2014-05-14T13:10:18-05:00 2013-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-07-01 636000090 REGIONAL MEDICAL CENTER BOARD REGI 2562355255 PO BOX 2208 ANNISTON AL 36202 LOUIS A BASS 2562355255 2014-05-14 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z NORTHEAST ALABAMA REGIONAL MEDICAL CTR J DAVID MCCORMACK PO BOX 2208 ANNISTON AL 36202 167352970 0 X WWW.RMCCARES.ORG X 1974 AL TO PROVIDE PERSONALIZED HEALTHCARE TO CITIZENS OF NORTHEAST ALABAMA 14 11 1717 220 221805 94557 35681 53298 164095203 162047970 2870121 2583966 192945 115407 167193950 164800641 266194 291436 0 0 68224069 67919126 0 0 0 98127205 97617642 166617468 165828204 576482 -1027563 185655664 185319050 53216654 55780790 132439010 129538260 X THE BOARD'S PRIMARY MISSION IS TO PROVIDE ADVANCED HEALTH CARE OF THE HIGHEST QUALITY, WITH COMPASSION AND INTEGRITY, TO EVERY PATIENT. 0 0 154375662 291436 161826165 DURING THE YEAR ENDED JUNE 30, 2013, NORTHEAST ALABAMA REGIONAL MEDICAL CENTER HAD 12,187 ADULT AND PEDIATRIC INPATIENT ADMISSIONS, 1,336 NEWBORN ADMISSIONS AND SERVED PATIENTS THROUGH AMBULATORY CARE INCLUDING: 3,565 OBSERVATION PATIENTS, 41,799 EMERGENCY DEPARTMENT PATIENTS, 54,463 REFERRED OUTPATIENTS, 4,041 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. 154375662 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 1 446 0 1 1717 1 1 1 0 0 0 0 0 0 0 0 0 X 14 11 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 1.00 X X 415 0 0 SANDRA FOX SUDDUTH 1.00 X X 65 0 0 JAMES E ROBERTS 1.00 X X 115 0 0 JIMMIE THOMPSON 1.00 X 0 0 0 JOHN E BLUE II 1.00 X 254 0 0 FRED WILSON 1.00 X 500 0 0 LARRY K DEASON 1.00 X 0 0 0 ARTHUR F FITE III 1.00 X 0 0 0 BILLY DON GRIZZARD 1.00 X 0 0 0 TRUDY D HARDEGREE 1.00 X 0 0 0 W E WILLIAMS 1.00 X 0 0 0 MICHAEL W KIMBERLY DRPH MPH HCLD 1.00 X 50 0 0 JEFFREY A PARKER 1.00 X 30 0 0 ROHIT G PATEL MD 1.00 X 18000 0 0 EDDYER L BROWN 1.00 X 326 0 0 JAMES S HIXON MD 1.00 X 0 0 0 JEFFREY COLLINS MD 1.00 X 0 0 0 J DAVID MCCORMACK 40.00 X 307494 0 27260 LOUIS BASS 40.00 X 164038 0 35413 JOSEPH WEAVER 40.00 X 194016 0 24735 RONALD J VARCAK 40.00 X 203923 0 5327 TERRY M PHILLIS JR 40.00 X 650072 0 2883 BARRY J BILLINGS 40.00 X 569951 0 2958 AYMAN ABDUL-GHANI 40.00 X 293826 0 2162 ANOUAR BAKIR 40.00 X 272205 0 2829 2675280 0 103567 35 0 1 0 ANESTHESIA SOLUTIONS OF ANNISTON 2901 2ND AVENUE SUITE 270 BIRMINGHAM AL 35233 CRNA SERVICES 2643058 MORRISONS HEALTH CARE DIVISION PO BOX 102289 ATLANTA GA 303682289 MANAGEMENT OF FOOD SERVICE 1548479 EMERGENCY ROOM SERVICES OF ANNISTON LLC PO BOX 3477 OXFORD AL 36203 ER PHYSICIAN SERVICES 604904 MEDMANAGEMENT LLC 1500 URBAN CENTER DR STE 325 VESTAVIA HILLS AL 35242 PHYSICIAN ADVISORY SERVICES 506649 COASTAL EXTRACORPOREAL TECH INC PO BOX 11407 DEPT 1614 BIRMINGHAM AL 35246 PERFUSION SERVICES 496347 29 1000 6840 45458 53298 NET PATIENT SERVICE 621400 155988829 155988829 MEDICAID DISP SHARE 900099 3492359 3492359 MEDICAID EHR PAYMENT 900099 915218 915218 PHARMACY REVENUE 900099 857815 857815 LONG TERM CARE HOSPITAL 621400 453745 453745 340004 118199 221805 162047970 2592847 2592847 1725150 9824 2501771 0 -776621 9824 -766797 -766797 41677 50558 -8881 -8881 -8881 FOOD SERVICE & VENDING 722210 703372 703372 OTHER INCOME 900099 153104 153104 GIFT SHOP REVENUE 453220 25728 25728 882204 164800641 161826165 221805 2699373 85452 85452 205984 205984 752956 250985 501971 133012 133012 53845916 49599846 4246070 3422059 3125277 296782 5765887 5265834 500053 3999296 3652453 346843 457460 457460 59320 59320 158188 158188 15070434 12951420 2119014 1067900 432040 635860 2333064 1026166 1306898 2867395 2867395 13175 10865 2310 201597 154630 46967 1336639 1336639 12094198 12094198 1944569 1944569 MEDICAL SUPPLIES 36623476 36623476 BAD DEBT 21242152 21242152 FOOD SERVICE EXPENSES 1278032 1278032 RECRUITMENT 707689 707689 162354 95237 67117 165828204 154375662 11452542 0 354144 320543 9315182 1293586 14787536 17544235 1547679 2015714 5464696 5316012 1859219 1540691 263345399 192557629 73836713 70787770 71565664 66081433 9006269 164000 164000 6760831 11248797 185655664 185319050 12473821 14946190 1770560 881786 35769716 39306492 3202557 646322 53216654 55780790 X 132428910 129528195 10100 10065 132439010 129538260 185655664 185319050 -1027563 -1873089 -98 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 40000 0 1 19320 59320 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 2012, 23.98% OF DUES TO THE AHA ($7,575) AND 26.63% OF DUES PAID TO THE ALAHA ($11,745) WERE ALLOCATED TO LOBBYING EFFORTS. IN ADDITION, THE ORGANIZATION PAID THE LAW FIRM OF GLASSCOX J. STANTON, LLC $40,000 DURING THE TAX YEAR FOR ASSISTANCE IN EXPLORING OPTIONS RELATED TO RECLASSIFICATION FOR MEDICARE WAGE INDEX. 10100 -35 10065 10160 -60 10100 10200 -40 10160 10212 -12 10200 10000 212 10212 0.00000 1.00000 0.00000 0 0 4015957 4015957 85647950 59989122 25658828 16451 5041 11410 169195628 129521921 39673707 4469413 3041545 1427868 70787770 UNAMORTIZED DEBT ISSUE COSTS 202461 OTHER ASSETS 10065 INTEREST RATE SWAP DEFERRED CHARGE 258013 INTEREST RECEIVABLE 3270 DUE FROM AFFILIATES 8920071 THIRD PARTY SETTLEMENTS 1854917 11248797 PROFESSIONAL LIABILITY SELF INSURANCE 565322 WORKER'S COMPENSATION LIABILITY 81000 646322 X 143470846 -1873089 -1873089 145343935 19456706 19456706 164800641 146371498 0 146371498 19456706 19456706 165828204 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013 AND 2012. FISCAL YEARS ENDED ON OR AFTER JUNE 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES, GENERALLY FOR THREE YEARS AFTER THE RELATED TAX RETURNS WERE FILED. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 21,242,152. INCOME NET W/ EXPENSES 716,325. RENTAL EXPENSE NET W/ REVENUES -2,501,771. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBTS NET W/ REVENUES 21,242,152. INCOME NET W/ EXPENSES 716,325. RENTAL EXPENSE NET W/ REVENUES -2,501,771. 1 1 1 X 1 X 1 1 1 0 1 1 6282982 6282982 0.04350 16224464 16156048 68416 0.00050 22507446 16156048 6351398 0.04400 15500 15500 0.00010 8152068 6641382 1510686 0.01040 85452 85452 0.00060 8253020 6641382 1611638 0.01110 30760466 22797430 7963036 0.05510 6 3509 4403 4403 0.00000 1 242 2729 2729 0.00000 7 3751 7132 7132 0 3566157 52953117 51196688 1756429 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 1 0 1 X 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 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, L7 COL(F): FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT AS A PERCENTAGE OF TOTAL EXPENSE IN LINE 7, COLUMN (F), A BAD DEBT EXPENSE OF $21,242,152 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. 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. PART VI, LINE 2: OUR ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IN SEVERAL WAYS, WHICH INCLUDES AN ANNUAL UPDATE OF THE MEDICAL STAFF DEVELOPMENT PLAN. THERE ARE SEVERAL COMPONENTS TO THIS PLAN, INCLUDING THE OVERALL POPULATION WITHIN OUR SERVICE AREA, THE AGE OF OUR CURRENT MEDICAL STAFF, AND PROJECTED PHYSICIAN NEEDS USING CALCULATIONS PROVIDED BY THE AMERICAN MEDICAL ASSOCIATION'S PHYSICIAN CHARACTERISTICS AND DISTRIBUTION IN THE US. 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 PRIVILEDGES TO ALL QUALIFIED LOCAL PHYSICIANS IN ALL HOSPITAL DEPARTMENTS.THE FACILTITY 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. REPORTS FILED WITH STATES PART VI, LINE 7 AL 1 EAST ALABAMA EMERGENCY MEDICAL SERVICES PO BOX 700 LINCOLN AL 35096 630707345 501(C)(3) 16500 GENERAL ACTIVITY SPONSORSHIP 1 0 MEDICATION/MEDICAL SUPPLIES 60 25455 TRANSPORTATION 122 3600 AMBULANCE TRANSPORTS 3 313 INFANT CAR SEATS 1 35 FOOD 69 302 MISCELLANEOUS 2 75 CLOTHING 1 348 SCHOLARSHIP LOANS/AWARDS 35 175856 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 307494 0 0 0 0 0 7500 0 19760 0 334754 0 0 0 LOUIS BASS 164038 0 0 0 0 0 16616 0 18797 0 199451 0 0 0 JOSEPH WEAVER 194016 0 0 0 0 0 5820 0 18915 0 218751 0 0 0 RONALD J VARCAK 171027 0 530 0 32366 0 0 0 5327 0 209250 0 0 0 TERRY M PHILLIS JR 543405 0 72500 0 34167 0 0 0 2883 0 652955 0 0 0 BARRY J BILLINGS 463345 0 72500 0 34106 0 0 0 2958 0 572909 0 0 0 AYMAN ABDUL-GHANI 293483 0 0 0 343 0 0 0 2162 0 295988 0 0 0 ANOUAR BAKIR 255432 0 16700 0 73 0 0 0 2829 0 275034 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 54568 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 JOHN FITE FAMILY MEMBER OF BOARD MEMBER 20541 COMPENSATION AS EMPLOYEE OF HOSPITAL 0 MELANIE GRIZZARD FAMILY MEMBER OF BOARD MEMBER 57903 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 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 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 1321700 QHG OF JACKSONVILLE INC R 961423