2011-08-08T12:32:30-05:00 2010-09-30 DIXON HUGHES GOODMAN LLP 500 Ridgefield Court Asheville NC 28806 990 2009-10-01 566000674 LENOIR MEMORIAL HOSPITAL INC LENO 2525227927 100 AIRPORT ROAD KINSTON NC 28501 SARAH MAYO 2525227927 2011-08-08 1 Amy Bibby 8282542254 2009 2016-02-24 21:20:13Z GARY BLACK 100 AIRPORT ROAD KINSTON NC 28501 128233676 0 X www.lenoirmemorial.org X 1950 NC PROVIDING EXCEPTIONAL HEALTHCARE AS AN OUTSTANDING COMMUNITY HOSPITAL 17 14 1332 290 1084500 380648 401444 150765 126335863 119991893 4271585 3475469 2536406 3418767 133545298 127036894 157076 178096 0 60647281 60925290 0 52824 68453849 67642967 129258206 128746353 4287092 -1709459 174976842 180931509 49788359 51400913 125188483 129530596 THE MISSION OF LENOIR MEMORIAL IS TO ENSURE EXCEPTIONAL HEALTHCARE FOR THE PEOPLE WE SERVE. 0 0 109686135 178096 120571834 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 2010 ANNUAL COMMUNITY HEALTH REPORT IS LOCATED ON THE HOSPITAL WEBSITE AT WWW.LENOIRMEMORIAL.ORG.2010 COMMUNITY HEALTH ACCOMPLISHMENTS:INJURY PREVENTION CENTER - 189 CAR SEATS INSPECTED, 122 CAR SEATS DISTRIBUTED, 660 GUN LOCKS DISTRIBUTED, 90 COMMUNITY PROGRAMS PROVIDED, 84 VAN EVENTS, AND FACILITATED THE TRI-COUNTY SAFE KIDS/SAFE COMMUNITIES COALITION. LINKLINE - PARTNERED WITH LENOIR-GREENE UNITED WAY TO RECEIVE CALLS AND MADE 1,316 REFERRALS FROM A COMPREHENSIVE NEWLY UPGRADED DATABASE THAT INCLUDED 983 PROGRAMS WITHIN 673 AGENCIES. PROVIDES COMMUNITY UNMET NEEDS INFORMATION, ON A MONTHLY BASIS, FOR COMMUNITY NETWORKING TO THE LENOIR COUNTY ALLIANCE FOR A HEALTHY COMMUNITY. HOSTED THE NINTH AGENCY EXPO WITH 70 AREA AGENCIES PARTICIPATING AT A VERNON PARK MALL EVENT.COMPLETED THE 3 YEAR DUKE ENDOWMENT GRANT FOR THE NEWLY NAMED MINNIE P. STACKHOUSE DIABETES CENTER. THE FREE OUTPATIENT DIABETES SELF-MANAGEMENT PROGRAM FEATURED A MANDATORY EXERCISE COMPONENT. 141 NEW STARTS, 652 COMMUNITY CONTACTS INCLUDING EDUCATION, SCREENINGS, AND "DEBILITATOR" ATTENDEES.SUPPORT GROUPS - COORDINATED 17 HOSPITAL BASED GROUPS, ATTENDED BY 4751 PARTICIPANTS. WE ADDED THE HEART FAILURE SUPPORT GROUP THIS YEAR.ANNUAL SCREENING EVENTS - PROVIDED EARLY DETECTION SCREENING EVENTS OF SEVEN DISEASES/DISORDERS/RISKS INCLUDING COLORECTAL, SKIN, PROSTATE CANCERS, MAMMOGRAM, CHOLESTEROL, AND BLOOD PRESSURES. COMMUNITY HEALTH EDUCATION CLASSES - PROVIDED TO 4,316 PARTICIPANTS IN ON-SITE AND OFF-SITE PROGRAMMING.CONDUCTED HOSPITAL TOURS OF FACILITIES AND HEALTH SERVICE CAPABILITIES WITH SCHOOL GROUPS AND CIVIC ORGANIZATIONS PHYSICIAN RECRUITMENT FOR HOSPITAL AND RELATED PRACTICES FOR IMPROVED CARE ACCESS IN COMMUNITY.LENOIR MEMORIAL HOSPITAL WALKING TRACK - AVERAGES 500 WALKERS PER MONTH. WRITE IT RIGHT - MEDICATION CARD INITIATIVE - PROVIDED OVER 500 FREE MEDICATION CARDS TO AREA RESIDENTS.HEALTH INFORMATION SERVICES DEPARTMENT PROVIDED OVER TEN HOURS ASSISTING PERSONS IN COMPLETING LIVING WILLS.COMMUNITY PARTNERSHIPS/YOUTH PROGRAMMING - COLLABORATED WITH OUTSIDE AGENCIES TO OFFER THE MONTHLY COMMUNITY DIABETES NUTRITION SERIES, 300 ASTHMA ACTION BOOKLETS FOR LC PUBLIC SCHOOLS AND AREA DAYCARE FACILITIES. 59 JUNIOR VOLUNTEERS PARTICIPATED IN ANNUAL VOLUNTEER PROGRAM THAT HELPS TEENS EXPLORE HEALTH CAREERS AND VALUABLE LIFE SKILLS.CANCER CENTER SOCIAL WORKER SERVICES PROVIDED TO CANCER CENTER CLIENTS AND FAMILIES IN ORDER TO MATCH COMMUNITY RESOURCES DURING THERAPIES.COMMUNITY EDUCATION FROM EMERGENCY DEPARTMENT STAFF ON A VARIETY OF EMERGENCY MEDICAL ISSUES AND PREPAREDNESS.LENOIR MEMORIAL HOSPITAL CONTINUES TO MAINTAIN THE JOHN HOOTEN RESOURCE CENTER, LOCATED IN THE HOSPITAL LOBBY, FOR VISITORS, STAFF, PHYSICIANS AND PATIENTS WHO DESIRE ACCESS TO HEALTH INFORMATION, 1000 + VISITORS.COMMUNITY EDUCATION FROM FAMILY BIRTH CENTER ON A VARIETY OF MATERNAL/CHILD HEALTH TOPICS FOR 220 ATTENDEES.LENOIR MEMORIAL HOSPITAL CONTRACTS STAFF WHO ARE MEDICAID COUNSELORS FROM THE LENOIR COUNTY DEPARTMENT OF SOCIAL SERVICES TO ASSIST LOW INCOME INDIVIDUALS WITH MEDICAID ELIGIBILITY.MULTIMEDIA HEALTH MARKETING - PUBLISHED NEWSLETTERS, TV SHOW, HEALTH PROMOTION INSERTS AND OTHER SPECIALTY HEALTH PROMOTIONS FOR EARLY DETECTION, DISEASE MANAGEMENT, AND RISK FACTOR REDUCTION IN THE COMMUNITY. PASTORAL SERVICES - PROVIDED TO COMMUNITY ORGANIZATIONS AND COMMUNITY CHAPLAINCY PROGRAM.COMMUNITY COMMUNICABLE DISEASE H1N1 READINESS AND PREPARATION WAS DONE IN 2010 UTILIZING TIME AND MANAGEMENT RESOURCES.CANCER REGISTRY PROGRAM AND COMMUNITY CANCER SURVEILLANCE - ANNUAL REPORTS AVAILABLE THROUGH ON-LINE LINK WWW.LENOIRMEMORIAL.ORG.BI-MONTHLY SAFE KIDS MEETINGS AND VEHICLE REGISTRATIONS AND INSURANCE. LENOIR MEMORIAL HOSPITAL IS LEAD ORGANIZATION FOR TRI-COUNTY CHAPTER.CLINICAL TRIAL OVERSIGHT AND MEDICAL TUMOR BOARD MANAGEMENT.FOUR COMMUNITY BLOOD PRESSURE MACHINES - PROVIDED 57,030 BLOOD PRESSURES INCLUDING SITES AT HOSPITAL, VERNON PARK MALL AND A TRAVELING CHURCH MACHINE.CORPORATE AND COMMUNITY HEALTH SERVICES - 252 WORKSITE WELLNESS VISITS WITH 2,829 EMPLOYEE CONTACTS. ALSO, PROVIDED COMMUNITY HEALTH SERVICES INCLUDING SMOKING CESSATION, DRIVERS SAFETY COURSE, HEALTH RISK APPRAISALS, AND BLS INSTRUCTION.MINGES WELLNESS CENTER - MEDICALLY BASED FITNESS CENTER FOR THE COMMUNITY HAS 65 PIECES OF EXERCISE EQUIPMENT WITH 25 GROUP EXERCISE CLASSES WEEKLY. WE EXPERIENCED 7 CORPORATE MEMBERSHIPS DURING THIS PERIOD AND 915 INDIVIDUAL MEMBERS. WE WERE VOTED THE #1 PLACE TO SHAPE UP BY 2010 FREE PRESS READERS.COMMUNITY EXERCISE INITIATIVES - WE FACILITATED THE FITKIDS AFTER SCHOOL EXERCISE PROGRAM FOR AREA YOUTH; THE THIRD ANNUAL COMMUNITY NEW YEAR'S CHALLENGE (EXERCISE FOCUS WITH OVER 200 ATTENDEES EVERY MONDAY NIGHT IN JANUARY); THE WALKTOBER COMMUNITY WALKING CAMPAIGN WHICH INCLUDED 100 PARTICIPANTS IN FALL; AND THE DIABETES WELLNESS 10,000 LIFE STEPS PROGRAM.CERTIFIED CARDIAC REHABILITATION - PROGRAM OFFERS CONTINUED EXERCISE MAINTENANCE CLASSES FOR INDIVIDUALS WHO COMPLETE 36 SESSIONS.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. DONATIONS OF RETIRED EQUIPMENT & MISCELLANEOUS SUPPLIES TO HAITI RELIEF EFFORTS - ORTHOPEDIC SURGICAL EQUIPMENT, OVER 300 GENTLY USED SHOES AND PERSONAL HYGIENE KITS.HOSPITAL LEADERSHIP TO COMMUNITY AGENCIES, BOARDS, COMMUNITY EVENTS - SPONSORED TEAM IN THE LENOIR COUNTY RELAY FOR LIFE, ALZHEIMER'S WALK, AND LEADERSHIP TO THE LENOIR COUNTY ALLIANCE FOR HEALTHY COMMUNITY, TRI-COUNTY SAFE KIDS, KINSTON COMMUNITY HEALTH CENTER, COUNCIL ON AGING, RED CROSS, AND BOYS & GIRLS CLUB.CAB FARES FOR THE DESTITUTE PATIENTS OR FAMILIES.COMMUNITY VOLUNTEER PROGRAM HAS 231 ADULT VOLUNTEERS AND 59 TEEN VOLUNTEERS FROM THE COMMUNITY WHO WORKED 38,000 HOURS TO ASSIST LENOIR MEMORIAL HOSPITAL WITH SERVICE INITIATIVES AND HOSPITAL PROGRAMMING.TRAINING - PRECEPTORSHIP AND TRAINING FOR MULTI-DISCIPLINE CLINICAL EDUCATION.FACILITY MEETING AND EVENT SPACE, COORDINATED COMMUNITY CONTRIBUTIONS.SPANISH INTERPRETATION FOR OUTSIDE AGENCIES.FACILITY ENVIRONMENTAL & ENERGY IMPROVEMENTS.LENOIR MEMORIAL HOLDS 6 BLOOD DRIVES PER YEAR AND COLLECTED OVER 300 PINTS OF BLOOD FOR THE AMERICAN RED CROSS. STAFF DONATED TIME FOR EVENTS.CASH DONATIONS INCLUDING HEALTH PROFESSIONAL SCHOLARSHIPS.EMPLOYEES RAISED $72,263 THROUGH EMPLOYEE PARTICIPATION IN THE 2010 UNITED WAY AND LENOIR MEMORIAL HOSPITAL FOUNDATION CAMPAIGNS TO SUPPORT OUTREACH IN THE COMMUNITY.PROVIDED ECONOMIC DEVELOPMENT FUNDING AND LEADERSHIP TO PROJECTS IN THE COMMUNITY THAT INCLUDE PRIDE OF KINSTON, KINSTON-LENOIR COUNTY PUBLIC LIBRARY, COMMUNITY COUNCIL FOR THE ARTS, COMMITTEE OF 100, KINSTON-LENOIR COUNTY CHAMBER OF COMMERCE, LAGRANGE CHAMBER OF COMMERCE AND GREENE COUNTY CHAMBER OF COMMERCE. 109686135 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 206 0 1 1332 1 1 1 0 0 0 0 0 0 0 0 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 399713 0 54212 MARY M CAULEY ED D 1.00 X X 0 0 0 RAY COLLIER JR 1.00 X X 0 0 0 RAY DEANE 1.00 X 0 0 0 DEXTER FLOYD 1.00 X 0 0 0 OSCAR GREENE III 1.00 X 0 0 0 KAY HARRELL 1.00 X X 0 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 DONALD RIDDLE MD 1.00 X 11458 0 0 LESLIE REYNOLDS MD 1.00 X 67187 0 0 CURTIS S SMITH 1.00 X 0 0 0 RALPH LEE COX MD 1.00 X 0 0 0 JAMES CLINE DOBBINS 40.00 X 180515 0 31109 WILLIAM DAVID LEASE 40.00 X 175303 0 31423 SARAH MAYO 40.00 X 207843 0 35825 ROSALIND MCDONALD 40.00 X 182458 0 33452 DALE ALTON HARDY 40.00 X 168703 0 11925 SCOTT A STEGBAUER 40.00 X 530225 0 15300 ARTHUR HUNSINGER 44.00 X 204561 0 11648 YVETTE GEORGE 40.00 X 195059 0 1006 ELIZABETH PRIDGEN PUTNAM 43.00 X 194650 0 11720 CONNIE SUE MANGEL 43.00 X 193113 0 11098 2710788 0 248718 29 0 1 0 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 DIXON HUGHES PLLC PO BOX 3049 ASHEVILLE NC 288023049 ACCOUNTING SERVICES 166510 K&L GATES PO BOX 402988 ATLANTA GA 303842988 LEGAL SERVICES 162096 7 46806 103959 150765 PATIENT SERVICES 621990 119543190 119543190 WELLNESS CENTER REVEUN 713940 159979 159979 PARTNERSHIP INCOME 541900 130085 130085 LAB REVENUE 541380 89093 44547 44546 AUXILLARY SERVICE REVE 621990 53460 53460 16086 16086 119991893 3548008 3548008 1502949 1502949 1502949 938411 564538 241154 313693 -72539 -72539 -72539 1573450 883089 690361 361116 329245 DIETARY AND CAFETERIA 900099 935486 935486 GIFT SHOP 900099 231008 231008 VENDING 900099 58963 58963 1225457 127036894 121028164 1084500 4773465 26908 26908 151188 151188 1591125 315009 1234690 41426 46188067 37584777 8603290 1673357 1327353 344553 1451 8046229 6382493 1656760 6976 3426512 2718005 705536 2971 49629 49629 358417 358417 122265 122265 7500 7500 8321390 5686773 2634617 373303 29504 343799 22445522 19836578 2608944 1756999 1756999 3232205 3010711 221494 77417 50982 26435 65729 37140 28589 58731 5 58726 7885173 7885173 62395 62395 BAD DEBT EXPENSE 22697781 22697781 MISCELLANEOUS 95728 43949 51779 RECRUITMENT 32783 32783 128746353 109686135 19007394 52824 2251035 2709213 25096054 15638265 8446946 9233420 3596659 3120114 1038303 1464055 140473540 74927695 70433022 65545845 60806419 78857992 3308404 4362605 174976842 180931509 10594215 10811648 8313473 9875313 20148911 19768872 7500000 7000000 3231760 3945080 49788359 51400913 X 82541675 90833596 42646808 38697000 125188483 129530596 174976842 180931509 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9981 9981 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 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 $ 9,981 HAS BEEN ALLOCATED TO LOBBYING EXPENDITURES. 425406 425406 69349937 37341059 32008878 69806022 37586636 32219386 892175 892175 65545845 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 3865107 CAPITAL LEASE OBLIGATION 79973 3945080 127036894 128746353 -1709459 6051573 6051573 4342114 111273775 6051573 883089 6934662 104339113 22697781 22697781 127036894 106931662 883089 883089 106048573 22697781 22697781 128746354 Part XII, Line 2d - Other Adjustments: COST OF GOODS SOLD: 883089. Part XII, Line 4b - Other Adjustments: PROVISION FOR BAD DEBTS: 22697781. Part XIII, Line 2d - Other Adjustments: COSTS OF GOODS SOLD: 883089. Part XIII, Line 4b - Other Adjustments: PROVISION FOR BAD DEBTS: 22697781. 1 1 1 X 1 X 1 1 1 0 1 1 1267807 377673 890134 0.00840 15735747 14333568 1402179 0.01320 271692 271692 0.00260 17275246 14711241 2564005 0.02420 468776 82126 386650 0.00360 210950 210950 0.00200 685588 110720 574868 0.00540 1365314 192846 1172468 0.01100 18640560 14904087 3736473 0.03520 10380 10380 0.00010 1882 1882 0.00000 1614 1614 0.00000 19693 19693 0.00020 33569 33569 0.00030 0 7117392 3005416 52756445 53988627 -1232182 X 1 1 LENOIR MEMORIAL HOSPITAL INC

100 AIRPORT ROAD KINSTON NC 28501

X X X X DISPROPORTIONARE SHARE HOSPITAL 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 III, Line 4: THE TOTAL BAD DEBT EXPENSE FOR FY10 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 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 EVERY FOUR YEARS. THE NEXT ASSESSMENT IS DUE IN 2011 AND INITIAL STEPS HAVE BEGUN FOR COMMUNITY SURVEY. LOCAL DEMOGRAPHIC INFORMATION AND HEALTH STATISTICS ARE COMPILED ALONG WITH USE OF COMMUNITY SURVEY DATA ABOUT PERCEIVED HEALTH ISSUES IN ORDER TO DEVELOP TARGETED COMMUNITY HEALTH STRATEGIES. LENOIR MEMORIAL PARTNERS WITH LENOIR, GREENE, AND JONES COUNTIES IN THE HEALTHY CAROLINIANS PROCESSES IN EACH COUNTY. ANNUAL CANCER REPORTS AND HOSPITAL DIAGNOSIS TRENDS ARE USED TO PRIORITIZE PROGRAMMING, SERVICES, AND INITIATIVES. PHYSICIAN NEEDS ASSESSMENT IS PERFORMED. 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 (-.2%), VS. THE NC AVERAGE OF +18.5%. KINSTON'S DECLINE WAS EVEN STEEPER, AT -8.4%. 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 - 8.4% - 0.2% 18.5%PERCENT BELOW POV. LV, 2009 35.8% 25.7% 15.1%MEDIAN HOUSEHOLD INCOME, $25,881 $32,457 $45,069CHILDREN IN POVERTY, 2009 52.9% 31.5% 20.8%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 5: 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, COMMITTEE OF 100, LENOIR-GREENE UNITED WAY, KINSTON COMMUNITY HEALTH CENTER, LENOIR COUNTY ALLIANCE FOR A HEALTHY COMMUNITY, SAFE KIDS, AND LENOIR-GREENE ASTHMA COALITION. WE WERE A SPONSOR OF THE 2010 LIVING THE GOOD LIFE EVENT AT VERNON PARK MALL WITH OVER 100 AREA AGENCIES AND BUSINESSES PARTICIPATING IN THE HEALTHY LIVING EVENT. DURING 2010, LENOIR MEMORIAL BEGAN A FIVE YEAR COLLABORATION WITH UNC-CH TO IMPLEMENT THE HEART HEALTHY LENOIR WITH THE PROJECT KICK-OFF. OVER 250 WORKSITE WELLNESS VISITS WERE PROVIDED TO AREA BUSINESS AND INDUSTRY. Part VI, Line 6: 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. NC 1 LENOIR MEMORIAL HOSPITAL FOUNDATION INC 100 AIRPORT ROAD KINSTON NC 28501 581584139 501(C)(3) 20908 N/A N/A OPERATIONAL SUPPORT PRIDE OF KINSTON 327 NORTH QUEEN STREET KINSTON NC 28501 561434180 501(C)(3) 6000 N/A N/A REVITALIZATION OF THE KINSTON COMMUNITY AND SPONSORSHIPS FOR COMMUNITY EVENTS 2 0 SCHOLARSHIPS 67 76185 N/A N/A EDUCATIONAL STIPENDS 5 14671 N/A N/A EMPLOYEE MENTAL HEALTHCARE ASSISTANCE 12 5700 N/A N/A RESOURCE MANAGEMENT COMMUNITY ASSISTANCE - MEDICATION COST SUPPORT 19 357 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 1 0 GARY BLACK 385673 0 0 0 14040 0 39186 0 15026 0 453925 0 0 0 JAMES CLINE DOBBINS 171314 0 450 0 8751 0 18812 0 12297 0 211624 0 0 0 WILLIAM DAVID LEASE 149495 0 0 0 25808 0 18480 0 12943 0 206726 0 0 0 SARAH MAYO 183955 0 0 0 23888 0 23402 0 12423 0 243668 0 0 0 ROSALIND MCDONALD 154436 0 0 0 28022 0 17931 0 15521 0 215910 0 0 0 DALE ALTON HARDY 140083 0 8180 0 20440 0 0 0 11925 0 180628 0 0 0 SCOTT A STEGBAUER 449723 0 42241 0 38261 0 0 0 15300 0 545525 0 0 0 ARTHUR HUNSINGER 186054 0 4000 0 14507 0 0 0 11648 0 216209 0 0 0 YVETTE GEORGE 177293 0 15000 0 2766 0 0 0 1006 0 196065 0 0 0 ELIZABETH PRIDGEN PUTNAM 190406 0 410 0 3834 0 0 0 11720 0 206370 0 0 0 CONNIE SUE MANGEL 183303 0 4000 0 5810 0 0 0 11098 0 204211 0 0 0 Part I, Line 4b: THE FOLLOWING INDIVIDUALS RECEIVED AMOUNTS FROM A 457B PLAN: GARY BLACK, CEO, $39,186.16; JIM DOBBINS, VP HUMAN RESOURCES, $18,811.93; WILLIAM LEASE, VP PLANT AND FACILITY, $18,480.17; SARAH MAYO, CFO, $23,402.08; ROSILAND MCDONALD, VP NURSING SERVICES, $17,931.05. Part I, Line 7 A PORTION OF THE SALARIES OF THE CEO AND VICE PRESIDENTS IS VARIABLE AND IS BASED UPON ATTAINMENT OF ANNUAL GOALS RELATED TO QUALITY, PATIENT SAFETY, STAFF ENGAGEMENT, PATIENT SATISFACTION, AND FINANCIAL STEWARDSHIP. NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 657902Y63 2005-09-22 22000000 CAPITAL PROJECTS 0 0 22021552 198858 9678822 2005 1 0 1 1 0 0 0 0 0 0.00520 0.00520 0 0 1 0 0 0 1 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 MEETING JUNE 2011. 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. IN ADDITION, 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. 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. 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 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 DME VENTURES LLC DBA PAMLICO MEDICAL EQUIPMENT 628 EAST TWELFTH STREET WASHINGTON NC 27889 562101748 RENTAL/SALES OF MEDICAL EQUIPMENT NC N/A UNRELATED 123587 506001 0 119917 1 SPRING ARBOR OF KINSTON LP 800 HETHWOOD BOULEVARD BLACKSBURG VA 24060 522118245 RENTAL REAL ESTATE VA N/A RELATED 34700 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0