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HomeMy WebLinkAbout2014-457 Health - Piedmont Health Services - Outside Agency Performance Agreement to properly and fully complete the work set forth in the Scope of Services $10,000 2014-15 OUTSIDE AGENCY PERFORMANCE AGREEMENT This Agreement, made and entered into the first day of July 2014, by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ("County") and Piedmont Health Services, Inc., a not-for-profit corporation, located at 299 Lloyd St., Carrboro, NC 27510 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; WHEREAS, for the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the services to the County in accordance with the terms of this Agreement. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Provider agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1,2014 to June 30, 2015. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Scope of Services and any amendments or revision thereto which is attached as Exhibit `B" and incorporated by reference, to the residents of Orange County. The Scope of Services may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Attachment B, Scope of Services and more particularly described in the Program Budget, the maximum sum of ten thousand dollars ($10,000). b. All funds appropriated shall be used for purposes described in Attachment B. Any funds not used for the purposes stated shall be returned to the County. Any substantive changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The County's obligation to make each payment is contingent upon receipt of Quarterly Progress Reports and satisfactory progress toward completion of performance measures and accounting of expenditures as detailed in the attached Scope of Services. d. The Provider shall be paid in four equal installments in the amount of $2,500, contingent upon receipt of the quarterly request for reimbursement and related supporting documentation. The first installment shall be paid no later than August 31 of the Program year and after execution of this Outside Agency Performance Agreement by both the County and the Provider; the remaining installments shall be disbursed on October 15, January 15 and April 15 of the program year and upon satisfactory completion of(c) and the information included in this paragraph. e. Once Provider has satisfied its obligations as provided in (c) and (d) above, payment will be made 30 days after receipt of the Quarterly Progress Report and Request for Reimbursement or 30 days after due date of Quarterly Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide the Orange County a quarterly report that includes a fiscal report, updates on 2014-2015 performance measures and objectives as provided in Scope of Services. Quarterly Progress Report dates are:July 1 — September 15, September 16 — December 15; December 16 —March 15 and March 16 -June 30. Quarterly reports are due on October 1, December 31, April 1 and July 31 of the program year. b. Reports shall be forwarded to the Orange County Health Director. c. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default"), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in Piedmont Health Services,Inc. 2014-15 Orange County Performance Agreement Page 2 writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings,be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered;or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance,incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws,regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within seven (7) from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty;provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. Piedmont Health Services,Inc. 2014-15 Orange County Performance Agreement Page 3 a. General Requirements. the Provider shall purchase and maintain, during the period of performance of this Agreement,insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury,including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance,including hired and non-owned vehicles,if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A - Statutory State NC &Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Workers Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 Piedmont Health Services,Inc. 2014-15 Orange County Performance Agirement Page 4 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they has or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers,which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color,gender, national origin, age, handicap,religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the Piedmont Health Services,Inc. 2014-15 Orange County Performance Agreement Page 5 successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $10.97 per hour. To the extent possible, Orange County recommends that Piedmont Health Services, Inc. provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County:. Provider: Orange County Health Dept. Piedmont Health Services, Inc. ATTN:Accounts Payable 299 Lloyd St. 300 West Tryon Street Cartboro,NC 27510 Hillsborough,NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings;written or oral,relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. 18. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. Consultant shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all and-discrimination laws. Pursuant to the terms of North Carolina General Statute 153A-449(b) no county may enter into a contract with a contractor unless the contractor and the contractor's subcontractors comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the General Statutes constitutes Consultant's breach of this Piedmont Health Services,Inc. 2014-15 Orange County Performance Agreement Page 6 Agreement. By executing this Agreement Consultant affirms Consultant is in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. 19. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. [SIGNATURES ON FOLLOWING PAGE] Piedmont Health Services Inc. 2014-1 S Orange County Performance Agreement Page 7 IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement,effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on be lfofthe Provider Brian Toomey, CE Date For and` behalf o Orange County Government L Bonnie Hammersley, Co anager ate Approved as to technical content Colleen Bridger, Ph.D., HeaKDirector Date Ap ved s to form and legal sufficiency Io� tSl( 4_ ette M.-Moore, Sthff Attorney Date This instrument has been pre-audited in the manner required by the Local Government Bud et and Fiscal ontrol Act ua'e� P. A-'e— tv Clarence Grier, Asst. County Manager/CFO Date Piedmont Health Services Inc. 2014-15 Orange County Performance Agreement Page 8 ATTACHMENT "A" Orange County Certifications —2014-15 Outside Agency Performance Agreement Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title,residential address;phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name,physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. Transparency I certify that board meetings are open to the public with the exception of closed session meetings. Additionally, all financial records are available for public inspection by request upon reasonable notice. Certified by: Title: Date: �y Piedmont Health Ser7 ices,Inc. 2014-15 Orange County Performance Agreem t Page 9 Outside Agency Funding Application July 1, 2014 through June 30,2015 APPLICATION DUE FRIDAY,JANUARY 24, 2014 AT 5:00PM Agency Name: Piedmont Health Services,Inc. Street Address: 299 Lloyd Street,Carrboro,NC 27510 Mailing Address: 299 Lloyd Street,Carrboro,NC 27510 Website Address: www iedmonthealth.or_ Executive Director: Brian Toomey, MSW Telephone: 919 537-7494 E-Mail:_toomeyb@tiedmonthealth.org Contact Person: fen Cunningham Telephone: (919)913-1097 E-Mail: cunningj @piedmonthealth.org Fax: 919 933-9201 Federal ID Number: 56-0952737 Funding Source Summary— Current Funding Requested Funding Briefly state haw any.awarded (FY13-14) (FY14-15) ftinds would be used, Orange County Government $10,000 $11,000 Summary of intended use of funds: To support the Carrboro Community Health Center in its mission of being a sliding-fee primary care home for vulnerable and/or economically- disadvantaged residents of Orange County. Town of Cho el Hill $3,000 $4,000 Summary of intended use of funds: To support the Carrboro Community Health Center in its mission of being a sliding-fee primary care home for vulnerable and/or economically- disadvantaged residents of Chapel Hill. Town of Carrboro $2,000 $3,000 Summary of intended use of funds: To support the Carrboro Community Health Center in its mission of being a sliding-fee primary care home for vulnerable and/or economically- disadvantaged residents of Carrboro. Executive A ctor Tian Toomey) / otr Chair anie Wiantafillou) Date Date Revised November 21,2013 Page 1 of 15 Pages Section l:Agency and Program Overview 1. Please provide a brief history of the agency—including mission,date of incorporation and years of operation. a. Date of Incorporation: May, 1970 b. Years in Operation: Forty three years c. Mission or Vision Statement (i£applicable): Our mission is to improve the health and well-being of the community by providing high quality, affordable and comprehensive primary health care. Our vision is a health community in which all people have timely access to quality health care. d. Brief History of Agency: Piedmont Health Services, Inc. (PHS) is a key part of this community's health care safety net for vulnerable and/or financially-disadvantaged residents. Founded in 1970 as Orange Chatham Community Health Services,PHS changed its name in 1995 to better reflect its growing service area. As a deemed Federally-qualified health center(FQHC),its primary mission is assuring high- quality, affordable primary care access for low-income populations in the community. All FQHC services are available on a sliding-fee scale for those living below 200%of the Federal poverty level. Like its FQHC colleagues nationally, PHS is overseen by a community Board of Directors, where>50%n of Board members are required to be consumers of the organization's services. The organization has grown substantially over its 43-year history and is one of the largest private,non-profit organizations administratively headquartered in Orange County. PHS now operates seven community health center sites in four counties, including: • Orange County—Carrboro Community Health Center(est. 1970) (the subject of this request) • Caswell County—rural Prospect Hill Community Health Center(est. 1970) • Chatham County--rural Moncure Health Center(est. 1970) and Siler City Health Center(est.2001) • Alamance County—Charles Drew Health Center, Burlington, NC (est. 1994) and the rural Scott Health Center, Union Ridge,NC (acquired 2001). A new school-based site, Sylvan Community Health Center,opened in Spring 2013. In 2008, as a natural extension of its primary care access mission,PHS launched Piedmont Health SeniorCare, a CMS-deemed Program of All-Inclusive Care for the Elderly(PACE)that focuses on providing a capitated, community-based alternative to nursing home institutionalization for frail elders in Alamance, Caswell, and northern Orange Counties(nearly all participants are dually eligible for Medicare and Medicaid), A second site serving Chatham, Lee,and Orange Counties opened in Pittsboro in Fall 2013. Revised November 21,2013 Page 2 of 15 Pages PLEASE ANSWER QUESTIONS 2 THROUGH 7 BELOW REGARDING THE SPECIFIC PROGRAM(S) FOR WHICH THE AGENCY IS REQUESTING FUNDING(NOT FOR THE ENTIRE AGENCY). IF MORE THAN ONE PROGRAM IS REQUESTING FUNDING, PLEASE IDENTIFY EACH BY LABELING, IE: PROGRAM 1, PROGRAM 2,ETC,UNDER EACH QUESTION. 2. Describe the identified community need(s)the Program(s)funded will address. As a FQHC,PHS conducts a community needs assessment every five years to assure that its service offerings are meeting identified community needs. The assessment takes into account available County level data and additional state and national data. FQHC programming then seeks to address access barriers faced by the community: • Financial Barriers—Insurance and Poverty: Many people in Orange County cannot afford primary medical care and medicines. An estimated 16%of the County population is uninsured, and 33%live below 200%© of the Federal poverty level. • Cultural/Language Barriers: Non-English-speaking populations face significant difficulty in finding medical providers with whom they can converse effectively. Many immigrant populations have culturally-determined beliefs about illness and health that differ from mainstream American groups, and these beliefs/practices impact health and health care use. The Latino immigrant population in North Carolina and Orange County has grown exponentially in recent decades, and more recently, Orange County has become home to a sizable group of Burmese refugees. • Geographic Barriers: For many in Orange County,transportation can be a barrier to health care access. We are fortunate to have an excellent free public transportation system, and our Carrboro Community Health Center location on Lloyd Street is purposefully situated a short distance from several bus routes. Second,FQHCs take a population health focus in developing primary care services that combat documented health care/health status disparities in the populations we serve, disparities which frequently break on economic and racial/ethnic lines, as depicted in the next three tables. Behavioral Risk Factors,PHS Service Area,2010 Total Service Service Service Area: Area: Service Area: Adult Behavioral Risk Area White Minority Household Income (% a alation) NC (range) (range) (range) <$50,000(range) Smoke 19.8 13.3 -29.8 12.2 - 28.2 16.7 - 35.5 15.8- 34.1 Overwei t/obese 65.3 53.2 - 72.3 46.2- 70.6 70.8 - 83.1 69.2 -78.8 No exercise p2st.month 25.7 15.4- 29.9 12.8 - 27.3 1 21.5 -44.2 L 22.3 -3 Source: State Center for Health Statistics. (2010). Behavioral Risk Factor Surveillance Survey (BFRSS), 2010. Raleigh, NC:NCDffHS, Revised November 21,2013 Page 3 of IS Pages Chronic Disease Prevalence Amon Adults,PHS Service Area: 2009.2010 Total Service Service Service Area: Service Area: Area: household Income Chronic Disease Area White Minority <$50,000 (% Adult population) NC (range) (range) (range) (range) Cardiovascular 9.0 4.6 - 11.7 4.8 - 11.9 3.4 - 11.2 5.5- 14.2 Diseases H ercholesteroiemia 2 40.0 132.3 - 39.9 34.6 -41.0 25.0-41.8 32.4 -46.3 Diabetes 9.8 5.2 - 11.4 3.5 - 10.7 10.5 - 14.0 8.9- 14.7 Hypertension ---- ertension 31.5 25.4 - 28.9 22.5 -29.5 17.2- 31.7 25.4 - 34.2 COPD2 5.6 3.4-6.9 4.3 -6.6 0.9- 8.1 3.8- 10.1 .Asthma 7.5 6.7 - 11.6 7.4- 12.1 2.7 - 16.0 9.9- 21.7 Sources: 1) State Center for Health Statistics. (2010).Behavioral Risk Factor Surveillance Survey(BFRSS), 2010, Raleigh, NC: NCDHHS;2)State Center for Health Statistics. (2009). Behavioral Risk Factor Surveillance Survey(BFRSS), 2009,Raleigh, NC: NCDHHS. PHS Service Area Mortalit : 2008-2012 Age-Adjusted Morality Rates per Service Service Service Area: 100,000 pop. Area Area: African (2005-2012) Total White American Rate Rate Selected Leading Causes of Death All Causes 780.4 Heart Disease 165.9 163.8 201.3 Cerebrovascular Disease(Stroke) 45.3 43.5 58.4 Cancer 174.0 171.0 214.5 Diabetes 21.2 18.4 42.5 Kidney Disease 16.7 14.2 34.0 Chronic Lower Respiratog Respirator Disease 46.6 50.4 31.5 MV/AIDS 13 N/A* 6.7 Suicide 13.1 16.0 6.2 Homicide 4.7 3.0 13.5 Alzheimer's Disease 26.5 27.2 24.1 *Note mortality rates for other races not calculable due to small numbers. Source: State Center for Health Statistics(November 2013)2014 County Health Data Book, Raleigh,NC: NCDHHS. In addition to overall behavioral risk, chronic disease, and mortality statistics, our health center model must address the preventive health needs of the community, which include the need for timely access to quality prenatal care, family planning,oral health and wellness services (screening/immunization), as well as the needs of the community for acute illness care. 3. Describe any operational and/or financial changes being considered in the Program(s) to be funded for FY 2014-15. There are no major operational/financial changes anticipated for the Carrboro Community Health Center operations/programming this year, although as previously stated, Revised November 21,2013 Page of 15 Pages given demand for care at CCHC,Piedmont Health is interested in pursuing viable funding opportunities to expand services in the region as they present themselves. 4. Outline anticipated internal or external revenue sources,for the program. Indicate whether these are ongoing or new sources. FQHCs are expected to maintain well-diversified funding portfolios that include local community investment,private, state and Federal grant support, and revenue generated from patient care. Currently,patient care revenue(from third party payers and patient out-of-pocket fees) represents over 75% of the PHS total operating budget. Twelve percent of the operating budget comes from the Federal section 330(e)community health center grant. The remaining funding comes from other grants/contracts. North Carolina FQHCs serve an exceptionally large number of low-income uninsured patients when compared to FQHCs nationally, and patient sliding fees collected from this group do not fully cover the cost of this care, making outside support key to sustaining our mission in the community and the reason for this request. To relate this specifically to our program unit cost table,the majority of uninsured patients served at CCHC pay$25 for a medical visit inclusive of laboratory testing when the true cost of that medical visit is well over$110.The cost difference is the reason why we aggressively pursue grants, seek to make our operations more efficient, and maximize our third-party revenue. These strategies allow us to serve more low- ineome uninsured in need. PHS' program development team continues to aggressively pursue available local,state, and private sector funding to help it fulfill its community health access mission. Importantly,the Orange County/Chapel HilLICarrboro support, while a small portion of our agency's overall operating budget,is critical to demonstrating community support for our organization,support that is often key to winning state,federal and private support from other funders. 5. Give specific examples of your agency's coordinated/collaborative efforts with other outside agencies which accomplish or enhance the Projected Results in the Program(s) to be funded.(if possible, please bullet list) PHS has a long track record for strategic partnerships with outside agencies to accomplish its health care access mission. A few of our partnerships involving the Carrboro Community Health Center include: * Orange County Health Department: the Orange County Health Department administrates this grant award with Piedmont Health, and reports its outcomes directly to the Health Director. Piedmont Health staff is involved in the County's needs assessment process, supplying data on our patient populations. Our medical program collaborates closely the Orange County Health Department to care for the Myanmar refugee population. PHS CEO Brian Toomey meets quarterly with Health Directors from four counties to discuss shared initiatives to improve community health. PHS has the Orange County and Chatham County State WIC contract and oversees the Revised November 21,2013 Page 5 of 15 Pages program at four PHS health center sites as well as the Orange County Health Department. New this year,Piedmont Health and the Department are collaborating on a Susan G. Komexi NC Triangle to the Coast Affiliate funded mammography program for low- income uninsured women. • Chapel Hi VCarrboro and Hillsborough Chambers of Commerce: PHS began the Small Business Health Care Initiative to offer Chamber members' uninsured employees (or those with high deductible plans)an affordable source of primary health care at Carrboro Community Health Center. • UNC SHAC Free Clinics: PHS provides its Carrboro Community Health Center facility and the technical assistance of its Directors in realizing the UNC SHAC Free Clinic(at the Carrboro Community Health Center on Wednesday evenings). • Interfaith Council on Social Services IFC Homeless Shelters: The Carrboro Community Health Center is a referral site for homeless residents in Orange County who have chronic medical problems, and we participate in the annual Project Homeless Connect program. • AccessCare Inc.(Medicaid Network): PHS is a major partner in its regional Community Care of North Carolina Program charged with case managing the Medicaid population of Alamance, Caswell,Chatham,and Orange Counties.The Medicaid network includes all area `safety-net' health care providers(hospitals, community health centers,health departments, departments of social services)in addition to the private practice community serving Medicaid clients and works collaboratively on quality initiatives to better serve the population. • UNC Health Care: Piedmont Health is a training location for many students from UNC health professional schools(e.g. medical, dental,pharmacy,nutrition, public health) Similar to the Chamber of Commerce program,Piedmont Health created the"Carolina Health Net"program with UNC Health Care to triage the primary care unassigned uninsured of our service area identified at UNC to a primary care home at PHS. • Orange County Partnership for Children: The Partnership funds a Bilingual Child Resource Coordinator as part of our CHC program who focuses on coordinating primary care services for immigrant/refugee children age 0-5 years. 6. How does your agency reach out to various ethnic and minority groups in the community to accomplish or enhance the results of the Program(s)to be funded? Community Health Centers nationally have the common goal of trying to guarantee "100%health care access and 0%health care disparities"to the communities they serve. Piedmont Health Services is committed to offering high-quality, accessible care to minority communities in its service area, and its current Carrboro Community Health Center patient population is approximately 69% Latino, 9%n African American, and 6% Asian. Specific to the Latino population, approximately 75% of PHS medical and dental providers and 40% of other staff are Spanish-bilingual (with many bi-cultural staff), and we pride ourselves on offering culturally-competent care to this large immigrant population. PHS frequently participates in various outreach events (e.g. church health fairs,El Fora,Fiesta del Pueblo) and advertises in various minority-targeted publications (e.g. La Voz,the Black Pages). It also has a community outreach focus on the African-American faith-based community in Orange County. Revised November 21,2013 Page 6 of 15 Pages Importantly,PHS strives to maintain Board and staff reflective of its diverse patient population.. Its current Board membership of 14(PHS is actively recruiting a 15`x`Director) includes 8 Whites,3 African-Americans,and 3 Hispanics.PHS reported the race/ethnicity of 360 employees to the EEOC in September 2013 and the distribution was 44%White,31% Black, 20% Hispanic/Latino, 3%Asian,and 2%v other. 7. Place an"X"in the box that best describes the category of Program(s) to be funded (multiple selections are permitted). W01"W""g, IM "A OKI Education Health and Nutrition X X X X Job Training Snorts and Arts Activities Pre-School Activities After-School Activities Mentoring Transportation Housing Other Revised November 21,2013 Page 7 of 15 Pages Section II: Program Results A. FY 2012.13 Programs and Outcomes If the Prograrn is ongoing, show the results for the previous year(FY 2012-13). If you did not niect Projected Program Result(s)provide an explanation in the designated space situated below the chart. If more than one program is requesting funding,provide a separate chart for each program. Stated Program Goals Program Activities Actual Results for FY 12-13 Evaluation Method Example: 80%of after, Counselor meets with students,as the first Out of 100 students participating in the School records were checked to school attendees will not be contact,for students referred for minor program,90 remained in good standing verify that students had not been re-suspended infractions. with the school system.90%n result(above suspender. goal) Provide timely access to high-quality,comprehensive 3,691 residents of Chapel primary care to over 3,400 PITS' electronic practice vulnerable and/or Funding was used as provider salary support HilUCarrbnro/Grange County were served management system generates at the Carrboro Community Health Center. financially disadvantaged for uncompensated medical care at the reports demonstrating the number residents(<200010 of Federal Carrboro Community Health Center. (4,802 Grange County residents were served and demographics of individuals poverty level)of Chapel across our system.) served at the health center. Hill/Carrboro/Orange Count . if programs)did not meet its stated goal(s), please explain; Revised November 21,2013 Page 8 of 15 Pages B. VY 2014.15 Programs and Anticipated Outcomes If more than one program is requesting funding,provide a separate chart for each program. Stated Program Goals Program Activities Anticipated Results for FY 14-15 Evaluation Method Example: 80%of after- Counselor meets with students,as the first Out of 100 students participating in the School records were checked to school attendees will not be contact,for students referred for minor program,90 remained in good standing verify that students had not been re-suspended itnfraCtiorns. wills the school system.90%result(above suspended. goal) provide timely access to high-duality,comprehensive PHS' electronic practice primary care to over 3,400 Funding will be used as provider salary Over 3,400 residents of Chapel vulnerable and/or support for uncompensated medical and I-fill/Carrboro/Orange County will receive management system generates financially disadvantaged dental care at the Carrboro Community primary care services at the Carrboro reports demonstrating the number Orange County residents Health Center. Community Health Center. and demographics of individuals (s200%a of Federal poverty served at the health center. level. Revised November 21,2013 Page 9 of 15 Pages i Section III. Program Information Program Budget Worksheet AGENCY NAME: Piedmont Health Services, Inc •Carrboro Community Health Center Actual Estimated Projected Percent PROGRAM REVENUE FY2012 FY2013 FY2014 Change Private Donations $ - $ 0 Program Generated Revenue(fees) $ 2,785,448 $ 3,078,048 $ 3,197,681 4% Local Government Grants. Orange County $ 10,000 $ 10,000 $ 10,000 0% Town of Chapel Hi $ 4,000 $ 3,000 $ 3,000 0% Town of Carrboro $ 2,000 $ 2,000 $ 2,000 0% Other Local: orange Partnership/Smarf Start $ 44,000 $ 37,300 $ 37,355 00/0 Other Local: 0 Other Local; ce 0 I rrore than 3 sours,please provide a separate fist. Non-Local Government Grants Triangle United Way $ $ - $ 0 State Government $ 6,969 $ 771 $ - -1000/0 Federal Godernment $ 380,772 $ 458,700 $ 400,710 -13% Other Grants:Non-Govt Grants $ 248,136 $ 139,983 $ 188,650 35% Other Grants: 0 MiseelleneousfOther Revenue $ 671,013 $ 73,460 $ 39,412 -46% Please 5st 3largest Wcelanous sources: Management Pees $ Patient Information $ 'fizer Share the Care Contribufioi $ Total Program Revenue $ 4,152,298 $ 3,803,262 $ 3,878,808 2% PROGRAM EXPENSES Compensation $ 2,932,208 $ 3,137,017 $ 2,833,199 -100/0 Rent&Utilities $ 96,761 $ 77,060 $ 147,374 91% Supplies&Nuipment $ 317,531 $ 418,239 $ 366,049 -12% Travel&Training $ 29,415 $ 25,562 $ 31,090 22% Other Expenses: $ 939,470 $ 735,467 $ 438,134 -40% Pease list 3 largest^Other fixpenses": Patient Care Contract Seruces Repairs/Maintenanee $ - Total Program Expenses $ 4,316,385 $ 4 393 345 1 $ 3 815,846 -131/ SURPLUS!(DEPICI-r)FOR PERIOD: $ (163,087) $ (690,083)1$ 62,962 111°t Revised November 21,2013 Page JO of 15 Pages Section IV: Program Statistics and Costs If you are seeking funding for more than one Program,please submit separate form for each, 1) Define one unit of service+: The HRSA Bureau of Primary Health Care defines a health center patient as an individual who receives a visit from a licensed independent provider. In the case of PHS,this includes individuals making a medical and/or dental primary care visit at one of our health center sites. Our other services(e.g. case management,pharmacy, nutrition)are provided as an enhancement to the provider visit. Thus, the primary care visit(medical or dental)is the appropriate unit of service for Carrboro Community Health Center. Xe:ar o Total Program Units that Totai Pr6gra In P rogram- "T Cost =Total.Program + Total I M gram Me't,o Actual PY2012 26,582 primary care visits 26,582 $4,315,385 $162.34 (21,599 medical+4,332 dental) Estimated PY2013 27,021 Primary rare visits 27,021 $4,393,345 $162.59 (21,521 medical+5,500 dental) Projected FY2014 26,660 primary care visits 26,660(budgeted) $3,815,846 $143.13 (21,660 medical+5,000 dental) DeflnlLig R Iult of SeEvIce+ In a brief statement,define one unit of service for each program Example: A Homeless Shelter may define a unit of service as one bed night provided to a homeless individual at the shelter or the placement of an individual into a permanent residence. Notes reg&rding/Pro ,gram Unit Cost' • Units of cost are units of activity. The most inexpensive unit cost may be the most expensive program. Example: Agency X provides training to reduce violence at a cost of$1.0 per student (total cost of training is$5,000 with 500 students participating). Follow up reveals that 5 student-,adopt the program recommendations. The unit of results,then,is$1,000($5,000/5=$1,000) Agency Y provides similar training to 500 students at a cost of $40 (total cost of training is $20,000). follow up reveals that 40 students adopt the program recommendations. The unit of result in this case is$500($20,000140=$500). • Unit costs are not always what they seem. harnpIv. If a high school drop-out prevention program has students who participate 5 days a week for 16 weeks at a daily cost of$150, the cost per student is $12,000. If we know, though, that the program serves only 20 students at a time and that 5 out of every 20 students do not graduate,the cost per graduate is$16,000(total cost of$240,000 for 16 weeks/]5=$16,000). Revised November 21,20113 Page 11 of 15 Pages Section V, Program Beneficiary Demographics If you are seeking funding for more than one Program,please submit a separate form for each. Please use real numbers, not percentages, for all units. Additional notes can be Eovided below the chart if needed. PROGRAM OUNRFICIARY.DEJ MOGRAPMCS: progeamo.—C mc—omminity Health Cefl ter-M ntermedPri ary.Care Home Client characteristics Actual Estimated Projected Client characteristics Actual Estimated Projected CY2012 CY2013 CY2014* CY2012 CY2013 CY2014* I. Gender 4. Geographic Location(s) Male 2,446 2,763 Durham City 1,577 1,666 Durham County(does not include Female 4,235 4,113 Durham City) 136 142 2. Ethnicity Raleigh City 95 88 Wake County not include African-American 602 614 Raleigh City) 168 158 Caucasian 759 738 Town ol'Chapel Hill 1,871 1 2,092 Hispanic 4,465 4,681 Town of Carrboro 1,340 1,312 Orange County(does not include Town of Chapel Hill or lbov of Other 755 843 Carrboro) 444 104 I Age Other(specify) 949 1,314 0-5 Years 1,398 1,224 Per cent of clients at,or below,federal poverty 6-18 Years 1,477 1,740 level 67.98% 67.52% 19-50 Years 2,679 2,814 51+Years 1,027 1,098 Unknown 0 0 TOTAL#OF CIJENTS SERVED 1 6,581 1 6,876 1 +PHS reports patient demographic characteristics on a calendar year basis to our Federal finders. *PHS does not routinely predict patient mix by gender,race/ethnicity,age,or geographic location,instead basing our budget on predicted payer mix,FY2014 budget goal is 21,660 medical visits and 5,000 dental visits. We would expect little if any change in CY2014 in terms of patient characteristics compared to prior years. I'lease note:Patients from Orange County are served by all seven PHS health center locations,and in CY2013 had the following geographic distribution:Durham City: 1,954;Durham County: 180;Raleigh City:427;Wake County: 1,0 15,,'rown of Chapel Hill:2,190;Town orCarrboro: 1,351;Orange County:786;Other;26,145;Total patients served:34,048,Final CY2013 data will be available summer 2014. Revised November 2,2011 Page 12 of 15 Pages Section Vi.Financial Data Comparative Budget for Entire Agency AGENCY NAME: Piedmont Health Services, Inc. Actual Estimated Projected Percent AGENCY REVENUE FY2012 FY2013 FY2014 Change Private Donations $ 38,945 $ 65,963 $ - 100% Agency Generated Revenue(fees) $ 23,424,369 $ 25,428,995 $ 31,554,515 24% Local Government Grants: Orange County $ 10,000 $ 10,000 $ 10,000 0% Town of Chapel}till $ 4,000 $ 3,000 $ 3,000 0°/C Town of Carrboro $ 2,000 $ 2,000 $ 2,000 0°/a Other Local; Orange Partnership/Smartstart $ 44,000 $ 37,300 $ 37,355 0% Other Local: 0 Other Local: 0 M more than 3 sources,please provide a separate list. Non-local Government Grants Triangle United Way $ - $ - $ 0 State Go%emment $ 696,6831$ 1,212,629 $ 636,060 .48% Federal Government $ 6,368,608 $ 5,348,722 $ 6,412,805 20% Other Grants:Other Non-Galt Grants $ 1,676,018 $ 1,284,151 $ 1,096,007 -15% Other Grants: 0 Miscellaneouatother Revenue $ 2,066,515 $ 536,690 $ 1,130,269 111% Please fist 3largest Mscabnous sources: Pharmacy contract $ 81 0,405.00 Patient Management Fees $ 230,724.00 Inpatient Revenue $ 60,000.00 Total Agency Revenue $ 34 331 138 $ 33,929,460 S 40,882,011 20% AGENCY EXPENSES Compensation $ 20,448,547 1 $ 22,149,456 $ 24,174,674 90/0 Rent&Utilities $ 708,356 $ 757,072 $ 1,901,982 151% Supplies&Equipment $ 2,324,482 $ 3,028,190 $ 3,378,893 12% Travel&Training $ 304,067 $ 293,434 $ 404,263 38% Other Etpenses: $ 9,706,399 $ 7,606,006 $ 11,022,199 45°/9 Please list 3 largest"Other Expenses': Patient Care $ 6,901,916.00 Fleparis/Maintenance $ 1,037,870,00 Contracted Services $ 443,720.00 Total Agency Expenses $ 33 491 851 $ 33.834,158 $ 40,882,011 21`Y SURPLUSI(OgFICIT)FOR PrzPJOD., $ 839,2871 $ 95,2921$ Revised November 2,2011 Page 13 of 15 Pages Section VII: Schedule of Positions Please include&I paid staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. i.e., 8 Occupational Therapists can be inserted as one line item). ---------- Agency Name:_Pie_dMo_n_t Wp Lth S-orvIcLe&Inc, Position Tides ftil Time Actual Estimated Projected %Total If provided,indicate: W, .. Equivalent** Program (R)Retirement Plan Position Vacant staff+ FV20.12 FY2013 FY2014 Budget (PY2014) (H)Health Plan ------------ Medical Provider:physician See notes at bottom of (CCUC:2.175) 20-570 0.08 $3,471,581 $3,985,664 $3,641,304 9% next page Medical Provider:FNP/CNM/PA See notes at bottom of (CCHC:2.950) 15.425 $828,346 $1,086,307 $1,052,791 3% next page See notes at bottom of Nurses:RtLs(CCHC: 100) 15,500 $1,102,847 $1,372,597 $1,148,725 3% next page See notes at bottom of Medical Assistants(CCHC-7,000) 35.825 $947,541 $1,014,714 $1,031,626 3% next page See notes at bottom of Case Managers(CCHC: 1.520) 12.500 $806,818 $944,851 $711,904 2% next page Ancillary Support(Lab/H/—PT) See notes at bottom -6,f7- (CCHC:1.000) 6.000 $310,404 $522,098 $487,710 1% next page See notes at bottom of Dentist(CCHC: 1,000) 4.000 $632,379 $749,785 $872,147 2% next page See notes at bottom of $85,390 $155,494 $150,965 <1% next page Dental Assistants/JICCs(CCHC: See notes at bottom of 4,450) 16.200 $491,645 $529,958 $637,753 2% next page See notes at bottom of Nutritionist(CCHC,0,900) 23.950 $963,703 $1,131,575 $1,024,884 3% next page Pharmacist&Pharmacy See notes at bottom of Technicians CCHC:5.050) 32.050 $1,401,934 $1,869,132 $1,800,520 4% next page Administration–Central and Site See notes at bottom of (Exempt and Non-Exempt) next page (CCIIC:810.650) 107.010 $5,318,673 $6,747,320 $6,068,077 1 15% 1 Revised November 2,2011 Page 14 of 15 Pages . t Total Personnel Salaries(CCHC: 40.095) 291.630 $16,361,263 $20,109,455 $18,6213,406 46% Benefit Package cost for FY 2014 239'r,of salar cost $4,284,533 10% TOTAL BUDGET FOR FY 2014 $40,1382,011 See Table See Table Notes See`]'able See Table See Table VOLUNTEER HOURS" Notes below below Notes below Notes below Notes below Notes: + Similar positions can be combined: i.e.8 Occupational Therapists can be inserted as one line item. + ** Full time staff will be rioted as 1.00;half time as.50;quarter time as.25,etc. • t Denotes the percentage of staff time involved with program,if applicable.If applying for multiple programs,write the percentage followed by the program number in parentheses. + Calculate a Pull Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours=Volunteer 17F 1,960 i 'rabic Notes: Benefits: PHS offers employees who work more than 60%time a benefit package which includes health and retirement plan(with PHS contribution of 3%a for the first 3%contributed by the employee). As of this submission,292 PHS employees participate in the health plan and 196 are enrolled in our 403(b) retirement plan. Volunteers: PHS has an all-volunteer,Board of Directors. PHS does not track or record volunteer hours. At clinical sites,because of the risks inherent in clinical environments,PHS generally limits unpaid staff to health professional students who are actively engaged in pursuing their education and meet our stringent employee health guidelines. Revised November 2,2011 Page 15 of 15 Pages Piedmont Health Services, Inc. FY2014-15 Outside Agency Funding Contact List Chief Contact: Name:Jen Cunningham Title: Data Analyst Address:299 Lloyd Street, Carrboro, NC 27510 Email: cunning*@Piedmonthealth.org Phone: (919) 913-1097 Fax: (919) 933-9201 Chief Executive Officer: Name: Brian Toomey, MSW Address: 299 Lloyd Street, Carrboro, NC 27510 Email:toomey@piedmonthealth.org Phone: (919) 537-7494 Fax: (919) 933-9201 Chief Financial Officer: Name: Lydia Mason Address: 299 Lloyd Street, Carrboro, NC 27510 Email: masonly @piedmontheaIth.org Phone: (919) 537-7484 Fax: (919) 933-9201 Medical Director: Name:Abigail DeVries, MD Address:299 Lloyd Street, Carrboro, NC 27510 Email:devriesa @piedmonthealth.org Phone: (919) 537-7489 Fax: (919) 933-9201 Orange County Government FY 2014-15 Outside Agency Performance Agreement Quarterly Report Agency Name: Piedmont Health Services, Inc. FY 2014-15 Appropriation: $10,000 Quarterly Appropriation: $ OUTCOME MEASURES (OUTLINED IN THE SCOPE OF SERVICES Unduplicated Proposed Measure Quarter 1 Quarter 2 Quarter 3 Quarter 4 Annual Count Year-End (7/14-6/ 5 Outcome Orange County unduplicated residents served with sliding-fee primary care home services (served at all 6 Piedmont Health health center sites) Total Carrboro Health Center site Medical patients served—all counties Carrboro CHC (Orange County site) Orange County residents served with Medical services Carrboro CHC patients living below 200% of Federal Poverty Guideline (all are eligible for sliding-fee care) Carrboro CHC uninsured medical patients Carrboro CHC uninsured medical visits *Unduplicated Orange County Residents Served was the only outcome measure addressed in our original funding application. Additional grant outcome measures were not discussed in original funding application, but were added as descriptive measures in the quarterly outcome reports. QUARTERLY EXPENSES Explain how your agency spent its Orange County allocation during the quarter. Also complete the Quarterly Expense Report worksheet. CHALLENGES Describe any challenges your agency has faced during the quarter. What are your plans for overcoming these obstacles? (If no challenges exist, please write none.) ADDITIONAL AGENCY COMMENTS FY 2014-15 Outside Agency Performance Agreement Quarterly Report Page 1 of 1 Piedmont Health Services, Inc. Board of Directors PHS BOARD TERMS Ethnicity Gender Employer Officers&Committees Date Total Years Board CTY Lives& Consumer January 2014 Elected PHS Director Expires Works (9 year max) Group 1'. 'Serve 9 ears ^^, .' Re-Election Cohort Freeman,Victoria White F UNC Shops Center, Research Quality Assurance Mar-10 4 2106 ORG LIW N 910 Emory Drive Fellow Chairperson Chapel Hill NC 27517 Reeb,Ken White M VP of Finance&Planning/CFO Finance Apr-11 2 2016 ORG LIW Y 750 Weaver Dairy Road Carol Woods Retirement Center Chapel Hill NC 27514 Finance Committee Helms,Eleanor White F Consultant Board Vice Chairperson Mar-09 5 2016 WAK N1Y N 11515 Auldbury Way Board Development Raleigh,INC 27617 Fundraising Chairperson Layton,Melanie Latino F Achieve Solutions,LLC,Owner Community 11112008 4 2016 DUR L1W Y 4716 Buttonbush Drive Relations 1-yr LOA Durham,NC 27712 1213113 Sterwart,Randy White M Riccobene&Associates, Board Secretary May-10 3 2016 ORG LIW N 6301 Oakview Court Hillsborough Chief Finance Officer Finance NC 27278 Group 2 --Serve 7-years McRae,Brad Black M Edward Jones Investments Community Jul-11 2 2014 ORG LIW N 160 NE Maynard Rd.Suite 112 Relations- Cary,INC 27519 Fund Raising Camarena,Paul Latino M UNC Sch of Med AIDS Clinical Trials Board Retreat Dec-13 less than 1 2014 WK LIW N 305 Chapel Valley Lane Unit Quality Assurance year Apex NC 27502 Ramsey,Delores Black F Retired Florist Community Dec-09 4 2014 ORG LNV Y 7702 Mary Hall Road Relations Rougemont INC 27572 Chairperson Triantafillou,Stephanie White F Health Center Administrator Board Chairperson Feb-07 6 2014 DUR LIW N 24 Hawthorne Drive Durham Pediatrics Durham,INC 27712 Gonzalez,Alexander"Alex" Latino M Community Relations Jan-14 less than 1 2014 CHT LfW Y 110 Wiley Street Sanford year INC 27330 Moore,Beverly Black F Independent Contractor Community Relations Mar-10 4 2015 PER LIW Y POB 230 Sales and Property Manager Hurdle Mills INC 27541 Barrows,Karen White F Duke Health Community Care, Quality Assurance Nov-06 7 2015 ORG LIW N 3816 Twin River Farm Rd. Nurse,RN Hurdle Mills, INC 27541 Sassano,Maria"Flori"Florencia Latino F UNC Research Board Development Aug-12 less than 1 2015 ORG L1W Y 502 W.Popolar St Unit D1 Community Relations year Carrboro NC 27510 Pink,George White M Humana Distinguished Professor Board Treasurer June-08 5 2015 ORG LIW N 7708 Still Crossing Rd UNC Chapel Hill Dept of Health Finance Chairperson Chapel Hill,NC 27516 Policy and Management 919 843-2727 Warren,Sandy White M Retired Post Master Caswell County Quality Assurance Aug-07 6 2015 CAS LIW Y 1511 NC 86 South and Teachers Aid Prospect Hill,NC 27314 ANNUAOLNBUDGET HEALTH SERVICES, INC � 2014 PHS Detail Budget Ca�r't-�a�'o CZMMUVI;i I FOR THE YEAR ENDED NOVEMBER 30,2014 `� C 1e�� I j CARRBORO Carrboro Carrboro Carrboro Carrboro Carrboro Medical Dental Pharmacy MNT WIC Admin. Total Budget Budget Budget Budget Budget Budget Budget ® Encounters/Scripts 21,660 44,619 { ® REVENUES: Program Income: ® Medicaid 1,022,655 170,430 66,523 21,600 0 0 1,281,208 Medicare 224,809 0 0 0 0 0 224,809 ® Private Insurance/Mcr Part D 229,769 60,720 246,966 15,000 0 0 552,455 Patient Payments 280,497 458,850 316,207 14,500 0 0 1,070,054 ® Cost Settlement Income($11 x 75%of Mcd En 69,155 0 0 0 0 0 69,155 Income Transfers 0 0 0 0 0 0 0 Total Program Income 1,826,886 690,000 629,695 51,100 0 0 3,197,681 Grant Income: ® Federal 330 Grant($50/SP enc) 400,710 0 0 0 0 0 400,710 ® Federal WIC'Grant 0 0 0 0 0 0 0 Federal Outreach&Enrollment Grant 0 0 0 0 0 0 0 State Meaningful Use 0 0 0 0 0 0 0 ® KOMEN Foundation Grant 0 0 0 0 0 0 0 ® State Farmworker Grant 0 0 0 0 0 0 0 UNC Psch Grant 20,000 0 0 0 0 0 20,000 ® State Bilingual Resource Grant 0 0 0 0 0 37,355 37,355 UNC Grant 156,000 0 0 0 0 0 156,000 ® Latino Family Planning(Title X)Grant 0 0 0 0 0 0 0 Carol Woods Grant 0 0 0 0 0 0 0 ® Caswell County nutrition Grant 0 0 0 0 0 0 0 ® UNC Obesity Grant 0 0 0 0 0 0 0 Kate B Reynolds 0 0 0 0 0 0 0 ® Duke Endowment/SHAPE 0 0 0 12,650 0 0 12,650 Total Grant Income 576,710 0 0 12,650 0 37,355 626,715 Other Income: Provider Contracts 0 0 0 0 0 0 0 ® UNC Inpatient Revenue 0 0 0 0 0 0 0 Management Fees-CA 41,912 0 0 0 0 0 41,912 ® County Appropiations 0 0 0 0 0 10,000 10,000 ® Patient Information 0 0 0 0 0 2,500 2,500 Board Fundraiser 0 0 0 0 0 0 0 ® Space Rental 0 0 0 0 0 0 0 PACE Pharmacy Contract 0 0 0 0 0 0 0 ® Interest Income 0 0 0 0 0 0 0 Total Other Income 41,912 0 0 0 0 12,500 54,412 Total Income from all Sources 2,445,508 690,000 629,695 63,750 0 49,855 3,878,808 OPERATING EXPENSES ® Personnel: ® Medical 1,177,116 1,177,116 Care Management(SW and Outreach) 73,273 73,273 ® Dental 397,924 397,924 Pharmacy 292,753 292,753 ® WIC/MNT 39,368 0 39,368 Center Administration 309,946 0 309,946 ® CHC Admin Staff PHS Corporate Staff(80%to CHC) ® Incentive pay for all begin 6/1/14 ® Total Personnel 1,560,335 397,924 292,753 39,368 0 0 2,290,380 Fringe Benefits: ® Payroll Taxes .0800 124,827 31,834 23,420 3,149 0 0 183,230 Retirement .0400 62,413 15,917 11,710 1,575 0 0 91,615 ® Health Insurance .0800 124,827 31,834 23,420 3,149 0 0 183,230 Life Insurance .0030 4,681 1,194 878 118 0 0 6,871 ® Disability Insurance .0100 15,603 3,979 2,928 394 0 0 22,904 Worker's Compensation .0030 4,681 1,194 878 118 0 0 6,871 ® Cafeteria Plan .0210 32,767 8,356 6,148 827 0 0 48,098 Total Fringe Benefits 369,799 94,308 69,382 9,330 0 0 542,819 ® Total Payroll and Fringe Benefits 1,930,134 492,232 362,135 48,698 0 0 2,833,199 2014 PHS Detail Budget PIEDMONT HEALTH SERVICES, INC ANNUAL BUDGET FOR THE YEAR ENDED NOVEMBER 30,2014 CARRBORO Carrboro Carrboro Carrboro Carrboro, Carrboro Medical Dental Pharmacy MNT WIC Admin. Total Budget Budget Budget . Budget Budget Budget Budget Travel 2,650 900 1,125 0 0 1,400 6,976 Equipment-Minor Purchases 0 0 0 0 0 0 0 Supplies: Medics l(includes location lab and x-ray) 75,810 0 0 0 0 0 75,810 Patient Education 0 0 0 0 0 0 0 Dental 0 48,300 0 0 0 0 48,300 Pharmacy 0 0 211,939 0 0 0 211,939 Office/Janitorial 0 0 0 0 0 30,000 30,000 Total Supplies 75,810 48,300 211,939 0 0 30,000 366,049 Patient Care Contracted Services-Medical 102,960 0 0 0 0 0 102,960 Contracted Services-LsbCorp 75,810 75,810 Contracted Services-Pharmacy 0 0 1,200 0 0 0 1,200 Contracted Services-Dental 0 20,700 0 0 0 0 20,700 Contracted Services-CPR 700 0 0 0 0 0 700 Contracted Services-Transcrip/Translation 13,000 0 0 0 0 0 13,000 Contracted Services-Other 0 0 0 0 0 10,060 10,060 Total Patient Care 192,470 20,700 1,200 0 0 10,060 224,430 Other Operating Expenses Repairs&Maintenance-Fac./Equip. 2,000 2,000 0 0 0 18,600 22,600 Repairs&Maintenance-Service contracts 4,000 2,000 6,300 0 0 12,240 24,540 Equipment Rental 600 480 480 0 0 1,700 3,260 Storage Rental 0 0 0 0 0 0 0 Mortgages/Notes 0 0 0 0 0 61,776 61,776 Equipment Leases 0 0 0 0 0 0 0 Space Cost 2,820 0 0 0 0 24,138 26,958 Utilities 0 0 0 0 0 27,180 27,180 Telephone 9,480 0 0 0 0 18,720 28,200 Community Education 0 0 0 0 0 0 0 Insurance 3,500 0 0 0 0 0 3,500 Printing 4,000 2,000 5,000 0 0 12,000 23,000 Periodicals 500 100 600 0 0 0 1,200 Organizational Dues&Subscription 12,275 1,390 1,490 0 0 1,350 16,505 Contract Svc-Processing 0 2,400 1,840 0 0 1,275 5,515 Contract Svc-Consultants 0 0 0 0 0 0 0 Postage - 0 0 0 0 0 7,200 7,200 Legal Fees 0 0 0 0 0 0 0 Auditing Fees 0 0 0 0 0 0 0 Continued Education 13,435 6,000 2,580 100 0 3,000 25,115 Recruitment 0 0 0 0 0 0 0 Board Expense 0 0 0 0 0 0 0 Employee Morale 0 0 0 0 0 4,800 4,800 Bank Charges 0 0 0 0 0 12,000 12,000 Miscellaneous 0 0 0 0 0 0 0 Depreciation 0 0 0 0 0 92,844 92,844 Total Other Operating Expense 52,610 16,370 18,290 100 0 298,823 386,193 Total Operating Expenses 2,263,674 578,602 594,689 48,798 0 340,283 3,815,846 Funding Reserves 73,365 20,700 18,891 1,913 0 1,496 116,364 Net Income Before Allocations 118,669 90,798 16,116 13,040 0 (291,924) (53,402) Overhead Allocations CHC Adm Office Overhead 279,638 71,315 52,466 7,055 0 0 410,474 Net Income After Corp.Overhead Allocations (161,069) 19,484 (36,361) 6,984 0 (291,924) (463,876) Location Overhead 198,875 50,718 37,313 5,018 0 (291,924) 0 Not Income(Loss) After all Ovhd Allocations (369,944) (31,234) (73,664) 967 0 (463,876) PIEDMONT HEALTH SERVICES, INC. Chapel Hill, North Carolina Financial Statements For the Years Ended November 30, 2013 and 2012 Together with Auditor's Report and Supplementary Information Report Date: March 24, 2014 Simmons, Richey & Company, P.C. Certified Public Accountants PIEDMONT HEALTH SERVICES, INC. TABLE OF CONTENTS Page TRANSMITTAL LETTER 1 Part I - Introduction Background 2 Scope of Audit 2 Part II - Financial Independent Auditor's Report 3 Financial Statements Statements of Financial Position 6 Statements of Operations Statements of Changes in Net Assets 10 0 Statements of Cash Flows 12 Notes to Financial Statements 14 Supplementary Information Schedule I - Schedule of Expenditures of Federal Awards 37 Notes to Schedule of Expendi- tures of Federal Awards 40 Schedule II - Schedule of Expenditures of State Awards 41 Schedule III - Schedule of Findings and Questioned Costs 42 Part III - Independent Auditor's Reports on Internal Control and Compliance Independent Auditor' s Report on Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed in Accordance with Government Auditing Standards 44 Independent Auditor' s Report on Compliance for Each Major Program and on Internal Control Over Compliance Required by OMB Circular A-133 46 Part IV - Exit Conference 49 Corrective Action Plan 50 Summary Schedule of Prior Audit Findings 51 Simmons, Richey & Company, P.C. Certified Public Accountants Simmons, Richey r.. & Company, P.C. Certified Public Accountants March 24, 2014 Piedmont .Health Services, Inc. 299 Lloyd Street Carrboro, NC 27510 We have completed our audit of the financial statements of Piedmont Health Services, Inc. for the year ended November 30, 2013. The financial statements, together with our auditor's report and supplementary_ information, are contained herein. We appreciate the courtesies extended to us during the audit and the assistance provided by the staff of Piedmont Health Services, Inc. Respectfully, SIMMONS, RICHEY & COMPANY, P.C. Lewis J. S' ons, CPA P.O.Box 937.6760 Old Covington Road Llthonia,Georgia 30068 (770)484-9322 Fax(770)484-9312 Members: Georgia Society of CPAs • American Institute of CPAs,Private Companies Practice Section PART I - INTRODUCTION PART I - INTRODUCTION BACKGROUND Piedmont Health Services, Inc. (the "Organization") , operates community medical and dental clinics. Also, the Organization started a comprehensive senior care program during 2008. The Organization provides comprehensive out-patient health services at seven locations in Orange, Caswell, Alamance, and Chatham Counties, North Carolina. The Organization is a not-for-profit corporation incorporated in March 1970 under the laws of the State of North Carolina. For federal funding purposes, November 30 has been designated the Organization' s fiscal year-end. For the year ended November 30, 2013, the Organization received Federal grant awards from the U. S. Department of Health and Human Services (DHHS) totaling $5,509,136; awards from the U. S. Department of Agriculture of $1,092,632, passed ' through the North Carolina Department of Health and Human Services; and $135,930 from the U. S. Department of Health and Human Services, passed through the North Carolina Department of Health and Human Services. SCOPE OF AUDIT Our audit of the Organization was performed in accordance with auditing standards generally accepted in the United States of America, the financial and compliance elements of the Government Auditing Standards issued by the Comptroller General of the United States and the provisions of Office of Management and Budget Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations. The audit covered the period December 1, 2012 through November 30, 2013, and field work was completed on February 7, 2014. -2- PART II - FINANCIAL ..: Simmons, Richey &Company, P.C. Certified Public Accountents INDEPENDENT AUDITOR'S REPORT To the Board of Directors Piedmont Health Services, Inc. Report on the Financial Statements We have audited the accompanying financial statements of Piedmont Health Services, Inc. ('a nonprofit organization) , which comprise the statements of financial position as of November 30, 2013 and 2012, and the related statements of operations, changes in net assets, and cash flows for the years then ended, and the related notes to . the financial. statements. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America; this. includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, _,.._ whether due to fraud or error. Auditor's. Responsibility Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to , financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States.. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. An. audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor's judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity's preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity's internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the -3- P.O.Box 937 6760 Old Covington Road Lithonle,Georgia 30068 • (770)464-9322 Fax(770)484-9312 Members: Georgia Society of CPAs• American Institute of CPAs,Private Companies Practice Section Board of Directors Page 2 reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. Opinion In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Piedmont Health Services, Inca as of November 30, 2013 and 2012, and the changes in its net assets and its cash flows for the years then ended in accordance with accounting principles generally accepted in the United States of America. Other Matters Other .Information Our audit was conducted for the purpose of forming an opinion on the financial statements as a whole. The accompanying schedule of expenditures of federal awards, and other supplementary information as required by Office of Management and Budget Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, is presented for purposes of additional analysis and is not a required part of the financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and. other records used to prepare the financial statements. The information has been subjected to the auditing procedures. applied in the audit of the financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures, in accordance with auditing standards generally accepted in the United States of America. In our opinion, the information is fairly stated, in all material respects, in relation to the financial statements as a whole. -4- Simmons, Richey &Company, P.G. CertmW Public Accounterds Board of Directors Page 3 other Reporting Required by Government Auditing Standards In accordance with Government Auditing Standards, we have also issued our report dated March 24, 2014, on our consideration of Piedmont Health Services, Inc. Is internal control over financial reporting and on our tests of its compliance with certain provisions of laws, regulations, contracts, grant agreements and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards in considering Piedmont Health Services, Inc. Is internal control over financial reporting and compliance. ,f ' Lithonia, Georgia March 24, 2014 -5- Simmons, Richey & Company, P.C. Certified Public Accounu nts . FINANCIAL STATEMENTS PIEDMONT HEALTH SERVICES, INC. STATEMENTS OF FINANCIAL POSITION NOVEMBER 30, 2013 and 2012 2013 2012 ASSETS CURRENT ASSETS Cash and cash equivalents $ 2,298,081 $ 2,842,085 Assets whose use is limited By grantors 196,319, 350,116 . Grants receivable 165,820 960,342 Unconditional promise to give 492,699 . 126,666 Accounts receivable, less allow- ance for doubtful accounts and contractual adjustments of $958,115 and $582,712, Respectively 1,188,396 918,272 Estimated retroactive adjustments- third-party payors 784,279 902,005 Accounts receivable---other 274,206 201,102 Inventory 740,756 . 608,618 Prepaid expenses 136,080 144,448 Total Current Assets 6,276, 636 7,053,654 PROPERTY AND EQUIPMENT AT COST, NET 12,835,645 11,375,409 INVESTMENTS 7,563 6,971 ASSETS WHOSE USE IS LIMITED- By note agreement for repair reserve 120,401 107,776 By note agreement as collateral 1,113,396 846,828 OTHER ASSETS Loan acquisition cost, net of amortization of $86,715 and $81,829, respectively 45,080 34,929 TOTAL ASSETS $ 20,398,721 19,425,567 -6- Statements of Financial Position Page 2 2013 2012 LIABILITIES AND NET ASSETS CURRENT LIABILITIES Notes payable — short-term $ 150,000 $ - Current portion of long-term notes 1,550,017 550,939 payable Current portion of obligation under capital leases 16,719 17,596 Accounts payable 789,579. 1,884,434 Retainage payable 1,495 37,485 Accrued expenses 1,190,949 872,502 Accrued vacation payable 728,311 699,798 Deferred revenue 216,780 341,876 Total Current .Liabilities 4,643,850 4,404,630 LONG-TERM LIABILITIES Notes payable, net of current portion 6,651,731 5,687,783 Obligations under capital leases - 16,718 Total Long-Term Liabilities 6,651,731 5,704,501 Total Liabilities 11,295;581 10,109,131 NET ASSETS Unrestricted Undesignated 7,012,619 7,689,469 Designated by Board of Directors for working capital and capital acquisitions 1,113,396 846,828 8, 126,015 8,536,297 Temporarily restricted 977,125 780, 139 Total Net Assets ,_ 9, 103,140 9,316,436 TOTAL LIABILITIES AND NET ASSETS $ 20,398,721 S 19,425,_567 The accompanying notes are an integral part of these financial statements. -7- PIEDMONT HEALTH SERVICES, INC. STATEMENTS OF OPERATIONS FOR THE YEARS ENDED NOVEMBER 30, 2013 and 2012 2013 2012 UNRESTRICTED REVENUES, GAINS AND OTHER SUPPORT Net patient service revenue-Community Health Centers $ 17,644,412 $ 16,224,708 Net patient service revenue-Senior Care Program-Capitated Payments 7,997,352 7,199,661 Government grants 6,599,310 6,368,608 Unrestricted contributions 24,412 38,945 Other revenue 525,194 853,254 Net assets released from restrictions- used for operations 1,891,592 3,645,962 Total Revenue, Operating Gains, and Other Support 34,682,272 34,331,138 EXPENSES Salaries 18,022,180 16,739,254 , Fringe benefits 4,125,663 3,709,293 Patient care expenses 4,479,524 4,144,306 Travel 230,937 242,732 Training , 62,497 61,335 Supplies-medical and other 2,646,595 2,324,482 Donated drugs 660,648 2,383,969 Consultant services 92,655 103,706 Occupancy 484,154 449,012 Insurance 108,575 87,037 Telephone 272,918 259,344 Repairs and maintenance 733,992 524,006 Bad debt expense 483, 137 17,447 Depreciation 1,231,684 1,103,715 Amortization 12,597 11,378 Interest expense 284,609 265,795 Other operating expenses 1,235,606 _ 1,065,040 Total Expenses 35, 167,971 33,491,851 OPERATING INCOME (LOSS) (485,699) 839,287 NON-OPERATING GAINS (LOSSES) Interest income 1,990 5,804 Unrealized gain (loss) on investments 265 844 Gain (loss) on disposition of fixed assets 1,980 ( 4,558) Government grants for capital improvement projects 44,631 458,749 Net assets released from restrictions- used for capital acquisitions 26,551 160,777 Total Non-Operating Gains 75,417 621,616 -8- Statements of Operations Page 2 2013 2012 Excess (deficit) of revenues, gains, and other support over expenses ( 410,282) 1,460.903 INCREASE (DECREASE) IN UNRESTRICTED S ( 410.2821 $ 1.460.4 NET ASSETS 03 The accompanying notes are an integral part of these financial statements. -9- PIEDMONT HEALTH SERVICES, INC. STATEMENTS OF CHANGES IN NET ASSETS FOR THE YEARS ENDED NOVEMBER 30, 2013 and 2012 2013 2012 UNRESTRICTED NET ASSETS Operating income (loss) $ ( 485,699) $ . 839,287 Interest income 1,990 5,804 Unrealized gain (loss) on investments 265 844 Gain (loss) on disposition of fixed assets 1,980 ( 4,558) Government grants for capital improvement projects 44,631 458,749 Net assets released from Restrictions for capital Acquisitions 26,551 160,777 Increase (decrease) in unrestricted net assets ( 410,282) 1,460,903 TEMPORARILY RESTRICTED NET ASSETS Contributions for: Care Management Initiative Program 106,000 106,_ 000 Increased access to care for the uninsured 750,000 187,500 Donated drugs for indigent patients 727,990 2,188,912 - Breast Health Education and Screening 64,983 100,000 Purchase of wheel chair equipped van - 67,000 Respite Care Program 10,000 10,000 Reach Out and Read Program - 2,941 Senior care support Program 262,374 - Health center renovation 150,000 Capital improvements 26,551 - Residency Program- 13,696 79,647 Dental technology Program 10,000 2,121,594 2,742,000 Net assets released from restrictions: For operations (1,891,592) (3,645,962) For capital acquisitions ( 26,551) ( 160,777) (1,918,143) (3,806,739) -10- Statements of Changes in Net Assets Page 2 2013 2012 Refund to Grantors ( 6,465) ( 2,645) Increase/(Decrease) in temporarily restricted net assets J 196,9.8_6) ( 1,067,384) INCREASE IN NET ASSETS ( 213,296) 393,519 NET ASSETS, BEGINNING OF YEAR 9,316,436 8,922,917 NET ASSETS, END OF YEAR 59,103,140 1_2,216,436 The accompanying notes are an integral part of these financial statements. -11- PIEDMONT HEALTH SERVICES, INC. STATEMENTS OF CASH FLOWS FOR THE YEARS ENDED NOVEMBER 30, 2013 and 2012 2013 2012 CASH FLOWS FROM OPERATING ACTIVITIES Change in net assets $ ( 213,296) $ 393,519 Adjustments to reconcile change in net assets to net cash provided by operating activities and gains: Provision for bad debts 483,137 _ 17,447 . Depreciation 1,231,684 1,103,715 Amortization 12,597 . 11,378 Contributed inventory-rugs ( 67,342) 195,057 Unrealized (gain) loss on investments ( 265) ( 844) Loss on disposition of fixed assets 10,554 4,558 (Increase) Decrease in: Grants receivable 794,522 ( 176,115) Unconditional promise to give ( 492,699) ( 126,666) Accounts receivable ( 753,252) (, 129,886) Estimated retroactive adjustments receivable 117,726 ( 222,189) Accounts receivable-other (_ 73, 104) ( 66,718) Prepaid expenses 8,358 ( 35,954) Inventory-purchased ( 64,797) ( 32,547) Increase (Decrease) in: Accounts payable (1,130,845) 936,609 Accrued liabilities .318,448 543,956 Accrued vacation 28,513 ( 170,568) Deferred revenue ( 1254,096) 297,939 Estimated retroactive adjustments payable - ( 30,868) Net Cash Provided by Operating Activities 84,843 2,511,823 CASH FLOWS FROM INVESTING ACTIVITIES (Increase) decrease in assets limited as to use- Limited: By grantors 153,797 98,444 By note agreement as collateral ( 266,567) ( 192) By note agreement for repair reserve ( 12,625) 318,862 Purchases of property (2,712,164) (1,876,513) Purchases of investments-common stock ( 327) ( 319) Proceeds from sale of fixed assets 1,980 Net Cash Used by Investing Activities (2,835,906) (1,459,718) -12- Statements of Cash Flows Page 2 2013 2012 CASH FLOWS FROM FINANCING ACTIVITIES Proceeds from short-term -debt $ 150,000 $ Proceeds from long-term debt 2,500,000 - Collection of contributions restricted for long-term purposes 126,666 830,519 Repayments of long-term debt ( 536,974) ( 495,765) Repayment of capital leases ( 17,595) ( 17,735) Loan acquisition costs 15,038) - Net Cash Used by Financing Activities 2,207,059 317,019 NET INCREASE IN CASH AND CASH EQUIVALENTS ( .544,.004) 1,369, 124 CASH AND CASH EQUIVALENTS, BEGINNING OF YEAR 2,842,085 1,472,961 CASH AND CASH EQUIVALENTS, END OF YEAR 2,298,081 $ 2,-842.085 SUPPLEMENTAL DISCLOSURE Cash paid for interest S _284,609 $ 265,462 The accompanying notes are an integral part of these financial statements. -13- PIEDMONT HEALTH SERVICES, INC. NOTES TO FINANCIAL STATEMENTS Note 1: Summary of Significant Accounting Policies Nature of Activities Piedmont Health Services, Inc. (the Organization) operates community medical and dental centers. Also, the Organization operates a comprehensive senior care program. The Organization provides comprehensive health care services at seven locations in Orange, Alamance, Caswell and Chatham Counties. Financial Statement Presentation The financial statement presentation follows the recommen- dations of the American Institute of Certified Public Accountants' Audit and Accounting Guide, Health Care Entities. Basis of Accounting-- The accompanying financial statements are prepared on the accrual basis of accounting. Financial statements are presented in accordance with U.' S. generally accepted accounting principles. Under U. S. generally accepted accounting principles, the Organization is required to report information regarding its financial position and activities according to three classes of assets: unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets, as applicable. Cash and Cash Equivalents The Organization considers all highly liquid investments . available for current use with maturity of three months or less to be cash equivalents. Inventory The Organization capitalizes inventories of pharmaceutical supplies. Purchased inventory is stated at cost and donated inventory is stated at fair market value based on the donor' s wholesale prices. -14- Notes to Financial Statements Page 2 . Accounts Receivable Accounts receivable are stated at the amount management expects to collect on outstanding balances. Management maintains an allowance for probable uncollectible amounts based on its assessment of the current status of individual accounts. A provision for bad debts is made periodically to adjust the allowance for .amounts which have not been collected in a reasonable period of time. Uncollectible balances are written- off through a charge to the valuation allowance and a credit to accounts receivable. All balances which have been outstanding over 30 days are considered delinquent. Reinsurance (Stop-Loss Insurance) Reinsurance premiums are reported as health care costs, and reinsurance recoveries are reported as a reduction of ,related health care costs. Investments Investments in equity securities with readily determinable fair ' values and all investments in debt securities are initially. recorded at (a) acquisition cost if purchased or (b) fair value if received by contribution or by agency transaction. Thereafter, these investments are reported in the statement of financial position at fair value,; and realized and unrealized gains and losses are reported. in the statement of operations. Accordingly, investments are reflected at fair market value at November 30, 2013 and 2012. Non-Expendable Property Property acquired is considered owned by the Organization. However, the United States Government has a reversionary interest in property purchased with Federal funds or acquired through government appropriations; therefore, its disposition, as well as ownership of any proceeds therefrom, is subject to Federal regulations. The Organization capitalizes all non- expendable property acquisitions of $500 or more. Depreciation is provided on the straight-line basis over the estimated useful lives of the assets ranging from four to 20 years. Capital Leases-- Capital lease obligations are recorded at the present value of the future minimum payments discounted at the interest rate implicit in the lease(s) . A corresponding amount is capitalized as the value of the asset and depreciated over its estimated useful life, ranging from five to ten years. -15- Notes to Financial Statements Page 3 Intangible Assets Loan acquisition cost is amortized over the life of the related loans, five to 20 years, respectively, on a straight-line basis. Revenue Grants-- The Organization recognizes Federal grant awards to the extent that allowable grant expenses have been incurred. Federal grant funds received prior to incurring allowable grant program expenses are recorded as deferred grant revenue. Deferred grant revenue balance at the grant program ending date is refundable to the Federal government or may be carried over to the subsequent grant period at the discretion of the Federal government. Third-party Contractual Adjustments-- Retroactively calculated third-party. contractual adjustments are accrued on an estimated basis in the period the related services are rendered. Net patient service revenue is adjusted as required in subsequent periods based on final settlements. Net Patient Service Revenue-- Patient service revenue is reported at the estimated. net realizable amounts from patients, third-party payors, and others for services rendered. Other Revenue-- Other revenue results from various health center program services and activities. These amounts were used primarily to meet the funding source matching or cost sharing requirements. Subject to the provisions of grant agreements, revenues realized in excess of the required matching or cost sharing amount may be utilized to absorb program costs currently or may be carried over to subsequent grant periods. Charity Care-- The Organization has a policy of providing charity care . to patients who are unable to pay. Such patients are -identified, and related charges are estimated based on financial information obtained from the patient and subsequent analysis. Since management does not expect payment for charity care, the estimated charges are excluded from revenue. -16- Notes to Financial Statements Page 4 Contributions The Organization accounts for contributions received and contributions made in accordance with U. S. generally accepted accounting principles. Contributions received are recorded as . unrestricted, temporarily restricted, or permanently restricted support, depending on .the existence and/or nature of any donor restrictions. Under U. S. generally accepted accounting principles, temporarily restricted support is reclassified to unrestricted net assets on expiration or fulfillment of the donor restrictions. Advertising Costs Advertising costs, consisting primarily of advertisement of employment opportunities and services offered by the Organization, are expensed as incurred, Expense Allocation Directly definable expenses are charged to programs and supporting services. Expenses related to more than one function are charged to programs and supporting services on the basis of periodic time and expense studies. Management and general expenses include those expenses that are not directly identifiable with any other specific function but provide for the overall support and direction of the Organization. Income from Operations Income from operations exclude (a) receipt of restricted contributions, including temporary or permanent restrictions, . (b) contributions of long-lived assets, and (c) other items required by generally accepted accounting principles- to be reported separately. Funds on Deposit Funds on deposit are in institutions insured by the Federal government. Deposits at each bank are insured up to a limit of $250,000 at November 30, 2013 and 2012. Deposits exceeded the FDIC insured limit at November 30, 2013 and 2012 by $2,722,708 and $2,185,804, respectively. -17- Notes to Financial Statements Page 5 Income Tax Status The Organization qualifies as a tax-exempt organization under Section 501(c) (3) of the Internal Revenue Code and, therefore, has no provision for federal or state income taxes. The Organization is not a private foundation under Section 170(b) (1) (A) (vi) of the Internal Revenue Code. On January 1, 2009, the Organization adopted the recognition requirements for uncertain income tax positions as required by generally accepted accounting principles, ASC 740-10, which prescribes how an organization should measure, recognize, present, and disclose uncertain income tax positions taken by an organization. There was no impact to the Organization's financial statements as a result of the implementation of ASC 740-10. The Organization's open audit periods are the fiscal years ended November 30, 2010 through November 30, 2012 . Estimates The presentation of financial statements in conformity with accounting principles generally accepted in the United States of America requires the Organization to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results may differ from those estimates. Reclassifications Certain 2012 balances have been reclassified to conform to 2013 presentation. Note 2: Estimated Retroactive Adjustments The Organization provides health care services to Medicare and Medicaid patients_ Reimbursements for covered services are based on tentative payment rates. Actual reimbursements are determined after the submission of annual cost reports which are audited by the intermediaries. Provision for estimated reimbursement adjustments is reported in the financial statements in the period that the services are provided. Total adjustments receivable as of November 30, 2013 and 2012 are $784,279 and $902,005, respectively. Total retroactive adjustments payable as of November 30, 2013 and 2012 are $-0- and $-0-, respectively. -18- Notes to Financial Statements Page 6 The final settlement may be significantly more or less than the recorded receivable because the Organization receives rate adjustments to conform to amounts paid to Community Health Centers that are paid under the Prospective Payment System (PPS) . Note 3: Investments Long-term investments consist of the following available-for- sale securities: Cost/Contributed Value Market Value 2013 2012 2013 2012 Equity securities 13 Unrealized gain (loss) on investments during 2013 and 2012 was . $265 and $844, respectively. The Organization's investments are reported at fair value in the accompanying. statement of financial position. Quoted Prices in Active Markets for Identical Fair Value Assets (Level 1) November 30, 2013 Investment Category: Common stock November 30, 2012 Investment Category: Common stock ASC-820, Fair Value Measurements, establishes a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. This hierarchy consists of three broad levels: -19- Notes to Financial Statements Page 7 . Level 1 inputs consist of unadjusted quoted prices in the active markets for identical assets and have the highest priority, Level 2 inputs consist of observable inputs other than quoted prices included in Level 1, and Level 3 inputs, which have the lowest priority, are based on unobservable inputs that reflect the Organization's own assumption about the assumptions market participants would use in pricing the assets. The Organization uses appropriate evaluation techniques based on the available inputs to measure the fair value of its investments. When available, the Organization measures fair value using Level 1 inputs because they generally provide the most . reliable evidence of fair value. Level 3 inputs are only used when Level 1 or Level 2.inputs are not available. Level 1 Fair Value Measurements The fair value of common stocks is based on quoted market price of shares held by the Organization at year end. Note 4: Property and Equipment Property and equipment consist of. the following: 2013 2012 Land $ 1,442,572 $ 1,442,572 ' Land improvements 373,699 - Buildings and facilities 13,649,341 11,173,518 Building improvements 3,040,389 2,349,326 Equipment 2,842,736 2,789,957 Furniture 193,249 170,722 Vehicles 366',577 387,434 Construction in progress 64,694 995,510 . 21,973,257 _ 19,309,039 Equipment acquired under capital leases 210,344 210,344 22,183,601 19,519,383 Less: Accumulated deprecia- tion and amortization ( 9,347,956) (8,143,974) S 12.835.645 11,375,409 Total interest cost incurred during the years ended November 30, 2013 and 2012 was $284,609 and $265,795, respectively. No interest costs were capitalized during the years ended November 30, 2013 and 2012, respectively. -20- Notes to Financial Statements Page 8 Note 5: Amortization of Intangible Costs Estimated amortization of loan cost for the .next five years is as follows: Year Amount 2014 $ 5,229 2015 4,548 2016 4,287 2017 4,287 2018 4,287 Thereafter 22,442 45,OkQ Note 6: Deferred Revenue Deferred revenue consists of the following: 2013 2012 Medicaid Capitated Payments—Senior Care $ 190,133 $ 227,912 U. S. Department of Health and Human Services— ACA Grants for New and Expanded Services under .the Health Program - 29,615 U. S. Department of Agriculture 26,647 - Migrant Health Centers 20,031 State Grants - 64,318 S 216,780 341,876 Note 7 : Notes Payable 2013 2012 Short-Term Notes Payable On July 10, 2013, the organi- zation entered into a loan agreement with Branch Bank & Trust Company. The loan is a Revolving line of credit which Provides funds up to $1,500,000; -21- Notes to Financial Statements Page 9 Note 7: Notes Payable, continued 2013 2012 Interest rate 30-day LIBOR; maturity Date January 2, 2014; secured by Health care related receivables. See Note 20. ' 150,000 - Long-Term Notes Payable Notes payable consists of the following: 2013 2012 $1,500,000 mortgage note payable to Branch Banking and Trust Company; dated April 15, 2011; interest rate 5.5%; payable interest only through April 10, 2012; thereafter, in monthly installments of $12,688 with all remaining outstanding balance due on August 10, 2016; secured by real estate, fixtures and equipment located in Caswell County, North Carolina. $ 1,384,965 $ 1,459,342 $2,600,000 mortgage note payable to Branch Banking and Trust Company; dated November 30, 2011; interest rate 4.95%; payable in installments of $20,621. commencing January 10, , 2012 with all remaining outstanding balance due on December 10, 2026; secured by real estate. 2,369,636 2,494,269 $2,100,000 mortgage note payable to Wells Fargo Bank; dated October 12, 2007; interest rate LIBOR plus 1.35%; payable interest only through March 31, 2009, thereafter, -22- Notes to Financial Statements Page 10 Note 7: Notes Payable, Continued 2013 2012 in monthly installments of $18,025 with all remaining outstanding balance due on October 1, 2014; secured by real estate located at 1214 Vaughan Rd. , Burlington, " N.C. ; assignment of cash deposits at the bank. 1,209,837 1,405,508 $850,000 mortgage note payable to U.S. Department of Agri- culture, Rural Development " (ORD) , dated February 28, 2006; interest rate 4.5%; payable in monthly installments $6,503; maturity February 28, 2021; secured by real property located in Siler City, N.C. 481,913 536,710 $300,000 note payable to Wells Fargo Bank; dated May 27, 2008, interest rate LIBOR plus 1.5%; payable interest only through March 31; 2009; principal of one-sixtieth . (1/60) monthly to March 31, 2014, plus accrued interest thereon; secured by personal property, accounts receivable, inventory, cash and investments. 30,000 85,000 On September 9, 2003, the Organization entered into a loan agreement with the U. S:. D. A. , Rural Development (RD) . The loan agreement provided funds totaling $200,000 at 4.25% interest with repayments over a 15 year period; principal and interest payable at $1,506 per month; secured by real property-- Scott Clinic. 78,493 90,534 -23- Notes to Financial Statements Page 11 Note 7: Notes Payable, Continued 2013 2012 On December 16, 2003, the Organi- zation entered into a loan agreement with the U. S. D. A. Rural Development (RD) . The loan agreement provided funds totaling $250,000 at 4.75% interest with repayment over a 15 year period; principal and interest payable at $1,945 per month; secured by real property at Moncure, N.C. 105,135. 119,609 On December 16, 2003, the Organi- zation entered into a loan agreement with the U. S. D. A. Rural Development (RD) . The loan agreement provided funds totaling $100,000 at 4.625% interest with repayment over a 15 year period; principal and interest payable at $772 per month; secured by real property at Moncure, N.C. 41,769 . 47,750 On January 14, 2013, the Organi- zation entered into a loan agreement with the State Employees Credit Union Foundation. The loan agreement provided funds totaling $2,500,000; interest rate 3.5%; payable interest only commencing August 1, 2013 through August 1,- 2015; thereafter, in monthly installments of $29,985; maturity date August 1, 2023; Secured by real estate 2,500,000 - 8,201,748 6,238;722 Less: Current portion ( 1,550,017) ! 550,939) Notes. payable; long-term 6.651,731 S 5.687,783 -24- Notes to Financial Statements Page 12 Note 7: Notes- Payable, Continued Maturities of the notes payable are as follows: 2014 $ 1,550,017 2015 393,902 2016 620,460 2017 647,705 2018 672,758 Thereafter 4,316,906. 8,201.748 On September 10, 2013, the Organization entered into a loan agreement with Branch Bank & Trust Company. The loan provides funding of $900,000 for the purchase of equipment and vehicles. for the new PACE facility in Pittsboro, NC. Interest rate. LIBOR plus 1.5%, maximum 7.7%; payable interest only commencing October 10, 2013 through September 10, 2015; thereafter, in monthly principal and interest installments of $10,317; maturity date September 10, 2020. As of November. 30; 2013, no funds have been disbursed under this loan agreement. On September 10, 2013, the Organization entered into a loan agreement with Branch Bank & Trust Company. The loan provides funding of $600,000 for the purpose of working capital needed for the new PACE facility in Pittsboro, NC. . Interest rate . LIBOR plus 1.5%, maximum 7.7%; payable interest only commencing October 10, 2013 through September. 10, 2015; thereafter, in monthly principal and interest installments of $5,914; maturity date September 10, 2020. As of November 30, 2013, no funds have been disbursed under this loan agreement. Pursuant to the U.S.D.A, loan agreements, the Organization is required to deposit an amount equal to one-tenth ( 1/10) of the annual debt service payments into a repair reserve until the balance therein totals one year's debt service for each loan. As of November 30, 2013, the repair reserve balances totaled $120,401. The required balance is $120,335. -25 Notes to Financial Statements Page 13 Note 7: Notes Payable, Continued Wells Fargo Bank has exclusive authority over withdrawals from assigned deposits of $1,113,396 at November 30, 2013. The Organization is not in compliance with the Wells Fargo Bank covenant which requires maintenance of a debt service coverage ratio of 1.25 to 1. As of November 30, 2013, the debt service ratio is approximately 0.63 to 1. The. default is caused by the maturity of the ,.Wells Fargo Senior Care Mortgage loan on October 1, 2014. Also, the Organization is in default on the cash flow coverage ratio requirement of the Branch Bank & Trust loans. The requirement is 1.15. As of November 30, 2013, the ratio is approximately 0.61 due to the Wells Fargo mortgage which matures on October 1, 2014. The Organization is generally in compliance with other loan covenants as of November 30, 2013. Note 8: Leases The Organization acquired equipment under various capital leases. The following is a schedule, by year, of future minimum lease payments under capital leases together with the present value of net minimum lease payments as of November 30, 2013: Year Ending November 30, 2014 Amount Total future minimum lease commitments 17,710 Less: Amount representing interest ( 991) Present value of net minimum lease -payments - current $ 16,719 The Organization acquired various facility and office equipment under operating leases. Rent expense for the years ended November 30, 2013 and 2012 was $45,284 and $31,185, respectively. -26- Notes to Financial Statements Page 14 Note 9: Insurance Coverage The Organization had the following insurance coverages at November 30, 2013: Type of Coverage Amount of Coverage Directors and Officers $3,000,000 Umbrella Coverage $3,000,000 General Liability $1,000,000/3,000,000 Buildings Variable/.$1,341,480 Maximum at any one location Personal Property Variable/$1,000,000 Maximum at any one location Workers Compensation $500,000 - each employee Fidelity Bonding $500,000 Automobile $1,000,000 The Organization, has been deemed eligible under the Federally Supported Health Center Assistance Acts of 1992 and 1995.. Thus, all providers are covered by the provisions of the Federal Tort Claims Act. Note 10: Government Grants Government grants consist of the following: 2013 2012 U. S. Department of Health and Human Services-Community Health Centers $ 2,942,597 $ 2,942,597 U.S. Department of Health and Human Services-Affordable Care Act (ACA) Grants for New and Expanded Services under the Health Center Program 2, 179,922 2,051,693 U. S. Department of Health and Human Services--Passed through the Duke University 98,303 60,876. -27- Notes to Financial Statements Page 15 Note 10: Government Grants, Continued 2013 2012 U. S. Department of Health and Human Services-Affordable Care Act (ACA) Grants for Capital Development in Health Centers 44,631 455,369 U. S. Department of Agriculture-- Passed through the N. C. Department of Environment, WIC Health and Natural Resources, Division of Maternal and Child Health 987,062 980,474 U. S. Department of Health and Human Services--Passed through the North Carolina Department of Health and Human Services 109,175 148,691 U. S. Department of Health and Human Services-Passed through the Duke University 798 - State Government 265,452 186, 157 Local Government 16,001 1,500 6,643,9U S 6,827,357 Note 11: Retirement Plan Upon the completion of three months of service, the Organization contributes 3% of , each full time employee's. compensation to a Section 403(b) tax-sheltered annuity plan._ Employees may make voluntary contributions to the plan. No mandatory contributions are required. Also, the Organization . matches employees' contributions up to 3% of the employees' compensation. Retirement expense for the years ended November 30, 2013 and 2012 was $842,957 and $699,306, respectively. -28- Notes to Financial Statements Page 16 Note 12: Charity Care The Organization- has a policy of providing charity care to patients who are unable to pay. The discounts are determined on a scale based on family size and income. During the year ended November 30, 2012, the Organization adopted ASU No. . 2010-23, Health Care Entities (Topic 954) , : Measuring Charity Care for Disclosure, which requires .that cost. be used as a measurement for charity care disclosure purposes and that cost be identified as the direct and indirect costs of providing the charity care. The impact of adoption had no effect on the financial statements and relates only to - disclosures. The estimated cost of charity care totaled approximately $6,729,307 and $6,110,077 for the years ended November 30, 2013 and 2012, respectively. The cost of charity care is estimated utilizing a ratio of cost to gross charges applied to the gross. uncompensated charges associated with providing charity care. . Funds received from gifts and grants to subsidize charity services provided for the years ended November 30, 2013 and 2012 were approximately $6,132,072 and $5,897,984, respectively. Total sliding fee scale . write-offs during the years ended November 30, 2013 and 2012 were $6,57.7,835 and $6,210,071, respectively. Note 13: In-Kind Contributions The Organization participates in programs sponsored by drug companies, which provides drugs to indigent patients. The inventory of donated drugs is replenished periodically by the donors upon receipt of documentation of amounts dispensed. The donated drugs are valued at the donors' wholesale .price. The amount remaining in inventory at November 30, 2013 and 2012 is $484,662 and $417,321, respectively. (See Note 16. ) Note 14: Concentration of Credit Risk The Organization grants credit to its patients.' A substantial percentage is insured under third-party payor agreements. The percentages of receivables from patients and third-party payors for 2012 and 2011 were as follows: -29- Notes to Financial Statements Page 17 Note 14: Concentration of Credit Risk, Continued' 2013 2012 Medicare 19% 8% Medicaid 34% 19% Other third-party payors 29% 31% Patients 18% 42% 100% 100% Note 15: Unconditional Promise to Give Unconditional promise -to give consists of the following: 2013 2012 Due in Less than One Year - University of North Carolina Health Care . System-Residency Program $ 33,518 $ 30,711 Rate B.' Reynolds -Foundation PACE II Support 89,190 - Prospect Hill renovation , 150,000 - Susan G. Romen Foundation Breast Health Education. and ,screening 32,491 - University of North Carolina Healthcare System-Access to Care for the Uninsured-Due .in less than one year 187,500 62,500 492,699 93,211 Due in More than One Year University of North Carolina Healthcare' - System-Residency Program - 33,455 S 492699 S 12a 6.66.6 The amount due in more than one year is not discounted because the discount would be immaterial. _30- Notes to Financial Statements Page 18 Note 16: Temporarily Restricted Net Assets Temporarily restricted net assets are available for the following purposes: 2013 2012 University of North Carolina Health Care System--Increase Access to Care for the Uninsured $ 62,500 $ 62,500 Pfizer Corporation--Drugs for Indigent Patients 484, 662 417,321 Triangle Community Foundation-- Respite Care 9,167 10,000 AccessCare—Care Management Initiative Program 25,930 45,337 Kate B. Reynolds Foundation-- PACE Operating 193,626 Kate B. Reynolds Foundation-- Prospect Hill Renovation 150,000 - . Blue Cross Blue Shield Foundation-Dental Technology Grant 10,000 - Susan G. Komen Foundation—Breast Health Education and Screening 211102 37,587: Kate B. Reynolds Foundation- School Linked Health Center Serving financially needy School children - 61,822 University of North Carolina- Residency Program - 77,862 North Carolina Medical Society Foundation-Pediatric Obesity Prevention and Treatment Program 20.138 67.710 Total temporarily restricted net assets 977.125 S 780,139 -31- Notes to Financial Statements Page 19 Note 16: Temporarily Restricted Net Assets, Continued Net assets released from restrictions by incurring expenses and capital expenditures satisfying restricted purposes: 2013 2012 Used for operations: University of North Carolina Health Care Systems $ 841,559 $ 805,752 Pfizer Corporation 660,648 2,383,969 Kate B. Reynolds Foundation 130,570 127,472 Susan G. Komen 75,003 121,930 Triangle Community Foundation 10,834 15,000 Blue Cross Blue Shield Foundation - 77,048 North Carolina Medical Society Foundation 47,571 5,990 AccessCare 125,407 73,298 Carol Woods Retirement. Community - 15,561 Fidelity Foundation - 16,498 Miscellaneous-reach Out and Read - 3,444 Total Amount Released from Restriction- operations X1,891,592 $ 3,645,962 -32- Notes to Financial Statements Page 20 Note 16: Temporarily Restricted Net Assets, Continued , 2013 2012 Used for capital acquisitions: Rural Hope Center $ 67, 000 University of North Carolina Health Care Systems - 2,253 Kate B. Reynolds Foundation - 1,468 Fidelity Foundation 89,502 AccessCare - 554 Hamlett Associates 26,551 - Total Amount Released from Restriction- Capital Acquisitions $ 26,551 S 160,777 Note 17: Stop-Loss Insurance The Organization entered into a stop-loss agreement with an insurance company to limit its losses on individual claims. Under the terms of this agreement, the insurance company will reimburse the Organization approximately 90 percent of the cost of each person's annual hospital services, in excess of a $100,000 .deductible, up to $1,000,000 per covered person per policy period in excess of the specific _deductible and . co- , insurance. Stop-loss insurance premiums of approximately $39,321 and $39,591 are included in patient care expenses in 2013 and 2012, respectively. Approximately $.-0- . and $100,209 in stop-loss insurance recoveries are deducted from patient care expenses in 2013 and 2012, respectively. Included in other receivables is approximately. $-0- and $100,209 recoverable from insurers at November 30, 2013 and 2012, respectively. -33- Notes to Financial Statements Page 21 Note 18: Classification of Expenses Expenses incurred during the years ended November 30, 2013 and 2012, by functional classification, are as follows: 2013 Program Services Community Health Piedmont General Centers SeniorCare Total Administrative. Total Salaries $11,874,141 $2,966,644 $14,840,785 $3,181,395 $18,022,180 Fringe Benefits 2,300,147 662,867 2,963,014 1,162,649 4,125,663 Patient Care Expenses 938,316 3,094,739 4,033,055 446,469 4,479,524 Travel 97,834 32,247 130,081 100,856 230,937 Training 45,581 5,868 51,449 11,048 62,497 Supplies--Medical &Other 2,276,617 310,465 2,587,082 59,513 2,646,595 Donated Drugs 660,648 - 660,648 _ 660,648 Consultant Services 1,969 19,724 21,693 70,962 92,655 Occupancy 302,465 82,473 384,938 99,216 484,154 Insurance 31,319 18,862 50,181 58,394 108,575 Telephone 181,132 37,414 218,546 54,372 272,918 Repairs and maintenance 201,860 88,985 290,845 443,147 733,992 Bad debt expense 393,485 89,652 483,137 - 483,137 Depreciation 644,888 319,705 964,593 267,091 1,231,684 Amortization 6,103 4,439 10,542 2,055 12,597 Interest Expense 165,241 43,525 208,766 75,843 284,609 Other Operating Expenses 436,444 313,292 749,736 485,870 1,235,606 $20,558,190 $8,090,901 $28,649,091 $6,518,880 $35,167,971 During the year ended November 30, 2013, the SeniorCare Pittsboro, North Carolina, site began operations. The site was licensed to serve enrollees effective January 1, 2014. Start-up costs, including personnel, incurred as of November 30, 2013, were approximately $554, 382 . No revenue was realized at this site as of November 30, 2013 . -34- Notes to Financial Statements Page 22 Note 18: Classification of Expenses, continued 2012 Program Services Community Health Piedmont General 8 Centers SeniorCare Total _ Administrative. Total Salaries 11,789,841 $2,342,692 $14,132,533 $2,606,721 $16,739,254 Fringe Benefits 2,201,240 468,868 2,670,108 1,039,185 3,709,293 Patient Care Expenses 792,179 3,259,917 4,052,096 92,210 4,144,306 Travel 97,192 33,025 130,217 112,515 242,732 Training 36,132 2,329 38,461 22,874 61,335 Supplies-Medical & Other 2,139,041 91,043 2,230,084 94,398 2,324,482 Donated Drugs 2,383,969 - 2,383,969 - 2,383,969 Consultant Services 1,859 _ 8,989 10,848 92,858 103,706 Occupancy 339,607 40,269 379,876 69,136 449,012 Insurance 22,338 13,844 36,182 50,855 87,037 Telephone 182,303 29,727 212,030 47,314 259,344 Repairs and maintenance 176,909 45,571 222,480 301,526 524,006 Bad debt expense .17,447 - 17,447 - 17,447 Depreciation 581,343 221,482 802,825. 300,890 1,103,715 Amortization 6,124 3,085 9,209 2,169 11,378 Interest Expense 173,800 26,432 200,232 65,563 265,795 Other Operating Expenses 393,619 203,238 596,857 468,183 .1,065,040 _ $21,334,943 $6,790,511 $28,125,454 $5,366,397 $33,491,851 -35- Notes to Financial Statements Page 23 Note 19: Commitments and Contingencies Financial awards from Federal,. State and local governmental entities are subject to audit for compliance with grantor restrictions. No provisions have been made in the financial statements for any potential disallowances resulting from noncompliance because the amount, if any, cannot be determined at this date. The Organization entered into a construction contract for up- fit of the Burlington Clinic on September 24, 2013.- The project was not completed as of November 30, 2013. Total contract amount $ 206,299 Amount Expended through November 30, 2013 63.373 Outstanding Commitment as of November 30, 2013 $ 142.926 Note 20: Subsequent Events An evaluation of subsequent events was performed through March 24, 2014, the date the financial statements are available for issuance. On January 22, 2014, the $1,500,000 revolving ,line of credit facility secured by health care related receivables was modified. The line was reduced to $750,000. Accrued interest only, at LIBOR plus 2.5%, is payable commencing on February 15, , 2014, and continuing on the same day of each calendar period thereafter, with one final payment of all remaining accrued interest and principal due on January 15, 2015. . -36- SUPPLEMENTARY INFORMATION : SCHEDULE I Page 1 PIEDMONT HEALTH SERVICES, INC. SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS FOR THE YEAR ENDED NOVEMBER 30, 2013 Federal Pass-through Federal Grantor/Pass-through CFDA Grantor' s Award Grantor/Program Title Number Number Amount E.xl5enditures Major Program U. S. Department of Health and Human Services Direct Program: Community Health Centers 93.224 $2,942,597 $2,942,597 Affordable Care Act (ACA) Grants for New and Expanded Services under the Health Center Program 93 .527 2.430,609 2.179. 922 5,373,206 5,122,519 Passed through North Carolina Department of Health and Human Services/Office of Research, Demonstrations, and Rural Health Development: 74, 773 Migrant Health Centers 93.224 0002875 135, 930 90010053 - 34,402 135, 930 109,175 Total Consolidated Health Center Cluster 5,509,136 5,231, 694 TOTAL MAJOR PROGRAMS $5,509,136 $5,231,694 -37- i I i SCHEDULE I Page 2 Federal Pass-through Federal Grantor/Pass-through CFDA Grantor' s Award Grantor/Program Title Number Number Amount Expenditures Other Federal Assistance U. S. Department of Health and Human Services Direct Program: Affordable Care Act (ACA)Grants for Capital Development in - Health Centers 93.526 44, 631 Passed through Duke University: Diagnostive Diseases and Nutritional Research 93 .848 1R01-DK078798-01AZ - 798 Passed through Duke University: Diabetes, Digestive and Kidney, Diseases Extramural Research 93.847 ROIDK093829-OIA1 - 98,303 143, 732 i -38 I SCHEDULE I . . Page.3 Federal Pass-through Federal Grantor/Pass-through CFDA Grantor' s Award Grantor/Program Title Number Number Amount Expenditures Department of Agriculture Passed through North Carolina Department of Health and Human Services/Division of Public Health: Special Supplemental Nutri tion Program for Women, Infants and Children 10.557 29455 1,092,632 164,339. 27246 - 822,723 1,092,632. 987, 062 Total Other Federal Assistance 1,092.632 1 130.794- TOTAL S 6_601,768 x{,362.48 i i -39- PIEDMONT HEALTH SERVICES, INC. NOTES TO SCHEDULE OF EXPENDITURES OF FEDERAL _AWARDS FOR THE YEAR ENDED. NOVEMBER 30, 2013 Note 1: The accompanying Schedule of Expenditures of Federal Awards includes the federal activity of Piedmont Health Services, Inc. , and is presented on the modified accrual basis of accounting. Certain non-cash expenses in the financial statements are excluded from .expenditures per the Schedule of Expenditures of Federal Awards. Also, certain capitalized costs for financial statement purposes are included in expenditures in the Schedule of Expenditures of Federal Awards. The information in this schedule is presented in accordance with the requirements of OMB Circular A-133, "Audits of States, Local Governments and Non- Profit Organizations, " and the grantor agency. Note 2: The Schedule of Expenditures of Federal Awards does not include the outstanding balances of Federal loans which were executed in prior years as follows: Total Out- CFDA standing balance Number Federal Grantor/Program Title November 30, 2013 10.766 U. S. Department of Agriculture/ Community Facilities Loans and Grants $ 707,310 -40- I , SCHEDULE II Page 1 i PIEDMONT HEALTH SERVICES, INC. SCHEDULE OF EXPENDITURES OF STATE AWARDS FOR THE YEAR ENDED NOVEMBER 30, 2013 Grant/ Contract Award Expendi- Grantor/Program Title Number Amount tuxes_ North Carolina Department of Health and Human Services: Office of Rural Health and Community Care - Primary Medical Care Services To the Uninsured and Indigen 00029449 150, 000 64, 727 Indigent 00027912 - 85,651 150,378 i Office of Rural Health and Community Care-Aged, , Blind and disabled 90009246 - 64,318 j . Passed through Orange County Partnership for Young Children 1314504 .37,355 20,745 1213404 - 17, 326 37,355 38,071 Office of Minority Health and Health Disparities = I Passed through University of North Carolina Chapel Hill - Eliminating ' Health Disparities 5-47401 13,530 12.685 $ 200. 885 5 265,452. I -41- I . SCHEDULE. III PIEDMONT HEALTH SERVICES, INC. SCHEDULE OF FINDINGS AND QUESTIONED COSTS FOR THE YEAR ENDED NOVEMBER 30, 2013 A. SUMMARY OF AUDITOR'S RESULTS Financial Statements Type of auditor' s report issued: Unqualified Internal control over financial reporting: --Material weaknesses) identified? yes X no --Significant deficiencies identified that are not considered to be material weaknesses? yes X none reported Noncompliance material to financial statements noted? yes X no Federal Awards Internal control over major programs: --Material weakness(es) identified? yes X no —Significant deficiencies identified that are not considered to be material weaknesses? yes . X none reported Type of auditor' s report issued on compliance for major program: Unqualified Any audit findings disclosed that are required to be reported in accordance with section 510(a) of Circular A-133? yes X no -42- Schedule of Findings and Questioned Costs -Page 2 Identification of major programs: CFDA Number Name of Federal Program or Closter Consolidated Health .Centers Cluster 93.224 ' Community Health Centers Program 93.224 Migrant Health.Centers 93.527 ACA Grants for New and Expanded Services under the .Health Center Program Dollar threshold used to distinguish between type A and type B programs: $ 300,000 Auditee qualified as low-risk auditee? X yes no B. FINDINGS - FINANCIAL STATEMENTS AUDIT SIGNIFICANT DEFICIENCIES NONE C. FINDINGS AND QUESTIONED COSTS-MAJOR FEDERAL AWARD PROGRAMS AUDIT Questioned Costs SIGNIFICANT DEFICIENCIES DEPARTMENT OF HEALTH AND HUMAN SERVICES Community Health Centers Program; ACA Grants for New and Expanded Services under the Health Center Program; CFDA Nos. 93.224 and 93,527; Grant No. 6H80CS00086-11 for Year Ended November 30, 2013 NONE Total Questioned Costs -43- PART III INDEPENDENT AUDITOR'S REPORTS ON INTERNAL CONTROL AND COMPLIANCE 't-- Simmons, Richey & Company, P.C. Certified Public Accountants INDEPENDENT AUDITOR'S REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS To the Board of Directors of Piedmont Health Services, Inc. We have audited, in accordance with the auditing standards generally accepted in the United States of America and the standards applicable, to financial audits contained in Government Auditing Standards issued by the Comptroller General of the United States, the financial statements of Piedmont Health Services, Inc. (a nonprofit organization) , which comprise the statement of financial position as of November 30, 2013, and the related statements of operations, changes in net assets, and cash flows for the year then ended., and the related notes to the financial statements, and have issued our report thereon dated March 24, 2014. Internal Control over Financial Reporting In planning and performing our audit of the financial statements, we considered Piedmont Health Services, Inc. 's internal control over financial reporting (internal control) to determine the audit procedures that are appropriate in the circumstances for the, purpose of expressing our opinion on the financial statements, but not for the purpose of expressing an opinion on the effectiveness of Piedmont Health Services, Inc. Is internal control. Accordingly, we do . not express an opinion on the, effectiveness of the Organization's internal control. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct, misstatements on a timely basis. A material weakness is a deficiency, or a combination of deficiencies, in internal control, such that there is a reasonable possibility that a material misstatement of the entity's financial statements will not be prevented, or detected and corrected, on a timely basis. A significant deficiency is a deficiency, or a combination of deficiencies, in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. -44- P.O.Box 937 6760 Old Covington Road Lithonia,Georgia 30058 (770)484-9322 Fax(770)484-9312 Members: Georgia Society of CPAs• American Institute of CPAs,Private Companies Practice Section To the Board of Directors - Page 2 Our consideration of internal. control was for the limited purpose, described in the first paragraph of this section and was not designed to identify all deficiencies in internal control that might be material weaknesses or significant deficiencies. Given these limitations, during our audit we did not identify any deficiencies in internal control that we consider to be material weaknesses. However, material weaknesses may exist that have not been identified. Compliance and Other Matters As part of obtaining reasonable assurance about whether Piedmont Health Services, Inc. 's financial statements are free from material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements, noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with . those provisions was not an objective of our audit, and accordingly, we do not express such an opinion. The results of our tests disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing Standards. Purpose of this Report The purpose of this report is solely to describe the scope of our testing of internal control and compliance and the results of that testing, and not to .provide an opinion on the effectiveness of the Organization's internal control or on compliance. This report is an integral part of an audit performed in accordance. with Government Auditing Standards in considering the Organization's internal control and compliance. Accordingly, this communication' is not suitable' for any ther purpose. Lithonia, Georgia March 24, 2014 -45- Simmons, Richey & Company, P.C. CwdfMd Public Accountants "- Simmons, Richey & Company, P.C. Certified Public Accountants INDEPENDENT AUDITOR'S REPORT ON COMPLIANCE FOR EACH MAJOR PROGRAM AND ON INTERNAL CONTROL OVER COMPLIANCE REQUIRED By OMB CIRCULAR A-133 To the Board of Directors of -- Piedmont Health Services, Inc. Report on Compliance for .Each Major Federal Program We have audited Piedmont Health Services, Inc. 's compliance with the types of compliance requirements described in the OMB Circular A-133 Compliance Supplement that could have a direct and material effect on each of Piedmont Health Services, Inc. 's major federal programs for the year ended November 30, 2013. Piedmont Health Services, Inc. ' s major federal programs are identified in the summary of auditor's results section of the accom panying schedule of findings and . questioned costs. Management's Responsibility Management is responsible for compliance with the requirements of laws, regulations, contracts, and grants applicable to its federal programs. Auditor's Responsibility Our responsibility is to express an opinion on compliance for each of Piedmont Health Services, Inc. 's major federal programs based on our audit of the types of compliance requirements referred to above. We conducted our audit of compliance in accordance with auditing standards generally accepted in the United States of America; the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States; and OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations. Those standards and OMB Circular A-133 require that we plan and perform the audit to obtain reasonable assurance about whether noncompliance with the types of compliance requirements referred to above that could have a direct and material effect on a major federal program occurred. An audit includes examining, on a test basis, evidence about Piedmont Health Services, Inc. 's compliance with those requirements and performing such other procedures as we considered necessary in the circumstances. We believe that our audit provides a reasonable basis for our opinion on compliance for each major federal program. However, our audit does not provide a legal determination of Piedmont Health Services, _ - " Inc. 's compliance. -46- P.O.Box 937 6760 Old Covington Road Lithonia,Georgia 30058 (770)484-9322 Fax.(770)484-9312 Members: Georgia Society of CPAs• American Institute of CPAs,Private Companies Practice Section To the Board of Directors Page 2 Opinion on Each Major Federal Program In our opinion, Piedmont Health Services, Inc. complied, in all material respects, with the types of compliance requirements referred to above that could have a direct and material effect on each of its major federal programs for the year ended November 30, 2013. Report on Internal Control Over Compliance Management of Piedmont Health Services, Inc. is responsible for establishing and maintaining effective internal control over compliance with the types of . compliance requirements referred to above. In planning and performing our audit of compliance, we considered Piedmont Health Services, Inc. 's internal control over compliance with the types of requirements that could have a direct and material effect on each major federal program to determine the auditing procedures that are appropriate in the circumstances for the purpose of expressing an opinion on compliance for each major federal' program and to test and report on internal control over compliance in' accordance with OMB Circular A-133, but not for the purpose , of expressing an opinion on the effectiveness of internal control over compliance. Accordingly, we do not express an opinion on the effectiveness of Piedmont Health Services, Inc. 's internal control over compliance. A deficiency in internal control over compliance exists when - the design or operation of a control over compliance does not allow management or employees, in the normal course of performing their assignment functions, to prevent, or detect and correct, noncompliance with a type of compliance requirement of a federal program on a timely basis. A material weakness in internal control over compliance is a deficiency, or combination of deficiencies, in internal control over compliance, such that there is a reasonable possibility that material noncompliance with a type of compliance requirement of a federal program will not be prevented, or detected and corrected, on a timely basis. A significant deficiency in internal control over compliance is a deficiency, or a combination of deficiencies, in internal control over compliance with a type of compliance requirement of a federal program that is less severe than a material weakness in internal control over compliance, yet important enough to merit attention by those charged with governance. -47- Simmons, Richey & Company, P.C. Certified Public Accountants To the Board of Directors Page 3 Our consideration of internal control over compliance was for the limited purpose described in the first paragraph of this section and was not designed to identify all deficiencies in internal control over compliance that might be material weaknesses or significant deficiencies. We did not identify any deficiencies in internal control over compliance that we consider to be material weaknesses. However, material weaknesses may exist that have not been identified. The purpose of this report on internal control over compliance is solely to describe the scope of our testing of internal control over compliance and the results of that testing based on the requirements of OMB Circular A-133. Accordingly, this report is not suitable for - any other purpose. Lithonia, Georgia March 24, 2013 -48- Simmons, Richey & Company, P.C. Certified Pudic Acoountanti EXIT CONFERENCE EXIT CONFERENCE On February 7, 2014, an exit conference was conducted with the Organization's chief financial officer to discuss the findings resulting from our audit. Participants in the exit conference were: Organization Personnel Chief Financial Officer Auditors Partner Senior Auditor Topics Discussed: 1) Results of our review of the Organization' s internal .control and compliance. 2) Items needed to complete .the audit. 3) Requirement for submission' of the audit . package to the Federal Audit Clearinghouse. See the reports on internal control . and compliance and the Schedule of . Findings and Questioned Costs for a summary of the results of our audit. -49- ' PIEDMONT HEALTH SERVICES, INC.' CORRECTIVE ACTION PLAN FOR THE YEAR ENDED NOVEMBER 30, 2013 NONE -50- GENERAL MAILING • PO Box 17179 Chapel I[ill,NC 27516-7179 WEBSITE ADMINISTRATIVE OFFICE wwnv.piWmcmthcalth.org 2991.1oydStccct PIEDMONT (arrboro,N(:27511 H E ALT H ©17accbookcom/11icdmont1 Icalth (919)933-8494 rnx(119)933-9211 PIEDMONT HEALTH SERVICES, INC. BURLINGTON COMMUNITY SUMMARY SCHEDULE OF PRIOR AUDIT FINDINGS HEALTH CENTER FOR THE YEAR ENDED NOVEMBER 30, 2013 1214 Vaughn Road,1"flrxrr Burhnq )n,NC 27217 Corrang.Sexy CARRBORO COMMUNITY 2012 -Finding No.Cl: Patient Management System Crash HEALTH CENTER Condition: The patient management system crashed during October 2012. 301 Lloyd Street The Organization implemented a virtual backup system during the year. (:arrbom,NC 27510 (919)942.8741 However,the back function was not operating properly. The malfunction was not discovered until October 2012 when the system crashed and the IT CHARLES DREW COMMUNITY Department attempted to restore the data from the backup. All transactions HEALTH CENTER subsequent to April 2012 were lost. The Chief Financial Officer has 221 N.Graham 1 iopedalc Read P Burlington,NC 27217-2971 developed and implemented a plan to re-enter all transactions for the period (336)570-3739 May 2012 through October 2012 from source documents. During the period for which data was lost,monthly postings to the general ledger were HEALTH C COMMUNITY made from reports generated from PMS. Therefore,the general ledger HEALTH CENTER P g g g 110&Y\319 balances appear reasonable. The cause of this finding was due to the IT 7228 Pinb curc Road Mun curc,NC 27559 Department failure to periodically test the backup system. (919)542-4991 PROSPECT HILL COMMUNITY Recommendation: The auditor recommended that the IT Department HEALTH CENTER l develop OI modify policies and procedures to include weekly test of backup 3222 Main street data for recoverability. Prospect I IiU,N(:27314 (336)562-3311 SCOTT COMMUNITY HEALTH Current Status: For the condition stated above the following is the current CENTER staff: 5270 Utticm Ridge-Road Budingtcm,NC 27217 (336)421-3247 A) An IT firm,.Progressive Computers,is managing the IT functions. a. They reviewed and updated our Information Services H� NT UN>n Computer Systems protocol. 1'0 Box B31 b. They assessed the skill sets of the department,aligned the IT 224.South 10th nva,uc task with the skill sets and plugged in the gaps with contract Silo(:icy,NC 27344 (919)663.1744 personnel. c. They implemented an electronic ticketing system to monitor SYLVAN COMMUNITY HEALTH all IT activities. With this system, an IT Scheduler position CENTER 110 Box 578 was created to manage the workload. This system has also 7718 sylvan Read been programmed to schedule and monitor the backup process. Jnoa Camp,NC 27349 (336)506-0631 d. They documented your current systems then designed and implemented a backup protocol with offsite capability. This PIEDMONT HEALTH protocol includes a 4-hour snapshot of our systems,an offsite SEMORCAREATBURLINGTON replication of our stems and a quarterly complete restore of 1214 Vaughn Read P systems, q Y P Burlington,NC 27217 our data to the test database. Once the data is restored (336)5324xxxl individuals that are our"super users"verify that data. PIEDMONT HEALTH e. They established the system error reporting protocol. SENIORCAREAT PITTSBORO 163 Chatham Business Dnve Pittsbord,NC 27312 (919)545.7337 -51- PIEDM17 OP ID:KB CERTIFICATE OF LIABILITY INSURANCE DATE(M4/20 4 1 011 412 0 1 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dick Dickens,CIC Senn Dunn-High Point FAX 2406 PHONE 336-899- 1400 Eastchester Drive,St 200 A/C No Ell: AIC No): High Point, as 27,CI E-MAIL ddickens@senndunn.com M.Bryan Beasley,CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Co of Amer 12572 INSURED Piedmont Health Services Inc. INSURER B:Selective Insurance Companies 12572 299 Lloyd St. Carrboro,NC 27510 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE DL UBR POLICYNUMBER MM/DIpYEFF MMIDDNYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY 51971482 02/01/2014 0210112015 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE EK OCCUR MED EXP(Any one person) $ 5,000 B X BusinessOwners S1971481 02/01/2014 02/0112015 PERSONAL BADVINJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,00 JECT POLICY PRO- L $ AUTOMOBILE LIABILITY (Ea accident) OMBI ED SINGLE LIMIT $ 1,000 000 B X ANY AUTO S1971482 02101/2014 02101/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 B EXCESS LIAR CLAIMS-MADE 51971482 0210112014 02/01/2015 AGGREGATE $ 3,000,00 DED I X I RETENTION$ -0- $ WORKERS AND EMPLO ERS'L ABILIITY X TNRY LATT OE H A ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N WC 7977892 0210112014 02/0112015 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION ORANGOV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE-`. ©1988-2010 ACORD CORPORATION. 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