2012-08-14T11:52:11-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 566000064 ANGEL MEDICAL CENTER INC ANGE 8285248411 PO BOX 1209 FRANKLIN NC 28744 JEFF RUSH 8285248411 2012-08-14 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z JEFF RUSH PO BOX 1209 FRANKLIN NC 28744 46718503 0 X WWW.ANGELMED.ORG X 1933 NC PROVISION OF HEALTHCARE SERVICES 17 17 432 177 300384 87990 228561 803239 41353719 44621112 48586 13528 1141914 1139700 42772780 46577579 0 0 0 0 15082613 19703106 0 0 138436 31656564 27317690 46739177 47020796 -3966397 -443217 32794138 31086811 21005163 19471021 11788975 11615790 X DEDICATED PROFESSIONALS PROVIDING COMPASSIONATE AND SUPERIOR HEALTHCARE TO ALL. 0 0 42459238 44781484 ANGEL MEDICAL CENTER, INC. (AMC) PROVIDES QUALITY MEDICAL HEALTHCARE SERVICES TO PEOPLE IN ITS SERVICE AREA REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF AMC, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PAY FOR ESSENTIAL MEDICAL SERVICES. AMC FURTHER RECOGNIZES THAT ITS MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND EDUCATION. TO THIS END, AMC PROVIDES FREE CARE, SUBSIDIZED CARE, CARE AT BELOW COST TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, AND HEALTHCARE ACTIVITIES, PROGRAMS AND EDUCATION TO SUPPORT THE COMMUNITY. DURING FISCAL YEAR ENDED SEPTEMBER 30, 2011, AMC PROVIDED HEALTHCARE SERVICE TO 1,544 INPATIENTS WITH A TOTAL OF 5,392 PATIENT DAYS, 49,412 OUTPATIENT VISITS, AND 14,622 EMERGENCY PATIENT VISITS.CHARITY CARE IS ALSO PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED UPON ACTIVITIES AND SERVICES WHICH AMC BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. AMC IS VERY INVOLVED IN THE COMMUNITY WORKING WITH OTHER HEALTH PROGRAMS AND OFFERING NUMEROUS ACTIVITY AND EDUCATIONAL OPPORTUNITIES FOR THE PEOPLE IN ITS SERVICE AREA. AMC HAS REGULAR COMMUNITY ACTIVITIES AND EDUCATION PROGRAMS, SUCH AS, DIABETES MANAGEMENT, CPR TRAINING, FIRST AID TRAINING, OSTEOPOROSIS EDUCATION, PREPARED CHILDBIRTH EDUCATION, TEDDY BEAR CLINIC, SMOKING CESSATION CLASSES, ETC., THAT IT OFFERS TO THE PUBLIC FOR NOMINAL FEES OR FREE. SUPPORT GROUPS FOR DIABETES, HEARING LOSS, HEALING HEARTS, AND OSTEOPOROSIS ARE OFFERED BY THE HOSPITAL. ADDITIONALLY, EMPLOYEES OF AMC SERVE ON NUMEROUS HEALTHCARE COMMITTEES AND BOARDS IN THE COMMUNITY AND GIVE FINANCIALLY THROUGH PROJECTS AND PROGRAMS ENDORSED BY AMC. 42459238 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 35 0 1 432 1 1 1 0 0 0 0 0 0 0 0 0 X 17 17 0 1 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X TRACY GIHL 8283694420 120 RIVERVIEW STREET FRANKLIN NC 28734 RANDOLPH BULGIN 1.00 X X 0 0 0 JAN UNGER 1.00 X X 0 0 0 EDWARD R SHATLEY 1.00 X X 0 0 0 MONTY C BECK 1.00 X X 0 0 0 GUS WILDE MD 1.00 X 0 0 0 KEN STONEBRAKER 1.00 X 0 0 0 JOE COLLINS 1.00 X 0 0 0 DAVID FRANKS MD 1.00 X 0 0 0 JANE C KIMSEY 1.00 X 0 0 0 JOHNNY MIRA-KNIPPEL 1.00 X 0 0 0 JANET J GREENE 1.00 X 0 0 0 THOMAS QUIGLEY 1.00 X 0 0 0 MARLA ANN D'ASCOLI 1.00 X 0 0 0 CONNIE HAIRE 1.00 X 0 0 0 JOHN MAHER 1.00 X 0 0 0 GEORGE RENFRO 1.00 X 0 0 0 BOB JONES 1.00 X 0 0 0 TIM HUBBS 50.00 X 182465 0 10052 CLIFF HENDREN 50.00 X 68305 0 6418 MARTIN WADEWITZ 50.00 X 90218 0 25515 SHEILA PRICE 50.00 X 7904 0 588 VICTOR ADAN MD 50.00 X 275525 0 43315 MICHAEL D SHEAFFER MD 50.00 X 212078 0 35123 MICHAEL D GOLIGHTLY MD 50.00 X 177824 0 12356 MAHENDRABHAI PATEL MD 50.00 X 210844 0 54145 GILBERTO ROBLES MD 50.00 X 378030 0 35414 TRAVIS PETRICEK MD 50.00 X 349770 0 26839 NELSON P DAVIS MD 50.00 X 273840 0 28302 SUSAN L MEDLOCK MD 50.00 X 209930 0 32143 2436733 0 310210 18 0 1 0 CLINICAL COLLEAGUES 613 TATUM AVENUE COLLINGSWOOD NJ 08108 CRNA SERVICES 1596840 HORIZON CONTRACTORS LLC 267 PIT ROAD MOORESVILLE NC 28115 BIO-MED SERVICES 443648 TRIANGLE CONSTRUCTION CO INC PO BOX 6266 GREENVILLE SC 29606 CONTRACTOR SERVICES 248072 BARRINGTON CONTRACTING INC PO BOX 1577 FRANKLIN NC 28744 CONTRACTOR SERVICES 219393 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28802 ACCOUNTING SERVICES 169727 7 13434 32930 116434 640441 803239 NET PATIENT SERVICES 621400 44621112 44621112 44621112 13454 13454 428141 134555 293586 293586 293586 212 138 -138 212 74 74 28262 13434 6231 22031 22031 CATERING/MEALSERVICE 722320 460756 160372 300384 CAFETERIA & VENDING 722210 225256 225256 PURCHASE DISCOUNTS 900099 24888 24888 113183 113183 824083 46577579 44781484 300384 692472 1354825 714449 640376 14620372 12911017 1648616 60739 251529 214533 36040 956 2014947 1718576 288710 7661 1461433 1246477 209400 5556 38491 38491 131143 131143 95337 95337 6849995 6395260 452422 2313 108785 12022 96763 7960419 7581232 371010 8177 236302 98557 137745 548396 548396 129109 104529 21928 2652 494665 494665 2233061 2233061 465151 465151 BAD DEBT EXPENSE 7290987 7290987 MISCELLANEOUS EXPENSES 565186 430326 84478 50382 RECRUITMENT 170663 170663 47020796 42459238 4423122 138436 1830076 774786 2536270 1839604 4542239 5234333 500829 292145 1109278 1245888 583100 667456 59809288 39784801 20271218 20024487 1421128 1008112 32794138 31086811 2758632 2732309 335930 268621 15565000 14485000 176643 137247 2168958 1847844 21005163 19471021 X 11520997 11310236 165970 203546 102008 102008 11788975 11615790 32794138 31086811 X -443217 270032 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 2061 2061 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE NORTH CAROLINA HOSPITAL ASSOCIATION. EACH YEAR, THESE ORGANIZATIONS ENGAGE IN LOBBYING ACTIVITIES ON BEHALF OF THEIR MEMBERSHIP BODIES. FOR THE CURRENT YEAR, APPROXIMATELY 29% OF THOSE DUES HAVE BEEN ALLOCATED TO LOBBYING EXPENDITURES. 1794040 1794040 31161818 18508598 12653220 1224517 908621 315896 25363363 20367582 4995781 265550 265550 20024487 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1673462 INTEREST RATE SWAP LIABILITY 174382 1847844 46577579 47020796 -443217 270032 270032 -173185 46988397 410818 410818 46577579 0 46577579 47161582 140786 140786 47020796 0 47020796 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION 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: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 270,032. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 134,555. FUNDRAISING EVENT EXPENSES 6,231. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 270,032. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 134,555. FUNDRAISING EVENT EXPENSES 6,231. OKTOBERFEST 2010 33250 10384 22866 634 300 3662 1244 5K WALK/RUN 8446 3050 5396 355 36 41696 13434 28262 989 300 3662 1280 6231 22031 1 1 X 0 1 X 1 1 0 1 1 584375 22591 561784 0.01410 5090442 3659303 1431139 0.03600 5674817 3681894 1992923 0.05010 52447 1396 51051 0.00130 359599 359599 0.00910 412046 1396 410650 0.01040 6086863 3683290 2403573 0.06050 9832 9832 0.00020 3394 3394 0.00010 419 419 0.00000 11011 11011 0.00030 24656 24656 0.00060 0 2793552 1448177 15423772 16559705 -1135933 X 0 1 1 ANGEL MEDICAL CENTER INC

120 RIVERVIEW STREET FRANKLIN NC 28734

X X X DISPROPORTIONATE SHARE HOSPITAL NA IN 2010 PER IRS ANNOUNCEMENT 2011-37 1 3 ANGEL HOME HEALTH AND HOSPICE

170 CHURCH STREET FRANKLIN NC 28734

HOME HEALTH; SKILLED NURSING ANGEL PHYSICIAN PRACTICES

MEDICAL PARK DRIVE FRANKLIN NC 28734

PHYSICIAN OFFICES ANGEL URGENT CARE

195 FRANKLIN PLAZA DRIVE FRANKLIN NC 28734

RURAL HEALTH CLINIC PART I, LINE 7: WORKSHEET 2 OF THE 2010 SCHEDULE H INSTRUCTIONS WAS USED TO DERIVE A COST-TO-CHARGE RATIO USED IN THE CALCULATION OF COMMUNITY BENEFIT EXPENSE AT COST. PART I, L7 COL(F): THE AMOUNT OF TOTAL EXPENSE ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $7,290,987 THAT WAS REMOVED FOR THE CALCULATION OF TOTAL CHARITY CARE PERCENTAGE FOR PART I, LINE 7. PART II: COMMUNITY SUPPORT- AMC IS VERY INVOLVED WITH HEALTH PROMOTION IN THE SURROUNDING AREA. IN 2010, 262 VOLUNTEER HOURS WERE SPENT SERVING ON BOARDS AND COMMITTEES THAT HELP IMPROVE THE OVERALL HEALTH IN MACON COUNTY. SUCH BOARDS INCLUDED A MEDICATION ASSISTANCE PROGRAM, MACON PROGRAM FOR PROGRESS, REACH AND KIDS PLACE, (ORGANIZATIONS HELPING BATTERED WOMEN AND CHILDREN). AMC ALSO ORGANIZES MULTIPLE BLOOD DRIVES EACH YEAR AND WILL CONTINUE TO BE A RED CROSS DONOR SITE.COALITION BUILDING- ANGEL MEDICAL CENTER HAS AN ACTIVE COMMUNITY RELATIONS BOARD THAT MEETS REGULARLY TO DISCUSS THE HOSPITAL AND ITS RELATIONSHIP TO THE COMMUNITY. OUR PUBLIC RELATIONS DIRECTORS SPENDS AN AVERAGE OF FIVE HOURS A MONTH PREPARING, CONDUCTING AND DOING FOLLOW UP.COMMUNITY HEALTH IMPROVEMENT ADVOCACY- REPRESENTATIVES FROM NUTRITION SERVICES AND COMMUNITY EDUCATION PARTICIPATED IN THE PLANNING OF THE "LIGHTEN UP FOR LIFE" PROGRAM IN MACON COUNTY. THIS PROGRAM IS A TEAM EFFORT TO BECOME HEALTHIER BY WORKING TOGETHER TO EAT RIGHT AND LOSE WEIGHT.WORKFORCE DEVELOPMENT- VOLUNTEERS FROM NURSING AND ALLIED HEALTH DEPARTMENTS PARTICIPATE ANNUALLY IN A PROGRAM WITH THE LOCAL HIGH SCHOOL THAT ALLOWS STUDENTS FROM THE HEALTH OCCUPATIONS CLASS TO OBSERVE AND LEARN FROM ACTUAL EXPERIENCE RATHER THAN JUST CLASS ROOM ACTIVITIES. THREE HUNDRED SEVENTY-SIX VOLUNTEER HOURS WERE SPENT WITH THESE STUDENTS, THE MAJORITY OF WHICH GO ON TO PURSUE A DEGREE IN SOME AREA OF HEALTHCARE. PART III, LINE 4: THERE IS NO FOOTNOTE ADDRESSING BAD DEBT IN THE ORGANIZATION'S FINANCIAL STATEMENTS.THE ORGANIZATION USED THE ANDI METHODOLOGY, WHICH USES A FACILITY-WIDE RATIO OF COST TO CHARGES AS DESCRIBED IN 2010 NCHA COMMUNITY BENEFITS GUIDELINES, TO DETERMINE BAD DEBT AT COST FOR THE PURPOSE OF PART III, LINE 2.APPROXIMATELY 81% OF THE ORGANIZATIONS'S BAD DEBT WRITE-OFFS ARE SELF PAY PATIENTS, AND APPROXIMATELY 64% OF THOSE ARE UNEMPLOYED. UNDER THE ASSUMPTION THAT SELF-PAY, UNEMPLOYED PERSONS WOULD LIKELY HAVE QUALIFIED FOR THE FINANCIAL ASSISTANCE POLICY, APPROXIMATELY 52% OF BAD DEBT WOULD QUALIFY AS COMMUNITY BENEFIT. $ 2,793,552 X 81% X 64% = $ 1,448,177 PART III, LINE 8: THE ORGANIZATION USED ITS MEDICARE COST REPORT TO DETERMINE AMOUNTS REPORTED IN PART III, LINES 5 AND 6.THE FULL SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. MEDICARE PATIENTS PROVIDE APPROXIMATELY 52% OF AMC'S REVENUE. APPROXIMATELY 4% OF BAD DEBT EXPENSE AND 7% OF CHARITY CARE ARE ATTRIBUTABLE TO MEDICARE PATIENTS. IN ADDITION, MANY OF OUR COMMUNITY BENEFIT PROGRAMS ARE DIRECTED TOWARD OLDER PATIENTS, MANY OF WHOM ARE ON MEDICARE. PART I, LINE 7E: THE COMMUNITY BENEFIT EXPENSE AMOUNT LISTED ON SCHEDULE H, PAGE 1, LINE 7E IS COMPRISED OF THE FOLLOWING COMMUNITY-BUIDING ACTIVITIES:HEALTH EDUCATION LECTURES AND WORKSHOPS $ 12,457HEALTH SCREENINGS AND FAIRS $ 7,685PUBLIC SERVICE ANNOUNCEMENTS/INTERVIEWS $ 266SUPPORT GROUPS $ 3,293CHILD BIRTH CLASSES $ 1,235 PART VI, LINE 2: ANGEL MEDICAL CENTER ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY THROUGH CONDUCTING A STRATEGIC PLANNING PROCESS THAT LOOKS AT A NUMBER OF INDICATORS THAT PROVIDE INPUT FOR PROVISION OF SERVICES FOR THE COMMUNITY. THE PROCESS INCLUDES BUT IS NOT LIMITED TO: - PARTICIPATION IN THE HEALTHY CAROLINIANS OF MACON COUNTY'S HEALTH ASSESSMENT. THIS ASSESSMENT INCLUDES PHONE SURVEYS, FOCUS GROUPS AND INTERVIEWS WITH LOCAL BUSINESS, COMMUNITY AND HEALTH CARE LEADERS. - AMC PARTICIPATES IN THE HEALTHY CAROLINIANS OF MACON COUNTY'S YOUTH RISK BEHAVIOR ASSESSMENT. - A NUMBER OF AMC EMPLOYEES PARTICIPATE IN VARIOUS HEALTHY CAROLINIANS OF MACON COUNTY COMMITTEES. THESE INCLUDE ACCESS TO CARE, CHRONIC DISEASE, COMMUNITY NEEDS ASSESSMENT, ELDERCARE AND CAREGIVERS, ENVIRONMENTAL QUALITY, STRENGTHENING FAMILIES, SUBSTANCE ABUSE AND MENTAL HEALTH. ANGEL MEDICAL CENTER HAS AN ACTIVE COMMUNITY RELATIONS BOARD THAT MEETS REGULARLY TO DISCUSS THE HOSPITAL AND ITS RELATIONSHIP TO THE COMMUNITY. THE CENTER HAS AN ACTIVE BOARD OF DIRECTORS THAT MEETS REGULARLY TO DISCUSS HOSPITAL OPERATIONS, QUALITY, PATIENT SAFETY AND THE NEEDS OF THE COMMUNITY. THE BOARD HAS AN ACTIVE PLANNING AND DEVELOPMENT COMMITTEE THAT MEETS MONTHLY, AND WORKS ACTIVELY ON THE PLANNING PROCESS FOR THE HOSPITAL AND ROUTINELY ASSESS THE PROVISION OF SERVICES FOR THE COMMUNITY. THE HOSPITAL CEO AND THE DIRECTOR OF THE MACON COUNTY HEALTH DEPARTMENT MEET ROUTINELY TO DISCUSS VARIOUS HEALTH CARE INITIATIVES, PROCESSES AND PROGRAMS. IN ADDITION, A NUMBER OF HOSPITAL EMPLOYEES ARE INVOLVED IN A NUMBER OF COMMUNITY ORGANIZATIONS THAT MEET THE VARIOUS NEEDS OF MACON COUNTY RESIDENTS. THESE INCLUDE BUT ARE NOT LIMITED TO: - REACH THE COUNTIES DOMESTIC VIOLENCE AND SEXUAL ASSAULT AGENCY; - KIDS PLACE, AN AGENCY FOR ABUSED CHILDREN; - CARENET, AN AGENCY THAT PROVIDES FOOD AND OTHER ESSENTIALS TO THOSE IN NEED; - THE COMMUNITY CARE CLINIC OF FRANKLIN, A FREE CLINIC OFFERING HEATH CARE SERVICES TO THE RESIDENTS OF MACON COUNTY; AND - THE FRANKLIN AREA CHAMBER OF COMMERCE. ADDITIONALLY, AMC ADMINISTRATION PARTICIPATES ON A NUMBER OF REGIONAL AND STATE BOARDS OR ORGANIZATIONS THAT PROVIDE INPUT INTO TRENDS AND CHANGES THAT MAY IMPACT THE PROVISION OF HEALTH CARE IN OUR COMMUNITY. PART VI, LINE 3: THE ORGANIZATION EMPLOYS A SOCIAL WORKER WHOSE RESPONSIBILTY IT IS TO ENROLL PATIENTS IN FEDERAL, STATE, OR LOCAL PROGRAMS. WE POST OUR CHARITY CARE POLICY IN THE REGISTRATION AREAS. THE CURRENT INDIGENT CARE POLICY IS POSTED AT THE REGISTRATION AREAS. PATIENT'S ARE ENCOURAGED TO SPEAK WITH A PATIENT COUNSELOR. PART VI, LINE 4: AMC SERVES A POPULATION OF APPROXIMATELY 34,000 PEOPLE, 23.8% OF WHICH ARE OVER THE AGE 65, 16.9% OF WHICH IS BELOW POVERTY LEVEL AND 10.1% OF WHICH ARE UNEMPLOYED. THE AVERAGE ANNUAL HOUSEHOLD INCOME OF THE POPULATION IS ROUGHLY $38,615. THE MINORITY ETHNIC DEMOGRAPHICS OF THE AREA IS WIDE-SPREAD INCLUDING AN HISPANIC POPULATION OF 6.6%, AN AFRICAN-AMERICAN POPULATION OF 1.3% AND OTHER MINORITY POPULATIONS TOTALING 1.1%. MACON COUNTY SEES APPROXIMATELY A 1.4% ANNUAL INCREASE IN ITS POPULATION. THE STATISTICS ARE ACCORDING TO THE US CENSUS BUREAU. PART VI, LINE 6: AMC'S BOARD OF DIRECTORS IS MADE UP OF A CROSS SECTION OF THE COMMUNITY DEDICATED TO ITS IMPROVEMNT. STAFF PRIVILEGES ARE EXTENDED TO AREA PHYSICIANS WHO ARE BOARD CERTIFIED, ALLOWING CERTAIN SPECIALTY SERVICES TO PATIENTS WHO WOULD OTHERWISE HAVE TO TRAVEL FOR TREATMENT. AMC IS WORKING TO EXPAND OUTPATIENT TREATMENTS SUCH AS ADDITIONAL CHEMOTHERAPY SERVICES. AMC FOUNDATION RAISES FUNDS FOR GAP SERVICES PROVIDED TO MAMMOGRAPHY AND CARDIAC REHAP PATIENTS THAT ARE NON OR UNDER INSURED.ALL SURPLUS IS PUT BACK INTO ANGEL MEDICAL CENTER THROUGH CAPITAL PURCHASES AND OPERATING EXPENSES. PART VI, LINE 7: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 NC X X X 0 0 0 0 0 0 0 0 0 TIM HUBBS 175265 0 0 0 7200 0 0 0 10052 0 192517 0 0 0 VICTOR ADAN MD 275105 0 420 0 0 0 33001 0 10314 0 318840 0 0 0 MICHAEL D SHEAFFER MD 202078 0 10000 0 0 0 22000 0 13123 0 247201 0 0 0 MICHAEL D GOLIGHTLY MD 171220 0 0 0 6604 0 0 0 12356 0 190180 0 0 0 MAHENDRABHAI PATEL MD 200844 0 10000 0 0 0 44000 0 10145 0 264989 0 0 0 GILBERTO ROBLES MD 378030 0 0 0 0 0 22001 0 13413 0 413444 0 0 0 TRAVIS PETRICEK MD 346142 0 0 0 3628 0 16500 0 10339 0 376609 0 0 0 NELSON P DAVIS MD 266272 0 7568 0 0 0 27463 0 839 0 302142 0 0 0 SUSAN L MEDLOCK MD 204080 0 5850 0 0 0 22000 0 10143 0 242073 0 0 0 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657902S6S 2007-03-22 18500000 HEALTHCARE FACILITY REVENUE BONDS 0 0 0 4015000 18500000 266550 25000 5183960 13024490 2007 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 WACHOVIA 5.000000000000 0 0 0 1 1 SCHEDULE K SUPPLENTAL INFORMATION BOND (A): THE QUALIFIED HOSPITAL BONDS WERE ISSUED IN PART TO REFUND A PRIOR ISSUE DATED NOVEMBER 21, 1997. THE PRIOR BONDS WERE CALLED AND REDEEMED BY MARCH 22, 2007. IN ADDITION, THE ISSUE WAS USED TO ACQUIRE NON-REAL ESTATE EQUIPMENT WITH VARIOUS RECOVERY PERIODS. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPOSED OF THE CHAIRMAN, VICE CHAIRMAN, SECRETARY, TREASURER, AND TWO TRUSTEES AT LARGE ELECTED BY THE BOARD. THE CHAIRMAN OF THE BOARD SERVES AS THE CHAIRMAN OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE HAS THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. ALL ACTIONS OF THE EXECUTIVE COMMITTEE SHALL BE REPORTED AT THE NEXT REGULAR MEETING OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 ON MAY 19, 2011, THE ORGANIZATION EXECUTED A MANAGEMENT AGREEMENT WITH MISSION HEALTH SYSTEM, INC., A NORTH CAROLINA NONPROFIT CORPORATION. THE TERM OF THE AGREEMENT IS TEN YEARS. THE AGREEMENT PROVIDES FOR A RANGE OF ADMINISTRATIVE MANAGEMENT SERVICES FOR THE ORGANIZATION INCLUDING BUT NOT LIMITED TO: (1) STRATEGIES FOR DEVELOPING AND MAINTAINING PRIMARY CARE, SURGICAL AND MEDICAL SECONDARY CARE, TERTIARY CARE AND OUTREACH CLINICS (2) RECRUITMENT AND CONTRACTING FOR CERTAIN MEDICAL SERVICES (3) IMPROVING FINANCIAL VIABILITY OF PHYSICIAN CONTRACTS (4) STAFF EDUCATION AND TRAINING (5) CREDENTIALING (6) MAINTAINING AN APPROPRIATE MANAGEMENT TEAM (7) CORPORATE COMPLIANCE MISSION HEALTH SYSTEM, INC. ALSO RESERVES THE RIGHT TO REQUIRE THE CEO OF THE ORGANIZATION TO BECOME A MISSION EMPLOYEE, WHO WOULD BE REPORTABLE TO BOTH THE BOARDS OF MISSION HEATH SYSTEMS AND THE ORGANIZATION'S. AS OF THE END OF THE CURRENT TAX YEAR, MISSION HAD NOT EXERCISED THAT OPTION. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION UPDATED ITS BYLAWS TO INCREASE THE MAXIMUM NUMBER OF MEMBERS OF THE BOARD OF DIRECTORS TO 21. FORM 990, PART VI, SECTION A, LINE 7A MISSION HEALTH SYSTEMS, INC., A NORTH CAROLINA NONPROFIT CORPORATION, HAS THE RIGHT TO APPOINT UP TO SEVEN MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B PER THE MANAGEMENT AGREEMENT DISCUSSED IN LINE 3 ABOVE, DURING THE TERM OF THE AGREEMENT THE FOLLOWING ACTIONS REQUIRE THE JOINT APPROVAL OF BOTH THE ORGANIZATION'S BOARD OF DIRECTORS AND THE BOARD OF MISSION HEALTH SYSTEM, INC.: (1) MATERIAL REDUCTION OR ELIMINATION OF MAJOR SERVICES LINES (2) CHANGE IN CERTAIN PHYSICIAN GROUPS PROVIDING HOSPITAL-BASED PHYSICIAN SERVICES (3) CHANGE IN NAME OF ORGANIZATION (4) AMENDMENT OF ARTICLES OF INCORPORATION AND/OR BYLAWS (5) ADOPTION OR MODIFICATION OF ANY STATEMENTS OR EXPRESSIONS OF MISSION, VALUES, AND VISIONS OF THE ORGANIZATION (6) SALE, LEASE, OR OTHER TRANSFER OF A MATERIAL PORTION OF THE ORGANIZATION'S ASSETS (7) ENCUMBRANCE ON A MATERIAL PORTION OF THE ORGANIZATION'S ASSETS (8) PURCHASE, SALE, LEASE, OR PLEDGE OF REAL PROPERTY OUTSIDE THE ORDINARY COURSE OF BUSINESS (9) DISSOLUTION, MERGER, OR CORPORATE BUSINESS COMBINATIONS (10) FORMATION OF NEW CORPORATIONS, PARTNERSHIPS, OR CONTRACTUAL JOINT VENTURES (11) HIRING OR REPLACEMENT OF THE ORGANIZATION'S CEO (MISSION RESERVES THE SOLE RIGHT TO REMOVE THE ORGANIZATION'S CEO) (12) TO ISSUE, REFINANCE, OR RETIRE DEBT (13) APPROVAL, ADOPTION, OR MODIFICATION OF CAPITAL OR OPERATING BUDGETS (14) APPROVAL, ADOPTION, OR MODIFICATION OF A STRATEGIC OR FINANCIAL PLAN (15) SELECTION OR RETENTION OF EXTERNAL AUDITORS AND LEGAL COUNSEL (WITH CERTAIN EXCEPTIONS) (16) FILING OF CERTAIN VOLUNTARY PETITIONS CONCERNING BANKRUPTCY, DEBT RELIEF, INSOLVENCY PLEAS, ETC. (17) MATERIAL MODIFICATION OF OFFICERS' INSURANCE CURRENTLY MAINTAINED 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 AND REVIEW BY MANAGEMENT, THE RETURN WAS PROVIDED TO EACH VOTING BOARD MEMBER FOR DISCUSSION AND COMMENT BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS CIRCULATES A CONFLICT OF INTEREST POLICY ANNUALLY, REQUIRING ALL VOTING BOARD MEMBERS TO REVIEW, SIGN, AND RETURN. MEMBERS PRESENTING A POTENTIAL CONFLICT OF INTEREST RECUSE THEMSELVES BEFORE ANY DISCUSSION OR VOTE ON A TOPIC THAT INCLUDES AN INTERESTED PARTY OR TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION PLAN FOR THE CEO INCLUDES A YEARLY REVIEW OF THE CEO'S ANNUAL BASE SALARY, A REVIEW OF PRE-APPROVED CRITERIA TO DETERMINE ANY INCENTIVE/BONUS, AND A GENERAL EVALUATION CONDUCTED BY THE EXECUTIVE COMMITTEE OF THE BOARD. THE REVIEW OF PERFORMANCE AND COMPENSATION ANALYSIS OF OTHER INDUSTRY CEOS' SALARIES INCLUDES BUT IS NOT LIMITED TO A REVIEW OF COMPILED DATA FROM PERRY & ASSOCIATES FOR NC HEALTHCARE HUMAN RESOURCES ASSOCIATION, YAFFE & COMPANY FOR NC HOSPITAL ASSOCIATION, AND SELECT WESTERN NORTH CAROLINA HOSPITALS IN THE IMMEDIATE AREA. THE CEO PRESENTS A CURRENT SELF-EVALUATION ALONG WITH THE NEXT FISCAL YEAR'S RECOMMENDED OBJECTIVES WITH WEIGHTED VALUES TO THE BOARD CHAIR. 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 AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 270,032. TOTAL TO FORM 990, PART XI, LINE 5: 270,032. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ANGEL MEDICAL CENTER AUXILIARY PO BOX 1209 FRANKLIN NC 28744 562133719 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11A, I ANGEL MEDICAL CENTER INC 1 ANGEL HEALTHCARE ENTERPRISES INC PO BOX 1209 FRANKLIN NC 28734 562031765 PHARMACY (DORMANT) NC N/A C 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 ANGEL MEDICAL CENTER AUXILIARY C 32930 CASH