2013-11-13T15:08:53-06:00 2012-12-31 990 2012-01-01 560928089 FORSYTH MEMORIAL HOSPITAL FORS 3367182803 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 FRED HARGETT 3367182803 2013-11-13 2012 2016-02-24 21:20:13Z FORSYTH MEDICAL CENTER JEFFERY LINDSAY 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 1064314661 0 X WWW.FORSYTHMEDICALCENTER.ORG X 1968 NC SEE SCHEDULE O 20 16 7566 997 473508 110036 2577799 3227743 887587244 994150186 -244870 302022 65567008 66353407 955487181 1064033358 372774 174071 0 0 425101646 442325759 0 0 0 477298833 515637285 902773253 958137115 52713928 105896243 889125682 988511859 46251404 49625408 842874278 938886451 X SEE SCHEDULE O 0 0 790806548 174071 1052954493 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. FMH AND KMC MAINTAIN AN OPEN DOOR POLICY, ACCEPTING ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. FMH HAS 921 LICENSED BEDS. DURING 2012 THERE WERE 224,587 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 6 DAYS, AN AVERAGE DAILY CENSUS OF 614, AND 40,639 DISCHARGES. THERE WERE 24,859 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 1,150,970 OUTPATIENT ENCOUNTERS AND 93,870 EMERGENCY DEPARTMENT VISITS. (CONTINUED ON SCHDULE 0)KMC HAS 50 LICENSED BEDS. DURING 2012 THERE WERE 6,504 PATIENT DAYS WITH AN AVERAGE LENGTH OF STAY OF 3.26 DAYS, AND AVERAGE DAILY CENSUS OF 17.7, AND 1,987 DISCHARGES. THERE WERE 2,148 INPATIENT AND OUTPATIENT SURGERIES, A TOTAL OF 25,640 OUTPATIENT ENCOUNTERS AND 25,291 EMERGENCY DEPARTMENT VISITS. 790806548 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 1 0 0 0 1 1 1 1 0 0 1 3 0 1 7566 1 1 1 0 0 0 0 1 1 0 0 0 0 X 20 16 1 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 BAREFOOTSAMUEL 2.00 X 0 0 0 CARROLLJOE 2.00 X 0 0 0 EARNHARDTHAROLD 2.00 X 0 0 0 EDWARDSJOEL LYNN 2.00 X 460114 0 50374 EGGERSGERALD 2.00 X 0 0 0 ELYJOSEPH 2.00 X X 0 0 0 FORIESTBRYANT 2.00 X 0 0 0 FULLERSTANLEY BRIAN 2.00 X 0 435421 43030 GREENGARY 2.00 X X 0 0 0 HAULSEEHADA DE VARONA 2.00 X X 0 0 0 JOHNSONJOIA 2.00 X 0 0 0 JONESBRUCE 2.00 X 0 0 0 LAMBECLARENCE 2.00 X 0 0 0 LEAVITT JRROBERT 2.00 X 0 0 0 MCNEIL-MILLERKAREN 2.00 X X 0 0 0 POLLARD IIIHAROLD 2.00 X 0 0 0 POLONSKYSHERRY 2.00 X 0 0 0 REAVESDONALD 2.00 X 0 0 0 SIGALBARRY 2.00 X 0 6710 0 WOLFE IIIJOHN 2.00 X 0 0 0 LINDSAYJEFFERY T 60.00 X 827408 0 435022 MCGEELAWRENCE UPCHURCH 2.00 X 0 1074617 501213 MORRISJOHN BENTON 2.00 X 0 286616 43622 ALLENJOANNE 60.00 X 221844 0 24738 HAMMESPAUL H 60.00 X 524243 4625 39351 LARSONKIP LEROY 60.00 X 358650 0 26010 LEWISLINDA C 60.00 X 326960 0 26760 MIHALDENISE BARBARA 60.00 X 289479 233123 259173 WALLEYBRUCE DOUGLAS 60.00 X 550303 0 19240 CHRYSSONNICK G 40.00 X 992097 0 39166 GROTETHOMAS H 40.00 X 911051 0 37262 PASCHOLD EUGENE H 40.00 X 724373 0 32444 PIPPITTCHARLES H 40.00 X 700339 0 39466 SHEARERHEATHER H 40.00 X 690927 0 39698 7577788 2041112 1656569 418 1 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 8489687 PIEDMONT TRIAD ANESTHESIA PO BOX 602365 CHARLOTTE NC 28260 ANESTHESIA SERVICES 4219039 AMERICAN RED CROSS PO BOX 905890 CHARLOTTE NC 28290 BLOOD PROCESSING 4122233 LABORATORY CORPORATION OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 3396105 NURSEFINDERS INC PO BOX 910738 DALLAS TX 75391 STAFFING 2048872 81 2991953 235790 249179 3227743 NET PATIENT REVENUE 621990 994150186 994150186 994150186 113847 113847 2746421 0 2746421 2746421 2746421 469478 281303 188175 188175 188175 PHARMACY 446110 51022310 50588926 433384 MISCELLANEOUS REVENUE 621990 7221900 7183662 38238 CAFETERIA 722210 3020750 3020750 2342026 1031719 1886 1308421 63606986 1064033358 1052954493 473508 7377614 56853 56853 117218 117218 5406431 5406431 348080994 330955409 17125585 18599718 17684612 915106 46363562 44082475 2281087 23875054 22700401 1174653 2677892 2677892 1492 1492 3150 3150 57405558 44645496 12760062 6719747 6389135 330612 5775230 5491089 284141 9549477 9079643 469834 27754896 26389355 1365541 898545 854337 44208 398625 379013 19612 16403302 15596363 806939 30105250 28624072 1481178 2105877 2002268 103609 CORPORATE ALLOCATION 118721944 118721944 UBI TAXES 28179 28179 MEDICAL SUPPLIES 92569690 92569690 DRUGS 80133947 80133947 64384484 63055172 1329312 958137115 790806548 167330567 0 3529739 2937802 167577 0 98613263 116770799 30685 211460 7792203 2686015 14946588 15877650 368711 1306979 383362107 237542411 156771340 145819696 31165047 31015047 575740529 671886411 889125682 988511859 38342075 43830247 189281 177878 7720048 5617283 46251404 49625408 X 842874278 938886451 842874278 938886451 889125682 988511859 X 105896243 -9884070 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 57164 57164 0 PART IV, SUPPLEMENTAL INFORMATION: SCHEDULE C, PART II-B, LINE 1I DUES PAID TO CERTAIN ORGANIZATIONS WHICH INCLUDE A PORTION RELATED TO LOBBYING ACTIVITIES. 4082278 4082278 73754456 5400932 68353524 9973628 6205552 3768076 283090877 221348710 61742167 12460868 4587217 7873651 145819696 DUE FROM AFFILIATES 671885626 STATE INCOME TAX RECEIVABLE 785 671886411 2070 CAPITAL LEASE PAYABLE 178962 THIRD PARTY PAYMENT ADJUSTMENTS 5436251 5617283 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2012 AND 2011. 1 1 X 1 X 300.000000000000 0 0 1 0 1 1 36111570 0 36111570 0.03770 135397348 130365227 5032121 0.00530 9987916 6456137 3531779 0.00370 181496834 136821364 44675470 0.04670 1655244 41704 1613540 0.00170 1457760 845971 611789 0.00060 43060449 30350432 12710017 0.01330 0 0 0 0.00000 134804 0 134804 0.00010 46308257 31238107 15070150 0.01570 227805091 168059471 59745620 0.06240 5675 5675 0.00000 5675 5675 1 37369567 0 166372410 176453658 -10081248 X 1 0 3 1 FORSYTH MEMORIAL HOSPITAL INC

3333 SILAS CREEK PARKWAY WINSTON SALEM NC 27103

X X X A 2 FMH DBA KERNERSVILLE MEDICAL CENTER

1750 KERNERSVILLE MEDICAL PARKWAY KERNERSVILLE NC 27284

X X X A 3 FMH DBA CLEMMONS MEDICAL CENTER

6915 VILLAGE MEDICAL CIRCLE CLEMMONS NC 27012

X X A FACILITY REPORTING GROUP - A 1 1 300.000000000000 0 0 1 1 X X X X X X 1 0 1 X 0 0 54 WINSTON-SALEM HEALTH CARE

250 CHARLOIS BOULEVARD WINSTONSALEM NC 27103

PHYSICIAN CLINIC FMCIMAPLEWOOD

3155 MAPLEWOOD AVENUE WINSTONSALEM NC 27103

IMAGING CENTER WINSTON SALEM CARDIOLOGY

186 KIMEL PARK DRIVE WINSTONSALEM NC 27103

PHYSICIAN CLINIC FMCIBREAST CLINIC

2025 FRONTIS PLAZA BLVD SUITE 300 WINSTONSALEM NC 27103

IMAGING CENTER MAPLEWOOD FAMILY PRACTICE

ROBINHOOD MEDICAL PLAZA BLDG 100 WINSTONSALEM NC 27106

PHYSICIAN CLINIC INPATIENT PHYSICIANS OF FORSYTH

3333 SILAS CREEK PARKWAY WINSTONSALEM NC 27103

PHYSICIAN CLINIC SALEM FAMILY PRACTICE

105 VEST MILL CIRCLE WINSTONSALEM NC 27103

PHYSICIAN CLINIC PHOA KERNERSVILLE

445 PINEVIEW DRIVE KERNERSVILLE NC 27284

PHYSICIAN CLINIC MOUNTAINVIEW MEDICAL

216 MOORE ROAD KING NC 27021

PHYSICIAN CLINIC FORSYTH INTERNAL MEDICINE

1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103

PHYSICIAN CLINIC FMCIWSHC RADIOLOGY

250 CHARLOIS BOULEVARD WINSTONSALEM NC 27103

IMAGING CENTER KERNERSVILLE FAMILY PRACTICE

291 BROAD STREET KERNERSVILLE NC 27284

PHYSICIAN CLINIC PHOA MT AIRY

865 WESTLAKE DRIVE SUITE 200 MOUNT AIRY NC 27030

PHYSICIAN CLINIC PHOA LEXINGTON

1370 PIEDMONT DRIVE SUITE 202 LEXINGTON NC 27295

PHYSICIAN CLINIC FMCIKERNERSVILLE IMAGING CENTER

445 PINEVIEW DRIVE SUITE 100 KERNERSVILLE NC 27284

IMAGING CENTER MEDICAL ASSOCIATES OF SURRY

865 WESTLAKE DRIVE MOUNT AIRY NC 27030

PHYSICIAN CLINIC MEDICAL ASSOCIATES OF DAVIE

485 VALLEY ROAD MOCKSVILLE NC 27028

PHYSICIAN CLINIC FORSYTH HEALTHCARE PHARMACY

3333 SILAS CREEK PARKWAY WINSTONSALEM NC 27103

PHARMACY UROLOGY PARTNERS

180 KIMEL PARK DRIVE SUITE 110 WINSTONSALEM NC 27103

PHYSICIAN CLINIC CHAIR CITY FAMILY PRACTICEMEDZONE

903 RANDOLPH STREET THOMASVILLE NC 27360

PHYSICIAN CLINIC PREMIER MEDICAL ASSOCIATES

3333 BROOKVIEW HILLS BLVD STE 204 WINSTONSALEM NC 27103

PHYSICIAN CLINIC YADKIN MEDICAL ASSOCIATES

305 EAST LEE AVENUE YADKINVILLE NC 27055

PHYSICIAN CLINIC FAMILY MEDICAL ASSO OF LEWISVILLE

1225 LEWISVILLE-CLEMMONS ROAD LEWISVILLE NC 27023

PHYSICIAN CLINIC WINSTON-SALEM HEALTH CARE DERMATOLOGY

175 KIMEL PARK DRIVE WINSTONSALEM NC 27103

PHYSICIAN CLINIC FORSYTH ENDOCRINE CONSULTANTS

755 HIGHLAND OAKS DRIVE SUITE 201 WINSTONSALEM NC 27103

PHYSICIAN CLINIC KING HEALTHCARE PHARMACY

212 MOORE ROAD KING NC 27021

PHARMACY THOMASVILLE MEDICAL ASSOCIATES

309 PINEYWOOD ROAD THOMASVILLE NC 27360

PHYSICIAN CLINIC CLEMMONS FAMILY PRACTICE

6301 STADIUM DRIVE CLEMMONS NC 27012

PHYSICIAN CLINIC ARCADIA FAMILY PRACTICE

12208 HWY 150 NORTH WINSTONSALEM NC 27127

PHYSICIAN CLINIC INFECTIOUS DISEASE SPECIALISTS

1381 WESTGATE CENTER DRIVE WINSTONSALEM NC 27103

PHYSICIAN CLINIC NORTH POINT MEDICAL ASSOCIATES

1995 BETHABARA ROAD WINSTONSALEM NC 27106

PHYSICIAN CLINIC LEXINGTON PRIMARY CARE

110 WEST MEDICAL PARK DRIVE LEXINGTON NC 27292

PHYSICIAN CLINIC RHEUMATOLOGY & ARTHRITIS ASSOCIATES

1995 BETHABARA ROAD WINSTONSALEM NC 27106

PHYSICIAN CLINIC WEST FORSYTH FAMILY MEDICINE

105 STADIUM OAKS DRIVE CLEMMONS NC 27012

PHYSICIAN CLINIC GATEWAY FAMILY PRACTICE

390 SALEM AVENUE WINSTONSALEM NC 27101

PHYSICIAN CLINIC FORSYTH FAMILY MEDICINE

400 JONESTOWN RD WINSTONSALEM NC 27104

PHYSICIAN CLINIC SALEM HEALTHCARE PHARMACY

105 VEST MILL CIRCLE WINSTONSALEM NC 27103

PHARMACY NEW GARDEN MEDICAL ASSOCIATES

1941 NEW GARDEN ROAD GREENSBORO NC 27410

PHYSICIAN CLINIC MAPLEWOOD FAMILY PRACTICE

5110 ROBINHOOD VILLAGE DR SUITE C-1 WINSTONSALEM NC 27106

PHYSICIAN CLINIC PHOA STATESVILLE

276 OLD MOCKSVILLE ROAD STATESVILLE NC 28625

PHYSICIAN CLINIC FORSYTH INTERNAL MEDICINE K'VILLE

445 PINEVIEW DRIVE SUITE 240 KERNERSVILLE NC 27284

PHYSICIAN CLINIC FORSYTH COMPREHENSIVE NEUROLOGY

2025 FRONTIS PLAZA BLVD SUITE 120 WINSTONSALEM NC 27103

PHYSICIAN CLINIC PILOT MOUNTAIN FAMILY MEDICINE

207 MEDICAL STREET PILOT MOUNTAIN NC 27041

PHYSICIAN CLINIC MEDICAL ASSOCIATES OF DAVIE HILLSDALE

121 MEDICAL DRIVE ADVANCE NC 27006

PHYSICIAN CLINIC PALLIATIVE CARE SERVICES

3333 SILAS CREEK PARKWAY WINSTONSALEM NC 27103

PHYSICIAN CLINIC INPATIENT PHYSICIANS OF DAVIDSON

207 OLD LEXINGTON ROAD THOMASVILLE NC 27360

PHYSICIAN CLINIC WINSTON-SALEM HEALTH CARE PSYCHIATRY

280 CHARLOIS BOULEVARD WINSTONSALEM NC 27103

PHYSICIAN CLINIC WS CARDIOLOGY KERNERSVILLE

1750 KERNERSVILLE MEDICAL BLVD KERNERSVILLE NC 27284

PHYSICIAN CLINIC PHOA ELKIN

505 SAMARITANS RIDGE COURT ELKIN NC 28621

PHYSICIAN CLINIC TRIAD ENDOCRINE CONSULTANTS

500 PINEVIEW DRIVE SUITE 101 KERNERSVILLE NC 27284

PHYSICIAN CLINIC PINEVIEW FAMILY MEDICINE

500 PINEVIEW DRIVE SUITE 101 KERNERSVILLE NC 27284

PHYSICIAN CLINIC STROKE BRIDGE CLINIC

3333 SILAS CREEK PARKWAY WINSTONSALEM NC 27103

PHYSICIAN CLINIC FRIEDBERG FAMILY MEDICINE

5010 PETERS CREEK PARKWAY WINSTONSALEM NC 27127

PHYSICIAN CLINIC WALKERTOWN FAMILY PRACTICE

2800 DARROW ROAD WALKERTOWN NC 27051

PHYSICIAN CLINIC PART I, LINE 6A: THE ORGANIZATION IS PART OF THE NOVANT HEALTHCARE SYSTEM AND THE COMMUNITY BENEFIT REPORT IS PREPARED BY A RELATED ORGANIZATION. NOVANT HEALTH, INC. PRODUCES ITS OWN COMMUNITY BENEFIT REPORT, WHICH REPRESENTS THE HEALTH SYSTEM AS A WHOLE AND CAN BE FOUND ATHTTP://WWW.NOVANTHEALTH.ORG/GIVEBACK/COMMUNITYBENEFITREPORT.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 OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AMOUNTS ARE CALCULATED USING AN ENTITY SPECIFIC COST TO CHARGE RATIO BASED ON WORKSHEET 2 (RCC). PART I, L7 COL(F): THE AMOUNT OF BAD DEBT REMOVED FROM TOTAL EXPENSES (DENOMINATOR) WAS $37,369,567. PART II: NOVANT HEALTH 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 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 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 PROVISION 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 HEALTH CARE 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 RCC 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 OR OFFER 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 TO 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: NEEDS ASSESSMENTTHE ORGANIZATION IS PART OF THE NOVANT HEALTHCARE SYSTEM, WHICH HAS A COMMUNITY BENEFIT COMMITTEE. THE COMMUNITY BENEFIT COMMITTEE IS RESPONSIBLE FOR ASSISTING THE HOSPITALS WITHIN THE HEALTHCARE SYSTEM WITH PREPARING COMMUNITY NEEDS ASSESSMENTS. 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 HEALTHCARE SYSTEM'S HOSPITAL FOUNDATIONS. EACH HOSPITAL, WITH THE ASSISTANCE OF THE COMMUNITY BENEFIT COMMITTEE, WILL IDENTIFY ORGANIZATIONS AND RESOURCES WITHIN ITS COMMUNITY TO CONTRIBUTE TO THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. THESE ORGANIZATIONS AND RESOURCES INCLUDE LOCAL HEALTH DEPARTMENTS, UNITED WAY, UNIVERSITIES, PUBLIC HEALTH DEPARTMENTS, ETC. THE EXISTING COMMUNITY HEALTH ASSESSMENTS PREPARED BY OTHER ORGANIZATIONS IN THE COMMUNITY WILL BE COMBINED WITH INTERNAL HOSPITAL DATA AND INFORMATION COLLECTED FROM LOCAL AGENCIES TO BECOME THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. EACH HOSPITAL HAS ALSO TRADITIONALLY RESPONDED TO REQUESTS FOR CERTAIN COMMUNITY BENEFIT ACTIVITIES OR PROGRAMS FROM PUBLIC AGENCIES OR COMMUNITY GROUPS AND THIS WILL ALSO BE INCLUDED IN THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT. ONCE THE COMMUNITY NEEDS ASSESSMENT IS COMPLETED, WHICH WILL BE EVERY THREE YEARS, THE HOSPITAL WILL PRIORITIZE THE NEEDS BY DETERMINING WHAT HOSPITAL RESOURCES ARE AVAILABLE TO MEET THE NEEDS AND WHAT OTHER COMMUNITY RESOURCES ARE BEING USED TO MEET A PARTICULAR NEED. THE HOSPITAL WILL DEVELOP A COMMUNITY BENEFIT PLAN, WHICH WILL BE REVIEWED AND UPDATED AS NECESSARY, AT LEAST EVERY THREE YEARS. ALL HOSPITALS' COMMUNITY NEEDS ASSESSMENTS WILL BE MADE AVAILABLE TO THE PUBLIC. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEAS 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 THREE 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 OR 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 CORPORATE WEBSITE AS WELL AS EACH INDIVIDUAL FACILITY'S WEBSITE, ALONG WITH CONTACT INFORMATION FOR OUR FINANCIAL COUNSELORS. ADDITIONALLY, OUR PROGRAMS ARE DOCUMENTED ON PATIENT FLYERS THROUGHOUT THE NOVANT 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. 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 EXECUTIVE TEAM. PART VI, LINE 4: COMMUNITY INFORMATIONTHE FORSYTH MEMORIAL HOSPITAL, INC. FORM 990 INCLUDES THE OPERATIONS OF THREE HOSPITALS. FORSYTH MEMORIAL HOSPITAL, INC. DBA FORSYTH MEDICAL CENTER, AS KERNERSVILLE MEDICAL CENTER AND AS 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 ONE OF WHICH IS PART OF THE NOVANT HEALTHCARE SYSTEM. THERE IS ALSO ONE ACADEMIC, TEACHING HOSPITAL. ACCORDING TO TRUVEN HEALTH DATA, THE SPECIFIC POPULATION GROUPS (ETHNIC AND CULTURAL) ARE AS FOLLOWS: WHITE NON-HISPANIC (225,551) 58.9%; BLACK NON-HISPANIC (92,888) 24.3%; HISPANIC (48,591) 12.7%; ASIAN AND PACIFIC ISLAND (7,738) 2.0%; OTHERS (7,980) 2.1%; FOR A TOTAL POPULATION OF 382,748. ACCORDING TO TRUVEN HEALTH DATA, THE MEDIAN HOUSEHOLD INCOME LEVEL WAS $45,356.ACCORDING TO TRUVEN HEALTH DATA, THE AGE BREAKDOWN IS AS FOLLOWS: 0-17 YEARS (92,677) 24.2%; 18-64 YEARS (236,581) 61.8%; 65+ YEARS (53,490) 14.0%. 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 FULL-TIME EMERGENCY ROOMS WHICH ARE OPEN TO AND ACCEPT 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 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/GIVEBACK/COMMUNITYBENEFITREPORT.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: AFFILIATED HEALTH CARE SYSTEMTHE ORGANIZATION 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 NORTH CAROLINA, VIRGINIA AND SOUTH CAROLINA. 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 HEALTHCARE SYSTEM AS A WHOLE IS DOCUMENTED IN A SYSTEM-WIDE COMMUNITY BENEFIT REPORT, LOCATED AT HTTP://WWW.NOVANTHEALTH.ORG/GIVEBACK/COMMUNITYBENEFITREPORT.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. THE NOVANT HEALTHCARE SYSTEM ALSO INCLUDES AN ORGANIZATION THAT OWNS PHYSICIAN PRACTICES IN VIRGINIA, SOUTH CAROLINA, AND NORTH CAROLINA, WHICH PROVIDE ADDITIONAL COMMUNITY BENEFIT TO THEIR COMMUNITIES, AND FIVE HOSPITAL FOUNDATIONS, WHICH SUPPORT AND ENHANCE THE COMMUNITY BENEFIT ACTIVITIES IN THOSE HOSPITAL'S COMMUNITIES. FURTHER, THE NOVANT HEALTHCARE SYSTEM INCLUDES AMBULATORY SURGERY CENTERS, SKILLED NURSING FACILITIES, REHABILITATION PROGRAMS, AND OTHER OUTPATIENT FACILITIES, WHICH ALSO PROVIDE COMMUNITY BENEFIT TO THEIR COMMUNITIES. THERE ARE SIGNIFICANT COMMUNITY BENEFIT ACTIVITIES WITHIN THE NOVANT HEALTH SYSTEM, WHICH MAY NOT BE REPORTABLE ON A SCHEDULE H BECAUSE THEY ARE NOT CONDUCTED BY AN ENTITY WHICH OWNS OR OPERATES A HOSPITAL. THE HEALTHCARE SYSTEM HAS A COMMUNITY BENEFIT COMMITTEE, WHICH WILL OVERSEE AND ASSIST ALL TAX-EXEMPT HOSPITALS WITHIN NOVANT HEALTH IN PREPARING THEIR COMMUNITY NEEDS ASSESSMENTS AND COMMUNITY BENEFIT PLANS. THE GOAL OF HAVING A SYSTEM-WIDE COMMITTEE IS TO IDENTIFY COMMUNITY BENEFIT ACTIVITIES THAT ARE DUPLICATIVE IN COMMUNITIES AND TO STREAMLINE AND COORDINATE EFFORTS TO RESULT IN BETTER AND MORE EFFICIENT USES OF RESOURCES, WHICH COULD LEAD TO ADDITIONAL RESOURCES TO BE ALLOCATED TO MEET OTHER COMMUNITY NEEDS, AND TO REPLICATE SUCCESSFUL PROGRAMS AND ACTIVITIES IN COMMUNITIES WHERE A SIMILAR NEED IS INDICATED. ALL OF THE TAX-EXEMPT HOSPITALS WITHIN THE NOVANT HEALTHCARE SYSTEM ARE COMMITTED TO IMPROVING THE HEALTH OF THEIR COMMUNITIES AND PROVIDING COMMUNITY BENEFIT ACTIVITIES TO SUPPORT THEIR MISSION. 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. PART VI, LINE 8: FACILITY REPORTING GROUP A SINGLE PART V, SECTION B HAS BEEN COMPLETED FOR THE FOLLOWING HOSPITALS INCLUDED IN THE FORSYTH MEMORIAL HOSPITAL REPORTING GROUP; FORSYTH MEDICAL CENTER, KERNERSVILLE MEDICAL CENTER AND CLEMMONS MEDICAL CENTER. PART V, LINE 8 FACILITY REPORTING GROUP A SEE BELOW FACILITY 1 -- FORSYTH MEMORIAL HOSPITAL, INC 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% (3A: FREE CARE). FACILITY 1 -- FORSYTH MEMORIAL HOSPITAL, INC PART V, SECTION B, LINE 18E: WE DID NOT CHECK BOXES FOR QUESTIONS 16, 17 AND 18 BECAUSE WE PROCEED WITH ALL REASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE PRIOR TO INITIATING ANY COLLECTION ACTIONS. FACILITY 1 -- FORSYTH MEMORIAL HOSPITAL, INC 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. FACILITY 2 -- FMH DBA 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% (3A: FREE CARE). FACILITY 2 -- FMH DBA KERNERSVILLE MEDICAL CENTER PART V, SECTION B, LINE 18E: WE DID NOT CHECK BOXES FOR QUESTIONS 16, 17 AND 18 BECAUSE WE PROCEED WITH ALL REASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE PRIOR TO INITIATING ANY COLLECTION ACTIONS. FACILITY 2 -- FMH DBA 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. FACILITY 3 -- FMH DBA 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% (3A: FREE CARE). FACILITY 3 -- FMH DBA CLEMMONS MEDICAL CENTER PART V, SECTION B, LINE 18E: WE DID NOT CHECK BOXES FOR QUESTIONS 16, 17 AND 18 BECAUSE WE PROCEED WITH ALL REASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE PRIOR TO INITIATING ANY COLLECTION ACTIONS. FACILITY 3 -- FMH DBA 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. 1 DAVIE COMMUNITY FOUNDATION 194 WILKESBORO STREET MOCKSVILLE NC 27028 581850531 501(C)(3) 25353 CONTRIBUTION MORAVIAN CHURCH IN AMERICA SOUTHERN PROVINCE 459 S CHURCH STREET WINSTONSALEM NC 27127 560552778 501(C)(3) 20353 CONTRIBUTION 2 0 DISCOUNTED PRESCRIPTION DRUG PROGRAM 744 117218 FMV PRESCRIPTION DRUG ASSISTANCE PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF 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 EDWARDSJOEL LYNN 428666 0 19716 0 11732 0 32046 0 18328 0 510488 0 0 0 FULLERSTANLEY BRIAN 0 353738 0 80089 0 1594 0 15000 0 28030 0 478451 0 0 LINDSAYJEFFERY T 520767 0 281200 0 25441 0 412993 0 22029 0 1262430 0 0 0 MCGEELAWRENCE UPCHURCH 0 414338 0 277860 0 382419 0 476900 0 24313 0 1575830 0 361584 MORRISJOHN BENTON 0 227267 0 44265 0 15084 0 21578 0 22043 0 330237 0 0 ALLENJOANNE 167498 0 38920 0 15426 0 16137 0 8601 0 246582 0 0 0 HAMMESPAUL H 162485 0 228545 0 133213 4625 15736 0 23615 0 563594 4625 0 0 LARSONKIP LEROY 344103 0 0 0 14547 0 3808 0 22202 0 384660 0 0 0 LEWISLINDA C 239167 0 67078 0 20715 0 14501 0 12258 0 353719 0 0 0 MIHALDENISE BARBARA 269945 58979 0 163620 19534 10524 247500 0 11673 0 548652 233123 0 0 WALLEYBRUCE DOUGLAS 340717 0 195000 0 14586 0 10251 0 8989 0 569543 0 0 0 CHRYSSONNICK G 819652 0 136984 0 35461 0 15000 0 24166 0 1031263 0 0 0 GROTETHOMAS H 444306 0 430125 0 36620 0 15000 0 22262 0 948313 0 0 0 PASCHOLD EUGENE H 443822 0 242535 0 38016 0 15000 0 17444 0 756817 0 0 0 PIPPITTCHARLES H 340275 0 323533 0 36531 0 15000 0 24466 0 739805 0 0 0 SHEARERHEATHER H 393443 0 262876 0 34608 0 15000 0 24698 0 730625 0 0 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 GROUP 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. 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. AT THIS TIME NOVANT HAS ONE SUCH MEMBERSHIP. 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 4B: PART I, LINE 4-SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SEVERANCE NONQUALIFIED EQUITY-BASED HAMMES, PAUL H. 95,130 0 0 MCGEE, LAWRENCE UPCHURCH 0 361,584 0 SUPPLEMENTAL INFORMATION PART III 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 INDEPENDENT AND DISINTERESTED MEMBERS OF THE BOARD OF TRUSTEES 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. 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 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. 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 AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THE PLAN. SCHEDULE J PART I LINE 4A - SEVERANCE PLAN: ELIGIBLE EXECUTIVES MAY RECEIVE SEVERANCE PAY THAT IS A SPECIFIED MULTIPLE OF ANNUAL COMPENSATION. 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. 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 AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SEVERANCE PLAN. SCHEDULE J PART I LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("SERP") IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES, AND TO OFFER COMPETITIVE TOTAL COMPENSATION. THESE SERP BENEFITS ARE CALCULATED WITH REFERENCE TO A FORMULA THAT TAKES INTO CONSIDERATION THE EXECUTIVE'S TOTAL YEARS OF SERVICE WITH THE ORGANIZATION AND OTHER RETIREMENT INCOME. THESE BENEFITS ARE FULLY AT RISK AND WILL NOT BE PAID UNLESS THE EXECUTIVE PROVIDES SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION. UNTIL THOSE REQUIREMENTS ARE SATISFIED, IF EVER, THE EXECUTIVE IS NOT ENTITLED TO ANY SERP BENEFIT. IF THE EXECUTIVE WERE TO HAVE LEFT THE ORGANIZATION VOLUNTARILY DURING THE YEAR FOR WHICH THESE AMOUNTS ARE BEING REPORTED (BEFORE REACHING BOTH AGE 55 AND HAVING FIVE YEARS OF SERVICE WITH THE ORGANIZATION), THE EXECUTIVE'S SERP BENEFIT WOULD HAVE BEEN ENTIRELY FORFEITED. THE SERP BENEFIT IS REDUCED AT THE RATE OF 2 PERCENTAGE POINTS PER YEAR FOR PAYMENTS RECEIVED BETWEEN THE AGES OF 55 AND 62. CURRENT YEAR PAYMENTS OF SERP BENEFITS HAVE BEEN INCLUDED IN THE COMPENSATION AMOUNTS REPORTED IN PART VII AND IN COLUMN (B)(III) OF SCHEDULE J. AN ESTIMATE OF THE ANNUAL INCREASE IN ACTUARIAL VALUE IS REPORTED AS DEFERRED COMPENSATION IN PART VII AND IN COLUMN (C) OF SCHEDULE J FOR ELIGIBLE EXECUTIVES. 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 AND ALL ELEMENTS OF EXECUTIVE COMPENSATION AND BENEFITS, INCLUDING THE AMOUNTS AWARDED UNDER THIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. NICK CHRYSSON EMPLOYEE EMPLOYMENT RELATED X 105000 42292 0 1 1 THOMAS GROTE EMPLOYEE EMPLOYMENT RELATED X 105000 42292 0 1 1 LAWRENCE NYCUM EMPLOYEE EMPLOYMENT RELATED X 105000 42292 0 1 1 EUGENE PASCHOLD EMPLOYEE EMPLOYMENT RELATED X 105000 42292 0 1 1 HEATHER SHEARER EMPLOYEE EMPLOYMENT RELATED X 105000 42292 0 1 1 211460 ELIZABETH WALLEY FAMILY MEMBER OF BRUCE WALLEY, KEY EMPLOYEE 96536 COMPENSATION PAID BY THE FILING ORGANIZATION TO A FAMILY MEMBER OF THE INTERESTED PERSON. 0 X 2 19160 FMV X 1 228000 FMV X TV 1 509 FMV X NESTING PROGRAM 1 1266 FMV X MISCELLANEOUS 4 205 FMV X TABLE 1 39 FMV 0 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): NUMBER OF CONTRIBUTIONS ACTIVITIES FORM 990, PART I, LINE 1: ORGANIZATION'S MISSION OR MOST SIGNIFICANT IN 2012, FORSYTH MEDICAL CENTER (FMC), A 921-BED NOVANT HEALTH TERTIARY CARE HOSPITAL LOCATED IN WINSTON-SALEM, NC, 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 NORTH CAROLINA, VIRGINIA AND SOUTH CAROLINA. THE NOVANT HEALTH SYSTEM REPORTED $3.555 BILLION IN REVENUES IN 2012. OUR HOSPITAL IS COMMITTED TO MEETING THE HEALTHCARE NEEDS OF RESIDENTS OF THE PIEDMONT TRIAD REGION OF NORTH CAROLINA, ONE PERSON AT A TIME. 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, FORSYTH MEDICAL CENTER'S BREAST CANCER CENTER PROGRAM IS NATIONALLY CERTIFIED. OUR STROKE AND NEUROSCIENCES INSTITUTE AND CARDIAC & VASCULAR CENTER HEART FAILURE PROGRAM AND STROKE REHABILITATION PROGRAM ARE ALL NATIONALLY ACCREDITED AS WELL AS ITS TOTAL HIP AND KNEE JOINT REPLACEMENT PROGRAM. OUR 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 FORSYTH MEDICAL CENTER WITHIN ITS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM. FORSYTH MEDICAL CENTER HAS BEEN RECOGNIZED FOR ACHIEVING THE TOP 10% OF HOSPITALS NATIONALLY FOR PATIENT SATISFACTION BASED ON HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) DATA AS WELL AS IN THE TOP 10% IN THE NATION FOR CUSTOMER SATISFACTION, EARNING THE HEALTHGRADES OUTSTANDING PATIENT EXPERIENCE AWARD. OUR COMMITMENT TO EXCELLENCE IN PATIENT CARE, INCLUDING NURSING CARE, CONTINUED DURING THE YEAR. FORSYTH MEDICAL CENTER IS AMONG ONLY FIVE 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 FORSYTH MEDICAL CENTER WERE SELECTED BY THE NORTH CAROLINA NURSES' ASSOCIATION TO BE AMONG THE "GREAT 100 NURSES." TO FURTHER ADVANCE THE QUALITY OF ITS NURSING, FORSYTH MEDICAL CENTER ADOPTED A NEW NURSING PROFESSIONAL PRACTICE MODEL IN 2012; THE DUFFY'S QUALITY-CARING MODEL WHICH, SOON AFTER, WAS ADOPTED BY NOVANT HEALTH'S ENTIRE ACUTE NURSING SYSTEM. DURING 2012, FORSYTH MEDICAL CENTER RECEIVED A NUMBER OF ACCREDITATIONS AND AWARDS FOR ITS HIGH LEVEL OF PATIENT CARE IN SPECIFIC CATEGORIES, INCLUDING THESE ACCOMPLISHMENTS: *FORSYTH MEDICAL CENTER RANKS WELL ABOVE THE STATE AVERAGE IN APPROPRIATE CARE MEASURE (ACM), A PATIENT-CENTERED COMPOSITE SCORE THAT CAPTURES WHETHER OR NOT A PATIENT RECEIVED ALL OF THE RECOMMENDED TREATMENTS IN THE FOLLOWING MEASURES: HEART ATTACK (100%) HEART FAILURE (100%) PNEUMONIA CARE (100%) SURGICAL CARE IMPROVEMENT PROJECT (99%) *FORSYTH MEDICAL CENTER ACHIEVED CYCLE IV CHEST PAIN NATIONAL ACCREDITATION FROM THE SOCIETY OF CHEST PAIN CENTERS. FORSYTH BECAME THE FIRST HOSPITAL IN NORTH CAROLINA AND ONE OF ONLY 26 IN THE NATION TO RECEIVE THIS DESIGNATION. THE NATIONAL SOCIETY EVALUATED FORSYTH'S ABILITY TO RAPIDLY AND ACCURATELY DIAGNOSE AND TREAT PATIENTS WHO MAY BE HAVING A HEART ATTACK, AND DETERMINED THE HOSPITAL'S SUCCESS AT MEETING STRICT CRITERIA: REDUCING THE TIME FROM ONSET OF SYMPTOMS TO DIAGNOSIS AND TREATMENT; TREATING PATIENTS MORE QUICKLY DURING THE CRITICAL WINDOW OF TIME WHEN THE INTEGRITY OF THE HEART MUSCLE CAN BE PRESERVED; AND MONITORING PATIENTS TO ENSURE THAT THEY ARE NOT SENT HOME TOO QUICKLY OR NEEDLESSLY ADMITTED TO THE HOSPITAL. THIS HIGHEST LEVEL OF ACCREDITATION ALSO RECOGNIZES TEAMWORK AMONG HOSPITAL CHEST PAIN EXPERTS, EMERGENCY DEPARTMENTS AND EMS PARTNERS. *THE DERRICK L. DAVIS FORSYTH REGIONAL CANCER CENTER RECEIVED NATIONAL RECOGNITION FOR ITS RESEARCH PROGRAM FROM THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO). FORSYTH'S AWARD, PRESENTED BY THE CONQUER CANCER FOUNDATION OF THE ASCO, RECOGNIZES ORGANIZATIONS THAT HAVE ESTABLISHED HIGH QUALITY CLINICAL CANCER RESEARCH PROGRAMS. FORSYTH IS ONE OF ONLY SIX PROGRAMS IN THE UNITED STATES AND THE ONLY ONE IN NORTH CAROLINA TO RECEIVE THIS AWARD IN 2012. *THE CANCER CENTER ALSO ACHIEVED THREE-YEAR ACCREDITATION WITH COMMENDATION FROM THE NATIONAL COMMISSION ON CANCER. THE COMMISSION IS DEDICATED TO IMPROVING SURVIVAL RATES AND QUALITY OF LIFE FOR CANCER PATIENTS THROUGH STANDARD-SETTING, PREVENTION, RESEARCH EDUCATION AND THE MONITORING OF COMPREHENSIVE QUALITY CARE. FORSYTH MET ALL 36 COMMISSION STANDARDS. *FORSYTH CARDIAC AND VASCULAR CENTER RECEIVED RE-DESIGNATION FOR ADVANCED HEART FAILURE CERTIFICATION FROM THE JOINT COMMISSION WITH NO RECOMMENDATIONS FOR IMPROVEMENT. THE SURVEYOR COMPLIMENTED THE EXPERTISE OF THE TEAM, THE STRENGTH OF THE PROGRAM, THE CONTINUUM OF CARE PROVIDED, AND THE PROGRAM'S QUALITY OUTCOMES. *FOR THE FOURTH CONSECUTIVE YEAR, FORSYTH CARDIAC AND VASCULAR CENTER HAS EARNED THE SOCIETY OF THORACIC SURGEONS (STS) 3-STAR RATING, REPRESENTING THE HIGHEST QUALITY RATING AWARDED FOR HEART SURGERY. THIS DESIGNATION IS BASED ON A COMPREHENSIVE RATING SYSTEM THAT COMPARES THE QUALITY OF CARDIAC SURGERY AMONG HOSPITALS ACROSS THE COUNTRY. ONLY 14 PERCENT OF ALL CARDIAC SURGERY HOSPITALS IN THE U.S. RECEIVED THIS TOP RANKING, WHICH PLACES OUR PHYSICIANS AMONG THE NATION'S BEST AT CONSISTENTLY PROVIDING EXCELLENT SURGICAL OUTCOMES. IN ITS FIRST FULL YEAR OF OPERATION, FORSYTH MEDICAL CENTER AFFILIATE HOSPITAL, KERNERSVILLE MEDICAL CENTER (KMC) IN KERNERSVILLE, NC, FOCUSED ON PROVIDING A FAST-ACCESS EMERGENCY DEPARTMENT, GENERAL, ORTHOPAEDIC AND EYE SURGICAL SERVICES, CONSISTENT QUALITY, EXCELLENT SERVICE AND A REMARKABLE WORK ENVIRONMENT FOR STAFF TO RESIDENTS IN THE KERNERSVILLE AREA, WESTERN GUILFORD AND ROCKINGHAM COUNTIES, AS WELL AS EASTERN STOKES AND FORSYTH COUNTIES. THE MEDICAL CENTERS ALSO MADE SIGNIFICANT CONTRIBUTIONS TOWARD IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. THE HIGHLIGHTS FOR 2012 INCLUDE THE FOLLOWING: *FORSYTH MEDICAL CENTER AND ITS AFFILIATE KERNERSVILLE MEDICAL CENTER SERVED MORE THAN 12,000 PATIENTS THROUGH A FREE SERVICE CALLED CARE CONNECTIONS, A 24/7 ADVICE SERVICE IN WHICH NURSES CAN MAKE RECOMMENDATIONS FOR A PRIMARY CARE PHYSICIAN, URGENT CARE LOCATION OR EMERGENCY DEPARTMENT. NURSES CAN VIEW CURRENT WAIT TIMES AT LOCAL NOVANT URGENT CARE LOCATIONS AND OFFER A RESERVED, SAME-DAY VISIT AND TIME. THEY CAN ALSO MAKE APPOINTMENTS AT SOME PRIMARY CARE PRACTICES OR CALL AHEAD TO TELL NOVANT HOSPITAL EMERGENCY DEPARTMENTS THAT A PATIENT IS ARRIVING. *FORSYTH MEDICAL CENTER OPENED THE MAYA ANGELOU CENTER FOR WOMEN'S HEALTH AND WELLNESS TO COORDINATE COMPREHENSIVE SERVICES SPECIFICALLY DESIGNED TO MEET THE UNIQUE NEEDS OF WOMEN THROUGH EVERY STAGE OF LIFE. THE CENTER IS THE REGION'S FIRST TO EMPLOY WOMEN'S HEALTH NAVIGATORS TO HELP COORDINATE THE VAST ARRAY OF WOMEN'S SERVICES AVAILABLE THROUGHOUT THE MEDICAL CENTER. THE CENTER BRINGS TOGETHER ALL OF THE CLINICAL PROGRAMS AND SERVICES AT FMC THAT TOUCH WOMEN'S HEALTH, INCLUDING HEART, WELLNESS, CANCER, SURGICAL SERVICES, MATERNITY, EMERGENCY CARE, BONE AND JOINT HEALTH, AND BEHAVIORAL HEALTHCARE, INCLUDING A NEW MIDLIFE WOMEN'S CENTER. THE CENTER WILL CREATE COLLABORATION IN RESEARCH, EDUCATION AND TREATMENT THAT WILL BRING ABOUT INNOVATIONS IN CARE TO IMPROVE THE HEALTH OF WOMEN IN OUR COMMUNITY AND THROUGHOUT NORTH CAROLINA. *FORSYTH BEHAVIORAL HEALTH OPENED A NEW 24-HOUR ASSESSMENT CENTER AS PART OF A HUB OF SERVICES DEDICATED TO MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES. THE HUB, LOCATED OFFSITE FROM THE HOSPITAL, HOUSES THE NEW ASSESSMENT CENTER, A 24-HOUR BEHAVIORAL HEALTH CALL CENTER. PARTIAL HOSPITAL AND INTENSIVE OUTPATIENT PROGRAMS AND THE MOBILE CRISIS RESPONSE TEAM. THIS CREATES THE MOST COMPREHENSIVE BEHAVIORAL HEALTH CENTER IN THE REGION. ABOUT ONE-THIRD OF BEHAVIORAL HEALTH-RELATED ADMISSIONS TO FORSYTH MEDICAL CENTER'S EMERGENCY DEPARTMENT WOULD QUALIFY TO COME TO THE ASSESSMENT CENTER, SO THE NEW HUB WILL BENEFIT THE EMERGENCY DEPARTMENT BY HELPING TO DECOMPRESS THE NUMBER OF BEHAVIORAL HEALTH PATIENTS. THE HUB IS ALSO EQUIPPED WITH VIDEO MONITORING EQUIPMENT, CONNECT TO FORSYTH MEDICAL CENTER'S PUBLIC SAFETY SYSTEM, TO ENSURE THE SAFETY OF PATIENTS AND STAFF. COMMUNITY BENEFIT REPORT: HTTP://WWW.NOVANTHEALTH.ORG/GIVEBACK/COMMUNITYBENEFITREPORT.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 $546,000,000 IN 2012. 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 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 WE 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. FORM 990, PART I, LINE 6: THE NUMBER OF VOLUNTEERS REPORTED INCLUDES THOSE VOLUNTEERS SERVING AS BOARD MEMBERS. *DURING 2012, FORSYTH MEDICAL CENTER BECAME THE FIRST HOSPITAL IN CENTRAL AND EASTERN NORTH CAROLINA TO OFFER PATIENTS AT RISK OF SUDDEN CARDIAC ARREST A NEW LIFE-SAVING DEVICE THAT CAN SHOCK THE HEART MUSCLE TO RESTORE NORMAL RHYTHM. THE DEVICE, A SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (S-ICD), IS THE FIRST HEART DEFIBRILLATOR THAT CAN BE IMPLANTED UNDER THE SKIN WITHOUT TOUCHING THE HEART. IT WAS APPROVED FOR USE BY THE FOOD AND DRUG ADMINISTRATION ON SEPTEMBER 28, 2012. *THE EMERGENCY DEPARTMENT AT FMC HAS TRANSFORMED ITS OPERATIONS IN THE PAST TWO YEARS TO ACHIEVE ITS LOWEST DOOR-TO-PROVIDER WAIT TIMES ALONG WITH PROVIDING NEW SERVICES. -39 MINUTES FOR THE AVERAGE PATIENT. UPON ARRIVAL, EVERY PERSON IS GREETED AND EVALUATED BY A NURSE PRACTITIONER WHO, IN MOST CASES, CAN BEGIN THEIR PLAN OF CARE RIGHT AWAY INCLUDING ORDERING DIAGNOSTIC TESTS BEFORE A PATIENT GOES BACK TO A TREATMENT ROOM. -58 MINUTES AVERAGE DOOR-TO-TPA TIME TO BEGIN ADMINISTERING TPA TO STROKE PATIENTS WHICH BEGINS THE PROCESS OF DISSOLVING THE BLOOD CLOT IN THEIR BRAIN. A NEW PRACTICE ALSO BRINGS POTENTIAL STROKE PATIENTS DIRECTLY TO A CT SCANNER, SKIPPING VALUABLE TIME THAT HAS BEEN LOST IN A TREATMENT ROOM. -ADDING A CLINICAL SERVICE NAVIGATOR WHO IS A CLINICAL NURSE THAT CALLS PATIENTS AFTER DISCHARGE ABOUT LAB RESULTS AND FOLLOW-UP NEEDS. *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 DERRICK L. DAVIS FORSYTH REGIONAL 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 SCREENING 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 BIRTH AND BEGINNING CLASSES, BREASTFEEDING EDUCATION AND SUPPORT GROUPS, A FREE ON-LINE HEALTH RISK ASSESSMENT, GIRLS ON THE RUN AND GIRLS ON TRACK WHICH PROMOTE YOUTH TO LEAD ACTIVE, HEALTHY LIFESTYLES, AND THE HANESBRANDS HEALTH LEARNING LIBRARY WHICH PROVIDES SCREENINGS, HEALTH CHECKS AND EDUCATION SERVICES. *FORSYTH MEDICAL CENTER RECEIVED A GRANT FROM THE KATE B. REYNOLDS CHARITABLE TRUST TO EDUCATE AND HELP LOW-INCOME ADULTS IN FORSYTH COUNTY MANAGE AND PREVENT DIABETES. OVER THREE YEARS THE HOSPITAL WILL ENROLL 300 ADULTS NEWLY DIAGNOSED WITH DIABETES OR WITH UNCONTROLLED DIABETES IN ITS DIABETES SELF-MANAGEMENT PROGRAM, WHICH IS RECOGNIZED BY THE AMERICAN DIABETES ASSOCIATION FOR MEETING NATIONAL EXCELLENCE STANDARDS. THE HOSPITAL WILL ALSO ENROLL 200 ADULTS WITH PRE-DIABETES IN AN EDUCATIONAL PREVENTION PROGRAM. *THE MEDICAL CENTER'S MAYA ANGELOU CENTER FOR WOMEN'S HEALTH AND WELLNESS HELD A THREE-DAY INTERNATIONAL SUMMIT FOCUSING ON CONTEMPORARY ISSUES AFFECTING WOMEN'S AND GIRLS' HEALTH. OPEN TO THE PUBLIC, THE SUMMIT BROUGHT TOGETHER INTERNATIONALLY RECOGNIZED ADVOCATES FOR WOMEN'S HEALTH TO DISCUSS A BROAD RANGE OF TOPICS RANGING FROM BARRIERS AND DISPARITIES IN WOMEN'S HEALTHCARE, TO VIOLENCE AGAINST WOMEN TO EMPOWERING WOMEN AND GIRLS TO LEAD. SPEAKERS INCLUDED EXPERTS IN THE FIELDS OF HEALTHCARE DESIGN, HEALTH SCIENCES, HEALTH POLICY, LAW, SOCIAL POLICY AND EDUCATION AS WELL AS LEADERS OF SEVERAL INTERNATIONAL ORGANIZATIONS WITH MISSIONS TO IMPROVE WOMEN'S HEALTH. 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 VI, SECTION A, LINE 2 FAMILY AND/OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIPS PAUL HAMMES GARY GREEN 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 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 DECISIONS SUBJECT TO APPROVAL OF MEMBERS NOVANT HEALTH, INC. HAS CERTAIN RESERVED POWERS, SUCH AS APPROVAL OF AMENDEMNTS 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 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 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 CERTAIN LEADERS AND EXECUTIVES ("EXECUTIVES") SERVING 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 DO NOT EXCEED FAIR MARKET VALUE WHEN COMPARED TO THE MARKET DATA FOR SIMILAR POSITIONS. 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. THE COMMITTEE REVIEWS AND APPROVES EACH ITEM OF THE NOVANT HEALTH SYSTEM CEO'S COMPENSATION AND BENEFITS. 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 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 DO NOT EXCEED FAIR MARKET VALUE WHEN COMPARED TO THE MARKET DATA FOR SIMILAR POSITIONS. 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. LASTLY, IT REVIEWS AND APPROVES ALL OF THE ELEMENTS AND SPECIFICATIONS INCLUDED IN ALL OTHER EXECUTIVE AND LEADER COMPENSATION PLANS AND PROGRAMS (E.G., INCENTIVE PLAN DESIGN, AWARD OPPORTUNITIES, ETC.). 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FMCF AND AUXILIARY OF FMC CONTRIBUTION: -2,763,953. AFFILIATE TRANSFERS: -3,354,434. MALPRACTICE INSURANCE: -3,765,692. ROUNDING 9. EXCEL IMAGING LLC 2085 FRONTIS PLAZA BLVD WINSTONSALEM NC 27103 204253946 INACTIVE NC 0 0 FORSYTH MEMORIAL HOSPITAL SALEM MRI LLC 2085 FRONTIS PLAZA BLVD WINSTONSALEM NC 27103 INACTIVE NC 0 0 FORSYTH MEMORIAL HOSPITAL THE BREAST CLINIC MRI LLC 2085 FRONTIS PLAZA BLVD WINSTONSALEM NC 27103 INACTIVE NC 0 0 FORSYTH MEMORIAL HOSPITAL AUXILIARY OF FORSYTH MEMORIAL HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560862112 HEALTHCARE NC 501(C)(3) LINE 9 FORSYTH MEMORIAL HOSPITAL INC 1 BRUNSWICK NOVANT MEDICAL CENTER FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 274616751 HEALTHCARE NC 501(C)(3) LINE 7 BRUNSWICK COMMUNITY HOSPITAL LLC 0 CAROLINA MEDICORP ENTERPRISES INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581466368 HEALTHCARE NC 501(C)(3) LINE 11B, II NOVANT MEDICAL GROUP INC 0 COMMUNITY GENERAL HEALTH PARTNERS INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560636250 HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH TRIAD REGION LLC 0 COMMUNITY GENERAL HOSPITAL FOUNDATION INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561828629 HEALTHCARE NC 501(C)(3) LINE 7 COMMUNITY GENERAL HEALTH PARTNERS INC 0 CONTINUING CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541288473 HEALTHCARE VA 501(C)(3) LINE 9 PRINCE WILLIAM HEALTH SYSTEM 0 FORSYTH MEDICAL CENTER FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 562120959 HEALTHCARE NC 501(C)(3) LINE 7 FORSYTH MEMORIAL HOSPITAL INC 1 FOUNDATION HEALTH SYSTEMS CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561373175 HEALTHCARE NC 501(C)(3) LINE 9 NOVANT HEALTH INC 0 MEDICAL PARK HOSPITAL INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561340424 HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH TRIAD REGION LLC 0 NOVANT HEALTH INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376950 HEALTHCARE NC 501(C)(3) LINE 11C, III-FI N/A 0 NOVANT MEDICAL GROUP INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581728803 HEALTHCARE NC 501(C)(3) LINE 3 NMG SERVICES INC 0 PERSONAL CARE SERVICES 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541291284 HEALTHCARE VA 501(C)(3) LINE 9 PRINCE WILLIAM HEALTH SYSTEM 0 PRESBYTERIAN HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560554230 HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH SOUTHERN PIEDMONT REGION LLC 0 PRESBYTERIAN HOSPITAL FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 581413074 HEALTHCARE NC 501(C)(3) LINE 7 NOVANT HEALTH SOUTHERN PIEDMONT REGION LLC 0 PRESBYTERIAN MEDICAL CARE CORPORATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561376368 HEALTHCARE NC 501(C)(3) LINE 3 NOVANT HEALTH SOUTHERN PIEDMONT REGION LLC 0 PRINCE WILLIAM HEALTH SYSTEM 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541278944 HEALTHCARE VA 501(C)(3) LINE 11C, III-FI NOVANT HEALTH INC 0 PWHS FOUNDATION 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 541307595 HEALTHCARE VA 501(C)(3) LINE 7 PRINCE WILLIAM HEALTH SYSTEM 0 PRINCE WILLIAM HOSPITAL 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 540696355 HEALTHCARE VA 501(C)(3) LINE 3 PRINCE WILLIAM HEALTH SYSTEM 0 ROWAN HEALTH SERVICES CORP 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561424814 HEALTHCARE NC 501(C)(3) LINE 11C, III-FI NOVANT HEALTH INC 0 NMG SERVICES INC (FKA ROWAN MEDICAL PRACTICES) 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 562098809 HEALTHCARE NC 501(C)(3) LINE 9 NOVANT HEALTH INC 0 ROWAN REGIONAL MEDICAL CENTER AUXILIARY 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 237022472 HEALTHCARE NC 501(C)(3) LINE 9 ROWAN REGIONAL MEDICAL CENTER INC 0 ROWAN REGIONAL MEDICAL CENTER FOUNDATION INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 561424818 HEALTHCARE NC 501(C)(3) LINE 7 ROWAN REGIONAL MEDICAL CENTER INC 0 ROWAN REGIONAL MEDICAL CENTER INC 2085 FRONTIS PLAZA BLVD WINSTON SALEM NC 27103 560547479 HEALTHCARE NC 501(C)(3) LINE 3 ROWAN HEALTH SERVICES CORP 0 SELF INSURANCE FUND - 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