2014-05-05T11:29:06-05:00 2013-09-30 560747981 DIXON HUGHES GOODMAN LLP 111 FRANKLIN RD SE SUITE 501 ROANOKE VA 240112114 990 2012-10-01 560529974 CHARLES A CANNON JR MEMORIAL HOSPITAL INC CHAR 8282624119 434 HOSPITAL DRIVE LINVILLE NC 28646 KEVIN B MAY 8282624119 2014-02-12 1 MICHAEL P NORTON P00430694 5409896144 2014-02-12 2012 2015-11-30 17:44:51Z KEVIN B MAY 434 HOSPITAL DRIVE LINVILLE NC 28646 22138301 0 X WWW.APPRHS.ORG X 1957 NC TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE. 14 14 0 90 0 0 325060 642397 20178161 21189610 -49397 5835 208420 300459 20662244 22138301 0 0 0 0 13425732 13352629 0 0 0 8844684 8887694 22270416 22240323 -1608172 -102022 27703569 27668729 10432375 10165298 17271194 17503431 TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE. 0 0 17520137 21490758 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. 17520137 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 14 14 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 1.00 X 0 0 0 JOHN BLACKBURN 1.00 X 0 0 0 JOE MILLER 1.00 X 0 0 0 SUSAN ROGGENKAMP 1.00 X 0 0 0 KENNETH WILCOX 1.00 X 0 0 0 KEITH TESTER 1.00 X 0 0 0 SAM ADAMS 1.00 X 0 0 0 CHARLES BAKER MD 1.00 X 0 0 0 JACK HOWARD 1.00 X 0 0 0 PATTIE TENNILLE 1.00 X 0 0 0 JAN WINKLER 1.00 X 0 0 0 KIM MILLER 1.00 X 0 0 0 NATHAN MILLER 1.00 X 0 0 0 MARK MURREY MD 1.00 X 0 0 0 RICHARD SPARKS 1.00 40.00 X 0 352223 130722 KEVIN MAY 1.00 40.00 X 0 265470 20035 CHARLES MANTOOTH 40.00 X 0 219303 19578 CARMEN LACEY 40.00 X 0 100125 15113 0 937121 185448 0 0 1 0 0 642397 642397 PROG.SERV.REVENUE-RELATED-990 900099 21101564 21101564 CAFETERIA REVENUE 900099 88046 88046 21189610 5146 5146 195750 0 195750 195750 195750 689 0 689 689 689 MISCELLANEOUS REVENUE 900099 104709 104709 104709 22138301 21490758 0 5146 X 10555373 9042913 1512460 2105417 2105417 691839 658488 33351 1890 1890 2505457 2204921 300536 630 630 1949792 1943141 6651 726036 195493 530543 32681 30733 1948 3179 3179 286692 286692 1333860 553269 780591 123118 123118 CORP. ALLOCATIONS 1046419 1046419 EQUIPMENT RENTAL AND MA 302278 302278 EQUIPMENT RENTAL AND MA 157191 157191 MISCELLANEOUS 152011 152011 266460 204546 61914 22240323 17520137 4720186 0 2075884 1205553 806066 0 3670818 5487423 563427 502536 171283 72762 36886174 19421592 16927927 17464582 3488164 2935873 27703569 27668729 396918 306622 7146251 7434575 2889206 2424101 10432375 10165298 X 16361379 16593616 909815 909815 17271194 17503431 27703569 27668729 X -102022 334259 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1220002 1220002 22562332 9879790 12682542 3299922 1858415 1441507 9803918 7683387 2120531 17464582 AUWIL 366685 INTEREST IN ARHF 2518736 OWNERSHIP EQUITY-OTHER 11089 CONSTRUCTION IN PROGRESS 39363 2935873 DUE TO AFFILIATE 2557101 ESTIMATED THIRD-PARTY SETTLEMENTS -623000 MISCELLANEOUS 490000 2424101 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. 1 1 1 X 175.000000000000 1 X 1 1 1 0 1 1 547325 547325 0.02460 2521821 1191448 1330373 0.05980 3069146 1191448 1877698 0.08440 37399 37399 0.00170 22187 22187 0.00100 31332 31332 0.00140 90918 90918 0.00410 3160064 1191448 1968616 0.08850 1 1686762 84338 12152673 12152673 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 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 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.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 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 175% AND 250% OF FPG. 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. 0 0 0 0 0 0 0 0 0 RICHARD SPARKS 0 341401 0 0 0 10822 0 124372 0 6350 0 482945 0 0 KEVIN MAY 0 257759 0 0 0 7711 0 13975 0 6060 0 285505 0 0 CHARLES MANTOOTH 0 213574 0 0 0 5729 0 11087 0 8491 0 238881 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. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 532,602. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 532,602. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 1,672,319. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,672,319. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 300,536. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 300,536. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFERS FROM AFFILIATE 334,259. 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 HOSPITAL 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 0 0 0 1 0 0 0 0 0 0 APPALACHIAN REGIONAL HEALTHCARE FOUNDATION C 642397 ACTUAL