2012-08-07T11:12:37-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 566000674 LENOIR MEMORIAL HOSPITAL INC LENO 2525227927 100 AIRPORT ROAD KINSTON NC 28501 SARAH MAYO 2525227927 2012-07-03 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z GARY BLACK 100 AIRPORT ROAD KINSTON NC 28501 126937841 0 X WWW.LENOIRMEMORIAL.ORG X 1950 NC PROVIDING EXCEPTIONAL HEALTHCARE AS AN OUTSTANDING COMMUNITY HOSPITAL 17 14 1305 280 407573 183672 150765 110980 119991893 118066876 3475469 4259213 3418767 3319392 127036894 125756461 178096 199111 0 0 60925290 54822042 0 0 52944 67642967 67132607 128746353 122153760 -1709459 3602701 180931509 180459030 51400913 49550658 129530596 130908372 X THE MISSION OF LENOIR MEMORIAL IS TO ENSURE EXCEPTIONAL HEALTHCARE FOR THE PEOPLE WE SERVE. 0 0 105206136 199111 119667341 STRATEGIC PRIORITIES FOCUS ON DELIVERING HEALTHCARE SERVICES CONSISTENT WITH COMMUNITY NEED. SERVICES ARE PROVIDED TO INDIVIDUALS REGARDLESS OF THE RACE, CREED, SEX, NATURAL ORIGIN AND/OR AN INDIVIDUAL'S INABILITY TO PAY.THE 2011 ANNUAL COMMUNITY HEALTH REPORT IS LOCATED ON THE HOSPITAL WEBSITE AT WWW.LENOIRMEMORIAL.ORG.2011 COMMUNITY HEALTH ACCOMPLISHMENTS:NC SAFE KIDS:LENOIR MEMORIAL HOSPITAL TRANSFERRED THE 2002 SAFEKIDS GMC VAN, BIKE RODEO TRAILER AND BIKES, AND APPROXIMATELY 600 CHILD PASSENGER SAFETY SEATS, 120 BIKE HELMETS, AND HUNDREDS OF EDUCATIONAL SUPPORT MATERIALS TO LENOIR-GREENE PARTNERSHIP FOR CHILDREN TO ENSURE A VIABLE LOCAL SAFEKIDS ORGANIZATION. A DONATION OF $1,000 WAS GIVEN TO SUPPORT CO-PAY COVERAGE FOR UNDERSERVED IN ORDER TO PROVIDE FREE CHILD PASSENGER SAFETY SEATS.ECONOMIC DEVELOPMENT:DOWNTOWN REVITALIZATION CASH DONATIONS INCLUDED SUPPORT FOR MAPLEWOOD CEMETERY ENTRANCE ENHANCEMENTS, CENTENNIAL PARK BEAUTIFICATION, LAGRANGE GARDEN SPOT FESTIVAL, AND A PRIDE OF KINSTON 10K RUN. DONATIONS WERE ALSO MADE TO SUPPORT ENHANCEMENTS AT THE KINSTON-LENOIR PUBLIC LIBRARY AND GREENE COUNTY PUBLIC LIBRARY.PINK HILL WELLNESS CENTER:A $5,000 DONATION WAS MADE TO ASSIST IN THE START-UP OF A COMMUNITY WELLNESS CENTER IN THE SOUTHERN PART OF THE COUNTY. COMMUNITY ART SUPPORT:CASH DONATIONS WERE PROVIDED TO SUPPORT COMMUNITY COUNCIL FOR THE ARTS, AND CONNECTING THE DOTS ERASING THE LINES PRE-SCHOOL PROGRAM.LITTLE BY LITTLE:OVER 15 MANAGEMENT TEAM MEMBERS JOINED A COMMUNITY MENTORING PROGRAM IN ORDER TO WEEKLY READ AND MENTOR UNDERSERVED ELEMENTARY CHILDREN AT SOUTHEAST ELEMENTARY SCHOOL. LEADERS ARE MATCHED WITH SPECIFIC CHILDREN OVER THE SCHOOL YEAR AND PROVIDED SUPPORT IN THE CLASSROOM FOR SUPPLIES AND CELEBRATIONS. A $1,000 DONATION WAS PRESENTED TO THE SCHOOL AT THE END OF THE SCHOOL YEAR FOR PURCHASING LIBRARY BOOKS AND IT EQUIPMENT IN THE ACCELERATED READER PROGRAM.COMMUNITY COALITION ACTIVITIES:LENOIR COUNTY ALLIANCE FOR A HEALTHY COMMUNITY MEETS ON A MONTHLY BASIS FOR COMMUNITY NETWORKING AND INFORMATION SHARING. THE LENOIR/GREENE ASTHMA COALITION MEETS FOUR TIMES A YEAR TO INCREASE COMMUNITY AWARENESS ABOUT ASTHMA.SUPPORT GROUPS:COORDINATED 18 HOSPITAL BASED GROUPS, ATTENDED BY 3,396 PARTICIPANTS. A STROKE SUPPORT GROUP WAS REORGANIZED THIS YEAR.FOUR COMMUNITY BLOOD PRESSURE MACHINES:PROVIDED 53,797 SCREENING BLOOD PRESSURES, INCLUDING SITES FOR BLOOD PRESSURE MACHINES AT VERNON PARK MALL AND A MACHINE THAT TRAVELS TO VARIOUS COMMUNITY CHURCHES.EMERGENCY PREPAREDNESS:LENOIR MEMORIAL PARTICIPATES IN THE LOCAL EMERGENCY PLANNING COMMITTEE, AND AS A MEMBER OF THE LENOIR COUNTY TEAM IN THE EASTERN REGIONAL ADVISORY COUNCIL FOR 29 COUNTIES TO PLAN, COORDINATE, AND EXECUTE DISASTER READINESS AND DRILLS. ONE COUNTY-WIDE DRILL WAS PERFORMED. A DE-CONTAMINATION TRAILER WAS GIVEN TO LENOIR COUNTY EMERGENCY MANAGEMENT IN ORDER TO PROVIDE COUNTY WIDE DECONTAMINATION SERVICES.MINGES WELLNESS CENTER:THE MEDICALLY BASED FITNESS CENTER FOR THE COMMUNITY HAS 73 PIECES OF STATIONARY EXERCISE EQUIPMENT WITH 25 GROUP EXERCISE CLASSES WEEKLY. A TOTAL OF 915 ACTIVE INDIVIDUAL MEMBERS WITH 169 MEMBERS PROVIDED PARTIAL SCHOLARSHIPS IN ORDER TO AFFORD TO JOIN. SIX CORPORATE MEMBERSHIPS DURING THIS PERIOD. VOTED THE #1 PLACE TO SHAPE UP, ONCE AGAIN, IN 2011, BY FREE PRESS READERS.SCREENING EVENTS:PROVIDED EARLY DETECTION SCREENING EVENTS OF DISEASES/DISORDERS/RISKS INCLUDING COLORECTAL, SKIN, PROSTATE CANCERS, MAMMOGRAM, CHOLESTEROL, AND BLOOD PRESSURES.COMMUNITY AIR QUALITY PROGRAM:INITIATED AN OUTDOOR FLAG ALERT PROGRAM WITH THE PARTNERSHIP OF THE ASTHMA COALITION AND NC AIR. DIFFERENT COLORED PENNANT FLAGS FLY TO SIGNIFY THE OUTDOOR AIR QUALITY FOR EASTERN NC AS TESTED DAILY BY THE EPA IN ROCKY MOUNT, NC.COMMUNITY EXERCISE INITIATIVES:IMPLEMENTED THE FIFTH ANNUAL COMMUNITY NEW YEAR'S CHALLENGE WITH OVER 200 ATTENDEES EVERY MONDAY NIGHT IN JANUARY, AND THE DIABETES WELLNESS 10,000 LIFE STEPS PROGRAM.LENOIR MEMORIAL COMMUNITY WALKING TRACK:AVERAGES OVER 700 WALKERS PER MONTH. CORPORATE HEALTH SERVICES:SERVICES INCLUDED 108 CORPORATE CLIENTS, 234 WORKSITE WELLNESS VISITS WITH 2,587 EMPLOYEE CONTACTS. FLU SHOTS, CPR TRAINING, AND TARGETED HEALTH EDUCATION IS PROVIDED.LIVING THE GOOD LIFE IN EASTERN NC:SPONSOR FOR THE KINSTON/LENOIR COUNTY CHAMBER OF COMMERCE EVENT WHICH FOCUSED ON HEALTHY LIVING ISSUES. OVER 2,000 PARTICIPANTS AT VERNON PARK MALL RECEIVED BP SCREENINGS. PLACED 2ND PLACE IN THE HEALTHY FOOD TASTE-TESTING AND BEST HEART HEALTHY RECIPE CONTEST.HEART HEALTHY LENOIR:WORKING WITH UNC CENTER FOR POPULATION HEALTH AND HEALTH DISPARITIES ON THE 5 YEAR NIH GRANT TO REDUCE STROKE AND HEART DISEASE IN LENOIR COUNTY. PARTNERSHIP INCLUDES A LOCAL ADVISORY COMMITTEE ON WHICH SEVERAL HOSPITAL LEADERS SERVE. A SITE OFFICE WAS OPENED IN FY11 AS PART OF THE STRATEGY TO FOCUS ON HYPERTENSION, GENETIC TESTING, AND LIFESTYLE INTERVENTION. GROW OUR OWN:THE GOLDEN LEAF FOUNDATION PROVIDED GRANT FUNDING FOR A HEALTHCARE WORKFORCE DEVELOPMENT PROJECT THAT CONCLUDED IN MARCH, 2011, WITH 25 COMMUNITY RESIDENTS HAVING WORKER SKILLS UPGRADES INTO CERTIFIED NURSING ASSISTANTS. THESE INDIVIDUALS WERE ALL SUCCESSFULLY PLACED INTO JOBS IN THE LOCAL JOB MARKET.DIABETES WELLNESS PROGRAM:LOCATED IN THE MINNIE P. STACKHOUSE DIABETES CENTER, THE FREE OUTPATIENT DIABETES SELF-MANAGEMENT PROGRAM FEATURES A MANDATORY EXERCISE COMPONENT. 136 NEW STARTS, WITH COMMUNITY OUTREACH WAS PERFORMED, INCLUDING EDUCATION AND SCREENINGS. KATE B. REYNOLDS CHARITABLE TRUST FUNDING ALLOWED PROGRAM EXPANSION TO INCLUDE A REGISTERED DIETITIAN AND MEDICAL NUTRITION COUNSELING AS PART OF A TWO YEAR $138, 307 GRANT WAS RECEIVED DURING THIS YEAR. TWO LOCAL AFRICAN AMERICAN CHURCHES RECEIVED TARGETED WEIGHT LOSS EDUCATION IN ORDER TO DECREASE TYPE 2 DIABETES RISK FACTORS.COMMUNITY HEALTH EDUCATION PROGRAMMING: WAS PROVIDED TO 2,557 PARTICIPANTS BY ON AND OFF-SITE PROGRAMMING. PROGRAMMING INCLUDED 55 ALIVE, INFANT CPR, QUITSMART, EXERCISE AND NUTRITION CLASSES. SHREDDING EVENT:THIS EVENT ALLOWED AREA RESIDENTS TO SAFELY AND CONFIDENTIALLY DISPOSE OF OLD PERSONAL RECORDS AND DOCUMENTS BY PARTNERING WITH CINTAS FOR THE FREE EVENT. OVER 200 RESIDENTS UTILIZED THE EVENT.FAMILY BIRTH CENTER COMMUNITY EDUCATION:LAMAZE/SIBLING/EARLY PRENATAL CLASSES INCLUDED OVER 220 ATTENDEES.EMPLOYEE OUTREACH:LENOIR MEMORIAL EMPLOYEES PARTICIPATED IN FUNDRAISING TO SUPPORT THE AMERICAN CANCER SOCIETY RELAY FOR LIFE, LENOIR MEMORIAL FOUNDATION, AND LENOIR-GREENE UNITED WAY. EMPLOYEES WORKED TOGETHER TO GIVE TIME, TALENT AND PERSONAL DONATIONS OF OVER $83,000 DURING FY11.NURSING SCHOLARSHIPS:NURSING LEADERSHIP, HIGH SCHOOL HEALTH OCCUPATION STUDENTS RECEIVE SCHOLARSHIP AWARDS.HOSPITAL VOLUNTEER PROGRAM:DURING FY 11, 200 ADULT VOLUNTEERS AND 55 YOUTH VOLUNTEERS PROVIDED 40,010 VOLUNTEER HOURS IN A VARIETY OF HOSPITAL SETTINGS ENRICHING THE PATIENT EXPERIENCE AND PERFORMING THE WORK OF 19.2 UNPAID FTES. LIGHTS OF LOVE HOLIDAY TREE LIGHTING CAMPAIGN COMMUNITY DONATIONS FUND A NUMBER OF HOSPITAL PROGRAMS AND PROJECTS EACH YEAR. 105206136 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 185 0 1 1305 1 1 1 0 0 0 0 0 0 0 0 0 X 17 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X X MICHELLE MITTEN CPA FINANCE DIR 2525227927 100 AIRPORT ROAD KINSTON NC 28501 GARY BLACK 40.00 X X 433132 0 54673 KAY HARRELL 1.00 X 0 0 0 MARY M CAULEY EDD 1.00 X 0 0 0 RAY COLLIER JR 1.00 X 0 0 0 RALPH LEE COX MD 1.00 X 0 0 0 DEXTER FLOYD 1.00 X 0 0 0 OSCAR SKIP GREENE III 1.00 X 0 0 0 MICHAEL HADDAD MD 1.00 X 12500 0 0 CLIFTON HARRISON 1.00 X 0 0 0 AGNES HO 1.00 X 0 0 0 ADRIAN KING 1.00 X 0 0 0 WILLIAM ANTHONY LAWSON JR 1.00 X 0 0 0 THOMAS A PHARO 1.00 X 0 0 0 DAPHNE POLLOCK 1.00 X 0 0 0 LESLIE REYNOLDS MD 1.00 X 96433 0 0 CURTIS S SMITH CPA 1.00 X 0 0 0 CARLTON YOUNGER JR 1.00 X 0 0 0 JIM DOBBINS 40.00 X 201711 0 30889 SARAH MAYO 40.00 X 261575 0 36379 WILLIAM LEASE 40.00 X 207343 0 29934 ROSILAND MCDONALD 40.00 X 237718 0 16210 DALE HARDY 40.00 X 186845 0 15557 SCOTT STEGBAUER MD 40.00 X 532804 0 21741 ARTHUR HUNSINGER 40.00 X 213743 0 16858 CONNIE MANGEL 40.00 X 195814 0 16160 GEORGE YVETTE 40.00 X 194259 0 14335 MARK HENNING 40.00 X 192554 0 14442 2966431 0 267178 22 0 1 1 LENOIR HM SERVICES PO BOX 82368 LAFAYETTE LA 705982368 HOSPITALIST STAFFING 541645 COMPREHENSIVE HOSPITALISTS SERVICES OF N PO BOX 203251 HOUSTON TX 77216 HOSPITALIST STAFFING 444037 EMERGENCY MEDICINE PHYSICIANS PO BOX 71-4287 COLUMBUS OH 432714287 EMERGENCY DEPARTMENT PHYSICIAN SERVICES 201000 DR ALAN KIROLLOS 2503 N QUEEN STREET KINSTON NC 285035455 PHYSICIAN GUARANTEE 187365 DIXON HUGHES GOODMAN LLP PO BOX 3049 ASHEVILLE NC 288023049 ACCOUNTING SERVICES 166510 9 19000 91980 110980 PATIENT SERVICES 621990 117606930 117606930 AUXILLARY SERVICE REVE 621990 180468 180468 WELLNESS CENTER REVEUN 713940 170753 170753 LAB REVENUE 541380 80795 40398 40397 PARTNERSHIP INCOME 541900 16645 16645 11285 11285 118066876 4506566 4506566 1597445 1597445 1597445 1258199 339246 2826 250179 -247353 -247353 -247353 1546821 931201 615620 410593 205027 DIETARY AND CAFETERIA 900099 847957 847957 GIFT SHOP 900099 200560 200560 VENDING 900099 57810 57810 1106327 125756461 119667341 612600 5365540 36379 36379 162732 162732 1712710 331240 1338615 42855 42661720 34847665 7814055 1576374 1249709 325143 1522 5716068 4531552 1178996 5520 3155170 2501338 650785 3047 49632 49632 450403 450403 70034 70034 317245 317245 7811988 6171930 1640058 445234 23802 421432 20725937 18436454 2289483 2125490 2125490 3328061 3116809 211252 75330 44046 31284 45661 27537 18124 47876 47876 7898342 7898342 62440 62440 BAD DEBT EXPENSE 23584344 23584344 RECRUITMENT 50872 50872 MISCELLANEOUS 43718 3455 40263 122153760 105206136 16894680 52944 2709213 3112445 15638265 17442567 9233420 11573208 3120114 3059169 1464055 1353423 143966945 80880181 65545845 63086764 78857992 76644225 4362605 4187229 180931509 180459030 10811648 9026065 9875313 10130696 19768872 19364230 7000000 6500000 3945080 4529667 51400913 49550658 X 90833596 93704950 38697000 37203422 129530596 130908372 180931509 180459030 X 3602701 -2224925 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10000 10000 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION. A PORTION OF THE DUES PAID TO THAT ORGANIZATION ARE ALLOCATED EACH YEAR TO LOBBYING EFFORTS ON BEHALF OF ITS MEMBERSHIP BODY. FOR THE YEAR, APPROXIMATELY $10,000 HAS BEEN ALLOCATED TO LOBBYING EXPENDITURES. 425406 425406 69451050 39321315 30129735 73403110 41558866 31844244 687379 687379 63086764 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 4510559 CAPITAL LEASE OBLIGATION 19108 4529667 125756461 122153760 3602701 -2224925 -2224925 1377776 100878393 -2224925 931201 -1293724 102172117 23584344 23584344 125756461 99500617 931201 931201 98569416 23584344 23584344 122153760 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL AND FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE HOSPITAL AND THE FOUNDATION HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2011. THE HOSPITAL AND FOUNDATION BELIEVE THEY ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2008. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 931,201. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 23,584,344. PART XIII, LINE 2D - OTHER ADJUSTMENTS: COSTS OF GOODS SOLD 931,201. PART XIII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 23,584,344. 1 1 1 X 1 X 1 1 1 0 1 1 938475 332803 605672 0.00610 14946659 12824227 2122432 0.02150 293122 218913 74209 0.00080 16178256 13375943 2802313 0.02840 1353921 525908 828013 0.00840 224409 224409 0.00230 402429 402429 0.00410 1980759 525908 1454851 0.01480 18159015 13901851 4257164 0.04320 1891 1891 0.00000 11108 11108 0.00010 12999 12999 0.00010 0 8077444 3050219 47682299 48359559 -677260 X 1 1 1 1 LENOIR MEMORIAL HOSPITAL INC

100 AIRPORT ROAD KINSTON NC 28501

X X X X DISPROPORTIONARE SHARE HOSPITAL LENOIR MEMORIAL HOSPITAL INC 1 1 LENOIR ORTHOPEDICS

701 DOCTORS DRIVE KINSTON NC 28501

ORTHOPEDIC CENTER PART I, LINE 3C: IN ADDITION TO DETERMINING ELIGIBILITY FOR FREE OR REDUCED-PRICE CARE USING INCOME LEVELS AND FEDERAL POVERTY GUIDELINES, PATIENTS MAY ALSO QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR ELIGIBILITY FOR SUBSIDIZED HOUSING UNDER HUD GUIDELINES. ALTHOUGH THE HOSPITAL PREFERS TO BE ABLE TO DISCUSS OPTIONS FOR FINANCIAL ASSISTANCE WITH HEALTHCARE COSTS - INCLUDING POSSIBLE ELIGIBILITY FOR MEDICAID OR OTHER PROGRAMS - WITH PATIENTS, IF EFFORTS TO DO SO PROVE UNSUCCESSFUL, ELIGIBILITY FOR LMH'S FINANCIAL ASSISTANCE PROGRAM MAY BE DETERMINED BASED UPON PATIENT ADDRESS IN A SUBSIDIZED HOUSING COMMUNITY. COMMUNITIES MEETING THIS DEFINITION, AS WELL AS INCOME AND ASSET CRITERIA FOR RESIDENTS, ARE REVIEWED PERIODICALLY WITH THE LOCAL HOUSING AUTHORITY. ADDITIONALLY, PATIENTS FACING EXTENSIVE MEDICAL COSTS WHO DO NOT MEET STANDARD FINANCIAL INDIGENCE CRITERIA BASED UPON INCOME LEVEL MAY QUALIFY FOR DISCOUNTED CARE IF THEY ARE DETERMINED TO BE "MEDICALLY INDIGENT"; THAT IS, HAVING INCURRED COSTS OF CARE IN EXCESS OF 20% OF FAMILY GROSS INCOME, AND FOR WHICH PAYMENT WOULD REQUIRE LIQUIDATION OF THOSE ASSETS CRITICAL TO LIVING OR EARNING A LIVING. THEREFORE, FINANCIAL AND OTHER ASSETS MUST BE FULLY DISCLOSED BY PATIENTS SEEKING THIS DESIGNATION IN ORDER FOR A MEDICAL INDIGENCE DETERMINATION TO BE MADE. ADDITIONALLY, DISCOUNTS FOR PROMPT PAYMENT OF BALANCES ARE AVAILABLE FOR ALL UNINSURED PATIENTS, AND ARE TIERED BASED UPON THE AMOUNT OWED (LARGER DISCOUNTS ARE APPLIED TO HIGHER BALANCES). PATIENT ACCOUNT LIAISONS (PALS) AND FINANCIAL COUNSELORS SCREEN PATIENTS FOR FINANCIAL ASSISTANCE EITHER AT THE POINT OF SERVICE OR AFTER SERVICE HAS BEEN RENDERED. THE STAFF ALSO UTILIZES A SOFTWARE SYSTEM THAT SCREENS PATIENTS FOR MEDICAID ELIGIBILITY AS WELL AS FINANCIAL ASSISTANCE. PALS INTERVIEW SCHEDULED PATIENTS PRIOR TO SERVICE, AFTER ADMISSION AS AN INPATIENT AND AFTER SERVICE IS RECEIVED THROUGH THE EMERGENCY DEPARTMENT REGARDING THEIR LIABILITY AND DISCUSS OPTIONS FOR PAYMENT INCLUDING FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS CONTACT PATIENTS AFTER THEY RECEIVE A STATEMENT FOR SERVICES TO DISCUSS PAYMENT OPTIONS INCLUDING FINANCIAL ASSISTANCE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 23584344. PART II: LENOIR MEMORIAL PARTNERS WITH AREA ORGANIZATIONS TO PROVIDE COMMUNITY HEALTH PROGRAMMING, HEALTH COALITION WORK, AND IN-KIND LEADERSHIP TO AREA BOARDS, AND NON-PROFITS. HOSPITAL LEADERSHIP TEAM MEMBERS SERVE ON COMMUNITY TASK FORCES AND ACTION GROUPS. SOME OF THESE INCLUDE THE LENOIR COUNTY SCHOOL HEALTH ADVISORY COMMITTEE, EASTERN AHEC, KINSTON-LENOIR COUNTY CHAMBER OF COMMERCE, PRIDE OF KINSTON, LENOIR COMMITTEE OF 100, LENOIR-GREENE UNITED WAY, KINSTON COMMUNITY HEALTH CENTER, LENOIR COUNTY ALLIANCE FOR A HEALTHY COMMUNITY, THE COMMUNITY MARKETING COMMITTEE, AND LENOIR-GREENE ASTHMA COALITION. LENOIR ALSO PARTICIPATES IN A MENTORING PROGRAM WITH SOUTH EAST ELEMENTARY SCHOOL. LENOIR PROVIDES MEETING SPACE FOR VARIOUS LOCAL COMMITTEES. WE WERE A SPONSOR OF THE 2011 LIVING THE GOOD LIFE EVENT AT VERNON PARK MALL WITH OVER 100 AREA AGENCIES AND BUSINESSES PARTICIPATING IN THE HEALTHY LIVING EVENT. DURING 2011, LENOIR MEMORIAL COMPLETED A GOLDEN LEAF FOUNDATION INITIATIVE FOR WORKFORCE DEVELOPMENT LEADERSHIP WHICH MENTORED AND TRAINED 25 NEW CERTIFIED NURSING ASSISTANTS FOR THE LOCAL HEALTHCARE WORKFORCE. LENOIR MEMORIAL PROVIDES WORKSITE WELLNESS CARE TO AREA BUSINESS AND INDUSTRY AND PROVIDED EMPLOYEE HEALTH SERVICES IN FY11 TO 108 CORPORATE CLIENTS WITH 234 REGIONAL SITE VISITS. LENOIR ALSO DONATED A DECONTAMINATION TRAILER TO LCEM. PART III, LINE 4: THE TOTAL BAD DEBT EXPENSE FOR FY11 WAS MULTIPLIED BY THE COST-CHARGE RATIO TO ESTIMATE TOTAL BAD DEBT AT COST.BAD DEBT ACCOUNTS WERE GEOCODED TO DETERMINE THE CENSUS TRACT WHICH CORRESPONDED TO THE ADDRESS ON FILE FOR EACH BAD DEBT ACCOUNT. THE AVERAGE PERCENTAGE OF HOUSEHOLDS FOR EACH CENSUS TRACT WHICH MET THE LMH CHARITY CARE GUILDELINES WAS THEN APPLIED TO DETERMINE AN ESTIMATED PERCENTAGE OF BAD DEBT WHICH COULD BE ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE LMH CHARITY CARE POLICY. PART III, LINE 8: THE MEDICARE COST REPORT WAS USED TO DETERMINE MEDICARE ALLOWABLE COSTS OF CARE. PART III, LINE 9B: THE HOSPITAL SENDS PATIENTS A STATEMENT EACH MONTH NOTING THE BALANCE DUE. INFORMATION IS INCLUDED ON THE STATEMENT REGARDING OPTIONS FOR PAYMENT INCLUDING FINANCIAL ASSISTANCE AND CONTACT NUMBERS. SELF PAY PATIENTS ARE OFFERED A PROMPT PAY DISCOUNT. NOTIFICATION OF THE DISCOUNT IS INCLUDED ON THE PATIENT'S STATEMENTS.FINANCIAL COUNSELORS AND PATIENT ACCOUNT LIAISONS ARE TRAINED TO INFORM PATIENTS OF FINANCIAL ASSISTANCE AS AN OPTION SHOULD THEY HAVE DIFFICULTY PAYING THEIR ACCOUNTS. THE PALS UTILIZE A SOFTWARE SYSTEM (RAMP) THAT SCREENS PATIENTS FOR POTENTIAL MEDICAID ELIGIBILITY AND FOR FINANCIAL ASSISTANCE. THE SCREENING IS BASED ON SOME PRELIMINARY QUESTIONS, AND THEN PATIENTS ARE SCHEDULED FOR AN INTERVIEW TO COMPLETE THE APPLICATION AND SUBMIT THE NECESSARY DOCUMENTS. PATIENTS RECEIVING LESS THAN 100% FINANCIAL ASSISTANCE WILL BE REQUESTED TO MAKE PAYMENT ARRANGEMENTS FOR THE REMAINING BALANCE.TELEPHONE CONTACTS TO DISCUSS ACCOUNT BALANCES WITH PATIENTS AND OFFER OPTIONS FOR RESOLUTION ARE ATTEMPTED ON MOST ACCOUNTS. THE HOSPITAL WILL OFFER PAYMENT PLANS TO PATIENTS THAT ARE ABLE TO PAY WITH A MINIMUM MONTHLY PAYMENT OF $50.00. PATIENTS ARE ALSO OFFERED ASSISTANCE WITH MEDICAID ELIGIBILITY APPLICATIONS. IF THE PATIENT IS NONRESPONSIVE AFTER RECEIVING THREE STATEMENTS (90 DAYS FROM DATE OF SERVICE OR LAST PAYMENT DATE), THE ACCOUNT MAY BE FORWARDED TO A COLLECTION AGENCY FOR FURTHER COLLECTION PROCEDURES. THE HOSPITAL DOES NOT UTILIZE PRACTICES SUCH AS GARNISHMENTS, LIENS, AND PERSONAL ATTACHMENTS AS PART OF THE COLLECTION PROCESS. LENOIR MEMORIAL FILES COMMUNITY BENEFIT DATA WITH THE NORTH CAROLINA HOSPITAL ASSOCIATION THROUGH ITS ANDI DATABASE; THIS DATA IS ALSO REPORTED TO THE NORTH CAROLINA MEDICAL CARE COMMISSION. DETAILED COMMUNITY BENEFITS INFORMATION HAS HISTORICALLY BEEN INCLUDED AS PART OF THE LENOIR MEMORIAL'S 990 FILING, WHICH IS AVAILABLE TO ANY MEMBER OF THE PUBLIC UPON REQUEST AND AT WWW.GUIDESTAR.ORG. INFORMATION ABOUT SOME OF THE SPECIFIC PROGRAMS THAT ADDRESS A VARIETY OF COMMUNITY HEALTH AND WELLNESS CONCERNS MAY BE FOUND ON THE HOSPITAL'S WEB SITE, WWW.LENOIRMEMORIAL.ORG. THE ORGANIZATION IS PART OWNER OF SPRING ARBOR, LLC WHICH OPERATES AN ASSISTED LIVING FACILITY. PART VI, LINE 2: LENOIR MEMORIAL WORKS CLOSELY WITH THE LENOIR COUNTY HEALTH DEPARTMENT TO CONDUCT THE COMMUNITY HEALTH ASSESSMENT PROCESS FOR LENOIR COUNTY, OUR LARGEST POPULATION SERVED. 2011 WAS THE CYCLICAL YEAR FOR SURVEYING THE COMMUNITY AND THIS WAS BEING IMPLEMENTED IN THE FALL OF 2011, WITH BOTH ENGLISH AND HISPANIC SURVEY INSTRUMENTS. LOCAL DEMOGRAPHIC AND HEALTH STATISTICS ARE COMPILED ALONG WITH THE COMMUNITY SURVEY DATA ABOUT PERCEIVED HEALTH ISSUES IN ORDER TO DEVELOP TARGETED COMMUNITY HEALTH STRATEGIES. THE FINAL 2011 SURVEY WILL BE READY EARLY SUMMER, 2012. LENOIR MEMORIAL ALSO PARTNERS WITH LENOIR, GREENE AND JONES COUNTIES IN HEALTHY CAROLINIANS LOCAL TASK FORCES. ANNUAL CANCER REPORTING AND HOSPITAL DIAGNOSIS TRENDS ARE USED TO PRIORITIZE PROGRAMMING, SERVICES, AND INITIATIVES AS WELL AS PHYSICIAN NEEDS ASSESSMENTS. PART VI, LINE 3: - THE HOSPITAL HAS POSTED SIGNS INFORMING PATIENTS OF PAYMENT OPTIONS INCLUDING THE FINANCIAL ASSISTANCE PROGRAM IN THE CASHIER'S OFFICE AND REGISTRATION AREAS OF THE HOSPITAL. - BROCHURES (PATIENT FINANCIAL HEALTH GUIDELINES) ARE PUBLISHED EXPLAINING "WHAT YOU NEED TO KNOW ABOUT PAYING FOR YOUR HEALTH SERVICES," AND INCLUDE INFORMATION REGARDING THE AVAILABILITY OF OUR FINANCIAL ASSISTANCE PROGRAM. THESE BROCHURES ARE INCLUDED AS PART OF THE INPATIENT ADMISSION INFORMATION PACKET, ARE ON DISPLAY IN WAITING ROOMS THROUGHOUT THE HOSPITAL AND ARE PROVIDED TO PATIENTS DURING INTERVIEWS SHOULD THEY HAVE ANY QUESTIONS. THE BROCHURE OFFERS ASSISTANCE THROUGH THE HOSPITAL INTERPRETER FOR SPANISH SPEAKING PATIENTS AND THE HOSPITAL HAS ACCESS TO TRANSLATION TELEPHONES FOR OTHER LANGUAGES.- THE FINANCIAL ASSISTANCE POLICY OVERVIEW IS ALSO INCLUDED ON THE HOSPITAL'S WEBSITE. - INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON PATIENT'S STATEMENT.- THE FINANCIAL COUNSELORS AND PATIENT ACCOUNT LIAISONS DISCUSS FINANCIAL ASSISTANCE AS AN OPTION FOR PATIENTS THAT CONTACT THE HOSPITAL WITH CONCERNS ABOUT PAYING THEIR ACCOUNT WITH PATIENTS AND THEIR FAMILY MEMBERS (WITH APPROPRIATE CONSENT). - THE HOSPITAL ALSO SCREENS SELF PAY PATIENTS FOR MEDICAID OR OTHER GOVERNMENT PROGRAMS. PART VI, LINE 4: LENOIR MEMORIAL HOSPITAL IS LOCATED IN KINSTON, NORTH CAROLINA (POPULATION 21,677), WHICH IS THE COUNTY SEAT AND LARGEST TOWN IN LENOIR COUNTY (POPULATION 59,495); KINSTON AND OTHER LENOIR COUNTY MUNICIPALITIES CONSTITUTE THE HOSPITAL'S PRIMARY SERVICE AREA. LMH IS DESIGNATED A SOLE COMMUNITY HOSPITAL BY CMS. THOUGH STRONG ECONOMIC AND CORRESPONDING POPULATION GROWTH OCCURRED THROUGHOUT MUCH OF NORTH CAROLINA DURING THE MOST RECENT DECADE (2000-2010), LOCAL TRENDS DID NOT FOLLOW SUIT. LENOIR COUNTY WAS ONE OF ONLY SEVEN COUNTIES STATEWIDE THAT LOST POPULATION (-.3%), VS. THE NC AVERAGE OF +18.5%. KINSTON'S DECLINE WAS EVEN STEEPER, AT -8.5%. OVER THE LAST TWO DECADES THE LOCAL AREA HAS WITNESSED THE CLOSING OR SIGNIFICANT DOWNSIZING OF FORMERLY LARGE EMPLOYERS - PARTICULARLY LIGHT MANUFACTURING ENTERPRISES - AS LESS EXPENSIVE LABOR HAS BEEN SOUGHT OVERSEAS. IN THE MOST RECENT YEARS, THE AREA'S CHALLENGES HAVE BEEN EXACERBATED BY THE DRAMATIC NATIONWIDE ECONOMIC DOWNTURN, AND LENOIR COUNTY'S UNEMPLOYMENT RATE HAS TYPICALLY EXCEEDED BOTH STATE AND NATIONAL AVERAGES. THE COUNTY HAS BEEN DESIGNATED TIER 1 - I.E., THE RANKING GIVEN TO THE MOST ECONOMICALLY DISTRESSED COUNTIES IN THE STATE - BY THE NC DEPARTMENT OF COMMERCE. POVERTY LEVELS IN KINSTON AND LENOIR COUNTY EXCEED STATE AVERAGES; IN 2010 THE COUNTY'S POVERTY LEVEL WAS RANKED THIRD HIGHEST FOR COUNTIES WITH POPULATIONS GREATER THAN 20,000 BY THE NC JUSTICE CENTER. THE ECONOMICALLY DISADVANTAGED PERCENTAGE OF CHILDREN IN LENOIR COUNTY SCHOOLS FOR 2009-2010 WAS 66.53%, AND ALL SCHOOLS WITH ELEMENTARY AND MIDDLE GRADES WERE TITLE 1. PORTIONS OF KINSTON ARE DESIGNATED AS HEALTH PROFESSIONAL SHORTAGE AREAS. THE TABLE BELOW PROVIDES SELECTED POPULATION, INCOME, AND POVERTY STATISTICS FROM THE US CENSUS BUREAU, INCLUDING THE AMERICAN COMMUNITY SURVEY. KINSTON LENOIR COUNTY NORTH CAROLINAPOP. CHANGE, 2000-2010 - 8.5% - 0.3% 18.5%PERCENT BELOW POV. LV, 2010 34.1% 22.7% 15.5%MEDIAN HOUSEHOLD INCOME, $27,725 $33,625 $45,570CHILDREN IN POVERTY, 2009 50.4% 31.2% 21.6%THE HISTORICAL DEPENDENCE UPON FARMING AND LIGHT MANUFACTURING JOBS, AS WELL AS POVERTY AND EDUCATION LEVELS THAT ARE HIGHER AND LOWER, RESPECTIVELY, THAN NC AVERAGES WILL LIKELY CONTINUE TO BE LIMITING FACTORS TO CONSISTENTLY STRONG OR RAPID ECONOMIC GROWTH. IN ORDER TO ADDRESS THESE CHALLENGES, NUMEROUS AREA ORGANIZATIONS CONTINUE TO WORK TOWARD DEVELOPMENT INITIATIVES THAT WILL CREATE LONG TERM SOCIAL AND ECONOMIC IMPROVEMENT. PART VI, LINE 6: THE HOSPITAL BOARD IS COMPRISED OF UNRELATED COMMUNITY MEMBERS. LOCAL PHYSICIANS HAVE PRIVILEDGES IN A MAJORITY OF HOSPITAL DEPARTMENTS. SURPLUS FUNDS MAY BE USED TO PURCHASE CAPTIAL EQUIPMENT OR OTHER MEDICAL EQUIPMENT USED IN PATIENT CARE. THEY ARE ALSO USED TO PURCHASE TECHNOLOGY, SUCH AS COMPUTER EQUIPMENT, SOFTWARE, AND CONNECTIVITY. THESE FUNDS ALSO SUPPORT GENERAL BUILDING REFURBISHMENTS AS WELL AS REPAIRS AND MAINTENANCE. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 LENOIR MEMORIAL HOSPITAL FOUNDATION INC 100 AIRPORT ROAD KINSTON NC 28501 581584139 501(C)(3) 28859 N/A N/A OPERATIONAL SUPPORT PRIDE OF KINSTON 327 NORTH QUEEN STREET KINSTON NC 28501 561434180 501(C)(3) 8500 N/A N/A REVITALIZATION OF THE KINSTON COMMUNITY AND SPONSORSHIPS FOR COMMUNITY EVENTS 2 0 SCHOLARSHIPS 33 33094 N/A N/A ASSISTANCE WITH PURCHASE OF MEDICATION 1 82 N/A N/A EMPLOYEE MENTAL HEALTHCARE ASSISTANCE 11 1750 N/A N/A PATIENT TRANSPORTATION ASSISTANCE 2 232 N/A N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION PROVIDES PRE-APPROVED FUNDS TO SELECTED ORGANIZATIONS AND INDIVIDUALS BASED UPON APPROVED CRITERIA. THE FUNDS ARE ONLY DISBURSED FOR THE APPROVED ACTIVITIES. X X X X X 0 1 0 0 0 0 0 0 0 GARY BLACK 400713 0 32419 0 0 0 39841 0 14832 0 487805 0 0 0 JIM DOBBINS 180901 0 16008 0 4802 0 21796 0 9093 0 232600 0 0 0 SARAH MAYO 224725 0 20350 0 16500 0 26827 0 9552 0 297954 0 0 0 WILLIAM LEASE 175303 0 15540 0 16500 0 20869 0 9065 0 237277 0 0 0 ROSILAND MCDONALD 202263 0 15078 0 20377 0 7374 0 8836 0 253928 0 0 0 DALE HARDY 162789 0 8000 0 16056 0 6684 0 8873 0 202402 0 0 0 SCOTT STEGBAUER MD 487984 0 28320 0 16500 0 9800 0 11941 0 554545 0 0 0 ARTHUR HUNSINGER 195754 0 4000 0 13989 0 8154 0 8704 0 230601 0 0 0 CONNIE MANGEL 180366 0 4000 0 11448 0 7556 0 8604 0 211974 0 0 0 GEORGE YVETTE 190259 0 4000 0 0 0 5729 0 8606 0 208594 0 0 0 MARK HENNING 188554 0 4000 0 0 0 5780 0 8662 0 206996 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED AMOUNTS FROM A 457F PLAN: GARY BLACK, CEO, $30,041; JAMES CLINE DOBBINS, VP HUMAN RESOURCES, $14,052; WILLIAM LEASE, VP PLANT AND FACILITY, $13,527; SARAH MAYO, CFO, $17,212 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657902Y63 2005-09-22 22000000 CAPITAL PROJECTS 0 0 0 2630000 22021552 198858 1159494 9657270 2005 1 0 1 1 0 0 0 0 1 0.00100 0.00000 0.00100 1 0 1 0 0 0 1 SCHEDULE K SUPPLENTAL INFORMATION THE PURPOSE OF THE ISSUE WAS TO ACCOMPLISH A CONVERSION OF THE HOSPITAL FROM PUBLIC TO A PRIVATE, NONPROFIT HOSPITAL IN ORDER TO PROVIDE GREATER OPERATING FLEXIBILITY AFFORDED PRIVATE, NONPROFIT HOSPITALS UNDER NORTH CAROLINA LAW. IN ADDITION TO REDEEMING PRIOR BONDS, A PORTION OF THE PROCEEDS WERE USED TO FUND VARIOUS CAPITAL PROJECTS THAT ENHANCED PATIENT CARE, SAFETY, AND COMMUNITY ACCESS TO HEALTH SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S ACCOUNTING FIRM PRESENTED THE FORM 990 TO THE BOARD OF DIRECTORS AT A SCHEDULED BOARD MEETING. EACH VOTING DIRECTOR OF THE BOARD RECEIVED A COPY OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C UPON THEIR APPOINTMENT TO THE BOARD, AND BEFORE ACTUALLY PARTICIPATING IN MEETINGS, MEMBERS MUST READ THE CONFLICTS OF INTEREST POLICY AND DISCLOSE ANY FINANCIAL INTERESTS THAT COULD CREATE A CONFLICT OF INTEREST. AS LONG AS THEY CONTINUE TO SERVE ON THE BOARD, MEMBERS THEN COMPLETE THESE FINANCIAL RELATIONSHIP DISCLOSURE STATEMENTS ON AN ANNUAL BASIS. IF SUCH INTERESTS ARE NOT DISCLOSED, THE CEO, BOARD CHAIR, OR ANY OTHER BOARD MEMBER MAY BRING THE FINANCIAL INTEREST OR ACTUAL/POSSIBLE CONFLICT TO THE ATTENTION OF THE BOARD; THUS THE ENTIRE BOARD IS RESPONSIBLE FOR ONGOING MONITORING OF POTENTIAL CONFLICTS AND THEIR DISCLOSURE. INTENTIONAL FAILURE TO DISCLOSE SUCH FINANCIAL INTERESTS WILL, BY POLICY, RESULT IN APPROPRIATE CORRECTIVE ACTION BY THE BOARD. SHOULD A CONFLICT OF INTEREST ARISE IN CONDUCTING THE BUSINESS OF THE HOSPITAL, THE AFFECTED MEMBER(S) MAY NOT PARTICIPATE IN DISCUSSION REGARDING THE RELEVANT TRANSACTION, AND DEPENDING UPON THE SPECIFIC NATURE OF THE MATTER, THE BOARD CAN TAKE A RANGE OF ACTIONS, SUCH AS APPOINTING A DISINTERESTED PERSON TO INVESTIGATE POSSIBLE ALTERNATIVES, REQUIRING THE INTERESTED PERSON TO REFRAIN FROM PERFORMING ANY FUNCTIONS RELATED TO THE INTEREST CREATING THE CONFLICT, OR REQUIRING THE INTERESTED PERSON TO DIVEST HIMSELF OF THE CONFLICT-CREATING INTEREST IN ORDER TO REMAIN ON THE BOARD. EDUCATION AND COMPLIANCE FORMS ARE UPDATED ANNUALLY BY THE HOSPITAL'S CORPORATE COMPLIANCE OFFICER. FORM 990, PART VI, SECTION B, LINE 15 THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS CONTRACTS WITH AN OUTSIDE, INDEPENDENT, PROFESSIONAL FIRM TO EXAMINE AND REVIEW THE WAGES AND BENEFITS OF THE CEO AND TOP MANAGEMENT OFFICIALS OF THE HOSPITAL EACH YEAR. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ADDITIONALLY, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,224,925. LENOIR MEMORIAL HOSPITAL FOUNDATION INC 100 AIRPORT ROAD KINSTON NC 28501 581584139 SUPPORT THE CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF LMH, INC. NC 501(C)(3) LINE 11A, I N/A 0 LENOIR HEALTH SERVICES INC 100 AIRPORT ROAD KINSTON NC 28501 581705689 SUPPORT CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF LMH, INC. NC 501(C)(3) LINE 11A, I N/A 0 PAMLICO MEDICAL EQUIPMENT LLC 628 EAST TWELFTH STREET WASHINGTON NC 27889 562101748 RENTAL/SALES OF MEDICAL EQUIPMENT NC N/A UNRELATED -16417 693583 0 1 SPRING ARBOR OF KINSTON LP 800 HETHWOOD BOULEVARD BLACKSBURG VA 24060 522118245 RENTAL REAL ESTATE VA N/A RELATED 35310 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0