2014-11-14T08:11:40-06:00 2013-12-31 990 2013-01-01 560928089 FORSYTH MEMORIAL HOSPITAL FORS 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT EVP & CFO 3367182803 2014-11-13 2013 2015-11-30 17:44:51Z NOVANT HEALTH FORSYTH MEDICAL CENTER DENISE MIHAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 1075713502 0 X WWW.NOVANTHEALTH.ORG X 1968 NC SEE SCHEDULE O 18 16 7747 920 407537 94513 3227743 2469354 994150186 1004595686 302022 465186 66353407 67719651 1064033358 1075249877 174071 639957 0 0 442325759 444745702 0 0 0 515637285 550050833 958137115 995436492 105896243 79813385 988511859 1060812977 49625408 54559584 938886451 1006253393 X SEE SCHEDULE O 0 0 799468388 639957 1064712615 FORSYTH MEMORIAL HOSPITAL, INC. (FMH), KERNERSVILLE MEDICAL CENTER (KMC), AND CLEMMONS MEDICAL CENTER (CMC) CARRY OUT THE PURPOSE OF THE FORSYTH COUNTY BOARD OF COMMISSIONERS BY ADVANCING AND SUPPORTING THE PROMOTION OF THE HEALTH OF THE INHABITANTS OF FORSYTH COUNTY AND THE KERNERSVILLE AREA OF NC. FMH, KMC, AND CMC MAINTAIN AN OPEN DOOR POLICY, ACCEPTING ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. FMH HAS 921 LICENSED BEDS. DURING 2013 THERE WERE 22,478 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 6 DAYS, AN AVERAGE DAILY CENSUS OF 616, AND 40,535 DISCHARGES. THERE WERE 25,157 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 1,011,042 OUTPATIENT ENCOUNTERS AND 91,575 EMERGENCY DEPARTMENT VISITS. (CONTINUED ON SCHEDULE O) 799468388 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 1 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 4 0 1 7747 1 1 1 0 0 0 0 1 1 0 0 0 0 X 18 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X KAREN DAUGHERTY 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 X EDWARDS JOEL TRUSTEE 2.00 X 508633 0 123402 MCNEIL-MILLER KAREN TRUSTEE 2.00 X 0 1015 0 SIGAL BARRY TRUSTEE 2.00 X 0 5436 0 BAREFOOT SAMUEL TRUSTEE 2.00 X 0 0 0 CARROLL JOE TRUSTEE 2.00 X 0 0 0 EARNHARDT HAROLD TRUSTEE 2.00 X 0 0 0 ELY JOSEPH VICE CHAIR 2.00 X X 0 0 0 FORIEST BRYANT TRUSTEE 2.00 X 0 0 0 GREEN GARY SEC/TREAS 2.00 X X 0 0 0 HAULSEE HADA DE VARONA CHAIR 2.00 X X 0 0 0 HAUSER CHARLES TRUSTEE 2.00 X 0 0 0 HICKMAN TOMMY TRUSTEE 2.00 X 0 0 0 JOHNSON JOIA TRUSTEE 2.00 X 0 0 0 LAMBE CLARENCE TRUSTEE 2.00 X 0 0 0 POLLARD III HAROLD TRUSTEE 2.00 X 0 0 0 POLONSKY SHERRY TRUSTEE 2.00 X 0 0 0 REAVES DONALD TRUSTEE 2.00 X 0 0 0 WOLFE III JOHN TRUSTEE 2.00 X 0 0 0 LINDSAY JEFFERY PRES FMCCOO WS MKT (*SEE ADD'L INFO IN SCH J P3) 60.00 X 2880561 0 75721 MCGEE LAWRENCE ASST SEC (*SEE ADD'L INFO IN SCH J P3) 2.00 X 0 1280041 180634 MORRIS JOHN ASST SEC 2.00 X 0 323127 75001 ALLEN JOANNE PRESIDENT NHKMC 60.00 X 243716 0 115482 LARSON KIP VP & SR MED DIR SPECIALTY SERV 60.00 X 547190 0 66513 LEWIS LINDA VP NURSING 60.00 X 205994 0 29552 MIHAL DENISE SVP WS MKT COO (*SEE ADD'L INFO IN SCH J P3) 60.00 X 1655123 0 72930 WALLEY BRUCE SVP MEDICAL AFFAIRS 60.00 X 613981 0 61346 CHEN FRANKLIN ONCOLOGIST 40.00 X 717726 0 87977 CHRYSSON NICK ONCOLOGIST 40.00 X 945036 0 99729 GROTE THOMAS ONCOLOGIST 40.00 X 925026 0 74805 HINES SUSAN ONCOLOGIST 40.00 X 721190 0 88437 PASCHOLD EUGENE ONCOLOGIST 40.00 X 787430 0 89189 ALLEN ELMS FMR SVP MAJOR GIFTS 0.00 X 105717 0 28126 HAMMES PAUL FMR SVO & COO FMC 0.00 X 374068 0 23925 11231391 1609619 1292769 372 1 1 0 CROTHALL HEALTH CARE INC 955 CHESTERBROOK BLVD STE 300 WAYNE PA 19087 FACILITY SERVICES 10249716 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 9473985 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 8894470 NURSEFINDERS INC PO BOX 910738 DALLAS TX 75391 STAFFING 6855679 SALEM CHEST SPECIALISTS 3001 LYNDHURST AVE WINSTONSALEM NC 27103 HEALTH SERVICES 4565597 75 2227734 241620 9993 2469354 NET PATIENT REVENUE 622110 1004595686 1004595686 1004595686 719522 719522 2598729 0 2598729 2598729 2598729 209289 463625 -254336 -254336 -254336 PHARMACY 446110 52066181 51659255 406926 MISCELLANEOUS REVENUE 621999 7259321 7259321 CAFETERIA MEALS 722514 3243826 3243826 2551594 1198353 611 1352630 65120922 1075249877 1064712615 407537 7660371 559314 559314 80643 80643 7200145 7200145 531836 531836 345271920 321517212 23754708 18982754 17676741 1306013 49776918 46352266 3424652 22982129 21400959 1581170 2551639 2551639 90590 90590 3174 3174 82497342 66267894 16229448 2716161 2529289 186872 5757180 5361086 396094 9007931 8388185 619746 28332397 26383128 1949269 986061 918220 67841 351991 327774 24217 14669275 13659997 1009278 22608724 21053244 1555480 2032630 1892785 139845 CORPORATE ALLOCATION 131533468 131533468 UBI TAXES 37881 37881 MEDICAL SUPPLIES 94691371 94691371 DRUGS 90484872 90484872 61698146 59923408 1774738 995436492 799468388 195968104 0 2937802 2589293 116770799 111373192 211460 87500 2686015 7887194 15877650 18536721 1306979 957274 431232380 255070330 145819696 176162050 31015047 31015047 671886411 712204706 988511859 1060812977 43830247 52210666 177878 162314 5617283 2186604 49625408 54559584 X 938886451 1006253393 938886451 1006253393 988511859 1060812977 X 79813385 -12446443 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 143403 143403 0 PART II-B, LINE 1I, LOBBYING ACTIVITIES: DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 4082278 4082278 100637282 9100389 91536893 8772389 5902743 2869646 291395801 229258920 62136881 26344630 10808278 15536352 176162050 DUE FROM AFFILIATE 712204040 STATE INCOME TAX RECEIVABLE 666 712204706 386 CAPITAL LEASE PAYABLE 105001 THIRD PARTY PAYMENT ADJUSTMENTS 2081217 2186604 X PART X, LINE 2: PART X, LINE 2: LIABILITY UNDER FIN 48 (ASC 740) FOOTNOTE THE AUDIT FOR NOVANT HEALTH AND ITS AFFILIATES IS PREPARED ON A CONSOLIDATED BASIS. THE COMPANY WAS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS. THIS EVALUATION INCLUDES A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF OUR FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S STATEMENT OF OPERATIONS FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012. 1 1 X 1 X 300.000000000000 0 0 1 1 0 1 1 38715314 0 38715314 0.04030 121589838 112690394 8899444 0.00930 8922098 6038632 2883466 0.00300 169227250 118729026 50498224 0.05260 677303 45449 631854 0.00070 7693996 875181 6818815 0.00710 42863137 29252750 13610387 0.01420 1871612 1236404 635208 0.00070 495802 0 495802 0.00050 53601850 31409784 22192066 0.02320 222829100 150138810 72690290 0.07580 0 0 0 0.00000 62947 0 62947 0.00010 72426 0 72426 0.00010 0 0 0 0.00000 577 0 577 0.00000 1540 0 1540 0.00000 447 0 447 0.00000 418945 0 418945 0.00040 0 0 0 0.00000 556882 0 556882 0.00060 1 35902559 0 185321784 194682672 -9360888 X 1 0 3 1 FMH DBA NH FORSYTH MEDICAL CENTER 3333 SILAS CREEK PARKWAY WINSTON SALEM NC 27103 WWW.NOVANTHEALTH.ORG H0209 X X X 2 FMH DBA NH KERNERSVILLE MEDICAL CENTER 1750 KERNERSVILLE MEDICAL PARKWAY KERNERSVILLE NC 27284 WWW.NOVANTHEALTH.ORG H0209 X X X 3 FMH DBA NH CLEMMONS MEDICAL CENTER 6915 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012 WWW.NOVANTHEALTH.ORG H0209 X X NOVANT HEALTH FORSYTH MEDICAL CENTER 1 1 X X X X X X 13 1 0 1 X WWW.NOVANTHEALTH.ORG X X X X 0 0 1 1 300.000000000000 0 0 1 1 X X X X X X 1 0 X X X X 1 X 0 0 NOVANT HEALTH KERNERSVILLE MEDICAL CENTE 2 1 X X X X X X 13 1 0 1 X WWW.NOVANTHEALTH.ORG X X X X 0 0 1 1 300.000000000000 0 0 1 1 X X X X X X 1 0 X X X X 1 X 0 0 NOVANT HEALTH CLEMMONS MEDICAL CENTER 3 1 X X X X X X 13 1 0 1 X WWW.NOVANTHEALTH.ORG X X X X 0 0 1 1 300.000000000000 0 0 1 1 X X X X X X 1 0 X X X X 1 X 0 0 NOVANT HEALTH FORSYTH MEDICAL CENTER PART V, SECTION B, LINE 3: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY(IES) SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, CHURCHES, COLLEGES/UNIVERSITIES, COMMUNITY COALITIONS AND OTHER SOCIAL SERVICE AGENCIES. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. THE ORGANIZATION IS A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. WHERE POSSIBLE, WE HAVE LEVERAGED THE RESOURCES OF THE ORGANIZATION TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 3: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY(IES) SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, CHURCHES, COLLEGES/UNIVERSITIES, COMMUNITY COALITIONS AND OTHER SOCIAL SERVICE AGENCIES. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. THE ORGANIZATION IS A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. WHERE POSSIBLE, WE HAVE LEVERAGED THE RESOURCES OF THE ORGANIZATION TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. NOVANT HEALTH CLEMMONS MEDICAL CENTER PART V, SECTION B, LINE 3: WHILE CONDUCTING THE CHNA, THE HOSPITAL FACILITY(IES) SOLICITED INPUT FROM, AND CONSULTED WITH, A VARIETY OF COMMUNITY REPRESENTATIVES INCLUDING, BUT NOT LIMITED TO, REPRESENTATIVES OF CITY AND COUNTY GOVERNMENT INCLUDING HEALTH DEPARTMENTS, COMMUNITY-BASED ORGANIZATIONS, FOUNDATIONS, CHURCHES, COLLEGES/UNIVERSITIES, COMMUNITY COALITIONS AND OTHER SOCIAL SERVICE AGENCIES. THE SCOPE OF EXPERTISE WAS BROAD AND INCLUDED SUCH AREAS AS PUBLIC HEALTH, MINORITY POPULATIONS, HEALTH DISPARITIES, AND SOCIAL SERVICES. THE ORGANIZATION IS A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. WHERE POSSIBLE, WE HAVE LEVERAGED THE RESOURCES OF THE ORGANIZATION TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. NOVANT HEALTH FORSYTH MEDICAL CENTER PART V, SECTION B, LINE 7: THE HOSPITAL FACILITY(IES) IS/ARE A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE CHNA RESOURCE GROUP AND SUBSEQUENTLY BY THE ORGANIZATION'S BOARD AND THE NOVANT HEALTH EXECUTIVE TEAM. THEY EVALUATED EACH DOCUMENTED NEED AND ITS INTERSECTION WITH THE ORGANIZATION'S VISION, COMMITMENTS, AND KEY STRENGTHS BEFORE FURTHER PRIORITIZING THE HEALTH NEEDS AND AGREEING UPON THE TOP HEALTH PRIORITIES TO BE ADDRESSED. WHERE POSSIBLE, WE HAVE LEVERAGED THE SYSTEM'S STRENGTHS AND RESOURCES TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. NOVANT HEALTH AND EACH OF ITS HOSPITAL FACILITIES ARE WORKING DILIGENTLY TO ADDRESS EACH OF THE IDENTIFIED AREAS OF NEED THROUGH RESOURCE ALLOCATION AND SUPPORT. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. IT WAS DETERMINED THAT THERE ARE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE; REFER TO LINE 5B FOR THE URL. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 7: THE HOSPITAL FACILITY(IES) IS/ARE A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE CHNA RESOURCE GROUP AND SUBSEQUENTLY BY THE ORGANIZATION'S BOARD AND THE NOVANT HEALTH EXECUTIVE TEAM. THEY EVALUATED EACH DOCUMENTED NEED AND ITS INTERSECTION WITH THE ORGANIZATION'S VISION, COMMITMENTS, AND KEY STRENGTHS BEFORE FURTHER PRIORITIZING THE HEALTH NEEDS AND AGREEING UPON THE TOP HEALTH PRIORITIES TO BE ADDRESSED. WHERE POSSIBLE, WE HAVE LEVERAGED THE SYSTEM'S STRENGTHS AND RESOURCES TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. NOVANT HEALTH AND EACH OF ITS HOSPITAL FACILITIES ARE WORKING DILIGENTLY TO ADDRESS EACH OF THE IDENTIFIED AREAS OF NEED THROUGH RESOURCE ALLOCATION AND SUPPORT. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. IT WAS DETERMINED THAT THERE ARE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE; REFER TO LINE 5B FOR THE URL. NOVANT HEALTH CLEMMONS MEDICAL CENTER PART V, SECTION B, LINE 7: THE HOSPITAL FACILITY(IES) IS/ARE A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS SUCH, NOVANT HEALTH INCLUDES MULTIPLE HOSPITAL FACILITIES AND HAS ENGAGED IN CHNAS FOR ALL OF THE COMMUNITIES BEING SERVED. THE FACILITY'S CHNA IDENTIFIED MULTIPLE NEEDS FOR THE COMMUNITY SERVED. THE NEEDS IDENTIFIED WERE REVIEWED AND PRIORITIZED BY THE CHNA RESOURCE GROUP AND SUBSEQUENTLY BY THE ORGANIZATION'S BOARD AND THE NOVANT HEALTH EXECUTIVE TEAM. THEY EVALUATED EACH DOCUMENTED NEED AND ITS INTERSECTION WITH THE ORGANIZATION'S VISION, COMMITMENTS, AND KEY STRENGTHS BEFORE FURTHER PRIORITIZING THE HEALTH NEEDS AND AGREEING UPON THE TOP HEALTH PRIORITIES TO BE ADDRESSED. WHERE POSSIBLE, WE HAVE LEVERAGED THE SYSTEM'S STRENGTHS AND RESOURCES TO BEST ADDRESS THOSE NEEDS THAT ARE HIGHEST IN PRIORITY AND CONSISTENT ACROSS COMMUNITIES. NOVANT HEALTH AND EACH OF ITS HOSPITAL FACILITIES ARE WORKING DILIGENTLY TO ADDRESS EACH OF THE IDENTIFIED AREAS OF NEED THROUGH RESOURCE ALLOCATION AND SUPPORT. CERTAIN NEEDS THAT WERE IDENTIFIED BY THE CHNA HAVE NOT BEEN ADDRESSED. IT WAS DETERMINED THAT THERE ARE OTHER RESOURCES IN THE COMMUNITY THAT CAN MORE APPROPRIATELY ADDRESS THESE NEEDS BASED ON SCOPE OF SERVICES AND SKILL SET. FOR MORE DETAILED INFORMATION, REFER TO THE PUBLICLY AVAILABLE IMPLEMENTATION PLAN AVAILABLE ON THE WEBSITE; REFER TO LINE 5B FOR THE URL. NOVANT HEALTH FORSYTH MEDICAL CENTER PART V, SECTION B, LINE 11: ALL UNINSURED PATIENTS RECEIVE A STANDARD DISCOUNT REGARDLESS OF THEIR ABILITY TO PAY. THIS DISCOUNT MIRRORS OUR AVERAGE MANAGED CARE RATE. PATIENTS BELOW 300% OF THE FEDERAL POVERTY GUIDELINES ARE DISCOUNTED AT 100%. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 11: ALL UNINSURED PATIENTS RECEIVE A STANDARD DISCOUNT REGARDLESS OF THEIR ABILITY TO PAY. THIS DISCOUNT MIRRORS OUR AVERAGE MANAGED CARE RATE. PATIENTS BELOW 300% OF THE FEDERAL POVERTY GUIDELINES ARE DISCOUNTED AT 100%. NOVANT HEALTH CLEMMONS MEDICAL CENTER PART V, SECTION B, LINE 11: ALL UNINSURED PATIENTS RECEIVE A STANDARD DISCOUNT REGARDLESS OF THEIR ABILITY TO PAY. THIS DISCOUNT MIRRORS OUR AVERAGE MANAGED CARE RATE. PATIENTS BELOW 300% OF THE FEDERAL POVERTY GUIDELINES ARE DISCOUNTED AT 100%. NOVANT HEALTH FORSYTH MEDICAL CENTER PART V, SECTION B, LINE 20D: ALL FINANCIAL ASSISTANCE POLICY (FAP) ELIGIBLE PATIENTS RECEIVE 100% FREE CARE AND THEREFORE DO NOT RECEIVE BILLS ONCE FAP ELIGIBILITY HAS BEEN ESTABLISHED. ALL PATIENTS DO RECEIVE INFORMATIONAL STATEMENTS WHICH INCLUDE TOTAL CHARGES LESS ANY NON-FINANCIAL ASSISTANCE POLICY ADJUSTMENTS. NOVANT HEALTH KERNERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 20D: ALL FINANCIAL ASSISTANCE POLICY (FAP) ELIGIBLE PATIENTS RECEIVE 100% FREE CARE AND THEREFORE DO NOT RECEIVE BILLS ONCE FAP ELIGIBILITY HAS BEEN ESTABLISHED. ALL PATIENTS DO RECEIVE INFORMATIONAL STATEMENTS WHICH INCLUDE TOTAL CHARGES LESS ANY NON-FINANCIAL ASSISTANCE POLICY ADJUSTMENTS. NOVANT HEALTH CLEMMONS MEDICAL CENTER PART V, SECTION B, LINE 20D: ALL FINANCIAL ASSISTANCE POLICY (FAP) ELIGIBLE PATIENTS RECEIVE 100% FREE CARE AND THEREFORE DO NOT RECEIVE BILLS ONCE FAP ELIGIBILITY HAS BEEN ESTABLISHED. ALL PATIENTS DO RECEIVE INFORMATIONAL STATEMENTS WHICH INCLUDE TOTAL CHARGES LESS ANY NON-FINANCIAL ASSISTANCE POLICY ADJUSTMENTS. 53 NH ARCADIA FAMILY MEDICINE 12208 HWY 150 NORTH WINSTONSALEM NC 27127 PHYSICIAN CLINIC NH BREAST CENTER 2025 FRONTIS PLAZA BLVD STE 119300 WINSTONSALEM NC 27103 IMAGING CENTER NH CHAIR CITY FAMILY PRACTICE 903 RANDOLPH STREET THOMASVILLE NC 27360 PHYSICIAN CLINIC NH CLEMMONS FAMILY MEDICINE 6301 STADIUM DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC NH DAVIE MEDICAL ASSOCIATES 485 VALLEY ROAD MOCKSVILLE NC 27028 PHYSICIAN CLINIC NH FORSYTH ENDOCRINE CONSULTANTS 755 HIGHLAND OAKS DRIVE SUITE 201 WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH FORSYTH FAMILY MEDICINE 400 JONESTOWN RD WINSTONSALEM NC 27104 PHYSICIAN CLINIC NH FORSYTH INTERNAL MEDICINE 1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH FORSYTH NEUROLOGY 2025 FRONTIS PLAZA BLVD SUITE 120 WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH GATEWAY FAMILY MEDICINE 390 SALEM AVENUE WINSTONSALEM NC 27101 PHYSICIAN CLINIC NH HILLSDALE MEDICAL ASSOCIATES 121 MEDICAL DRIVE ADVANCE NC 27006 PHYSICIAN CLINIC NH IMAGING KERNERSVILLE 445 PINEVIEW DRIVE SUITE 100 KERNERSVILLE NC 27284 IMAGING CENTER NH IMAGING MAPLEWOOD 3155 MAPLEWOOD AVENUE WINSTONSALEM NC 27103 IMAGING CENTER NH IMAGING WINSTON-SALEM HEALTHCA 250 CHARLOIS BOULEVARD WINSTONSALEM NC 27103 IMAGING CENTER NH INFECTIOUS DISEASE SPECIALISTS 1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH KERNERSVILLE FAMILY MEDICINE 291 BROAD STREET KERNERSVILLE NC 27284 PHYSICIAN CLINIC NH KERNERSVILLE INTERNAL MEDICINE 445 PINEVIEW DRIVE SUITE 240 KERNERSVILLE NC 27284 PHYSICIAN CLINIC NH LEWISVILLE FAMILY MEDICINE 1225 LEWISVILLE-CLEMMONS ROAD LEWISVILLE NC 27023 PHYSICIAN CLINIC NH LEXINGTON PRIMARY CARE 110 WEST MEDICAL PARK DRIVE LEXINGTON NC 27292 PHYSICIAN CLINIC NH MAPLEWOOD FAMILY MEDICINE ROBINHOOD MEDICAL PLAZA BLDG 100 WINSTONSALEM NC 27106 PHYSICIAN CLINIC NH MOUNTAINVIEW MEDICAL 216 MOORE ROAD KING NC 27021 PHYSICIAN CLINIC NH NEW GARDEN MEDICAL ASSOCIATES 1941 NEW GARDEN ROAD SUITE 216 GREENSBORO NC 27410 PHYSICIAN CLINIC NH NORTH POINT MEDICAL ASSOCIATES 1995 BETHABARA ROAD WINSTONSALEM NC 27106 PHYSICIAN CLINIC NH NORTHWEST FAMILY MEDICINE 7607 NC HIGHWAY 68 N STE B OAK RIDGE NC 27310 PHYSICIAN CLINIC NH ONCOLOGY SPECIALISTS 276 OLD MOCKSVILLE ROAD STATESVILLE NC 28625 PHYSICIAN CLINIC NH ONCOLOGY SPECIALISTS 865 WESTLAKE DRIVE SUITE 200 MOUNT AIRY NC 27030 PHYSICIAN CLINIC NH ONCOLOGY SPECIALISTS 1010 BETHESDA COURT WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH ONCOLOGY SPECIALISTS 1370 PIEDMONT DRIVE SUITE 202 LEXINGTON NC 27295 PHYSICIAN CLINIC NH ONCOLOGY SPECIALISTS 1710 KERNERSVILLE MEDICAL PLZ STE 116 KERNERSVILLE NC 27284 PHYSICIAN CLINIC NH PHARMACY 105 VEST MILL CIRCLE WINSTONSALEM NC 27103 PHARMACY NH PHARMACY 212 MOORE ROAD KING NC 27021 PHARMACY NH PHARMACY 291 BROAD STREET KERNERSVILLE NC 27284 PHARMACY NH PHARMACY 100 ROBINHOOD MEDICAL PLAZA WINSTONSALEM NC 27106 PHARMACY NH PHARMACY 1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103 PHARMACY NH PHARMACY 1010 BETHESDA COURT WINSTONSALEM NC 27103 PHARMACY NH PHARMACY 255 CHARLOIS BLVD WINSTONSALEM NC 27103 PHARMACY NH PILOT MOUNTAIN MEDICAL CARE 207 MEDICAL STREET PILOT MOUNTAIN NC 27041 PHYSICIAN CLINIC NH PINEVIEW FAMILY MEDICINE 500 PINEVIEW DRIVE SUITE 101 KERNERSVILLE NC 27284 PHYSICIAN CLINIC NH PREMIER MEDICAL ASSOCIATES 3333 BROOKVIEW HILLS BLVD ST 203/204 WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH RHEUMATOLOGY AND ARTHRITIS 1995 BETHABARA ROAD WINSTONSALEM NC 27106 PHYSICIAN CLINIC NH SALEM FAMILY MEDICINE 105 VEST MILL CIRCLE WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH SURRY MEDICAL ASSOCIATES 865 WESTLAKE DRIVE MOUNT AIRY NC 27030 PHYSICIAN CLINIC NH THOMASVILLE MEDICAL ASSOCIATES 309 PINEYWOOD ROAD THOMASVILLE NC 27360 PHYSICIAN CLINIC NH TRIAD ENDOCRINE 500 PINEVIEW DRIVE SUITE 101 KERNERSVILLE NC 27284 PHYSICIAN CLINIC NH UROLOGY PARTNERS 2010 BALDWIN LANE WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH UROLOGY PARTNERS 1710 KERNERSVILLE MEDICAL PKY STE 201 KERNERSVILLE NC 27284 PHYSICIAN CLINIC NH WEST FORSYTH INTERNAL MED & PED 105 STADIUM OAKS DRIVE CLEMMONS NC 27012 PHYSICIAN CLINIC NH WINSTON-SALEM CARDIOLOGY 186 KIMEL PARK DR WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH WINSTON-SALEM CARDIOLOGY 1710 KERNERSVILLE MEDICAL PKY STE 205 KERNERSVILLE NC 27284 PHYSICIAN CLINIC NH WINSTON-SALEM CARDIOLOGY 5175 OLD CLEMMONS SCHOOL RD CLEMMONS NC 27012 PHYSICIAN CLINIC NH WINSTON-SALEM HEALTH CARE 250 CHARLOIS BOULEVARD WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH WINSTON-SALEM HEALTH CARE 175 KIMEL PARK DRIVE WINSTONSALEM NC 27103 PHYSICIAN CLINIC NH YADKIN MEDICAL ASSOCIATES 305 EAST LEE AVENUE YADKINVILLE NC 27055 PHYSICIAN CLINIC PART I, LINE 6A: THE ORGANIZATION IS A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. THE COMMUNITY BENEFIT REPORT IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. IS THE NOVANT HEALTH PARENT COMPANY AND PRODUCES A COMMUNITY BENEFIT REPORT REPRESENTING THE HEALTH SYSTEM AS A WHOLE. THE REPORT CAN BE FOUND AT HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL -PROFILE/COMMUNITY-BENEFIT-REPORT.ASPX. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART I, LINE 7: COSTS REPORTED IN THE TABLE FOR CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (CCR). PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $35,902,559. PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION IS A PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. NOVANT HEALTH'S COMMUNITY BUILDING ACTIVITIES IMPACTS THE HEALTH OF OUR COMMUNITY THROUGH PARTNERSHIPS WITH LOCAL AGENCIES DEDICATED TO IMPROVING THE LIVES OF ALL INDIVIDUALS. OUTREACH INCLUDES PROVIDING SUPPORT FOR ORGANIZATIONS SUCH AS HABITAT FOR HUMANITY AND LOCAL CHAMBERS OF COMMERCE, ASSISTING WITH COMMUNITY/COUNTY COALITIONS, PROVIDING EDUCATIONAL SEMINARS AND TRAINING FOR COMMUNITY WORKFORCES, AND SUPPORTING COMMUNITY AGENCIES SUCH AS ROTARY, LIONS CLUBS AND MORE. THROUGH EACH OF THESE PARTNER AGENCIES, NOVANT HEALTH ADDRESSES THE UNDERLYING ISSUES IMPACTING THE HEALTH OF OUR COMMUNITIES AND ENSURES THAT OUR COMMUNITIES GROW FOR YEARS TO COME. PART III, LINE 2: THE ALLOWANCE FOR BAD DEBT IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, THE AGE OF THE ACCOUNTS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS. PART III, LINE 4: BAD DEBT EXPENSE ONLY REPRESENTS ACCOUNTS FOR WHICH COLLECTION EFFORTS HAVE BEEN MADE BUT NO PAYMENTS HAVE BEEN RECEIVED. DISCOUNTS ARE RECORDED AS EITHER CONTRACTUALS (FOR PATIENTS WHO DO NOT QUALIFY FOR CHARITY) OR AS CHARITY (FOR PATIENTS WHO DO QUALIFY FOR CHARITY). THE TEXT OF THE NOVANT HEALTH, INC. CONSOLIDATED FINANCIAL STATEMENTS READS: "THE ALLOWANCE FOR BAD DEBTS IS DETERMINED BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, BUSINESS AND ECONOMIC CONDITIONS, THE AGE OF THE ACCOUNTS, TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE AND OTHER COLLECTION INDICATORS." PART III, LINE 8: THE METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6 IS DETERMINED BY FOLLOWING THE MEDICARE PRINCIPLES OF ALLOWABLE COSTS. COST FOR THE OVERHEAD DEPARTMENTS ARE STEPPED DOWN TO THE REMAINING COST CENTERS BASED ON STATISTICS FOR EACH OVERHEAD COST CENTER. ONCE THE STEP-DOWN PROCESS IS COMPLETE, A RATIO OF COST TO CHARGES IS DEVELOPED FOR EACH COST CENTER. THE CCR IS THEN APPLIED TO THE MEDICARE REVENUE BY COST CENTER AND TOTALED.IT SHOULD BE NOTED THAT THE MEDICARE COST REPORTS DO NOT ADDRESS ANY MANAGED CARE MEDICARE REVENUES, COSTS, OR RELATED SHORTFALL. THE TOTAL REVENUES REPORTED AS RECEIVED FROM MEDICARE IN LINE 5 OF SECTION B ARE ONLY REPRESENTATIVE OF MEDICARE FEE FOR SERVICE PAYMENTS RECEIVED. THE ALLOWABLE COSTS ON LINE 6 ARE SIGNIFICANTLY LOWER THAN THE ACTUAL EXPENDITURES. AS SUCH, THE SHORTFALL IS UNDERESTIMATED.EVERY HOSPITAL TREATS MEDICARE PATIENTS. SOME HOSPITALS ARE LOCATED IN HIGH MEDICARE POPULATION AREAS; OTHERS PROVIDE SERVICES DISPROPORTIONATELY USED BY MEDICARE PATIENTS. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THIS SERVICE THESE PATIENTS WOULD BECOME AN OBLIGATION ON THE GOVERNMENT. ANY UNREIMBURSED COSTS OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY DOES EXPLAIN ACTIONS AGAINST PATIENTS WHO HAVE OUTSTANDING DELINQUENT AMOUNTS, BUT THE POLICY DOES NOT CONTAIN PROVISIONS FOR COLLECTION PRACTICES AGAINST PATIENTS WHO ARE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY (FAP) BECAUSE FAP ELIGIBLE PATIENTS RECEIVE 100% FREE CARE AND THEREFORE DO NOT RECEIVE BILLS ONCE FAP ELIGIBILITY HAS BEEN ESTABLISHED. PART VI, LINE 2: PART VI, LINE 2: NEEDS ASSESSMENTTHE ORGANIZATION IS PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM, WHICH HAS A COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE IS RESPONSIBLE FOR ASSISTING THE HOSPITALS WITHIN THE SYSTEM PREPARE THEIR COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) INCLUDING THE CHNAS REPORTED IN PART V, SECTION B. THE COMMUNITY BENEFIT COMMITTEE IS MADE OF INDIVIDUALS REPRESENTING CORPORATE-WIDE DEPARTMENTS, SUCH AS COMMUNITY RELATIONS, LEGAL, TAX, INTERNAL AUDIT, MARKETING/COMMUNICATIONS, AS WELL AS INDIVIDUALS FROM VARIOUS DEPARTMENTS OF HOSPITAL OPERATIONS AND THE SYSTEM'S HOSPITAL FOUNDATIONS. EACH HOSPITAL, WITH THE ASSISTANCE OF THE COMMUNITY BENEFIT COMMITTEE, IDENTIFIES ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY THAT CONTRIBUTE TO THE PROCESS. THESE ORGANIZATIONS AND RESOURCES INCLUDE LOCAL HEALTH DEPARTMENTS, UNITED WAY, UNIVERSITIES, PUBLIC HEALTH DEPARTMENTS, ETC. COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY ARE USED IN COMBINATION WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO PREPARE THE HOSPITAL'S CHNA. IN ADDITION TO ADDRESSING NEEDS IDENTIFIED THROUGH THE CHNA, EACH HOSPITAL MAY RESPOND TO REQUESTS FOR SPECIFIC COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS. PART VI, LINE 3: PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE ORGANIZATION IS PART OF NOVANT HEALTH, AN INTEGRATED NOT-FOR-PROFIT HEALTH SYSTEM. AS A NOT-FOR-PROFIT ORGANIZATION, NOVANT HEALTH IS COMMITTED TO PROVIDING OUTSTANDING HEALTHCARE TO ALL MEMBERS OF OUR COMMUNITIES, REGARDLESS OF THEIR ABILITY TO PAY. OUR ACUTE CARE FACILITIES PROVIDE CARE IN 35 COUNTIES ACROSS FOUR STATES. ADDITIONALLY, OUR PHYSICIANS AND ACUTE CARE FACILITIES OFFER CARE TO NATIONAL AND INTERNATIONAL MISSION PATIENTS. OUR FINANCIAL COUNSELING TEAMS ARE CONSTANTLY WORKING WITH THE PATIENTS WITHIN OUR COMMUNITIES TO UNDERSTAND THEIR NEEDS AND ENSURE THAT OUR POLICIES AND PROCESSES ADDRESS THESE NEEDS. WE ALSO MAINTAIN CONTRACTS WITH MEDICAID ELIGIBILITY VENDORS AND LOCAL DEPARTMENT OF SOCIAL SERVICES TEAMS TO HAVE EMBEDDED CASE WORKERS WITHIN OUR FACILITIES. THESE TEAMS OFFER ADDITIONAL SUPPORT IN PROCESSING AND ASSESSING HOW WE SERVE THE FINANCIAL NEEDS OF OUR PATIENTS. BASED ON THE ASSESSMENTS OF OUR COMMUNITIES, NOVANT HEALTH HAS DEVELOPED FINANCIAL ASSISTANCE POLICIES AND PROGRAMS THAT ADDRESS THE FINANCIAL NEEDS OF OUR PATIENTS. WE PRIDE OURSELVES IN THE TRANSPARENCY OF OUR PROGRAMS AND THE EDUCATION WE OFFER OUR PATIENTS AROUND OUR FINANCIAL ASSISTANCE POLICIES. OUR PROGRAMS ARE DOCUMENTED ON OUR WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE NOVANT HEALTH AFFILIATED FACILITIES AND PHYSICIAN OFFICES. OUR PATIENT ACCESS SPECIALISTS, FINANCIAL COUNSELORS AND BUSINESS OFFICE TEAMS WORK WITH ALL ELIGIBLE PATIENTS TO EDUCATE THEM ON THE VARIOUS OPTIONS AVAILABLE VIA OUR FINANCIAL ASSISTANCE PROGRAMS OR GOVERNMENT SPONSORED CARE. THEY ALSO REFERENCE OUR FINANCIAL ASSISTANCE POLICY IN ALL CONVERSATIONS RELATED TO PATIENTS BILLS. FINALLY, WE WORK WITH LOCAL AREA FREE HEALTH CLINICS AND OTHER CHARITABLE ORGANIZATIONS TO PROVIDE CONTINUATION OF CARE FOR THEIR PATIENTS. IN ADDITION TO OUR FINANCIAL COUNSELING PROCESSES USED TO IDENTIFY CHARITY CARE PATIENTS, OUR COLLECTIONS PROCESSES WITHIN OUR BUSINESS OFFICES ALSO HELP IDENTIFY PATIENTS WHO ARE ALREADY ELIGIBLE FOR CHARITY OR WHO MAY BE ELIGIBLE BASED ON THEIR STATUS WITHIN THE FEDERAL POVERTY GUIDELINES ("FPG"). WE UTILIZE PREVIOUSLY SUBMITTED PATIENT DOCUMENTATION AND CREDIT AGENCY REPORTED FPG FOR DETERMINATION. SUPPORTING DOCUMENTS ARE VALID 6 MONTHS FROM THE DATE OF SUBMISSION. OUR POLICIES ARE CONSIDERED FLUID AND ARE UPDATED FREQUENTLY BASED ON LOCAL AND NATIONAL MARKET STANDARDS AND NATIONAL ECONOMIC CONDITIONS. ANY UPDATES TO OUR POLICIES REQUIRE MULTI-LEVEL LEADERSHIP APPROVAL AND ARE ULTIMATELY APPROVED BY THE NOVANT HEALTH EXECUTIVE TEAM. PART VI, LINE 4: PART VI, LINE 4: COMMUNITY INFORMATIONTHE FORSYTH MEMORIAL HOSPITAL, INC. FORM 990 INCLUDES THE OPERATIONS OF THREE HOSPITALS. FORSYTH MEMORIAL HOSPITAL, INC. DBA NOVANT HEALTH FORSYTH MEDICAL CENTER, AS NOVANT HEALTH KERNERSVILLE MEDICAL CENTER AND AS NOVANT HEALTH CLEMMONS MEDICAL CENTERTHE ORGANIZATION DEFINES ITS COMMUNITY BY ITS PRIMARY SERVICE AREA, WHICH IS FORSYTH COUNTY, NORTH CAROLINA. THIS IS AN URBAN AREA.THERE ARE FOUR NONPROFIT ACUTE CARE HOSPITALS IN THE COMMUNITY, THREE OF WHICH ARE THE ORGANIZATION AND ANOTHER THAT IS A PART OF NOVANT HEALTH ALSO. THERE IS ALSO ONE ACADEMIC, TEACHING HOSPITAL. ACCORDING TO SG2 DATA, THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC (230,015) 59.62%; BLACK NON-HISPANIC (92,491) 23.98%; HISPANIC (47,526) 12.32%; ASIAN AND PACIFIC ISLAND (8,947) 2.32%; OTHERS (6,795) 1.76%; FOR A TOTAL POPULATION OF 385,774. ACCORDING TO SG2 DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $45,462.ACCORDING TO SG2 DATA, THE AGE BREAKDOWN IS AS FOLLOWS: 0-17 YEARS (92,148) 23.43%; 18-64 YEARS (238,440) 60.27%; 65+ YEARS (55,186) 16.31%. PART VI, LINE 5: PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION FURTHERS ITS EXEMPT PURPOSES BY DOING THE FOLLOWING:1. ADOPTING A CHARITY CARE POLICY, WHICH PROVIDES FREE CARE TO INDIVIDUALS WHOSE INCOME IS AT OR BELOW 300% OF THE FEDERAL POVERTY LEVEL;2. REMAINING CERTIFIED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROVIDE SERVICES TO ALL BENEFICIARIES OF MEDICARE, MEDICAID, AND OTHER GOVERNMENT PAYMENT PROGRAMS, AND PROVIDING SERVICES IN A NONDISCRIMINATORY MANNER TO SUCH BENEFICIARIES;3. OPERATING A FULL-TIME EMERGENCY ROOM WHICH IS OPEN TO AND ACCEPTS ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY;4. MAINTAINING AN OPEN MEDICAL STAFF, SUBJECT TO EXCLUSIVE CONTRACTS FOR HOSPITAL-BASED SERVICES SUCH AS ANESTHESIOLOGY, RADIOLOGY, PATHOLOGY, HOSPITALIST, AND EMERGENCY DEPARTMENT SERVICES, TO THE EXTENT AN EXCLUSIVE CONTRACT FOR THOSE SERVICES IS REQUIRED TO OBTAIN PROPER STAFFING COVERAGE OR TO PERMIT A MORE EFFICIENT DELIVERY OF THOSE SERVICES WITHIN THE HOSPITAL FACILITY;5. MAINTAINING A GOVERNING BOARD CONSISTING PRIMARILY OF A BROAD CROSS-SECTION OF LEADERS IN THE COMMUNITY;6. ADOPTING AND APPLYING A CONFLICT OF INTEREST POLICY, WHICH APPLIES TO THE GOVERNING BOARD AND ORGANIZATION OFFICERS;7. PROVIDING HEALTH EDUCATION LECTURES AND WORKSHOPS; 8. PROVIDING HEALTH FAIRS, EDUCATION ON SPECIFIC DISEASES OR CONDITIONS, AND HEALTH PROMOTION AND WELLNESS PROGRAMS TO THE COMMUNITIES IT SERVES; 9. PROVIDING SUPPORT GROUPS AND SELF HELP PROGRAMS TO THE COMMUNITIES IT SERVES; 10. PROVIDING COMMUNITY-BASED CLINICAL SERVICES, INCLUDING WITHOUT LIMITATION, HEALTH SCREENINGS AND CLINICS FOR UNINSURED OR UNDERINSURED PERSONS TO THE COMMUNITIES IT SERVES; 11. PROVIDING HEALTHCARE SUPPORT SERVICES, INCLUDING WITHOUT LIMITATION, INFORMATION AND REFERRAL TO COMMUNITY SERVICES, CASE MANAGEMENT OF UNDERINSURED AND UNINSURED PERSONS, TELEPHONE INFORMATION SERVICES AND ASSISTANCE TO ENROLL IN PUBLIC PROGRAMS, SUCH AS STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) AND MEDICAID TO THE COMMUNITIES IT SERVES; 12. PROVIDING SUBSIDIZED HEALTH SERVICES AND CLINICAL PROGRAMS TO THE COMMUNITIES IT SERVES; 13. PROVIDING CASH AND IN-KIND CONTRIBUTIONS TO NONPROFIT COMMUNITY HEALTHCARE ORGANIZATIONS IN THE COMMUNITIES IT SERVES; AND14. GENERALLY PROMOTING THE HEALTH, WELLNESS, AND WELFARE OF THE COMMUNITIES IT SERVES BY PROVIDING QUALITY HEALTHCARE SERVICES AT REASONABLE COST.FOR SPECIFIC EXAMPLES OF THIS ORGANIZATION'S COMMUNITY BENEFIT ACTIVITIES, WHICH FURTHER THE ORGANIZATION'S EXEMPT PURPOSES (AND THOSE OF ALL HOSPITALS AND HEALTHCARE FACILITIES IN THE SAME HEALTHCARE SYSTEM), PLEASE SEE THE NOVANT HEALTH COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL -PROFILE/COMMUNITY-BENEFIT-REPORT.ASPX.PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. PART VI, LINE 6: PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMTHE ORGANIZATION IS AN INTEGRAL PART OF NOVANT HEALTH, A NOT-FOR-PROFIT INTEGRATED GROUP OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. NOVANT HEALTH IS RANKED AS ONE OF OUR NATION'S TOP 25 INTEGRATED HEALTHCARE SYSTEMS CARING FOR PATIENTS AND COMMUNITIES IN GEORGIA, NORTH CAROLINA, SOUTH CAROLINA, AND VIRGINIA. EACH HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES, AS REPORTED INDIVIDUALLY ON EACH HOSPITAL'S FORM 990, SCHEDULE H. THE COMMUNITY BENEFIT OF THE SYSTEM AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY-INFORMATION/FINANCIAL -PROFILE/COMMUNITY-BENEFIT-REPORT.ASPX. PLEASE NOTE THAT THE NUMERIC INFORMATION IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN NOVANT HEALTH WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL.IN ADDITION TO HOSPITALS, NOVANT HEALTH INCLUDES A PHYSICIAN ORGANIZATION WITH PRACTICES IN GEORGIA, NORTH CAROLINA, SOUTH CAROLINA, AND VIRGINIA AND FIVE HOSPITAL FOUNDATIONS WHICH SUPPORT AND ENHANCE THE ACTIVITIES IN THOSE HOSPITALS' COMMUNITIES. FURTHER, NOVANT HEALTH INCLUDES AMBULATORY SURGERY CENTERS, IMAGING CENTERS, REHABILITATION CENTERS, AND OTHER OUTPATIENT FACILITIES; ALL DEDICATED TO PROMOTING THE HEALTH OF THEIR RESPECTIVE COMMUNITIES. PART VI, LINE 7: STATE FILING OF COMMUNITY BENEFIT REPORT NOVANT HEALTH, INC. FILES A SYSTEM-WIDE COMMUNITY BENEFIT REPORT PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES WITH THE NORTH CAROLINA MEDICAL CARE COMMISSION AS PART OF THE DOCUMENTATION REQUIRED FOR THE ISSUANCE OF TAX EXEMPT BOND FINANCING. 1 AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)(3) 108750 COMMUNITY OUTREACH ARTS COUNCIL 206 N SPRUCE ST SUITE 3 WINSTONSALEM NC 27101 560526856 501(C)(3) 10000 COMMUNITY OUTREACH GREATER WINSTON-SALEM CHAMBER OF COMMERCE 411 W 4TH STREET SUITE 211 WINSTONSALEM NC 27101 560459820 501(C)(6) 26500 COMMUNITY OUTREACH CRISIS CONTROL MINISTRY 200 E TENTH STREET WINSTONSALEM NC 27101 237348168 501(C)(3) 7500 COMMUNITY OUTREACH FORSYTH FUTURES 301 N MAIN STREET SUITE 1700 WINSTONSALEM NC 27101 561092807 501(C)(3) 25000 COMMUNITY OUTREACH JUVENILE DIABETES FOUNDATION 408 N EUGENE STREET GREENSBORO NC 27401 231907729 501(C)(3) 20000 COMMUNITY OUTREACH SUSAN G KOMEN BREAST CANCER FOUNDATION 1106 BURKE STREET WINSTONSALEM NC 27101 752891104 501(C)(3) 15000 COMMUNITY OUTREACH MARCH OF DIMES 410 BROOKSTOWN AVE WINSTONSALEM NC 27101 131846366 501(C)(3) 12500 COMMUNITY OUTREACH OLD HICKORY COUNCIL 6600 SILAS CREEK PARKWAY WINSTONSALEM NC 27106 560529985 501(C)(3) 10000 COMMUNITY OUTREACH SCEPTOR PAIN FOUNDATION 145 KIMEL PARK DRIVE SUITE 300 WINSTONSALEM NC 27103 020723571 501(C)(3) 25000 COMMUNITY OUTREACH SENIOR SERVICES INC 2895 SHOREFAIR DRIVE NW WINSTONSALEM NC 27105 561085968 501(C)(3) 20000 COMMUNITY OUTREACH UNITED WAY OF FORSYTH COUNTY 301 N MAIN STREET SUITE 1700 WINSTONSALEM NC 27101 237357234 501(C)(3) 91131 COMMUNITY OUTREACH WS ALLIANCE 100 N MAIN STREET SUITE 2550 WINSTONSALEM NC 27101 311726654 501(C)(6) 30000 COMMUNITY OUTREACH WS STATE UNIVERSITY FOUNDATION 601 S MARTIN LUTHER KING JR DRIVE SUITE 304 WINSTONSALEM NC 27110 560989620 501(C)(3) 100000 COMMUNITY OUTREACH 12 2 DISCOUNTED PRESCRIPTION DRUG PROGRAM 900 80643 FMV PRESCRIPTION DRUG ASSISTANCE PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS THE ORGANIZATION IS AN AFFILIATE IN AN INTEGRATED HEALTHCARE SYSTEM AND FOLLOWS A SYSTEM-WIDE CORPORATE POLICY WITH STANDARDIZED GUIDELINES THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY AND SELECTION OF GRANTEES RECEIVING CERTAIN EXEMPT PURPOSE FUNDS. THE ORGANIZATION MAINTAINS DOCUMENTATION OF THE ELIGIBILITY AND SELECTION CRITERIA AND RECORDS OF THE AMOUNTS ARE MAINTAINED VIA THE GENERAL LEDGER. FUNDS ARE GENERALLY NOT TRACKED AFTER BEING GRANTED, AS THE ORIGINAL ELIGIBILITY AND SELECTION CRITERIA HAVE ALREADY BEEN MET. X X X X X X 1 1 1 1 0 0 0 0 0 0 0 EDWARDS JOEL TRUSTEE 481069 0 6742 0 20822 0 104804 0 18598 0 632035 0 7500 0 LINDSAY JEFFERY PRES FMCCOO WS MKT (*SEE ADD'L INFO IN SCH J P3) 598311 0 355104 0 1927146 0 52049 0 23672 0 2956282 0 708380 0 MCGEE LAWRENCE ASST SEC (*SEE ADD'L INFO IN SCH J P3) 0 384909 0 304420 0 590712 0 156200 0 24434 0 1460675 0 445287 MORRIS JOHN ASST SEC 0 237363 0 80201 0 5563 0 56043 0 18957 0 398127 0 0 ALLEN JOANNE PRESIDENT NHKMC 174431 0 59136 0 10149 0 105722 0 9760 0 359198 0 0 0 LARSON KIP VP & SR MED DIR SPECIALTY SERV 344453 0 186900 0 15837 0 37300 0 29213 0 613703 0 0 0 LEWIS LINDA VP NURSING 86036 0 101943 0 18015 0 24947 0 4604 0 235545 0 0 0 MIHAL DENISE SVP WS MKT COO (*SEE ADD'L INFO IN SCH J P3) 405664 0 219529 0 1029930 0 56800 0 16130 0 1728053 0 405349 0 WALLEY BRUCE SVP MEDICAL AFFAIRS 349797 0 245580 0 18604 0 46117 0 15229 0 675327 0 0 0 CHEN FRANKLIN ONCOLOGIST 341354 0 373367 0 3005 0 57224 0 30753 0 805703 0 0 0 CHRYSSON NICK ONCOLOGIST 655683 0 245033 0 44320 0 63300 0 36429 0 1044765 0 0 0 GROTE THOMAS ONCOLOGIST 443829 0 435078 0 46119 0 47814 0 26991 0 999831 0 0 0 HINES SUSAN ONCOLOGIST 394448 0 283111 0 43631 0 62734 0 25703 0 809627 0 0 0 PASCHOLD EUGENE ONCOLOGIST 442960 0 295964 0 48506 0 57226 0 31963 0 876619 0 0 0 ALLEN ELMS FMR SVP MAJOR GIFTS 76883 0 12600 0 16234 0 10240 0 17885 0 133842 0 7500 0 HAMMES PAUL FMR SVO & COO FMC 0 0 102268 0 271800 0 0 0 23925 0 397993 0 7500 0 PART I, LINE 1A PART I, LINE 1A: FRINGE OR EXPENSE EXPLANATION FIRST-CLASS OR CHARTER TRAVEL: FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES FOR COMMERCIAL FLIGHTS. HOWEVER, CHARTER TRAVEL IS AVAILABLE TO CERTAIN EXECUTIVES, BOARD MEMBERS, AND APPROVED BUSINESS PERSONNEL IN LIMITED CIRCUMSTANCES DEEMED TO INVOLVE BUSINESS NECESSITY. TRAVEL FOR COMPANIONS: COMPANIONS ARE ALLOWED ON CERTAIN CHARTER FLIGHTS PAID FOR BY THE ORGANIZATION. IN THAT CASE, THE VALUE OF THE COMPANION'S FLIGHT IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: EXECUTIVES WHO PURCHASE SPLIT DOLLAR INSURANCE THROUGH THEIR DISCRETIONARY SPENDING ACCOUNT MAY HAVE THE ADDITIONAL INCOME TAX OWED ON THE PS-58 COSTS PAID BY THE ORGANIZATION. EXECUTIVES WHO RECEIVE TAXABLE RELOCATION INCOME MAY HAVE THE ADDITIONAL INCOME TAX OWED ON THE INCOME PAID BY THE ORGANIZATION. EXECUTIVES MAY RECEIVE AS SEVERANCE BENEFITS CASH PAYMENTS IN LIEU OF PREMIUMS PAID FOR COVERAGE OF CERTAIN BENEFITS THAT ENDED WITH THE EXECUTIVE'S TERMINATION. THE ORGANIZATION MAY PAY THE ADDITIONAL TAX OWED ON ACCOUNT OF THESE PAYMENTS. DISCRETIONARY SPENDING ACCOUNT: CERTAIN EXECUTIVES RECEIVE A DISCRETIONARY SPENDING ACCOUNT. THE DOLLAR AMOUNT IN THE ACCOUNT IS PRE-APPROVED BY THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE NOVANT HEALTH BOARD OF TRUSTEES. THE ACCOUNT CAN BE USED ONLY FOR AN APPROVED LIST OF EXPENDITURES. ALL OPTIONS OTHER THAN A DEFERRED, AT-RISK, COMPENSATION OPTION ARE CONSIDERED TAXABLE AND ARE INCLUDED IN THE EXECUTIVE'S TAXABLE INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: WE PROVIDE TEMPORARY HOUSING ALLOWANCES IN CERTAIN EXECUTIVE RECRUITMENT AND RELOCATION PACKAGES. IN THE CASE THAT SUCH EXPENSE IS NOT REIMBURSABLE UNDER THE ACCOUNTABLE PLAN RULES, THE VALUE IS CALCULATED UNDER APPLICABLE TAX LAWS AND THAT AMOUNT IS INCLUDED IN THE EXECUTIVE'S INCOME AS PRESCRIBED BY THE APPLICABLE TAX LAWS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: IN CASES WHERE CORPORATE MEMBERSHIPS ARE NOT AVAILABLE, A MEMBERSHIP MAY BE OBTAINED IN AN EXECUTIVE'S NAME WITH A "BUSINESS USE ONLY" RESTRICTION. PART I, LINE 3 PART I, LINE 3: THE FILING ORGANIZATION IS AN AFFILIATE IN AN INTEGRATED HEALTHCARE SYSTEM AND IS SUPPORTED BY A PARENT ORGANIZATION THAT USES THE PROCESS DESCRIBED IN PART VI, LINE 15A OF THIS RETURN TO ESTABLISH THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL OF THE FILING ORGANIZATION. THIS PROCESS ADHERES TO THE REQUIREMENTS SET FORTH TO SECURE THE REBUTTABLE PRESUMPTION OF REASONABLENESS AND INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT AND DISINTERESTED MEMBERS OF A COMPENSATION COMMITTEE, CONSULTATION WITH INDEPENDENT COMPENSATION CONSULTANTS, THE UTILIZATION OF THIRD-PARTY COMPARABILITY DATA SUCH AS PUBLISHED COMPENSATION SURVEYS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. PART I, LINES 4A-B PART I, LINE 4A-C: SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED HAMMES, PAUL 271,800 0 0 LINDSAY, JEFFERY 0 *1,885,932 0 MCGEE, LAWRENCE 0 *437,787 0 MIHAL, DENISE 0 *999,460 0 *SCHEDULE J PART II COLUMN B (III): IN 2012, THE INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES COMPENSATION AND LEADERSHIP COMMITTEE (THE "COMMITTEE") ENGAGED INTEGRATED HEALTHCARE STRATEGIES TO ASSESS THE MARKET AND DESIGN A NEW SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("NEW SERP") THAT WOULD BE MORE IN LINE WITH MARKET PRACTICE AND INDUSTRY TRENDS AND THAT WOULD BETTER ACCOMPLISH NOVANT HEALTH'S STRATEGIC EXECUTIVE RETENTION AND ATTRACTION GOALS, AND TO REPLACE THE EXISTING PLAN. IN 2013, THE COMMITTEE APPROVED A NEW DEFINED CONTRIBUTION SERP, TO BE EFFECTIVE 1/1/2014, AND TERMINATED THE EXISTING DEFINED BENEFIT PLAN, WHICH HAS BEEN DESCRIBED IN DETAIL IN PRIOR NOVANT HEALTH FORM 990S. AS 2013 WAS A TRANSITION YEAR, SERP BENEFITS PAID OUT AS A RESULT OF THE TERMINATION OF THE EXISTING DEFINED BENEFIT PLAN HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J, AND DEFERRED COMPENSATION AMOUNTS THAT ACCRUED IN 2013 UNDER THE NEW SERP TO BE CONTRIBUTED TO PARTICIPANTS IN 2014 ARE REPORTED IN COLUMN (C) OF SCHEDULE J. THE AMOUNTS REFLECTED IN COLUMN F AS PREVIOUSLY REPORTED REFLECT THE CUMULATIVE AMOUNTS RECORDED ON PRIOR 990S IN COLUMN C AS DEFERRED COMPENSATION. THE AMOUNT IS THEN ADJUSTED FOR ANY PRIOR YEAR'S PAYMENTS THAT HAVE BEEN REPORTED PREVIOUSLY IN COLUMNS B(III) AND F. THE AMOUNTS PREVIOUSLY REPORTED AS DEFERRED COMPENSATION IN COLUMN C WERE DETERMINED USING AN ACTUARIAL CALCULATION THAT IS BASED ON SEVERAL FACTORS INCLUDING CURRENT AND FUTURE SALARY EXPECTATIONS, EXPECTED FUTURE YEARS OF SERVICE, AND DISCOUNTED USING INTEREST RATES IN PLACE AT THE TIME OF CALCULATION. THE AMOUNT REPORTED IN COLUMN B(III) FOR THE PLAN PAYOUT WILL NOT EXACTLY REFLECT THE CUMULATIVE ACCRUALS REPORTED IN COLUMN F BECAUSE OF THE VARIABILITY OF THE CALCULATION'S FACTORS OVER TIME. IN ADDITION, DUE TO THE LUMP SUM NATURE OF THE FINAL PAYOUT, THE AMOUNTS REPORTED IN COLUMN C AS ACCRUED IN THE PRIOR YEAR WOULD NOT INCLUDE A PORTION OF THE AMOUNTS ACCELERATED INTO 2013. THE EXISTING DEFINED BENEFIT PLAN PARTICIPANTS' PAYMENTS VARIED BASED ON LENGTH OF SERVICE TO THE ORGANIZATION, WHICH RANGED FROM 8 TO 37 YEARS, AND VESTING STATUS AT THE TIME OF PLAN TERMINATION. THE NEW SERP IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. ELIGIBLE EXECUTIVES WILL BE NOMINATED BY THE CEO AND APPROVED BY THE COMMITTEE TO PARTICIPATE. GENERALLY, ANNUAL CONTRIBUTIONS TO THE PLAN OR PAYMENTS TO PARTICIPANTS WILL BE BASED ON A PERCENTAGE OF THE PARTICIPANT'S BASE SALARY AS OF JANUARY 1ST OF THE PREVIOUS PLAN YEAR. PRIOR TO MAKING THE CONTRIBUTIONS OR PAYMENTS, THE COMMITTEE WILL APPROVE THE AMOUNTS AS TO REASONABLENESS, WHEN COMBINED WITH ALL OTHER ANNUAL COMPENSATION. A 3 YEAR CLASS-YEAR VESTING PERIOD WILL APPLY UP TO AGE 62, WHEN ALL MONEY WOULD BE VESTED AND PAID OUT TO THE PARTICIPANT. OTHERWISE, VESTING WILL OCCUR ON JANUARY 1ST OF EACH YEAR FOR THE APPROPRIATE CLASS-YEAR VESTING PERIOD. THE COMMITTEE REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS. PART III - OTHER ADDITIONAL INFORMATION DESCRIPTIONS OF SUPPLEMENTAL EXECUTIVE BENEFITS INCLUDED IN PART VII AND SCHEDULE J: EXECUTIVE ANNUAL INCENTIVE PLAN: AS PART OF THE REPORTED COMPENSATION AMOUNTS, THE REPORTING ORGANIZATION PROVIDES ANNUAL INCENTIVE COMPENSATION TO OFFICERS AND KEY EMPLOYEES UNDER AN EXECUTIVE ANNUAL INCENTIVE PLAN. THE INCENTIVE PLAN IS DESIGNED TO OFFER OPPORTUNITIES FOR ADDITIONAL COMPENSATION, BUT ONLY TO THE EXTENT THAT ELIGIBLE EXECUTIVES HAVE PROVIDED EXTRAORDINARY SERVICES AND ACHIEVED EXTRAORDINARY RESULTS THAT MEET OR EXCEED PREDETERMINED GOALS IN THE AREAS OF QUALITY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION AND FINANCIAL VITALITY. THESE GOALS ARE ESTABLISHED AND APPROVED BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). THESE GOALS ARE WEIGHTED EQUALLY. THE ADDITIONAL COMPENSATION CAN RANGE ANYWHERE FROM ZERO TO A MAXIMUM PERCENTAGE OF BASE SALARY THAT DIFFERS BY THE CLASS OF EXECUTIVE; THIS MAXIMUM PERCENTAGE RANGES FROM 30% TO 70% OF BASE SALARY. IN ADDITION, THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD WHO OVERSEE THE INCENTIVE COMPENSATION PROGRAM APPLY TWO "CIRCUIT BREAKERS," WHICH ARE SUBSTANTIAL LEVELS OF ORGANIZATION-WIDE ACHIEVEMENT THAT MUST BE SATISFIED BEFORE ANY AWARDS ARE PAID TO ANY EXECUTIVE UNDER THE PROGRAM. THE INCENTIVE COMPENSATION AWARDS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THEY ARE REPORTED IN THE YEAR PAID. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD REVIEW, APPROVE, AND OVERSEE ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS ANNUAL INCENTIVE PLAN. LONG-TERM INCENTIVE PLAN: THE REPORTING ORGANIZATION OFFERS A LONG-TERM INCENTIVE PLAN (THE "PLAN") TO CERTAIN KEY EXECUTIVES. THE PLAN TIES A KEY EXECUTIVE'S COMPENSATION TO THE ORGANIZATION'S LONG-TERM STRATEGIC PERFORMANCE, PROVIDES A RETENTION INCENTIVE FOR KEY EXECUTIVES, AND ALLOWS THE ORGANIZATION TO COMPETE IN THE MARKETPLACE FOR TOP LEADERSHIP TALENT. THE PLAN OPERATES ON THREE-YEAR PERFORMANCE CYCLES THAT BEGIN EACH YEAR. LONG-TERM STRATEGIC GOALS (IN THE PRINCIPAL AREAS OF QUALITY OF PATIENT CARE AND LONG-TERM FINANCIAL STRENGTH) ARE ESTABLISHED AND APPROVED FOR EACH CYCLE, IN ADVANCE, BY INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD). NOVANT HEALTH'S INTERNAL AUDIT DEPARTMENT REVIEWS THE METHODOLOGY AND PROCESS USED TO DETERMINE ACHIEVEMENT OF THE QUALITY METRICS. AWARDS ARE PAYABLE FOR A PARTICULAR THREE-YEAR PERFORMANCE CYCLE ONLY IF THE REQUISITE LEVEL OF COMMUNITY BENEFIT AND CHARITY CARE, ALONG WITH THE REQUIRED LEVEL OF FINANCIAL PERFORMANCE TO DEMONSTRATE LONG-TERM FINANCIAL STRENGTH, HAVE BEEN MET FOR THAT RESPECTIVE THREE-YEAR PERFORMANCE PERIOD. IF AN AWARD IS EARNED AT THE END OF A PERFORMANCE CYCLE, THEN THE INCENTIVE AWARD IS PAID OUT AND IS INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(II) OF SCHEDULE J. THEY ARE REPORTED IN THE YEAR PAID. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THE PLAN. PART I, LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS BASED ON ANNUAL COMPENSATION FOR A SPECIFIED PERIOD OF TIME. THE SEVERANCE PAY WOULD BE PAID ONLY IN THE EVENT OF CERTAIN TYPES OF EMPLOYMENT TERMINATION, AND IS FURTHER CONTINGENT ON THE SATISFACTION OF OTHER CONDITIONS SUCH AS COMPLIANCE WITH A NON-COMPETITION COVENANT. ANY CURRENT YEAR PAYMENTS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD REVIEWS, APPROVES, AND OVERSEES ALL ASPECTS AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. NICK CHRYSSON EMPLOYEE EMPLOYMENT RELATED X 105000 21875 0 1 1 THOMAS GROTE EMPLOYEE EMPLOYMENT RELATED X 105000 21875 0 1 1 EUGENE PASCHOLD EMPLOYEE EMPLOYMENT RELATED X 105000 21875 0 1 1 SUSAN HINES EMPLOYEE EMPLOYMENT RELATED X 105000 21875 0 1 1 87500 ELIZABETH WALLEY FAMILY MEMBER OF BRUCE WALLEY, KEY EMPLOYEE 99724 COMPENSATION PAID BY THE FILING ORGANIZATION TO A FAMILY MEMBER OF THE INTERESTED PERSON. 0 MARY J ALLEN FAMILY MEMBER OF ELMS ALLEN, FORMER KEY EMPLOYEE 51203 COMPENSATION PAID BY THE FILING ORGANIZATION TO A FAMILY MEMBER OF THE INTERESTED PERSON. 0 FORM 990, PI, L1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES FORSYTH MEMORIAL HOSPITAL, INC. DOING BUSINESS AS NOVANT HEALTH FORSYTH MEDICAL CENTER (NHFMC) IS A TERTIARY CARE HOSPITAL LOCATED IN WINSTON-SALEM, NC. NHFMC IS FOCUSED ON PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT SERVICE AND A REMARKABLE WORK ENVIRONMENT FOR STAFF. IT IS AN INTEGRAL PART OF THE NOVANT HEALTH SYSTEM (COLLECTIVELY KNOWN AS "NOVANT HEALTH"), A NOT-FOR-PROFIT INTEGRATED GROUP OF HOSPITALS, PHYSICIAN CLINICS, OUTPATIENT CENTERS AND OTHER HEALTHCARE SERVICE PROVIDERS. NOVANT HEALTH IS RANKED AS ONE OF OUR NATION'S TOP 25 INTEGRATED HEALTHCARE SYSTEMS CARING FOR PATIENTS AND COMMUNITIES IN GEORGIA, NORTH CAROLINA, SOUTH CAROLINA AND VIRGINIA. IN 2013, THE SYSTEM REPORTED $3.6 BILLION IN REVENUES. NHFMC IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITIES IN THE PIEDMONT TRIAD REGION OF NORTH CAROLINA, ONE PERSON AT A TIME. IT OFFERS A FULL CONTINUUM OF EMERGENCY, MEDICAL, SURGICAL, REHABILITATIVE AND BEHAVIORAL HEALTH SERVICES. CENTERS OF EXCELLENCE INCLUDE THE FOLLOWING: NOVANT HEALTH MAYA ANGELOU WOMEN'S HEALTH AND WELLNESS CENTER, NOVANT HEALTH HEART AND VASCULAR INSTITUTE, NOVANT HEALTH DERRICK L. DAVIS CANCER CENTER, NOVANT HEALTH STROKE AND NEUROSCIENCES SPECIALISTS, NOVANT HEALTH ORTHOPEDIC CENTER AND NOVANT HEALTH FORSYTH BEHAVIORAL HEALTH. QUALITY WE ARE PROUD OF THE ACHIEVEMENTS IN QUALITY THIS YEAR AS WE RANK WELL ABOVE STATE AVERAGES IN HEART ATTACK, HEART FAILURE AND PNEUMONIA CARE. IN ADDITION, NHFMC'S BREAST CANCER CENTER PROGRAM IS NATIONALLY CERTIFIED. THE CENTER'S STROKE AND NEUROSCIENCES INSTITUTE AND CARDIAC AND VASCULAR CENTER HEART FAILURE PROGRAM AND STROKE REHABILITATION PROGRAM ARE ALL NATIONALLY ACCREDITED AS WELL AS ITS TOTAL HIP AND KNEE JOINT REPLACEMENT PROGRAM. NHFMC IS AMONG 22 HOSPITALS NATIONWIDE TO EARN THE ADVANCED COMPREHENSIVE STROKE CENTER DESIGNATION FROM THE JOINT COMMISSION AND THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION. THE DESIGNATION WAS EARNED FOR HAVING ADVANCED CAPABILITIES AND EXPERTISE IN TREATING THE MOST COMPLEX STROKE CASES. NHFMC'S HEART FAILURE PROGRAM RECEIVED ADVANCED HEART FAILURE CERTIFICATION FOR EXCEPTIONAL EFFORTS TO IMPROVE HEART FAILURE PATIENT OUTCOMES AND THE AMERICAN COLLEGE OF SURGEONS (ACS) NAMED NHFMC WITHIN ITS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM. THE NOVANT HEALTH MAYA ANGELOU WOMEN'S HEALTH AND WELLNESS CENTER WAS DESIGNATED A CENTER OF EXCELLENCE IN MINIMALLY INVASIVE GYNECOLOGIC SURGERY BY THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS (AAGL). NHFMC ALSO PASSED A SUCCESSFUL SURVEY BY THE JOINT COMMISSION TO ACHIEVE ACCREDITATION FOR ADVANCED PALLIATIVE CARE. THE ONSITE SURVEYOR CONGRATULATED STAFF FOR HAVING A "PHENOMENAL" PROGRAM THAT IS A NATIONAL LEADER IN TEAMWORK, BEST PRACTICES AND DATA UTILIZATION. NHFMC HAS BEEN RECOGNIZED FOR ACHIEVING THE TOP 10 PERCENT OF HOSPITALS NATIONALLY FOR PATIENT SATISFACTION BASED ON HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) DATA. IN ADDITION, U.S. NEWS & WORLD REPORT RELEASED ITS 2013-2014 BEST HOSPITALS REPORT, RANKING NHFMC IN EIGHT SPECIALTIES: DIABETES & ENDOCRINOLOGY, GASTROENTEROLOGY & GI SURGERY, GERIATRICS, GYNECOLOGY, NEPHROLOGY, NEUROLOGY & NEUROSURGERY, ORTHOPEDICS AND PULMONOLOGY. OUR COMMITMENT TO EXCELLENCE IN PATIENT CARE, INCLUDING NURSING CARE, CONTINUED DURING THE YEAR. NHFMC IS AMONG ONLY 6.9 PERCENT OF HOSPITALS IN THE UNITED STATES TO BE DESIGNATED BY THE AMERICAN NURSES CREDENTIALING CENTER AS A MAGNET FACILITY, CONFIRMING THE EXCEPTIONAL QUALITY OF CARE THAT OUR NURSES PROVIDE. AT THE STATE LEVEL, TWO NURSES FROM NHFMC WERE SELECTED BY THE NORTH CAROLINA NURSES' ASSOCIATION TO BE AMONG THE "GREAT 100 NURSES." SAFETY OVER THE PAST SEVERAL YEARS, NHFMC HAS ACHIEVED SIGNIFICANT PROGRESS IN THIS AREA BY PROVIDING SAFETY EDUCATION FOR ALL TEAM MEMBERS AND MAKING CHANGES IN AREAS WHERE THE FREQUENCY OF SERIOUS SAFETY EVENTS IS GREATER THAN ZERO. IN 2013, NHFMC IMPLEMENTED NEW BIOMETRIC TECHNOLOGY TO AID PATIENT SAFETY. THE RIGHTPATIENT BIOMETRIC PATIENT IDENTIFICATION SYSTEM IS NOW PART OF THE ADMISSION PROCESS AND USES IRIS RECOGNITION TO IDENTIFY PATIENTS. THIS TECHNOLOGY IMPROVES PATIENT SAFETY BY ACCURATELY IDENTIFYING PATIENTS AND LIMITING DUPLICATE MEDICAL RECORDS. IT ALSO HELPS TO ELIMINATE MEDICAL IDENTIFY THEFT AT THE POINT OF SERVICE. 2013 HIGHLIGHTS DURING 2013, NHFMC EXPANDED ACCESS TO MEDICAL CARE AND PROVIDED ADDITIONAL RESOURCES TO HELP PATIENTS AND OUR LOCAL COMMUNITIES TO GET BETTER AND STAY HEALTHY. -NOVANT HEALTH CLEMMONS MEDICAL CENTER (NHCMC) OPENED APRIL 3 IN CLEMMONS, NC, STAFFED BY APPROXIMATELY 100 EMPLOYEES. THE NEW $26 MILLION FACILITY INCLUDES AN EMERGENCY ROOM WITH 12 BAYS, TWO OPERATING ROOMS, LABORATORY AND AN IMAGING CENTER. A SECOND PHASE OF THE MEDICAL PLAZA, PLANNED FOR THE END OF 2014, WILL INCLUDE A MEDICAL OFFICE BUILDING. CLEMMONS VILLAGE LEADERS EXPECT THE NEW FACILITY TO STIMULATE FURTHER DEVELOPMENT OF A 124-ACRE VILLAGE POINT MIXED-USE AREA THAT WILL EVENTUALLY INCLUDE APARTMENTS AND CONDOMINIUMS AS WELL AS 30,000 SQUARE FEET OF RETAIL SPACE. NOVANT HEALTH DONATED MORE THAN 17 ACRES OF LAND TO THE VILLAGE AND REBUILT THE ADJACENT REYNOLDS POND DAM TO HELP ENCOURAGE DEVELOPMENT FOR THIS MASTER PLANNED AREA. -IN ITS SECOND FULL YEAR OF OPERATION, NOVANT HEALTH FORSYTH MEDICAL CENTER AFFILIATE HOSPITAL, NOVANT HEALTH KERNERSVILLE MEDICAL CENTER (NHKMC) IN KERNERSVILLE, NC, FOCUSED ON PROVIDING A FAST-ACCESS EMERGENCY DEPARTMENT, GENERAL, ORTHOPEDIC AND EYE SURGICAL SERVICES, CONSISTENT QUALITY, EXCELLENT SERVICE AND A REMARKABLE WORK ENVIRONMENT FOR STAFF TO RESIDENTS IN THE KERNERSVILLE, NC AREA, WESTERN GUILFORD AND ROCKINGHAM COUNTIES OF NC, AS WELL AS EASTERN STOKES AND FORSYTH COUNTIES OF NC. THE MEDICAL CENTER ALSO OPENED A BREAST HEALTH CENTER AND A CANCER CENTER, AND SUCCESSFULLY COMPLETED ITS SECOND JOINT COMMISSION ACCREDITATION SURVEY WITH OUTSTANDING RESULTS. -NOVANT HEALTH PATIENTS DISCHARGED FROM NHFMC EXPERIENCE A SIMPLER TRANSITION TO HOME FROM THE HOSPITAL DUE TO READY AT HOME. THE PROGRAM'S TEAM COORDINATES DETAILS AROUND A PATIENT'S DISCHARGE AND AT-HOME MEDICATIONS. IF PATIENTS NEED MEDICATIONS OR OTHER HEALTHCARE SUPPLIES, THE TEAM'S TRANSITION SPECIALISTS PROVIDE AFFORDABLE SOLUTIONS. SINCE DISCHARGE MEDICATIONS AND SUPPLIES ARE NOT INCLUDED IN THE HOSPITAL BILL, READY AT HOME HELPS MAKE SURE THEY ARE PROPERLY PROCESSED BY THE INSURER. NEARLY HALF OF ALL AMERICANS NEVER FILL THEIR PRESCRIPTIONS, FILL THEM BUT NEVER TAKE THE DRUG, OR DON'T TAKE THE FULL DOSE. READY AT HOME IS ADDRESSING THAT PROBLEM. -THE MEDICAL CENTER ADDED A NEW HELICOPTER LANDING PAD ON THE TOP OF ITS PARKING DECK. IT ALLOWS FOR AIR TRANSPORTATION FOR PATIENTS NEEDING QUICK ACCESS TO HIGHLY SPECIALIZED TREATMENT, SUCH AS FOR STROKE AND CARDIAC PATIENTS. -NHFMC'S CARDIAC SURGERY PROGRAM IS RANKED AMONG THE HIGHEST IN THE NATION WITH A 3-STAR RATING FROM THE SOCIETY OF THORACIC SURGEONS. ONLY 13.5 PERCENT OF ALL CARDIAC SURGERY HOSPITALS IN THE U.S. RECEIVED THIS TOP RANKING. IN ADDITION, THE HEART AND VASCULAR INSTITUTE PERFORMED ITS FIRST TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) PROCEDURE, A NEW TREATMENT OPTION FOR PEOPLE WITH SEVERE AORTIC STENOSIS WHO CANNOT UNDERGO SURGERY. NOVANT HEALTH WAS AMONG THE FIRST MEDICAL CENTERS IN THE COUNTRY APPROVED TO OFFER THIS NON-SURGICAL TREATMENT THAT INSERTS A WIRE MESH VALVE INTO THE HEART THROUGH AN ARTERY IN THE LEG. COMMUNITY BENEFIT REPORT: HTTP://WWW.NOVANTHEALTH.ORG/HOME/ABOUT-US/COMPANY - INFORMATION/FINANCIALPROFILE/COMMUNITY-BENEFIT-REPORT.ASPX THE COMMUNITY BENEFIT REPORT PREPARED BY NOVANT HEALTH IS A SYSTEM-WIDE REPORT THAT INCLUDES QUALITATIVE AND QUANTITATIVE INFORMATION. IN THIS REPORT, THE NOVANT HEALTH SYSTEM'S COMMUNITY BENEFIT WAS APPROXIMATELY $566,000,000, INCLUDING $129,000,000 IN CHARITY CARE, IN 2013. PLEASE NOTE THAT THE NUMERIC DATA IN THIS REPORT IS NOT BASED UPON THE FORM 990, SCHEDULE H CRITERIA, BUT RATHER IT HAS BEEN PREPARED IN ACCORDANCE WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION REPORTING GUIDELINES. IT SHOULD NOT BE RELIED UPON AS THE ORGANIZATION'S FORM 990, SCHEDULE H COMMUNITY BENEFIT REPORT. FORM 990, PART III, LINE 1: MISSION, VISION, AND VALUES MISSION: NOVANT HEALTH EXISTS TO IMPROVE THE HEALTH OF COMMUNITIES, ONE PERSON AT A TIME. VISION: WE, THE EMPLOYEES OF NOVANT HEALTH AND OUR PHYSICIAN PARTNERS, WILL DELIVER THE MOST REMARKABLE PATIENT EXPERIENCE, IN EVERY DIMENSION, EVERY TIME. VALUES: COMPASSION: WE TREAT OUR CUSTOMERS AND THEIR FAMILIES, STAFF AND OTHER HEALTHCARE PROVIDERS AS FAMILY MEMBERS BY SHOWING THEM KINDNESS, PATIENCE, EMPATHY AND RESPECT. DIVERSITY: WE RECOGNIZE THAT EVERY PERSON IS DIFFERENT, EACH SHAPED BY UNIQUE LIFE EXPERIENCES. THIS ENABLES US TO BETTER UNDERSTAND ONE ANOTHER AND OUR CUSTOMERS. PERSONAL EXCELLENCE: WE STRIVE TO GROW PERSONALLY AND PROFESSIONALLY, AND APPROACH EACH SERVICE OPPORTUNITY WITH A POSITIVE, FLEXIBLE ATTITUDE. HONESTY AND PERSONAL INTEGRITY GUIDE ALL THAT WE DO. TEAMWORK: THE NEEDS AND EXPECTATIONS OF ANY ONE CUSTOMER ARE GREATER THAN THAT WHICH ONE PERSON'S SERVICE EFFORTS CAN SATISFY. WE SUPPORT EACH OTHER SO THAT TOGETHER AS A TEAM, WE CAN BE SUCCESSFUL IN THE EYE OF THE CUSTOMER AS A QUALITY SERVICE PROVIDER. NOVANT HEALTH'S BRAND PROMISE: WE ARE MAKING YOUR HEALTHCARE EXPERIENCE REMARKABLE. WE WILL BRING YOU WORLD-CLASS TECHNOLOGY, CLINICIANS, AND CARE - WHEN AND WHERE YOU NEED IT. WE ARE REINVENTING THE HEALTHCARE EXPERIENCE TO BE SIMPLER, MORE CONVENIENT, AND MORE AFFORDABLE, SO THAT YOU CAN FOCUS ON GETTING BETTER AND STAYING HEALTHY. FORM 990, PART I, LINE 6: THE NUMBER OF VOLUNTEERS REPORTED INCLUDES THOSE VOLUNTEERS SERVING AS BOARD MEMBERS. FORM 990, PART I, LINE 1 -THE NOVANT HEALTH MAYA ANGELOU WOMEN'S HEALTH AND WELLNESS CENTER CONTINUED TO PROVIDE A WIDE RANGE OF CLINICAL PROGRAMS AND SERVICES THAT TOUCH WOMEN'S HEALTH, INCLUDING HEART, WELLNESS, CANCER, SURGICAL SERVICES, MATERNITY, EMERGENCY CARE, BONE AND JOINT HEALTH, BEHAVIORAL HEALTHCARE AND A MIDLIFE WOMEN'S CENTER. -THE NOVANT HEALTH BREAST CENTER (FORSYTH) -HAS EARNED A THREE-YEAR ACCREDITATION IN BREAST MAGNETIC RESONANCE IMAGING (MRI) BY THE AMERICAN COLLEGE OF RADIOLOGY (ACR), MAKING IT WINSTON-SALEM, NC'S ONLY ACR-ACCREDITED BREAST MRI FACILITY. THE MEDICAL CENTER ALSO MADE SIGNIFICANT CONTRIBUTIONS TOWARD IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. THE HIGHLIGHTS FOR 2013 INCLUDED THE FOLLOWING: -NHFMC HOSTED A HEALTH INSURANCE MARKETPLACE EVENT, A FREE INFORMATIONAL EVENT FOR PATIENTS AND COMMUNITY MEMBERS WHO ARE ELIGIBLE FOR INSURANCE PLANS THROUGH THE MARKETPLACE. MORE THAN 125 PEOPLE ATTENDED THE EVENT IN WINSTON-SALEM, NC TO HEAR AN EXPERT SPEAKER AND HAVE AN OPPORTUNITY TO SIGN UP FOR PLANS THROUGH ONSITE INSURANCE BROKERS, AS WELL AS TO LEARN ABOUT HEALTH AND WELLNESS SERVICES THAT NOVANT HEALTH PROVIDES. -THE MEDICAL CENTER JOINED WITH THE AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION TO START A PARTNERSHIP TO PROMOTE AWARENESS OF STROKE SYMPTOMS. THE GOAL IS TO TEACH PEOPLE TO MORE EASILY RECOGNIZE STROKE WARNING SIGNS, WHICH OFTEN COME ON SUDDENLY, THROUGH AN ACRONYM CALLED F.A.S.T. - FACE DROOPING, ARM WEAKNESS, SPEECH DIFFICULTY AND TIME TO CALL 9-1-1. A FIRST EVENT WAS HELD AT THE MEDICAL CENTER'S CONFERENCE CENTER AND INCLUDED A SPECIAL LUNCHEON TO THANK CAREGIVERS OF STROKE SURVIVORS, HELPING THEM TO TAKE CARE OF THEMSELVES SO THAT THEY CAN CONTINUE TO CARE FOR OTHERS. -FOR THE FIFTH CONSECUTIVE YEAR, NHFMC JOINED WITH THE WINSTON-SALEM, NC MAYOR'S OFFICE AND THE AMERICAN HEART ASSOCIATION'S GO RED FOR WOMEN INITIATIVE TO HOST AN AWARENESS BREAKFAST EVENT AT THE MEDICAL CENTER'S CONFERENCE CENTER. APPROXIMATELY 150 GUESTS ATTENDED. -VASCULAR CLINIC/PAD SCREENINGS COMBINE FREE EDUCATION AND SCREENINGS ON CARDIOVASCULAR DISEASE RISK FACTORS WITH AN EMPHASIS ON PREVENTING PERIPHERAL ARTERIAL DISEASE (PAD) IN THE COMMUNITY. -BEHAVIORAL HEALTH COMMUNITY OUTREACH WHICH PROVIDES A 24/7 BEHAVIORAL HEALTH CALL CENTER, DEPRESSIONS AND BIPOLAR SUPPORT GROUP, DIALECTIC BEHAVIORAL THERAPY SKILLS TRAINING, A FAMILY RECOVERY PROGRAM AND A MOBILE CRISIS RESPONSE TEAM. -THE NOVANT HEALTH DERRICK L. DAVIS CANCER CENTER'S COMMUNITY SERVICES INCLUDE COMMUNITY EDUCATION FORUMS, A PALLIATIVE CARE SYMPOSIUM, AN EMPLOYEE MAMMOGRAM PROGRAM AS WELL AS PUBLIC SUPPORT GROUPS AND LEARNING SESSIONS FOR CAREGIVERS AND THOSE WITH LEUKEMIA AND LYMPHOMA, GASTROINTESTINAL CANCER, GYNECOLOGIC CANCER AS WELL AS TEACHING ABOUT SPIRITUALITY AND CANCER. -CARDIAC COMMUNITY SERVICES INCLUDE COMMUNITY HEALTH & NUTRITION EDUCATION AND SCREENINGS, A HEART FAILURE CLINIC AND LIPID CLINIC, AN OPEN HEART CLINIC, STRESS MANAGEMENT PROGRAMS AS WELL AS TOBACCO AND SMOKING CESSATION PROGRAMS. -DIABETES SERVICES FEATURE CONTINUOUS GLUCOSE MONITORING, DIABETES PREVENTION AND SCREENINGS SESSIONS, DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT GROUPS AS WELL AS INSULIN PUMP TRAINING. -REHABILITATION SERVICES TO THE COMMUNITY INCLUDE AN APHASIA SUPPORT GROUP, AUDIOLOGY AND POSTURE SCREENINGS. -STROKE AND NEUROSCIENCES COMMUNITY SUPPORT INCLUDES A SLEEP MEDICINE SYMPOSIUM, A STROKE SYMPOSIUM AS WELL AS STROKE EDUCATION AND SUPPORT GROUPS. -WOMEN'S SERVICES COMMUNITY OUTREACH INCLUDE BABY BOOT CAMP, BIRTH AND BEGINNING CLASSES, BREASTFEEDING EDUCATION AND SUPPORT GROUPS, A FREE ON-LINE HEALTH RISK ASSESSMENT AND GIRLS ON THE RUN AND GIRLS ON TRACK WHICH PROMOTE YOUTH TO LEAD ACTIVE, HEALTHY LIFESTYLES. IN ADDITION TO OUR QUALITY AND COMPREHENSIVE CATEGORIES OF SERVICES, WE'RE VERY PROUD OF OUR PATIENT FINANCIAL ASSISTANCE PROGRAM. WE WORK WITH CUSTOMERS TO HELP QUALIFY THEM FOR PUBLIC ASSISTANCE, ESTABLISH A REASONABLE PAYMENT PLAN, DISCOUNT THEIR BILL OR PROVIDE THEM WITH FREE CHARITY CARE. FORM 990, PART III, LINE 4A: PROGRAM SERVICE ACCOMPLISHMENTS KMC HAS 50 LICENSED BEDS. DURING 2013 THERE WERE 8,920 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 4 DAYS, AND AVERAGE DAILY CENSUS OF 24, AND 2,422 DISCHARGES. THERE WERE 2,749 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 33,104 OUTPATIENT ENCOUNTERS AND 29,419 EMERGENCY DEPARTMENT VISITS. DURING 2013 CMC HAD 427 OUTPATIENT SURGERIES, A TOTAL OF 7,393 OUTPATIENT ENCOUNTERS AND 6,732 EMERGENCY DEPARTMENT VISITS. FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 6: CLASSES OF MEMBERS OR STOCKHOLDERS THE CORPORATION IS A NONPROFIT CORPORATION WITH MEMBERS (OR A MEMBER). FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF MEMBERS AND THEIR RIGHTS NOVANT HEALTH, INC. ELECTS ALL MEMBERS OF THE GOVERNING BODY OF FORSYTH MEMORIAL HOSPITAL,INC. FORM 990, PART VI, SECTION A, LINE 7B FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS SUBJECT TO APPROVAL OF MEMBERS NOVANT HEALTH, INC. HAS CERTAIN RESERVED POWERS, SUCH AS APPROVAL OF AMENDMENTS TO THE ARTICLES AND BYLAWS OF THE CORPORATION, AND TO ADOPT CERTAIN POLICIES WHICH SHALL BE IMPLEMENTED BY THE CORPORATION BOARD. FORM 990, PART VI, SECTION B, LINE 11 FORM 990, PART VI, SECTION B, LINE 11: ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE BOARD HAS DELEGATED REVIEW OF THE FORM 990 TO NOVANT HEALTH'S AUDIT AND COMPLIANCE COMMITTEE, WHICH OVERSEES TAX MATTERS FOR NOVANT HEALTH. THE AUDIT AND COMPLIANCE COMMITTEE IS THE REVIEW BODY FOR ALL OF THE FORM 990S FILED FOR ORGANIZATIONS WITHIN THE NOVANT HEALTH SYSTEM. THE AUDIT AND COMPLIANCE COMMITTEE MEETS BEFORE THE FORM 990S ARE FILED WITH THE IRS AND AFTER ALL BOARD MEMBERS HAVE RECEIVED A COPY OF THE FORM 990 AND A SUMMARY OF ITS CONTENTS. THE SENIOR DIRECTOR OF TAX AND LEGAL COUNSEL FOR NOVANT HEALTH ATTEND THE MEETING TO ANSWER ANY QUESTIONS AND ADDRESS ANY SIGNIFICANT DISCLOSURES WITHIN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C FORM 990, PART VI, SECTION B, LINE 12C: MONITORING AND ENFORCEMENT OF COI THE ORGANIZATION'S TRUSTEE CONFLICT OF INTEREST POLICY APPLIES TO ALL TRUSTEES, PRINCIPAL OFFICERS OR MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS INCLUDING ANY APPLICABLE DISREGARDED ENTITIES. ALL TRUSTEES ARE SENT AN ANNUAL DISCLOSURE FORM. ANY POSITIVE ANSWERS ON THE TRUSTEE ANNUAL DISCLOSURE FORM ARE REVIEWED BY THE GENERAL COUNSEL. IF THE RELATIONSHIP DISCLOSED IS DETERMINED NOT TO POSE A POTENTIAL CONFLICT OF INTEREST GENERALLY, THEN NO ACTION IS TAKEN. WITH RESPECT TO PARTICULAR TRANSACTIONS THAT COME BEFORE THE BOARD, THE CONFLICT OF INTEREST POLICY WOULD BE FOLLOWED. THE POTENTIAL CONFLICT OF INTEREST WOULD BE DISCLOSED BY THE BOARD MEMBER BEFORE A VOTE ON THE TRANSACTION AND THE REST OF THE BOARD WOULD DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. IF THE REST OF THE BOARD DETERMINED THAT A CONFLICT OF INTEREST EXISTED THEN THE BOARD MEMBER WITH THE CONFLICT OF INTEREST WOULD NOT PARTICIPATE IN THE DELIBERATIONS AND VOTE. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINE 15A: COMPENSATION PROCESS FOR TOP OFFICIAL INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR NOVANT HEALTH'S CEO AND FOR CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING NOVANT HEALTH AND ITS RELATED OR DISREGARDED ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT, USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS, AND MAKES SURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION B, LINE 15B: COMPENSATION PROCESS FOR OFFICERS INDEPENDENT AND DISINTERESTED MEMBERS OF THE NOVANT HEALTH BOARD OF TRUSTEES (WHO COMPRISE THE COMPENSATION AND LEADERSHIP COMMITTEE OF THE BOARD) REVIEW, APPROVE, AND OVERSEE ALL ASPECTS OF COMPENSATION AND BENEFITS FOR CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING NOVANT HEALTH AND ITS RELATED OR DISREGARDED ENTITIES. THE COMMITTEE WORKS WITH AN INDEPENDENT COMPENSATION CONSULTANT, USES THIRD PARTY COMPARABILITY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS, AND MAKES SURE THAT TOTAL COMPENSATION AND BENEFITS FOR EACH EXECUTIVE IS REASONABLE FOR THAT EXECUTIVE'S POSITION. THE COMMITTEE REVIEWS AND APPROVES EXECUTIVE COMPENSATION AND BENEFITS ANNUALLY, CONSISTENT WITH THE WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY OF NOVANT HEALTH, AND IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THEREBY ASSURING THAT TOTAL COMPENSATION AND BENEFITS PROVIDED TO EACH EXECUTIVE IS REASONABLE. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS DISCLOSURE THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAINING ALL ORGANIZATIONS IN THE NOVANT HEALTH SYSTEM ARE POSTED TO THE NOVANT HEALTH WEBSITE. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, COLUMN B: RELATED ORGANIZATIONS THE ORGANIZATION EMPLOYS CERTAIN EXECUTIVES WHOSE ROLES ARE SUCH THAT THEY PROVIDE SERVICES TO NOT ONLY THE ORGANIZATION, BUT ALSO TO SOME OR ALL OF THE OTHER TAX-EXEMPT ORGANIZATIONS WITHIN THE NOVANT HEALTHCARE SYSTEM. FOR EXAMPLE, MANY OF THESE EXECUTIVES' ROLES FOCUS ON PARTICULAR SERVICE LINES WHICH CROSS THE VARIOUS GEOGRAPHIC MARKETS OUR ORGANIZATIONS SERVE, THUS THE SERVICES PROVIDED BY THESE EXECUTIVES MAY BENEFIT AND BE RECEIVED BY MULTIPLE ORGANIZATIONS WITHIN THE SYSTEM. THE EXECUTIVES DO NOT ALLOCATE THEIR HOURS BETWEEN THE VARIOUS ORGANIZATIONS, BUT RATHER THEIR TIME SPENT ON SERVICES TO THE ORGANIZATION IS INCLUSIVE OF SERVICES TO ALL OF THE ORGANIZATIONS THEY SERVE WITHIN THE SYSTEM. FORM 990, PART XI, LINE 9: FMCF AND AUXILIARY OF FMC CONTRIBUTION: -2,227,734. AFFILIATE TRANSFERS: -8,192,357. MALPRACTICE INSURANCE: -2,451,841. ROUNDING 5. PROGRAM INVESTMENT ADJUSTMENT 425,484. 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