2012-08-13T15:59:48-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 560532309 HIGH POINT REGIONAL HEALTH SYSTEM HIGH 3368786000 PO BOX HP-5 HIGH POINT NC 27261 KIMBERLY S CREWS 3368786000 2012-08-13 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z KIMBERLY S CREWS PO BOX HP-5 HIGH POINT NC 27261 286402395 0 X WWW.HIGHPOINTREGIONAL.COM X 1933 NC OPERATION OF HOSPITAL AND HEALTH CARE FACILITIES IN HIGH POINT, NC 19 15 2571 419 464996 180460 1490103 1745590 276802447 272066954 5464357 7319737 2504611 2970611 286261518 284102892 276967 1605062 0 0 118482774 113669069 0 0 447647 161821415 161698049 280581156 276972180 5680362 7130712 341432654 293131896 114838404 113335392 226594250 179796504 X OUR MISSION: TO PROVIDE EXCEPTIONAL HEALTH SERVICES TO THE PEOPLE OF OUR REGION. OUR VISION: TO BE THE BEST HEALTHCARE ORGANIZATION IN EVERYTHING WE DO - THE BEST PLACE TO RECEIVE CARE, THE BEST PLACE TO WORK, AND THE BEST PLACE TO PRACTICE MEDICINE. OUR VALUES: TEAMWORK, COMPASSION, AND INTEGRITY. 0 0 232549340 1605062 271874954 THE SYSTEM PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE SYSTEM DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.THE SYSTEM MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. ESTIMATED COST OF THE CHARGES IDENTIFIED AS CHARITY CARE WAS $8,554,300 FOR THE YEAR ENDED SEPTEMBER 30, 2011.IN PROVIDING CHARITY CARE TO PATIENTS, THE HOSPITAL INCURRED NON-REIMBURSED COSTS RELATED TO TREATING MEDICARE AND MEDICAID PATIENTS AND PATIENTS FROM OTHER GOVERNMENT NON-NEGOTIATED PLANS. THE AMOUNT OF NON-REIMBURSED COSTS ASSOCIATED WITH TREATING MEDICARE AND MEDICAID PATIENTS, AND PATIENTS WITH OTHER GOVERNMENT NON-NEGOTIATED PLANS FOR THE YEAR WAS $10,669,778, $6,377,905, AND $269,994 RESPECTIVELY. (SEE SCHEDULE H FOR DETAILS.) THE ESTIMATED COST OF RECORDED BAD DEBT EXPENSE IS $13,091,953 FOR THE YEAR.IN MEETING ITS OBJECTIVE OF PROVIDING QUALITY HEALTH CARE TO THE COMMUNITY, THE HOSPITAL PROVIDED MEDICAL SERVICE FOR AND DISCHARGED 17,216 PATIENTS DURING THE YEAR. TOTAL DAYS OF CARE WERE 75,144 AND THE AVERAGE DAILY CENSUS WAS 206 PATIENTS. THE EMERGENCY DEPARTMENT REGISTERED 63,081 VISITS.THE HOSPITAL ALSO PROVIDED SEVERAL SUBSIDIZED SERVICES TO THE COMMUNITY. THERE ARE SEVERAL GREAT REASONS TO BE PROUD OF HIGH POINT REGIONAL, SUCH AS, - THE CHARLES E. AND PAULINE LEWIS HAYWORTH CANCER CENTER IS RATED AS THE TOP COMMUNITY COMPREHENSIVE CANCER CENTER IN THE TRIAD BY THE US NEWS & WORLD REPORT. - THE WOMEN'S IMAGING CENTER WAS THE FIRST COMPLETELY FULL-FIELD DIGITAL MAMMOGRAPHY FACILITY IN HIGH POINT TO OFFER BOTH DIAGNOSTIC AND SCREENING MAMMOGRAPHY SERVICES. THIS ADVANCED EQUIPMENT WAS FULLY FUNDED BY COMMUNITY DONORS THROUGH PROCEEDS FROM THE HEALTH SYSTEM'S ENDOWMENT FUNDS. - WE HAVE DA VINCI SI SURGICAL SYSTEM, ENHANCED HIGH-DEFINITION 3D VISION THAT OFFERS OUR SURGEONS SUPERIOR CLINICAL CAPABILITY, INCREASED DEXTERITY FAR GREATER THAN THE HUMAN HAND, INTUITIVE MOTION TECHNOLOGY AND INTUITIVE INSTRUMENT CONTROL DURING MINIMALLY INVASIVE SURGERY FOR UROLOGY AND GYNECOLOGY. SINCE THE PROGRAM BEGAN IN 2005, WE HAVE PERFORMED OVER 700 PROCEDURES. - WE ARE THE ONLY HOSPITAL IN THE TRIAD TO OFFER 24 HOUR CONTINUOUS ELECTRONIC MONITORING OF CRITICALLY ILL PATIENTS. - THE SOCIETY OF CHEST PAIN CENTERS ACCREDITS HIGH POINT REGIONAL AS AN OFFICIAL CHEST PAIN CENTER FOR MEETING AND EXCEEDING QUALITY-OF-CARE MEASURES IN ACUTE CARDIAC MEDICINE. - OUR STROKE CENTER WAS RE-CERTIFIED AS A PRIMARY STROKE CENTER BY THE JOINT COMMISSION. - WE HAVE RECEIVED RENEWAL OF LEVEL III TRAUMA DESIGNATION FOR THE EMERGENCY DEPARTMENT. OUR EMERGENCY DEPARTMENT HAS A CAREFULLY COORDINATED PROCESS, CENTERED AROUND THE AMERICAN COLLEGE OF SURGEONS TRAUMA PROTOCOL, FOR RECEIVING, TREATING, AND REFERRING CRITICALLY INJURED TRAUMA PATIENTS WHO NEED STABILIZATION OR RESUSCITATION. - WE HAVE RECEIVED MAGNET DESIGNATION FOR THE THIRD TIME. - WE ARE THE ONLY HOSPITAL IN THE TRIAD TO OFFER 24 HOUR CONTINUOUS ELECTRONIC MONITORING OF CRITICALLY ILL PATIENTS. - WE ARE THE SECOND LARGEST EMPLOYER OF HIGH PONT, NC, WITH OVER 2,500 TALENTED AND DEDICATED INDIVIDUALS WHO PROVIDE COMPASSIONATE CARE TO MORE THAN 130,000 PEOPLE EVERY YEAR. 232549340 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 396 0 2571 1 1 1 0 0 0 0 0 0 0 0 0 X 19 15 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X X KIMBERLY CREWS 3368786143 601 N ELM STREET HIGH POINT NC 27261 DONALD W CAMERON EDD 2.00 X X 0 0 0 OWEN BERTSCHI 2.00 X X 0 0 0 BARRY CHEEK MD 2.00 X 0 0 0 GEORGE CLOPTON 2.00 X 0 0 0 LOUISE FOSTER 2.00 X 0 0 0 RON L JONES 2.00 X 0 0 0 JAMES KEEVER 2.00 X 0 0 0 REID MARSH 2.00 X 0 0 0 CHARLES MYERS 2.00 X 0 0 0 NED COVINGTON 2.00 X 0 0 0 KEN SMITH 2.00 X 0 0 0 LINDA TAYLOR MD 2.00 X 0 0 0 VIRGIL V WILLARD MD 2.00 X 0 159926 0 HARRY R CULP DDS 2.00 X 0 0 0 TOM DAYVAULT 2.00 X 0 0 0 ELLIOT F WILLIAMS MD 2.00 X 25000 0 0 MICHAEL J LUCAS MD 2.00 X 15000 0 0 STEPHEN A MILLS MD 2.00 X 0 0 0 CHARLES CAIN 2.00 X 0 0 0 JEFFREY S MILLER 40.00 X 521053 0 312342 KIMBERLY S CREWS 40.00 X 224800 0 41016 MARTHA D BARHAM 40.00 X 268344 0 48141 LINDA C RONEY 40.00 X 223236 0 55582 DARRELL R DEATON 40.00 X 175744 0 35849 TAMMI E ERVING-MENGEL MD 40.00 X 202114 0 27232 GREG TAYLOR MD 40.00 X 342090 0 96160 KATHERINE R BURNS 40.00 X 177497 0 11053 DENISE M POTTER 40.00 X 191929 0 28235 ANN L JOHNSTON 40.00 X 31443 0 121 BRIAN A FARAH 36.00 X 418382 0 22334 ZARINA W CHOW 40.00 X 142293 0 15928 MELANIE J MARTIN 40.00 X 143348 0 9479 EDWARD W LOVE 40.00 X 243770 0 14602 ALFRED D BELEN 40.00 X 232091 0 11895 3546691 159926 729848 55 0 1 0 SPECTRUM LABORATORY 4380 FEDERAL DRIVE SUITE 100 GREENSBORO NC 27410 LABORATORY 4685904 CORNERSTONE HEALTHCARE 1701 WESTCHESTER DRIVE HIGH POINT NC 27262 PHYSICIAN SERVICES 2648247 ARAMARK HEALTHCARE FOOD SERVICES 25271 NETWORK PLACE CHICAGO IL 60673 FOOD SERVICE MGMT 1938916 COGENT HEALTHCARE OF NC PO BOX 645037 CINCINATTI OH 45264 HOSPITALIST 1551552 LOCKTON COMPANIES 5901-C PEACHTREE DUNWOODY RD STE 3 ATLANTA GA 30328 INSURANCE 1351055 63 7475 1125577 34702 577836 1745590 PATIENT SERVICES 621400 269343333 269343333 OTHER AFFILIATE REV 900099 890875 890875 HP SURGERY CENTER 621400 660046 660046 REFERENCE LAB 621500 558300 366300 192000 FITNESS CENTER 713940 532879 532879 81521 81521 272066954 7624050 7624050 2534808 446034 1824520 710288 446034 1156322 272996 883326 304313 -304313 -304313 -304313 333919 7475 170670 163249 163249 CAFETERIA/VENDING 722210 829033 829033 MISCELLANEOUS REVENUE 900099 822007 822007 1651040 284102892 271874954 464996 10017352 1413148 1413148 191914 191914 3178635 40000 2922469 216166 94286 94286 88934592 72137047 16759354 38191 5302762 4150330 1137798 14634 9651418 7553907 2070876 26635 6507376 5158181 1330446 18749 384127 384127 51536 51536 26612217 20428714 6170588 12915 2013019 15649 1975987 21383 64265538 54517562 9737209 10767 13874 13148 726 3703596 3703596 264197 119698 138038 6461 2923928 2923928 18805494 18805494 1682510 1546590 135920 BAD DEBT EXPENSE 39317380 39317380 MISCELLANEOUS EXPENSES 1166344 513054 571544 81746 RECRUITMENT 494289 494289 276972180 232549340 43975193 447647 303705 271669 4260956 4333206 4244649 1353827 33147925 38126112 3494578 3296499 6204377 4707365 356104603 213158173 147271313 142946430 127545345 85255402 6842333 2019212 309309 3151843 7808164 7670331 341432654 293131896 34112083 39887132 50770094 47745327 6560171 4390103 15000000 12835108 8396056 8477722 114838404 113335392 X 206141042 176283719 6542645 3512785 13910563 0 226594250 179796504 341432654 293131896 X 7130712 -53928458 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12280 12280 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND A PORTION OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ATTRIBUTABLE TO LOBBYING EXPENDITURES. FOR THE TAX YEAR 2011, THE AMOUNT OF DUES ATTRIBUTABLE TO LOBBYING WAS APPROXIMATELY $12,280 BASED ON ALL AVAILABLE INFORMATION FROM THOSE ORGANIZATIONS. THE HOSPITAL ALSO MAKES OCCASIONAL CONTRIBUTIONS TO THE NORTH CAROLINA CHAMBER OF COMMERCE AND THE HIGH POINT CHAMBER OF COMMERCE. THE CONTRIBUTIONS ARE NOT SPECIFICALLY FOR LOBBYING EXPENDITURES, BUT SOME PORTION OF THOSE ORGANIZATIONS' ACTIVITIES COULD BE CONSIDERED LOBBYING. THE PORTION OF THOSE CONTRIBUTIONS ALLOCATED AS LOBBYING, IF ANY, IS UNKNOWN. PLEASE SEE SCHEDULE I FOR DETAILS ON CONTRIBUTIONS TO THOSE ORGANIZATIONS. 13910563 13910563 13673783 236780 13910563 13403545 270238 13673783 0.00000 0.00000 0.00000 0 1 1 13009705 13009705 156490737 77888504 78602233 7124273 5449640 1674633 175476726 129820029 45656697 4003162 4003162 142946430 RETIREMENT & DEATH BENEFITS PAYABLE 3656150 ESTIMATED THIRD-PARTY SETTLEMENTS 4821572 8477722 284102892 276972180 7130712 -5364245 -48564213 -53928458 -46797746 229872878 -5364245 534773 170670 -4658802 234531680 49571212 49571212 284102892 276670624 534773 170670 705443 275965181 1006999 1006999 276972180 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE HEALTH SYSTEM'S ENDOWMENT CONSISTS OF A FUND ESTABLISHED FOR A VARIETY OF HEALTHCARE PROGRAMS AS DEEMED NECESSARY BY THE BOARD OF TRUSTEES. THE ENDOWMENT INCLUDES DONOR-RESTRICTED ENDOWMENT FUNDS AND AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. THE HEALTH SYSTEM HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT ASSETS. ENDOWMENT ASSETS INCLUDE THOSE ASSETS OF DONOR-RESTRICTED FUNDS THAT THE ORGANIZATION MUST HOLD IN PERPETUITY. UNDER THIS POLICY, AS APPROVED BY THE BOARD OF TRUSTEES, THE ENDOWMENT ASSETS ARE INVESTED IN A MANNER THAT IS INTENDED TO PRODUCE RESULTS THAT EXCEED THE PRICE AND YIELD RESULTS OF THE S&P 500 INDEX WHILE ASSUMING A MODERATE LEVEL OF INVESTMENT RISK. IN THE TAX YEAR 2010, THE ORGANIZATION TRANSFERRED THE ENDOWMENT TO THE NEWLY-CREATED HIGH POINT REGIONAL HEALTH SYSTEM FOUNDATION. FUTURE ACTIVITY OF THE ENDOWMENT IS TRACKED WITHIN THAT ORGANIZATION, AND AMOUNTS RELEASED FROM RESTRICTION ARE TRANSFERRED TO THE FILING ORGANIZATION AS CONTRIBUTIONS FROM THE FOUNDATION. SEE FORM 990, PART VIII, LINE 1. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HEALTH SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND FROM STATE INCOME TAXES UNDER SIMILAR PROVISIONS OF NORTH CAROLINA TAX LAWS. HOWEVER, INCOME FROM CERTAIN ACTIVITIES NOT DIRECTLY RELATED TO THE HEALTH SYSTEM'S TAX-EXEMPT PURPOSE IS SUBJECT TO TAXATION AS UNRELATED BUSINESS INCOME. THE HEALTH SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2011. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: TRANSFER OF EQUITY TO AFFILIATE -15,030,980. TRANSFER OF ENDOWMENT TO HIGH POINT REG. HEALTH SYSTEM FOUNDATION -33,533,233. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES 170,670. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NET W/ REVENUES ON FINANCIAL STATEMENTS 1,006,999. TRANSFER OF EQUITY TO AFFILIATE 15,030,980. TRANSFER OF ENDOWMENT TO HIGH POINT REG. HEALTH SYSTEM FOUNDATION 33,533,233. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES 170,670. PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NET W/ REVENUES ON FINANCIAL STATEMENTS 1,006,999. LOVELINE TREE LIGHTING 65226 65226 349 SUN AND STARS 189975 7475 182500 3049 40049 30600 73698 2 86193 86193 2500 20425 341394 7475 333919 2500 3049 40049 30600 94472 170670 163249 1 1 X 1 X 1 X 1 1 1 0 1 1 8554300 8554300 0.03600 6377905 6377905 0.02680 269994 269994 0.00110 15202199 15202199 0.06390 831873 3320 828553 0.00350 502112 0 502112 0.00210 0 189094 23756 165338 0.00070 301902 8275 293627 0.00120 1824981 35351 1789630 0.00750 17027180 35351 16991829 0.07140 42808 42808 0.00020 43869 43869 0.00020 86677 86677 0.00040 0 13091953 0 103706963 114376741 -10669778 X 1 1 1 HIGH POINT SURGERY CENTER AMBULATORY SURGERY 0.50000 0.50000 1 1 HIGH POINT REGIONAL HEALTH SYSTEM

601 NORTH ELM STREET HIGH POINT NC 27262

X X X DISPROPORTIONATE SHARE HOSPITAL NA IN 2010 PER IRS ANNOUNCEMENT 2011-37 1 9 REGIONAL PSYCHIATRIC ASSOC

320 BOULEVARD ST HIGH POINT NC 27262

BEHAVIORAL HEALTH HIGH POINT WEST

1720 WESTCHESTER DR HIGH POINT NC 27262

PHYSICAL THERAPHY CAROLINA CARDIOLOGY CORNERSTONE

306 WESTWOOD AVE HIGH POINT NC 27262

HEART CENTER EMERYWOOD HEMATOLOGYONCOLOGY

302 WESTWOOD AVE HIGH POINT NC 27262

CANCER/RADIATION THOMASVILLE MEDICAL OFFICE BUILDING

711 NATIONAL HWY THOMASVILLE NC 27360

REHABILITATION DIABETES CENTER

319 WESTWOOD AVE HIGH POINT NC 27262

DIABETES TREATMENT REGIONAL REHAB & PAIN

300 GATEWOOD AVE HIGH POINT NC 27262

REHABILITATION REHAB AT YMCA

900 BONNER DR JAMESTOWN NC 27282

REHABILITATION PHYSICIANS OFFICES

222 W RAY ST HIGH POINT NC 27262

PATHOLOGY PART I, LINE 7: THE ORGANIZATION HAS USED THE ANDI (ADVOCACY NEEDS DATA INITIATIVE) METHODOLOGY, WHICH USES A FACILITY-WIDE RATIO OF COST TO CHARGES AS DESCRIBED IN THE 2010 NORTH CAROLINA HOSPITAL ASSOCIATION COMMUNITY BENEFIT GUIDELINES TO DETERMINE FINANCIAL ASSISTANCE, UNREIMBURSED MEDICAID, AND OTHER AMOUNTS ON PART I, LINE 7 AT COST. PART I, L7 COL(F): TOTAL EXPENSES REPORTED ON FORM 990, PART XI, LINE 25 INCLUDES A BAD DEBT EXPENSE OF $39,317,380 WHICH HAS BEEN REMOVED FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT PERCENTAGE ON LINE 7, COLUMN (F). PART II: HIGH POINT REGIONAL PROMOTED THE HEALTH OF THE COMMUNITY IT SERVES BY SUPPLYING MEETING SPACE FOR NON-PROFIT ORGANIZATIONS SUCH AS LEADERSHIP HIGH POINT. HIGH POINT REGIONAL GENEROUSLY SPONSORED AN ARRAY OF COMMUNITY GROUPS INCLUDING HIGH POINT CHAMBER OF COMMERCE, ARCHDALE-TRINITY CHAMBER OF COMMERCE, KERNERSVILLE CHAMBER OF COMMERCE, AND THOMASVILLE CHAMBER OF COMMERCE.IN ADDITION, HIGH POINT REGIONAL PROMOTED THE HEALTH OF THE COMMUNITY IT SERVES BY SUPPLYING MEETING SPACE FOR NON-PROFIT ORGANIZATIONS SUCH AS BRAIN INJURY ALLIANCE, RELAY FOR LIFE, AND ALCOHOLICS ANONYMOUS. HIGH POINT REGIONAL PROMOTED THE CHILD SAFETY SEAT PROGRAM BECAUSE CURRENTLY FOUR OUT OF FIVE CAR SEATS IN THE U.S. ARE USED INCORRECTLY, SO THE TRAINING AND EDUCATION IS CRUCIAL. HIGH POINT REGIONAL GENEROUSLY SPONSORED AN ARRAY OF COMMUNITY GROUPS INCLUDING SPECIAL OLYMPICS AND OPEN DOOR MINISTRIES. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT.THE COST OF BAD DEBT IS CALCULATED USING THE ANDI (ADVOCACY NEEDS DATA INITIATIVE) METHODOLOGY, WHICH USES A FACILITY-WIDE RATIO OF COST TO CHARGES AS DESCRIBED IN THE 2010 NORTH CAROLINA HOSPITAL ASSOCIATION COMMUNITY BENEFIT GUIDELINES.THERE IS NO REASONABLE METHOD AVAILABLE TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. IN FUTURE YEARS, THE ORGANIZATION WILL MAKE EFFORTS TO GATHER INFORMATION THAT MAY LEAD TO AN ESTIMATE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE IS CALCULATED USING THE ANDI (ADVOCACY NEEDS DATA INITIATIVE) METHODOLOGY, WHICH USES A FACILITY-WIDE RATIO OF COST TO CHARGES AS DESCRIBED IN THE 2010 NORTH CAROLINA HOSPITAL ASSOCIATION COMMUNITY BENEFIT GUIDELINES.THE ENTIRE MEDICARE SHORTFALL AMOUNT SHOULD BE TREATED AS A COMMUNITY BENEFIT. MEDICARE RATES AND NUMBERS OF MEDICARE PATIENTS ARE NOT NEGOTIATED. AS REIMBURSEMENT RATES DECLINE RELATIVE TO COSTS OF CARE, HIGH POINT REGIONAL CONTINUES TO SERVE THE MEDICARE POPULATION. IN FY 2011, MEDICARE ACCOUNTED FOR APPROXIMATELY HALF OF HIGH POINT REGIONAL'S BUSINESS BASED ON GROSS CHARGES. WITHOUT THIS SERVICE, THESE PATIENTS WOULD BECOME AN OBLIGATION TO THE GOVERNMENT. ANY UNREIMBURSED COST OF THIS CARE ARE A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: HIGH POINT REGIONAL HEALTH SYSTEM HAS A ROBUST FINANCIAL ASSISTANCE UNIT CONSISTING OF SIX FINANCIAL COUNSELORS, TWO SOCIAL WORKERS, AN OFFICE SPECIALIST, AND A DEPARTMENT COORDINATOR. A DAILY REPORT IS GENERATED INDENTIFYING ALL PATIENTS REGISTERED AS "SELF PAY". USING THIS REPORT, THE FINANCIAL COUNSELORS SCHEDULE MEETINGS WITH PATIENTS FACE-TO-FACE FOR FINANCIAL EVALUATIONS. PATIENTS CAN BE SCREENED FOR MEDICAID ELIGIBILITY, HPRHS'S CHARITY CARE PROGRAM AND/OR OTHER FINANCIAL ASSISTANCE OPPORTUNITIES. WHEN FACE-TO-FACE EVALUATIONS ARE NOT POSSIBLE, FINANCIAL COUNSELORS REACH OUT TO PATIENTS VERBALLY VIA TELEPHONE CALLS AND WRITTEN CORRESPONDENCE.FINANCIAL COUNSELORS ALSO PROVIDE PATIENTS WITH INFORMATION ON FINANCING MEDICAL BILLS THROUGH FIRSTPOINT COLLECTION RESOURCES (FORMERLY MOSAIC FINANCE SOLUTIONS OR HEALTH FINANCE). PATIENTS CAN THEN PAY THEIR ACCOUNT WITH MONTHLY INSTALLMENTS WHICH IS 2.5% OF THEIR HIGHEST ACCOUNT BALANCE, WITH A MINIMUM OF $25. PATIENTS ARE ALLOWED TO PAY OVER A PERIOD OF 56 MONTHS AND FIRSTPOINT CHARGES A FINANCE CHARGE WHICH IS EQUAL TO AN ANNUAL RATE OF 4%. CREDIT REPORTS ARE USED TO ASSIST IN THE QUALIFICATION PROCESS. HPRHS ALSO OFFERS A PROMPT PAY DISCOUNT IN THE AMOUNT OF 40% OF CHARGES TO UNINSURED PATIENTS. IN ORDER TO QUALIFY, A PATIENT MUST PAY THE BILL IN FULL WITHIN 30 DAYS FROM THE DATE OF THE FIRST STATEMENT. THIS 40% DISCOUNT IS NOT AVAILABLE TO THE PATIENTS WHO ELECT TO PAY THEIR BILL OVERTIME THROUGH FIRSTPOINT PAYMENT PLANS.HIGH POINT REGIONAL USES A THIRD-PARTY VENDOR, PARAGON, TO COLLECT ALL PATIENT PAYMENTS BEGINNING TEN DAYS AFTER THE PATIENT'S SERVICE DATE. IF THE PATIENT HAS NOT PAID WITHIN 120 DAYS, THE BALANCE IS TRANSFERRED TO BAD DEBT AND THE ACCOUNT IS TRANSFERRED TO FIRSTPOINT FOR DEBT COLLECTION.PAYMENTS CAN BE MADE BY CASH, CHECK, MASTERCARD, VISA, OR AMERICAN EXPRESS. PART VI, LINE 2: AS A PART OF THE YEARLY STRATEGIC PLANNING PROCESS, DEMOGRAPHIC TRENDS AND PROJECTIONS, INCLUDING POPULATION GROWTH, AGE DISTRIBUTION AND HOUSEHOLD INCOME BY ZIP CODE IN PRIMARY AND SECONDARY SERVICE AREAS, ARE USED TO IDENTIFY FUTURE SERVICE NEEDS. THIS DATA IS COLLECTED BY THE HPRHS DEPARTMENTS OF PLANNING AND BUSINESS INTELLIGENCE. DATA SOURCES INCLUDE CLARITAS, NC DIVISION OF AGING AND ADULT SERVICES, STATEHEALTHFACTS.ORG, THE HIGH POINT ECONOMIC DEVELOPMENT CORPORATION, AND OTHERS. A LIAISON FROM THE PLANNING DEPARTMENT ALSO WORKS WITH THE LOCAL UNITED WAY AGENCY, PROVIDING OUR HEALTH SYSTEM WITH A METHOD TO SHARE THE DATA GATHERED THROUGH THEIR ANNUAL COMMUNITY NEEDS ASSESSMENT. ADDITIONALLY, THERE IS EVALUATION OF SERVICE GROWTH OPPORTUNITIES DEFINED IN THE NORTH CAROLINA STATE MEDICAL FACILITIES PLAN. DATA IS ALSO COLLECTED AND TRENDED THROUGH VOICE-OF-THE-CUSTOMER METHODS INCLUDING PATIENT COMMENTS ON HPRHS SATISFACTION SURVEYS AND THROUGH OUR SERVICE RECOVERY PROCESS. THIS DATA INFORMS THE HEALTH SYSTEM'S STRATEGIC DECISIONS REGARDING NEW OR IMPROVED HEALTH CARE ACCESS POINTS, PROGRAMS, COLLABORATIVE EFFORTS, AND TECHNOLOGY NEEDED TO SERVE CHANGING POPULATION DEMOGRAPHICS. PART VI, LINE 3: DURING THE PATIENT REGISTRATION PROCESS FOR SCHEDULED PROCEDURES, IF A PATIENT DECLINES ALL PAYMENT OPTIONS AND EXPRESSES CONCERN ABOUT THEIR ABILITY TO PAY FOR THE SERVICES RENDERED, THE REGISTRAR OFFERS TWO OPTIONS--THE PATIENT CAN BE SCREENED FOR MEDICAID ELIGIBILITY OR BE SCREENED FOR HIGH POINT REGIONAL HEALTH SYSTEM'S CHARITY CARE PROGRAM WITH HELP FROM TRAINED FINANCIAL COUNSELORS IN THE HOSPITAL'S FINANCIAL ASSISTANCE UNIT. COUNSELORS DIRECT PATIENTS TO AS MANY PROGRAMS FOR FINANCIAL ASSISTANCE AS POSSIBLE, INCLUDING SOCIAL SECURITY DISABILITY, MEDICAID, CRIME VICTIMS, SANE FOR RAPE VICTIMS, PURCHASE OF MEDICAL CARE PROGRAM FOR CANCER, AND ANY OTHER STATE, LOCAL OR FEDERAL PROGRAM OFFERED TO ASSIST PEOPLE WITH THEIR MEDICAL BILLS OR ACCESS TO CONTINUED CARE. FOR PATIENTS WITH UNSCHEDULED CARE THAT IS EMERGENCY OR URGENT, THIS PROCESS IS COMPLETED EITHER DURING THE PATIENT'S STAY OR AT DISCHARGE. THIS INFORMATION IS AVAILABLE IN A PACKET IN BOTH ENGLISH AND SPANISH VERSIONS. ADDITIONALLY, HPRHS PROVIDES AN OVERALL SUMMARY OF OUR CHARITY POLICY AND HOW TO APPLY ON THE HPRHS WEBSITE AT HTTP://WWW.HIGHPOINTREGIONAL.COM/PATIENTSANDVISITORS/PAYMENT/PAY.ASP. THE HPRHS PATIENT CARE STAFF IS ALSO TRAINED TO RECOGNIZE FINANCIAL NEED IN PATIENTS AND REFER THEM FOR ASSISTANCE. PATIENTS WHO HAVE FURTHER QUESTIONS REGARDING THEIR HOSPITAL BILL CAN CALL AN AUTOMATED BILLING SYSTEM 24 HOURS A DAY, 7 DAYS A WEEK TO OBTAIN BALANCE INFORMATION OR REQUEST A COPY OF AN ITEMIZED BILL. CUSTOMER SERVICE REPRESENTATIVES ARE ALSO ON DUTY MONDAY - FRIDAY, 8 A.M. TO 5 P.M. TO ANSWER ACCOUNT QUESTIONS. PART VI, LINE 4: HIGH POINT REGIONAL HEALTH SYSTEM (HPRHS) HAS A PRIMARY SERVICE AREA COMPRISED OF THE GEOGRAPHIC AREA THAT INCLUDES HIGH POINT, ARCHDALE, TRINITY, THOMASVILLE, AND JAMESTOWN, NORTH CAROLINA. THIS INCLUDES ZIP CODES 27260-27262, 27264, 27265, 27282, 27263, 27360-27361, AND 27370. HPRHS OPERATES WITH A 61.2% SHARE OF THE PRIMARY SERVICE AREA MARKET THAT ENCOMPASSES A TOTAL POPULATION OF 197,600, WITH AN AVERAGE HOUSEHOLD INCOME OF $57,066, BUT WITH 27.1% OF ALL HOUSEHOLDS HAVING AN AVERAGE INCOME EQUAL TO OR LESS THAN $25,000. THE SECONDARY SERVICE AREA FOR HPRHS INCLUDES COLFAX, DENTON, SOUTHWESTERN GREENSBORO, KERNERSVILLE, LEXINGTON, ASHEBORO, RANDLEMAN, AND SOPHIA, NORTH CAROLINA. THIS INCLUDES ZIP CODES 27235, 27239, 27407, 27284-27285, 27292-27295, 27203-27205, 27317, 27350, AND 27107. THE TOTAL POPULATION OF THIS AREA IS 320,796, WITH AN AVERAGE INCOME OF $53,830, OF WHICH 26.5% OF THESE HOUSEHOLDS HAVE AN AVERAGE ANNUAL INCOME AT OR LESS THAN $25,000. HPRHS OPERATES WITH A 9.0% SHARE OF THE SECONDARY MARKET AREA. HPRHS' COMBINED PRIMARY AND SECONDARY SERVICE AREAS SERVE AN ESTIMATED DEPENDENT POPULATION OF 129,304 OR 24.9% OF THE COMBINED PRIMARY AND SECONDARY SERVICE AREAS TOTAL POPULATION OF 518,396. HPRHS' COMBINED SERVICE AREA POPULATION HAS AN AVERAGE INCOME OF $55,065, OF WHICH 26.7% OF ALL HOUSEHOLDS HAVE AN ANNUAL INCOME EQUAL TO OR LESS THAN $25,000. THE RACE/ETHNICITY MIX FOR THE AREA IS APPROXIMATELY: 68.94% WHITE NON-HISPANIC, 16.8% BLACK NON-HISPANIC, 9.9% HISPANIC, AND 4.5% OTHER. BASED ON JANUARY 2011 DATA, THE UNEMPLOYMENT RATE FOR GUILFORD COUNTY, WHICH INCLUDES THE LARGEST PERCENTAGE OF HPRHS'S COMBINED SERVICE AREA POPULATION, WAS 10.3% WITH HIGHER UNEMPLOYMENT RATES NOTED IN SEVERAL METROPOLITAN AREAS INCLUDING GREENSBORO-HIGH POINT AT 10.9%, UP FROM DECEMBER'S REPORT OF 10.2%. HIGH POINT REGIONAL HEALTH SYSTEM'S SELF-DEFINED SERVICE AREA DOES NOT ENCOMPASS A MEDICALLY UNDERSERVED AREA. HPRHS SHARES PARTS OF ITS SERVICES AREA WITH SEVEN OTHER HOSPITAL SYSTEMS INCLUDING : MOSES H. CONE HEALTH SYSTEM, WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, FORSYTH MEDICAL CENTER, THOMASVILLE MEDICAL CENTER, RANDOLPH HOSPITAL, LEXINGTON MEMORIAL HOSPITAL, AND KERNERSVILLE MEDICAL CENTER. PART VI, LINE 6: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS OR BUSINESS ASSOCIATES OF SUCH PERSONS. HIGH POINT REGIONAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PROFESSIONALLY COMPETENT PHYSICIANS WHO MEET ETHICAL STANDARDS. THIS HOLDS TRUE THROUGHOUT ALL HOSPITAL AREAS AND DEPARTMENTS. HIGH POINT REGIONAL UTILIZES SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE AND TO UPDATE OUR FACILITIES. DURING FY 2011, SURPLUS FUNDS IN THE AMOUNT OF $1.7 MILLION HAS BEEN USED TO SUPPORT MASSIVE RENOVATIONS ON THE FOURTH FLOOR OF OUR HOSPITAL. ANOTHER $3.2 MILLION HAS BEEN USED TO REPLACE THE AIR HANDLING UNIT. MAJOR AND MINOR EQUIPMENT, INCLUDING ITEMS SUCH AS AN ULTRASOUND UNIT AND HEART/LUNG BYPASS MACHINES, WERE PURCHASED IN THE AMOUNT OF $1.1 MILLION. APPROXIMATELY $5.5 MILLION WAS SPENT IN FY 2011 FOR I.T. EQUIPMENT AND ITEMS RELATED TO THE CONSTRUCTION OF A NEW DATA CENTER. THESE DATA SYSTEM UPDATES WILL IMPROVE PATIENT CARE BY REDUCING ERRORS AND INCREASING EFFICIENCY. A CERTIFICATE OF NEED TO RENOVATE WOMEN'S SERVICES ON THE 5TH FLOOR HAS BEEN FILED, AND CONDITIONAL APPROVAL WAS RECEIVED. THE RENOVATION WILL INCLUDE REDUCING THE 6-BED PODS TO 4-BED PODS AND CREATING AN ENVIRONMENT THAT WILL ENHANCE THE BIRTH EXPERIENCE FOR THE PARENTS. A CERTIFICATE OF NEED TO RENOVATE THE EMERGENCY DEPARTMENT HAS BEEN RECEIVED. THIS RENOVATION WILL PROVIDE A SAFE ENVIRONMENT FOR PATIENTS WITH PSYCHIATRIC DISEASE AND PROMOTE BETTER PATIENT FLOW. THIS RENOVATION WILL ALSO INCREASE THE NUMBER OF BEDS TO TREAT PATIENTS. PLANS ARE IN DEVELOPMENT FOR AN EXPANSION OF THE MAIN HOSPITAL. THE FOCUS OF THE EXPANSION WILL BE TO CREATE A STATE-OF-THE-ART SURGICAL SUITE COMPLETE WITH A CARDIOVASCULAR HYBRID OPERATING ROOM, EXPAND AND CONSOLIDATE THE CARDIAC CATH, ELECTROPHYSIOLOGY, AND CARDIOLOGY SERVICES. IN CONJUNCTION WITH THE BUILDING EXPANSION, THERE WILL BE A MAJOR FACILITIES INFRASTRUCTURE UPGRADE THAT WILL BE NECESSARY FOR FUTURE HEATING, COOLING, AND ELECTRICAL REQUIREMENTS OF THE FACILITY. PART VI, LINE 7: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 TRIAD ADULT & PEDIATRIC MEDICINE 1046 E WENDOVER AVE GREENSBORO NC 27405 561991438 501(C)(3) 850000 76740 COST CLINIC PHARMACY INVENTORY & TELEFILL SYSTEM SUPPORT FOR HEALTH CARE OF INDIGENT POPULATION THE COMMUNITY CLINIC OF HIGH POINT INC PO BOX 5607 HIGH POINT NC 27262 561795022 501(C)(3) 56250 388158 COST DIAGNOSTIC TESTS, PHYSICAL THERAPY, LAB SERVICES AND FACILITY USE. SUPPORT FOR HEALTH CARE OF INDIGENT POPULATION HIGH POINT CHAMBER OF COMMERCE 1634 NORTH MAIN STREET HIGH POINT NC 27262 560473292 501(C)(6) 42000 SPONSORSHIP & DUES 2 1 HEART STRIDES CARDIAC & PULMONARY REHAB SCHOLARSHIPS 97 65050 SCHOLARSHIPS FOR HEART AND LUNG PATIENTS TO PARTICIPATE IN CARDIAC & PULMONARY REHAB PROJECT C.A.R.E. - CRISIS ASSISTANCE FOR EMPLOYEES 1 2262 CRISIS ASSISTANCE FOR EMPLOYEES CANCER FITT/YOGA PROGRAM SCHOLARSHIPS 9 1910 SCHOLARSHIPS FOR CANCER PATIENTS TO PARTICIPATE IN THE PROGRAM, ALSO FOR SPECIALISTS' FEES MAMMOGRAM ASISSTANCE PROGRAM 44 16409 COST OF SERVICE MAMMOGRAMS PROVIDED FOR INDIGENT PATIENTS LOVELINE CANCER SUPPORT 255 87306 FINANCIAL SUPPORT FOR CANCER CENTER PATIENTS BEHAVIORAL HEALTH/PATIENT PRESCRIPTION ASSITANCE FOR INDIGENT PATIENTS 103 18977 DONATION TO SUPPORT PRESCRIPTIONS AT DISCHARGE PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: HIGH POINT REGIONAL HEALTH SYSTEM ADMINISTERS CONTRIBUTED DOLLARS EXACTLY AS THE DONORS DIRECT WHEN GIFTS ARE MADE. EACH FUND FOR GRANTMAKING HAS A POLICY THAT DETAILS THE SPECIFIC USES FOR THE FUNDS. A VICE PRESIDENT OF THE ORGANIZATION IS ASSIGNED OVERSIGHT OF THE FUND ALONG WITH THE COMMITTEE FOR THE FUND. IN ORDER TO RECEIVE ASSISTANCE, GRANTEES AND AID RECIPIENTS MUST DEMONSTRATE FINANCIAL NEED IN THE APPLICATION PROCESS. THIS IS ACCOMPLISHED BY HAVING A HOSPITAL FINANCIAL COUNSELOR CONDUCT A CONSULTATION WITH THE APPLICANT. ONCE AN APPLICANT IS DETERMINED TO BE ELLIGIBLE, A MEMBER OF THE COMMITTEE MAY AUTHORIZE EXPENDITURES FOR APPROVAL WITHIN THE POLICY CRITERIA. DISBURSEMENT FORMS MUST BE SIGNED BY THE VICE PRESIDENT CHARGED WITH OVERSIGHT, BEFORE THEY ARE SUBMITTED TO THE FINANCE COMMITTEE FOR PROCESSING. COMPLETE RECORDS OF EXPENDITURES ARE KEPT IN A CENTRAL LOCATION, THE DSCED OFFICE. WHEN APPROVAL FOR ASSISTANCE IS GIVEN, THE DSCED OFFICE MUST BE IMMEDIATLEY PROVIDED WITH THE FOLLOWING INFORMATION: THE NAME OF THE PATIENT, THE NATURE OF THE EXPENDITURE, THE EXACT AMOUNT, THE VENDOR'S NAME, AND DETAILS ON HOW THE EXPENSE IS TO BE PAID. MAXIMUM AMOUNTS FOR ASSISTANCE GRANTED TO EACH PER PERSON ARE STRICLTY MONITORED. OTHER INFORMATION: PART IV: PART III THE BOARD OF DIRECTORS DIRECTS THE USE OF ENDOWMENT FUNDS TO THE ORGANIZATION. CEO JEFF MILLER SIGNS THE INVOICES FOR PAYMENT. ONCE APPROVED, THE ORGANIZATION SEND THE FUNDS TO THE GRANTEE ORGANIZATION. COMPLETE RECORDS OF ALL ENDOWMENT FUNDS RECEIVED FOR GRANTMAKING ARE KEPT BY HIGH POINT REGIONAL FOUNDATION. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 VIRGIL V WILLARD MD 0 159926 0 0 0 0 0 0 0 0 0 159926 0 0 JEFFREY S MILLER 469164 0 0 0 51889 0 268323 0 44019 0 833395 0 0 0 KIMBERLY S CREWS 182223 0 0 0 42577 0 23969 0 17047 0 265816 0 0 0 MARTHA D BARHAM 215791 0 0 0 52553 0 41472 0 6669 0 316485 0 0 0 LINDA C RONEY 175707 0 0 0 47529 0 37295 0 18287 0 278818 0 0 0 DARRELL R DEATON 154309 0 0 0 21435 0 21058 0 14791 0 211593 0 0 0 TAMMI E ERVING-MENGEL MD 154087 0 0 0 48027 0 17259 0 9973 0 229346 0 0 0 GREG TAYLOR MD 301010 0 0 0 41080 0 72079 0 24081 0 438250 0 0 0 KATHERINE R BURNS 166708 0 0 0 10789 0 2699 0 8354 0 188550 0 0 0 DENISE M POTTER 168201 0 0 0 23728 0 8802 0 19433 0 220164 0 0 0 BRIAN A FARAH 203801 0 195208 0 19373 0 14700 0 7634 0 440716 0 0 0 ZARINA W CHOW 115324 0 0 0 26969 0 12793 0 3135 0 158221 0 0 0 MELANIE J MARTIN 126418 0 0 0 16930 0 5343 0 4136 0 152827 0 0 0 EDWARD W LOVE 174917 0 68295 0 558 0 3607 0 10995 0 258372 0 0 0 ALFRED D BELEN 172452 0 56704 0 2935 0 4231 0 7664 0 243986 0 0 0 PART I, LINE 4B THE SYSTEM HAS ESTABLISHED A 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. IN GENERAL, THE ORGANIZATION CONTRIBUTES AMOUNTS TO THE PLAN IN AMOUNTS EQUAL TO AN EMPLOYEE'S APPLICABLE PERCENTAGE MULTIPLIED BY HIS COMPENSATION FOR A PLAN YEAR, LESS ANY AMOUNTS CONTRIBUTED TO THE HOSPITAL'S 457(B) EXECUTIVE SAVINGS PLAN. VESTING IN THE PLAN OCCURS UPON A PARTICIPANT REACHING HIS ESTABLISHED PAYMENT DATE OR HIS INVOLUNTARY TERMINATION OF CONTINUOUS SERVICE, PURSUANT TO PLAN STIPULATIONS. FOR THE YEAR ENDED 9/30/11, THE FOLLOWING INDIVIDUALS ACCRUED THE FOLLOWING AMOUNTS TO THIS PLAN: JEFFREY MILLER $ 247,498 MARTHA BARHAM 20,647 KIMBERLY CREWS 5,078 GREGORY TAYLOR 57,379 TAMMI ERVING-MENGEL 376 DARRELL DEATON 5,220 LINDA RONEY 16,470 DENISE POTTER 3,604 THESE AMOUNTS ARE REPRESENTED ON SCHEDULE J, PART II, COLUMN (C). NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2009-11-04 9540000 CURRENT REFUNDING 0 0 0 3915000 9540000 190294 9349706 2007 1 0 1 1 0 1 0 0 0 1 TRACY WAGNER FAMILY MEMBER OF OFFICER MARTHA BARHAM 94286 COMPENSATION AS DIRECTOR OF FINANCE OF A RELATED ORGANIZATION 0 CORNERSTONE HEALTHCARE BOARD MEMBER MICHAEL LUCAS IS PART OWNER & TRUSTEE OF CORNERSTONE HEALTH 220818 THE ORGANIZATION RECEIVES PERSONAL PROPERTY RENTAL PAYMENTS FROM THE INTERESTED PERSON FOR THE USE OF A MOBILE MRI MACHINE. 0 CORNERSTONE HEALTHCARE BOARD MEMBER MICHAEL LUCAS IS PART OWNER & TRUSTEE OF CORNERSTONE HEALTH 2648247 THE ORGANIZATION CONTRACTS WITH CORNERSTONE HEALTHCARE FOR THE PROVISIONS OF PROFESSIONAL PHYSICIAN SERVICES. 0 CAROLINA ANESTHESIOLOGY BOARD MEMBER ELLIOTT WILLIAMS IS A PART OWNER OF CAROLINA ANESTHESIOLOGY 1320689 COMPENSATION FOR MEDICAL SERVICES PROVIDED 0 REGIONAL EMERGENCY PHYSICIANS BOARD MEMBER LINDA TAYLOR IS A PART OWNER OF REGIONAL EMERGENCY PHYSICIANS 776189 COMPENSATION FOR MEDICAL SERVICES PROVIDED 0 FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION MAINTAINS AN EXECUTIVE COMMITTEE CONSISTING OF THE CHAIRMAN, VICE CHAIRMAN, FORMER CHAIRMAN AND AT LEAST 4 OTHER MEMBERS OF THE BOARD OF DIRECTORS, ONE OF WHOM MUST BE THE CORPORATE PRESIDENT. ALL COMMITTEE MEMBERS EXCEPT THE CORPORATE PRESIDENT HAVE VOTING RIGHTS. THE EXECUTIVE COMMITTEE IS CHARGED WITH GENERAL MANAGEMENT OF THE HEALTH SYSTEM, CARE FOR THE REAL ESTATE AND OTHER PROPERTY OF THE CORPORATION, SUPERVISION OF CONSTRUCTION AND ALTERATIONS, MAKING RULES FOR GOVERNING THE HEALTH SYSTEM AND FOR THE ADMISSION AND DISCHARGE OF PATIENTS AND EMPLOYEES, REGULATION OF CHARGES TO PATIENTS AND EXPENSES OF THE HEALTH SYSTEM, AND IS ACCOUNTABLE TO THE BOARD OF DIRECTORS AT ALL TIMES. FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS CHARLES MYERS AND NED COVINGTON HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, MANAGEMENT MADE A DETAILED REVIEW OF THE DRAFT FORM 990. FOLLOWING MANAGEMENT'S REVIEW, THE RETURN WAS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO A SCHEDULED MEETING AND WAS DISCUSSED AT THE MEETING, ALLOWING TIME FOR QUESTIONS AND COMMENTS. FOLLOWING THE BOARD REVIEW, THE RETURN WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C HIGH POINT REGIONAL HEALTH SYSTEM REQUIRES BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. THE SYSTEM HAS ADMINISTRATIVE STAFF MONITOR AND TRACK THAT ALL FORMS ARE COMPLETE. IF ANY ISSUES ARE RAISED ON THOSE DISCLOSURES, THE APPROPRIATE INDIVIDUALS ARE NOTIFIED OF THE SITUATION AND APPROPRIATE MEASURES ARE TAKEN AT THE BOARD'S DISCRETION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES SETS COMPENSATION FOR THE CEO AND APPROVES COMPENSATION FOR VICE PRESIDENTS. AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTING FIRM, THE HAY GROUP, EVALUATES THESE POSITIONS AND PROVIDES COMPARISONS AGAINST A NATIONAL DATABASE. COMPENSATION IS SET AGAINST THE 50TH PERCENTILE OF THE MARKET. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -5,364,245. TRANSFER OF EQUITY TO AFFILIATE -15,030,980. TRANSFER OF ENDOWMENT TO HIGH POINT REG. HEALTH SYSTEM FOUNDATION -33,533,233. TOTAL TO FORM 990, PART XI, LINE 5: -53,928,458. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HIGH POINT REGIONAL HEALTH SERVICES INC 601 N ELM STPO BOX HP-5 HIGH POINT NC 27261 561497163 HEALTHCARE NC 501(C)(3) LINE 11A, I HIGH POINT REGIONAL HEALTH SYSTEM 1 HIGH POINT REGIONAL HEALTH SYSTEM FOUNDATION INC 601 N ELM STPO BOX HP-5 HIGH POINT NC 27261 272854711 SUPPORT/FUNDRAISING NC 501(C)(3) LINE 11A, I HIGH POINT REGIONAL HEALTH SYSTEM 1 HIGH POINT SURGERY CENTER 600 NORTH LINDSAY STREET HIGH POINT NC 27260 561867005 HEALTHCARE NC N/A RELATED 731930 3186253 0 1 0.50000 REGIONAL WELLNESS LLC SPORTSCENTER 861 OLD WINSTON ROAD KERNERSVILLE NC 27284 204475769 FITNESS CENTERS NC N/A PREMIER IMAGING LLC 4515 PREMIER DR SUITE 101 HIGH POINT NC 27265 611614223 HEALTHCARE NC N/A PREMIER MEDICAL PROPERTIES LLC 1701 WESTCHESTER DR SUITE 850 HIGH POINT NC 27262 208245501 REAL PROPERTY HOLDING NC N/A HIGH POINT HEALTHCARE VENTURES INC 601 N ELM STPO BOX HP-5 HIGH POINT NC 27261 561343468 HOLDING COMPANY NC N/A C 1.00000 PRACTICE DIRECTIONS 601 N ELM STPO BOX HP-5 HIGH POINT NC 27261 561892728 DORMANT NC HIGH POINT HEALTHCARE VENTURES INC C 1.00000 0 1 1 0 0 1 0 0 1 1 1 0 1 1 1 1 1 1 HIGH POINT REGIONAL HEALTH SERVICES INC B 13093516 CASH HIGH POINT REGIONAL HEALTH SERVICES INC F 769351 CASH HIGH POINT REGIONAL HEALTH SERVICES INC I 1286086 CASH HIGH POINT REGIONAL HEALTH SERVICES INC Q 68922 CASH HIGH POINT REGIONAL HEALTH SERVICES INC M 511924 CASH HIGH POINT REGIONAL HEALTH SERVICES INC N 227329 CASH HIGH POINT REGIONAL HEALTH SERVICES INC O 2292196 CASH HIGH POINT REGIONAL HEALTH SERVICES INC P 850071 CASH HIGH POINT REGIONAL HEALTH FOUNDATION C 1125577 CASH HIGH POINT REGIONAL HEALTH FOUNDATION K 407349 INTERCOMPANY HIGH POINT REGIONAL HEALTH FOUNDATION Q 33533233 FMV OF INVESTMENTS HIGH POINT HEALTHCARE VENTURES INC I 192000 CASH HIGH POINT SURGERY CENTER R 610000 CASH