOME BETWEEN 200% AND 300% OF FPG. 0 0 0 0 0 0 0 0 0 CHARLES BAKER MD TRUSTEE 0 239413 0 0 0 4740 0 0 0 12116 0 256269 0 0 RICHARD SPARKS CEO ARHS 0 358873 0 100000 0 2322 0 162340 0 6350 0 629885 0 0 KEVIN MAY CFO ARHS 0 265190 0 10000 0 2322 0 21390 0 6060 0 304962 0 0 CHARLES MANTOOTH CEO CMH 0 237107 0 0 0 716 0 19905 0 11923 0 269651 0 0 FORM 990, PART VI, SECTION A, LINE 3 PARENT COMPANY, APPALACHIAN REGIONAL HEALTH CARE SYSTEM (ARHS) OVERSEES CMH OPERATIONS. ALSO NOTE THAT SALARIES AND OTHER COMMON EXPENSES INCURRED BY ARHS ARE ALLOCATED APPROPRIATELY TO CMH. PAYMENTS TO VENDORS ARE PAID THROUGH ARHS AND ALL 1099S ARE ISSUED THROUGH ARHS. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL MAY BE NEEDED BY THE PARENT COMPANY, APPALACHIAN REGIONAL HEALTH CARE SYSTEM. FORM 990, PART VI, SECTION B, LINE 11 THE SVP/CFO AND THE VICE PRESIDENT OF FINANCE REVIEW THE 990 AND THEN IT IS MADE AVAILABLE TO THE BOARD UPON COMPLETION. FORM 990, PART VI, SECTION B, LINE 12C REVIEW OF POLICY STATEMENT EACH YEAR. FORM 990, PART VI, SECTION B, LINE 15 INDEPENDENT COMPENSATION AND BENEFIT ANALYSIS WAS PERFORMED BY HLF REWARDS CONSULTING IN APRIL 2013. THE EXECUTIVE COMMITTEE (COMPENSATION COMMITTEE) REVIEWED THIS INFORMATION TO ESTABLISH APPROPRIATENESS OF TOTAL COMPENSATION, COMPLY WITH INTERMEDIATE SANCTION REGULATIONS, AND DETERMINE EXCUTIVE COMPENSATION FOR CEO, COO, AND CFO POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 PROVIDED UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 609,821. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 609,821. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 1,656,970. MANAGEMENT AND GENERAL EXPENSES 335,343. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,992,313. FORM 990, PART XI, LINE 9: TRANSFERS FROM AFFILIATE -473,932. FORM 990, PART XI, LINE 2C THE PROCESS OF FINANCIAL STATEMENT REVIEW AND OVERSIGHT HAS NOT CHANGED FROM THE PRIOR YEAR. APPALACHIAN REGIONAL HEALTHCARE SYSTEM PO BOX 2600 BOONE NC 28607 201067022 PARENT COMPANY NC 501(C)(3) 11C 0 BLOWING ROCK HOSPITAL INC PO BOX 148 BLOWING ROCK NC 28605 560513181 POST ACUTE CARE AND REHABILITATION CENTER NC 501(C)(3) 3 0 WATAUGA MEDICAL CENTER INC 336 DEERFIELD RD BOONE NC 28607 560510824 HOSPITAL NC 501(C)(3) 3 0 APPALACHIAN REGIONAL HEALTHCARE FOUNDATION 336 DEERFIELD RD BOONE NC 28607 204625618 PHILANTHROPIC ORGANIZATION FOR THE SYSTEM NC 501(C)(3) 7 0 APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC PO BOX 2600 BOONE NC 28607 205755130 EMPLOYMENT ALTERNATIVE TO BOTH NEW AND ESTABLISHED PHYSICIAN PRACTICES NC 501(C)(3) 9 0 ARHS PROPERTIES INC 336 DEERFIELD RD BOONE NC 28607 203470765 HOLD FUTURE PURCHASE OF NON-PROFIT LAND ACQUISITIONS NC 501(C)(3) 9 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 0