Dickenson Community Hospital Inc.

“The corporation is organized as a virginia non-stock, nonprofit corporation. Dickenson community hospital is a 100% owned subsidiary of norton community hospital,inc.”

“The board of directors of norton community hospital annually elect members to the board of directors for dickenson community hospital. A requirement of at least (1) member is to be from dickenson county industrial development authority. Norton community hospital is the sole owner of dickenson community hospital.”

“Certain decisions of the board are, pursuant to charter and virginia statute, subject to approval of the members. These decisions include: dissolution of the corporation; merger of the corporation; non-ordinary course of business sale of assets, etc. No ordinary day-to-day decisions are subject to member approval.”

“The cfo reviewed the form 990 with the board of directors prior to filing the return with the irs. The return was made available to each board member in an electronic format prior to the review.”

“Annually, the corporate audit and compliance department of msha forwards the conflict of interest policy and disclosure form to all msha management team members and board members, including those at dch. Employees and board members must note any conflicts or attest they have "none", and return the form to the audit and compliance department. Any noted disclosures are forwarded to the appropriate management or board personnel to evaluate and utilize when a transaction involving a conflicted person arises. Additionally, personnel who have a conflict arise between the annual distribution of the policy and forms are required to disclose the conflict and would be disciplined in any instance where they have not disclosed and engaged in a conflicted transaction.”

“Msha's human resource (h/r) department evaluates salary and benefits for dch's ceo on an annual or near-annual basis. H/r's evaluation is based on market data obtained from independent third-party consultants for positions with similar responsibilities at similarly situated organizations. Based on that review, h/r makes a recommendation to msha's president & ceo, who has final approval for the compensation of dch's ceo. In addition, msha offers an incentive plan to executives based on targeted achievement metrics set in advance of the pay year. Established metrics include: communication with patients, patient evidence-based care scores and patient safety, value- based purchasing, etc. These same metrics are used for all employees within msha, with a small number of exceptions for our companies that do not provide direct patient care.”

“Similiar to the ceo's compensation, the cfo receives compensation and benefits that comply with msha's salary policy. His pay is set at a market percentile specific to his position.”

“Governing documents and our conflict of interest policy are made available upon request to appropriate parties requesting them. Financial statements are made available upon request to appropriate parties requesting them, and they are made available to those parties who own indebtedness of the company on a quarterly basis. Form 990, part vii - related organizations director compensation: dickenson community hospital's board of director members, shane hilton and monty mclaurin, receive compensation for services provided to related organizations and do not receive compensation for services as a dch board member.”

“Dickenson community hospital is committed to bringing loving care to health care. We exist to identify and respond to the health care needs of individuals and communities in our region and to assist them in attaining their highest possible level of health. Part i, line i - organization's primary activities: dch is a federally designated critical access hospital. Federal critical access hospital designation requires that a hospital be small and located in a rural area and located more than a 35-mile drive from another hospital or more than a 15-mile drive from another hospital in an area with mountainous terrain or only secondary roads, and be state-designated as a "necessary provider" of health care services to residents in the area. Dch is located in one of the poorest and most unhealthy regions of virginia. Out of a statewide ranking of 1 to 134 (with 134 being the worst), dickenson county is ranked 130 for length of life, 125 for health factors (factors that influence the health of a county), and 132 for clinical care (a very low number of physicians and dentists available in the area). Dch is the only hospital located in dickenson county, with the next nearest hospitals located a 45 minute drive away. Dch is a wholly-owned subsidiary of norton community hospital (nch) and part of mountain states health alliance. Similar to other rural hospitals, dch does not enjoy net operating profits. Dch is able to continue operating in the area due to the generous support of nch and msha.”

“During fy16, we experienced 7,141 visits to our er, 28,003 outpatient visits (an increase of more than 17%) and 114 inpatient admissions. Our new inpatient behavioral health unit, green oak behavioral health, opened this year with five staffed inpatient beds. The new inpatient service focuses on senior citizens and is the only inpatient behavioral health unit in southwest virginia specifically for older adults. We sustained a significant loss from operating the new unit. We continued to offer our outpatient behavioral health program, senior life solutions. Our new inpatient behavioral health unit along with senior life solutions allows seniors access to behavioral health services without having to travel outside of the area. 19% of our residents are 65 years of age or older and with mountainous terrain especially dangerous in winter months, residents needing behavioral health services previously had to leave the area or do without needed care. The benefit of the two programs extends to patients' families and friends since they often provide transportation for seniors to medical care appointments. Similar to our inpatient behavioral health unit for seniors, our outpatient unit incurred a net operating loss. The growth seen in our wound care program continued unabated this year with volumes increasing by 41% over prior year. The program began as an outgrowth from norton community hospital in an effort to reach patients that could not access care. Wound care patients often have multiple health issues and many times travel is very difficult for them. These hardships often caused patients the inability to access necessary care. Patients served at dch include those with diabetic ulcers, venous stasis ulcers, arterial ulcers, non-healing traumatic and surgical wounds and other chronic wound conditions. The primary care physician ratio in our county is 3,000:1 compared to 1,330:1 for the state of virginia. Recruiting physicians to a rural county such as ours is often challenging due to a myriad of factors, such as geography, economics, culture and education. Geographically, rural communities are often far removed from suburban and urban centers that provide access to educational, cultural and economic opportunities. These limitations influence the relocation decision of the physician candidate and his/her spouse/children to locate to a rural area. Dch continues to subsidize a rural physician clinic to provide some relief of the physician shortage in our area. Rural life often includes hazardous occupations, which is certainly true of dickenson county due to the high employment rates in the coal mining industry and trauma accidents related to rural occupations and activities. Rural trauma is generally different from urban trauma. Rural trauma is more likely to be from accidents related to farming, hiking, horseback riding, use of four-wheelers, etc. When more advanced care is needed, our patients can be transferred to mountain states health alliance's flagship facility, johnson city medical center, which is a tertiary care facility. Our hospital served as a clinical training hospital for health professional education students. Our dedicated staff worked with regional colleges and universities to coordinate the placement of healthcare professional students as part of their educational curriculum. In addition to clinical training, the healthcare students are required to complete orientation and computer training. Participants receiving clinical experience at dch during fy16 included 26 nursing students from various colleges, universities and programs. This nursing clinical experience required extensive hospital nursing staff involvement. We invested 69,000 in the clinical setting and hands-on instruction for these students. In addition to nursing students, we provided respiratory therapy training, incurring an additional cost of 2,100. Dch has partnered with the company advanced patient advocacy to work with self-paying patients who have”

“Line 2a: w-2 employees dickenson community hospital (dch) team members are paid by norton community hospital, sole member of dch, except for the ceo and cfo who are paid by mountain states health alliance. The ceo and cfo salary and benefit costs are allocated between nch and dch. Norton community hospital bills dch for its share of salary and benefits and the expense is recorded on dch's books.”

“Physician fees 1,396,016 0 0 geropsych services 259,585 0 0 collection fees 0 53,746 0 health info. & lab tests 46,169 0 0 linen & environmental serv. 0 75,651 0 engineering 0 27,265 0 contract labor 56,884 0 0 dietary 13,411 0 0 transcription & coding 0 21,981 0 various fees 21,110 68,256 0”

“Change in temp. Restricted contributions & grants -1,679 elimination of intercompany rec/pay 3,294,338 pension liability adjustment 471,988 total 3,764,647”