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Mission Health releases annual reports to Independent Monitor

FILE - Mission Health sign (Photo credit: WLOS staff)
FILE - Mission Health sign (Photo credit: WLOS staff)
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Mission Health has just released its annual reports to the group in charge of making sure the hospital system is keeping its promises.

The reports were posted on the website for Mission Health's Independent Monitor.

The 25-page document is broken into two sections.

One goes through parts of the purchase agreement made when HCA bought Mission Health.

It then includes HCA's response, in terms of status.

The report says HCA is in compliance in every aspect of the agreement listed.

The second section goes through the capital expenditures made by Mission Health during 2020.

Now, Mission's Health Independent Monitor, Gibbins Advisors, will spend several months reviewing the information.

In a recent interview with News 13, Ron Winters said, "There is a 90-day period from the date we receive the annual report where Dogwood needs to make a determination if they are going to tell the Attorney General if they are going to move forward with any enforcement action."

According to the reports, Mission Health spent about 60 million dollars last year that will go toward their Capital Expenditure Target.

Winters tells News 13:

We are in the process of reviewing the Cap Ex Report plus initial supporting information we requested. Buyer (HCA) is seeking $60,739,224 million (page B-2) credit toward the Capital Expenditure Target of $232 million (page 5 of the APA) spent over 5 years (a total of $98,686,062 cumulatively). The Cap Ex Report indicates the total capital expenditures was $89,363,498 (page B-1 and Attachment B-1) for the 12 months ended 1/31/2021 but a portion does not count toward the Capital Expenditure Target.

The Independent Monitor sent the following additional information concerning these annual reports:

Gibbins Advisors has received the 2020 Annual Report and Cap Ex Report from HCA for the Reporting Periods ending December 31, 2020 and January 31, 2021 respectively regarding the status of compliance of relevant matters.

These documents are the starting point used to evaluate HCA’s compliance with its 15 Commitments from the Asset Purchase Agreement when acquiring Mission Health.

The reports can be accessed HERE.

“We have been preparing to receive these reports and will immediately begin assessing the information. We urge the public to also review the documents and to continue to provide feedback and contact us,” said Ronald Winters of Gibbins Advisors.

Gibbins Advisors can be reached on the contact form on the Independent Monitor website, or via email at

The Gibbins Advisors’ Independent Monitor team will spend the next several months evaluating the documents as well as other materials and information to evaluate compliance. Additionally, they will be speaking with community officials, other leaders and the public for input.

Ultimately, Gibbins Advisors will advise Dogwood Health Trust, which is charged with enforcing compliance, on their conclusions. Gibbins Advisors communicates with Dogwood’s Covenant Compliance Committee regularly to report progress.

What's next

On Monday, Gibbins Advisors also released the following:

Looking Ahead: Monitoring Year 2 of HCA’s Compliance with its 15 Commitments at Mission Health System

Update from the Independent Monitor, Gibbins Advisors, LLC

By Ronald Winters

As we begin year two of our monitoring and evaluation of HCA’s compliance with its 15 commitments at Mission Health, we wanted to provide an update. In our recent public meeting, conducted via Zoom on April 7, 2021, we recognized the need to clarify roles and what we do with the input gathered in these forums.

Our goals for that April 7 meeting, just as they have been for the previous seven community forums hosted in 2020, were to: Remind the community of HCA's 15 commitments made in the contract to purchase Mission Health System;

Inform the community of the role of the Independent Monitor, Dogwood Health Trust and the six advisory boards that were set up in relation to HCA’s 15 commitments; and, perhaps most importantly,

Engage with the community to hear concerns and feedback, while providing an opportunity to ask questions.

If you were unable to attend this most recent webinar, a recording of it is on our website ( We also plan to post a transcript of the oral presentation in English and Spanish, along with answers to frequently asked questions from the webinar.

Our Focus on the 15 Commitments

Each of the 15 commitments is important, and they include many services provided at Mission Health facilities. However, the asset purchase agreement (APA) does not protect all services (i.e., primary care services).

While our role is limited to the 15 commitments, that does not mean that we won’t consider other factors or issues brought before us. For example, we may consider in our evaluation whether changing a service that is not protected affects a service that is protected. We also consider factors that underpin the ability to provide a protected service – for example having qualified and available physicians and clinical staff.

Our evaluation requires a nuanced examination of the facts and circumstances as well as a review of data to determine whether HCA is delivering the required services listed in the APA.

We sometimes hear concerns about quality, safety and staffing. Certainly, meeting standards in those areas can have an impact on HCA’s ability to provide required healthcare services – but many of those concerns also may fall outside of the 15 commitments. What we are not able to do is resolve individual issues, such as what you might expect from a patient advocate. Issues of quality, safety and staffing at Mission Health are regulated by the NC Department of Health and Human Services and surveyed by accrediting bodies including notably The Joint Commission. If those organizations cite deficiencies, we will take that into account if it affects the 15 commitments.

Who holds HCA accountable to these commitments?

In our role as Independent Monitor, we carefully monitor and evaluate whether HCA is upholding its 15 commitments. We share our findings with Dogwood Health Trust, the party empowered to enforce HCA’s compliance with the 15 commitments.

Why your input matters

We are now embarking on a formal review of HCA’s second year of compliance (2020). Your input is a critical part of our evaluation process. It helps to guide areas where we may need to probe HCA for more information and could support the fact base for our evaluation.

Individual cases also help to inform our compliance evaluation, and we share all feedback with HCA. While the formal evaluation looks “backward” to the prior year, that doesn't mean we are not looking at conditions going on now. We accept real time information and use it to monitor ongoing compliance with the 15 commitments. If there is a direct, immediate violation, actions can be taken. Otherwise, we take all information into account and will use it in our formal annual evaluation of HCA’s compliance.

Continuing to engage

The forums we held last year helped us to establish a dialogue with individuals, community interest groups and local leaders. We have maintained many of these communication channels.

As concerns or questions arise, we ask that you continue to engage with us. We will engage with HCA and follow up concerns that relate to the 15 commitments.

This year, due to COVID-19 we were forced to host our public input sessions virtually. Are they ideal means of reaching everyone, particularly those in more rural areas of the region with limited access to internet? Certainly not. We hear you. We are making plans to safely visit communities in person as soon as possible. Until then, we encourage you to continue to reach out via our website or email (

Thank you for your input and feedback.


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