2012-05-14T13:37:37-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 111 FRANKLIN RD SE SUITE 501 ROANOKE VA 240112114 990 2010-10-01 560529974 CHARLES A CANNON JR MEMORIAL HOSPITAL INC CHAR 8282624119 434 HOSPITAL DRIVE LINVILLE NC 28646 KEVIN B MAY 8282624119 2012-05-09 1 MICHAEL P NORTON 5409896144 2012-05-09 2010 2016-02-24 21:20:13Z KEVIN B MAY 434 HOSPITAL DRIVE LINVILLE NC 28646 20106856 0 X WWW.APPRHS.ORG X 1957 NC TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE, NORTH CAROLINA. THIS INCLUDES A BEHAVORIAL HEALTH CENTER, NEW LIFE CENTER, PATIENT CARE CENTER, DIAGNOSTIC SERVICES, EMERGENCY DEPARTMENT AND A CRITICAL CARE UNIT. 14 14 0 81 0 0 605360 77719 20795236 19820513 -127794 19742 216833 188882 21489635 20106856 0 0 0 0 12095784 12699913 0 0 0 9059281 8854565 21155065 21554478 334570 -1447622 29203737 27723828 9653546 9319408 19550191 18404420 TO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE, NORTH CAROLINA. THIS INCLUDES A BEHAVORIAL HEALTH CENTER, NEW LIFE CENTER, PATIENT CARE CENTER, DIAGNOSTIC SERVICES, EMERGENCY DEPARTMENT AND A CRITICAL CARE UNIT. 0 0 16630892 20029137 HEALTHCARE SERVICES PROVIDED FOR THE COMMUNITY OF LINVILLE, NORTH CAROLINA, CONSISTED OF THE FOLLOWING:ER VISITS 10,119DISCHARGES 2,250DAYS OF CARE 9,730 16630892 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN B MAY 8282624100 336 DEERFIELD ROAD BOONE NC 28607 PAUL MILLER JR 1.00 X 0 0 0 JOHN BLACKBURN 1.00 X 0 0 0 JIM DEAL 1.00 X 0 0 0 JOE MILLER 1.00 X 0 0 0 SUSAN ROGGENKAMP 1.00 X 0 0 0 KENNETH WILCOX 1.00 X 0 0 0 KEITH TESTER 1.00 X 0 0 0 SAM ADAMS 1.00 X 0 0 0 WILLIAM ATKINS MD 1.00 X 0 0 0 CHARLES BAKER MD 1.00 X 0 0 0 MARGARET HAYDEN 1.00 X 0 0 0 JACK HOWARD 1.00 X 0 0 0 PATTIE TENNILLE 1.00 X 0 0 0 JAN WINKLER 1.00 X 0 0 0 RICHARD SPARKS 40.00 X X 0 371261 111971 JOHN BARRETT 40.00 X 0 255639 11069 KEVIN MAY 40.00 X X 0 240680 11374 CHUCK MANTOOTH 40.00 X X 0 166904 9757 0 1034484 144171 0 1 1 0 0 77719 77719 PROG.SERV.REVENUE-RELA 900099 19743144 19743144 CAFETERIA REVENUE 900099 77369 77369 19820513 19742 19742 57359 57359 57359 57359 MISCELLANEOUS 900099 131523 131523 131523 20106856 20009395 0 19742 10221479 8880349 1341130 1863861 1602920 260941 614573 590223 24350 6702 6702 2111704 1694898 416806 384 384 2660726 2571833 88893 736293 213694 522599 18538 17607 931 2720 2720 452208 452208 1273683 435666 838017 180221 180221 CORP. ALLOCATIONS 653685 653685 EQUIPMENT RENTAL AND MA 462695 269349 193346 MISCELLANEOUS 74347 31652 42695 MINOR EQUIPMENT 59041 59041 DUES AND SUBSCRIPTIONS 54772 29047 25725 106846 51288 55558 21554478 16630892 4923586 0 3436102 2158322 800177 803320 3084651 3426455 415630 510497 146928 145580 35843483 18171485 18613220 17671998 2707029 3007656 29203737 27723828 308273 339872 7892404 7533509 1452869 1446027 9653546 9319408 X 18212074 17407505 341202 0 996915 996915 19550191 18404420 29203737 27723828 X -1447622 301851 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1307101 1307101 21812832 8470068 13342764 3156844 1503285 1653559 9566706 8198132 1368574 17671998 AUWIL 1255447 INTEREST IN ARHF 1719110 OWNERSHIP EQUITY-OTHER 33099 3007656 DUE TO AFFILIATE 1260027 ESTIMATED THIRD-PARTY SETTLEMENTS -25000 MISCELLANEOUS 211000 1446027 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ARHS AND THE COMPANIES FOR WHICH IT SERVES AS SOLE MEMBER ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS. THE SYSTEM HAS DETERMINED 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 TAXING AUTHORITIES. 1 1 1 X 175.000000000000 1 X 1 1 1 0 1 1 439401 439401 0.02040 2348972 2240361 108611 0.00500 2788373 2240361 548012 0.02540 45527 45527 0.00210 39457 39457 0.00180 47129 47129 0.00220 132113 132113 0.00610 2920486 2240361 680125 0.03150 1 1765922 88296 7207344 7207344 X 1 1 1 APPALACHIAN REGIONAL HEALTHCARE SYSTEM SOLE MEMBER OF CHARLES A. CANNON JR., MEMORIAL HOSPITAL, INC. 1.00000 1 1 CHARLES A CANNON JR MEMORIAL HOSPITAL

434 HOSPITAL DRIVE LINVILLE NC 28646

X X X X NOT REQUIRED 1 0 0 0 0 0 0 0 0 0 0 0 PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENT'S EVALUATION OF THE ACCOUNTS RECEIVABLE. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE.WE ESTIMATE 5% OF CHARITY COSTS FAIRLY ESTIMATE AMOUNTS INCLUDED AS BAD DEBT THAT WOULD BE ELIGIBLE FOR CHARITY CARE BUT FAILED TO APPLY. PART III, LINE 9B: CHARITY WRITE-OFFS ARE SEGREGATED FROM NORMAL BAD DEBTS THROUGH A SEPARATE TRANSACTION CODE. FAMILY INCOME BELOW 175% OF FPG ARE ELIGIBLE FOR 100% WRITE-OFF. PARTIAL WRITE-OFF IS AVAILABLE BETWEEN FAMILY INCOME BETWEEN 175% AND 250% OF FPG. 0 0 0 0 0 0 0 0 0 RICHARD SPARKS 0 307589 0 25000 0 38672 0 103219 0 8752 0 483232 0 0 JOHN BARRETT 0 233359 0 7500 0 14780 0 0 0 11069 0 266708 0 0 KEVIN MAY 0 217697 0 10000 0 12983 0 5389 0 5985 0 252054 0 0 CHUCK MANTOOTH 0 147666 0 5000 0 14238 0 3772 0 5985 0 176661 0 0 FORM 990, PART VI, SECTION A, LINE 3 PARENT COMPANY, APPALACHIAN REGIONAL HEALTH CARE SYSTEM (ARHS) OVERSEES CMH OPERATIONS. ALSO NOTE THAT SALARIES AND OTHER COMMON EXPENSES INCURRED BY ARHS ARE ALLOCATED APPROPRIATELY TO CMH AND THE OTHER ENTITES SUPPORTED BY ARHS. THIS IS WHY SALARIES EXPENSES IS REPORTED EVEN THOUGH NO EMPLOYEES ARE LISTED. ALL WAGES AND PAYMENTS TO VENDORS ARE PAID OUT THROUGH ARHS. FORM 990, PART VI, SECTION A, LINE 7B APPROVAL MAY BE NEEDED BY THE PARENT COMPANY, APPALACHIAN REGIONAL HEALTH CARE SYSTEM. FORM 990, PART VI, SECTION B, LINE 11 THE SVP/CFO AND THE SYSTEM DIRECTOR OF FINANCE REVIEW THE 990 AND THEN IT IS MADE AVAILABLE TO THE BOARD UPON COMPLETION. FORM 990, PART VI, SECTION B, LINE 12C REVIEW OF POLICY STATEMENT EACH YEAR. FORM 990, PART VI, SECTION B, LINE 15 INDEPENDENT COMPENSATION AND BENEFIT ANALYSIS WAS PERFORMED BY FINDLEY DAVIES IN DECEMBER 2011. THE EXECUTIVE COMMITTEE (COMPENSATION COMMITTEE) REVIEWED THIS INFORMATION IN DECEMBER, 2011 TO ESTABLISH APPROPRIATENESS OF TOTAL COMPENSATION, COMPLY WITH INTERMEDIATE SANCTION REGULATIONS, AND DETERMINE EXECUTIVE COMPENSATION FOR CEO AND CFO POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 PROVIDED UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFERS FROM AFFILIATE 301,851. TOTAL TO FORM 990, PART XI, LINE 5: 301,851. APPALACHIAN REGIONAL HEALTHCARE SYSTEM PO BOX 2600 BOONE NC 28607 201067022 PARENT COMPANY NC 501(C)(3) 11C 0 BLOWING ROCK HOSPITAL INC PO BOX 148 BLOWING ROCK NC 28605 560513181 HOSPITAL NC 501(C)(3) 3 0 WATAUGA MEDICAL CENTER INC 336 DEERFIELD RD BOONE NC 28607 560510824 HOSPITAL NC 501(C)(3) 3 0 APPALACHIAN REGIONAL HEALTHCARE FOUNDATION 336 DEERFIELD RD BOONE NC 28607 204625618 PHILANTHROPIC ORGANIZATION FOR THE SYSTEM NC 501(C)(3) 7 0 APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC PO BOX 2600 BOONE NC 28607 205755130 EMPLOYMENT ALTERNATIVE TO BOTH NEW AND ESTABLISHED PHYSICIAN PRACTICES NC 501(C)(3) 9 0 ARHS PROPERTIES INC 336 DEERFIELD RD BOONE NC 28607 203470765 HOLD FUTURE PURCHASE OF NON-PROFIT LAND ACQUISITIONS NC 501(C)(3) 9 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 APPALACHIAN REGIONAL HEALTHCARE FOUNDATION C 184629 ACTUAL