HUGH CHATHAM MEMORIAL HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HUGH CHATHAM MEMORIAL HOSPITAL INC (EIN 56-0642846)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-14
- IRS object ID
- 202332269349301613
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-14T11:03:52-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1Txt |
| City | ASHEVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560642846 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HUGH | BusinessNameControlTxt |
| Phone | 3365277000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DR | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PAUL H HAMMES | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3365277000 | PhoneNum |
| Signature | 2023-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | PAUL | PersonFirstNm |
| Person Last | HAMMES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY BIBBY | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Preparation | 2023-08-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAUL H HAMMES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DR | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $155,415,691 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HUGHCHATHAM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1930 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE BIRTHING AND ACUTE CARE SERVICES IN ADDITION TO SKILLED NURSING, RETIREMENT COMMUNITY, HOME HEALTH, AND HOSPICE SERVICES PRIMARILY TO THE RESIDENTS OF AND SURROUNDING COUNTIES TO SURRY COUNTY, NORTH CAROLINA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 1095 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,800,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,647,181 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $136,807,043 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $135,635,601 | CYProgramServiceRevenueAmt |
| PY Investment Income | $17,281,643 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,390,499 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,214,838 | PYOtherRevenueAmt |
| CY Other Revenue | $1,397,765 | CYOtherRevenueAmt |
| PY Total Revenue | $158,103,524 | PYTotalRevenueAmt |
| CY Total Revenue | $155,071,046 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $8,883 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $87,359 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $65,578,740 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $70,246,289 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $112,925 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $74,016,679 | PYOtherExpensesAmt |
| CY Other Expenses | $75,449,198 | CYOtherExpensesAmt |
| PY Total Expenses | $139,604,302 | PYTotalExpensesAmt |
| CY Total Expenses | $145,782,846 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $18,499,222 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,288,200 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $281,613,706 | TotalAssetsBOYAmt |
| Total Assets EOY | $255,924,917 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $75,713,171 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $76,467,441 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $205,900,535 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $179,457,476 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $132,057,495 | ExpenseAmt |
| Grant | $87,359 | GrantAmt |
| Revenue | $135,635,601 | RevenueAmt |
| Desc | WHILE 2021 WAS A YEAR TO NEVER FORGET, HUGH CHATHAM MEMORIAL HOSPITAL CONTINUED THEIR LEGACY OF PROVIDING HEALTHCARE TO ALL WITHIN THE COMMUNITY DURING THE GLOBAL PANDEMIC, COVID-19. THE ORGANIZATION'S VISION, "TO BE THE BEST COMMUNITY HEALTH SYSTEM IN THE NATION WITH SERVICE AS OUR GUIDING PRINCIPLE," DECLARES THAT EVERY MEMBER OF THE STAFF PROVIDES THE HIGHEST LEVEL OF CARE FOR EVERY PATIENT, AT EVERY LOCATION. HUGH CHATHAM MAKES A DIFFERENCE EVERY DAY FOR LOCAL CITIZENS AND EMPLOYERS. THE NONPROFIT HEALTH CARE SYSTEM HAS RECENTLY RECEIVED MANY PRESTIGIOUS AWARDS THAT ACCENTUATE ITS COMMITMENT TO EXCELLENCE.- WOMEN'S CHOICE AWARD FOR BEST IN PATIENT SAFETY AND STROKE CARE FOR 2022- AMERICAN HEART ASSOCIATION 2021 GET WITH THE GUIDELINES: STROKE SILVER PLUS WITH HONOR ROLL ELITE AND TARGET: TYPE 2 DIABETES- JOINT COMMISSION'S GOLD SEAL OF APPROVAL FOR THE ADVANCED CERTIFICATION FOR TOTAL HIP AND KNEE REPLACEMENT- NATIONALLY RECOGNIZED AS AN "A" GRADE FOR PATIENT SAFETY BY THE LEAPFROG GROUP SPRING 2021- YADKIN VALLEY HOME HEALTH RANKS IN THE TOP 20% IN PATIENT SATISFACTION AMONG 4,000+ AGENCIES NATIONWIDE.- HUGH CHATHAM MEMORIAL HOSPITAL RANKED IN THE TOP 10% AMONG NORTH CAROLINA HOSPITALS FOR PATIENT SATISFACTION.HUGH CHATHAM ACKNOWLEDGED THAT HELPING OUR COMMUNITY WAS ESSENTIAL IN COMBATTING COVID-19 AND TO PROTECT THE PEOPLE WHO MAKE HUGH CHATHAM'S HEALTH SYSTEM SO IMPACTFUL. THE ORGANIZATION PROVIDED COVID-19 VACCINE CLINICS FOR EMPLOYEES AND THE COMMUNITY. IN ADDITION, HUGH CHATHAM PROVIDED EDUCATION TO DECREASE THE SPREAD OF THE VIRUS TO COMMUNITY MEMBERS. HUGH CHATHAM MEDICAL GROUP ALSO OPENED THREE NEW PHYSICIAN PRACTICES AND EXPANDED EXPRESS CARE SERVICES, PROVIDING GREATER ACCESS TO HEALTHCARE THROUGHOUT THE AREA. OUR COMMUNITY RALLIED TO ENSURE SAFETY FOR ALL. HUGH CHATHAM CREATED PARTNERSHIPS WITH LOCAL ORGANIZATIONS TO PROVIDE PERSONAL PROTECTION EQUIPMENT (PPE) TO PROTECT OUR STAFF WHILE THEY PROVIDED EXCEPTIONAL CARE TO PATIENTS. IN HUGH CHATHAM'S RAPID RESPONSE TO COVID-19, THE HEALTH SYSTEM CREATED A VIRTUAL CARE PLATFORM TO PROVIDE CARE TO PATIENTS WHO WERE IN QUARANTINE, DID NOT WANT TO BE AT RISK FOR COVID-19, OR OTHERWISE HOME-BOUND. HUGH CHATHAM VIRTUAL CARE ALLOWS ACCESS TO PROVIDERS VIA WEBSITE OR APPLICATION.A COMPLETE LISTING OF SERVICES IS AVAILABLE ON THE HEALTH SYSTEM'S WEBSITE AT WWW.HUGHCHATHAM.ORG. FOR REAL-TIME UPDATES AND STORIES ABOUT THE PEOPLE WHO MAKE THIS HEALTH SYSTEM SUCCESSFUL, VISIT HUGH CHATHAM MEMORIAL HOSPITAL ON FACEBOOK, INSTAGRAM, TWITTER AND LINKEDIN. | Desc |
| Total Program Service Expenses | $132,057,495 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | Yes (1) | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 172 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1095 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NC | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KAYLA WAGONER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3365277542 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 560 | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DR SARBA KUNDU | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $894,006 | $0 | $69,251 | ||||
| DR DOMINICK CARBONE | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $789,825 | $0 | $70,251 | ||||
| DR JOHNATHAN WHITAKER | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $763,031 | $0 | $66,051 | ||||
| DR JONATHAN SNYDER | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $740,293 | $0 | $63,361 | ||||
| DR MURUG SUBBIAH | |||||||||
| BOARD MEMBER | 1.00 | $674,312 | $0 | $69,224 | Yes (X) | ||||
| PAUL HAMMES | |||||||||
| CEO | 40.00 | $488,370 | $0 | $66,974 | 2.00 | Yes (X) | |||
| DR MARC STEVENS | |||||||||
| PHYSICIAN | 40.00 | Yes (X) | $483,304 | $0 | $49,059 | ||||
| MARY BLACKBURN | |||||||||
| CNO | 40.00 | $263,013 | $0 | $63,295 | Yes (X) | ||||
| ANDREW TATE | |||||||||
| CPO & VP AMB SERVICES | 40.00 | $224,943 | $0 | $27,114 | Yes (X) | ||||
| KENT THOMPSON | |||||||||
| CFO | 40.00 | $211,432 | $0 | $24,687 | 2.00 | Yes (X) | |||
| TERRY DARNELL | |||||||||
| CHAIRMAN | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |||
| CYNTHIA GONZALEZ | |||||||||
| VICE CHAIRMAN | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |||
| BILL JOHNSON | |||||||||
| TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | 1.00 | Yes (X) | ||
| PHIL HARRIS | |||||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |||
| BOB BALL | |||||||||
| ASST SECRETARY/TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |||
| DAVID ACKERMAN | |||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| DR WILL BALLARD | |||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| DAVID CLINE | |||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| MYRA COX | |||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| BOB MIDKIFF | |||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| ELENA THOMASSON | |||||||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,532,529 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $569,267 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 91 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SODEXO INC & AFFILIATES | |||||
| PO BOX 536922 | ATLANTA | GA | 30353 | DIETARY & HOUSEKEEPING SERVICES | $4,320,333 |
| QUALIVIS LLC | |||||
| PO BOX 123847 | DALLAS | TX | 75312 | CONTRACT LABOR | $4,010,439 |
| CARDINAL PHARMACY | |||||
| 25025 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACEUTICALS | $2,328,575 |
| CARDINAL HEALTH | |||||
| PO BOX 70539 | CHICAGO | IL | 60673 | MEDICAL SUPPLIES | $1,994,854 |
| HORIZON CSA LLC | |||||
| 265 PITT RD | MOORESVILLE | NC | 28115 | EQUIPMENT MAINTENANCE | $1,844,433 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,204,681 | GovernmentGrantsAmt |
| All Other Contributions | $442,500 | AllOtherContributionsAmt |
| Total Contributions | $6,647,181 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT CARE SERVICES | 621400 | $135,105,144 | $135,105,144 |
| OTHER OPERATING REVENUE | 621400 | $301,597 | $301,597 |
| NET HOSPICE INVESTMENT | 623000 | $225,764 | $225,764 |
| EHR MEANINGFUL USE REVENUE | 621400 | $3,096 | $3,096 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $135,635,601 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,553,479 | TotalRevenueColumnAmt |
| Exclusion | $3,553,479 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,719,833 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $326,700 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,393,133 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,393,133 | TotalRevenueColumnAmt |
| Exclusion | $1,393,133 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,854,965 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $17,945 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $7,854,965 | SecuritiesAmt |
| Other | -$17,945 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,837,020 | TotalRevenueColumnAmt |
| Exclusion | $7,837,020 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA & VENDING | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $4,632 | TotalRevenueColumnAmt |
| Exclusion | $4,632 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,632 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $155,071,046 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $135,635,601 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $12,788,264 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,359 | TotalAmt |
| Program Services | $87,359 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,821,512 | TotalAmt |
| Program Services | $455,377 | ProgramServicesAmt |
| Management And General | $1,275,060 | ManagementAndGeneralAmt |
| Fundraising | $91,075 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,786 | TotalAmt |
| Program Services | $78,786 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,753,973 | TotalAmt |
| Program Services | $50,398,027 | ProgramServicesAmt |
| Management And General | $4,355,946 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $885,285 | TotalAmt |
| Program Services | $795,871 | ProgramServicesAmt |
| Management And General | $87,991 | ManagementAndGeneralAmt |
| Fundraising | $1,423 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,936,337 | TotalAmt |
| Program Services | $8,033,767 | ProgramServicesAmt |
| Management And General | $888,204 | ManagementAndGeneralAmt |
| Fundraising | $14,366 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,770,396 | TotalAmt |
| Program Services | $3,389,586 | ProgramServicesAmt |
| Management And General | $374,749 | ManagementAndGeneralAmt |
| Fundraising | $6,061 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,004 | TotalAmt |
| Management And General | $68,004 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,135 | TotalAmt |
| Management And General | $100,135 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $314,346 | TotalAmt |
| Management And General | $314,346 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $677,777 | TotalAmt |
| Management And General | $677,777 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,709,268 | TotalAmt |
| Program Services | $20,336,104 | ProgramServicesAmt |
| Management And General | $2,373,164 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $541,903 | TotalAmt |
| Program Services | $331,733 | ProgramServicesAmt |
| Management And General | $210,170 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,899,535 | TotalAmt |
| Program Services | $10,697,682 | ProgramServicesAmt |
| Management And General | $1,201,853 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,659,097 | TotalAmt |
| Program Services | $1,491,528 | ProgramServicesAmt |
| Management And General | $167,569 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,853 | TotalAmt |
| Program Services | $224,568 | ProgramServicesAmt |
| Management And General | $33,285 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,319,852 | TotalAmt |
| Program Services | $1,186,547 | ProgramServicesAmt |
| Management And General | $133,305 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,912,599 | TotalAmt |
| Program Services | $5,315,427 | ProgramServicesAmt |
| Management And General | $597,172 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $645,152 | TotalAmt |
| Program Services | $645,152 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $17,482,019 | $17,482,019 | |
| MEDICAL SUPPLIES | $8,494,272 | $8,494,272 | |
| PROVIDER TAX | $1,963,893 | $1,963,893 | |
| MISCELLANEOUS | $1,069,935 | $649,797 | $420,138 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $333,558 | TotalAmt |
| Management And General | $333,558 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,782,846 | TotalAmt |
| Program Services | $132,057,495 | ProgramServicesAmt |
| Management And General | $13,612,426 | ManagementAndGeneralAmt |
| Fundraising | $112,925 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $331,953 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,836,662 | BOYAmt |
| EOY | $22,017,763 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,093,409 | BOYAmt |
| EOY | $1,150,113 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,786,184 | BOYAmt |
| EOY | $2,594,853 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $152,452,014 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $97,348,281 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,105,478 | BOYAmt |
| EOY | $55,103,733 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $187,810,784 | BOYAmt |
| EOY | $153,471,273 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,871,090 | BOYAmt |
| EOY | $15,200,212 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,778,146 | BOYAmt |
| EOY | $6,386,970 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $281,613,706 | BOYAmt |
| EOY | $255,924,917 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,074,451 | BOYAmt |
| EOY | $21,067,909 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $756,797 | BOYAmt |
| EOY | $175,658 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,554,980 | BOYAmt |
| EOY | $50,383,569 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,326,943 | BOYAmt |
| EOY | $4,840,305 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,713,171 | BOYAmt |
| EOY | $76,467,441 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $202,675,123 | BOYAmt |
| EOY | $176,232,064 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,225,412 | BOYAmt |
| EOY | $3,225,412 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $205,900,535 | BOYAmt |
| EOY | $179,457,476 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $281,613,706 | BOYAmt |
| EOY | $255,924,917 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $9,288,200 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$41,017,503 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$312,914 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $5,599,158 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | Yes (1) | VolunteersInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $13,223 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $13,223 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS TO LEGISLATIVE BODIES ON BEHALF OF THEIR MEMBERSHIP BASES. EACH YEAR, A PORTION OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ENDEAVORS. FOR THE CURRENT YEAR, THE PORTION OF DUES PAID ALLOCATED TO LOBBYING IS APPROXIMATELY $ 13,223. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,189,614 | OtherCostOrOtherBasisAmt |
| Book Value | $4,189,614 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $89,221,038 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,925,333 | DepreciationAmt |
| Book Value | $40,295,705 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $47,537,131 | OtherCostOrOtherBasisAmt |
| Depreciation | $40,061,644 | DepreciationAmt |
| Book Value | $7,475,487 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,504,231 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,361,304 | DepreciationAmt |
| Book Value | $3,142,927 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $55,103,733 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVESTMENT IN HOSPICE OF SURRY COUNTY | Desc |
| Book Value | $15,200,212 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $15,200,212 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)
| DescDesc | AmtAmt |
|---|---|
| INTEREST PAYABLE | $191,586 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $1,700,000 |
| PHYSICIAN GUARANTEE | $632,980 |
| INTEREST RATE SWAP | $336,330 |
| RESIDENT TRUST FUNDS | $87,276 |
| LEASE LIABILITY | $758,350 |
| OPERATING ACCOUNT OVERDRAFT | $1,133,783 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,840,305 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL, FOUNDATION, AND AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE HOSPITAL HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2022. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| Most Hospitals Policy | Yes (X) | MostHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,260,219 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,260,219 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00980 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,322,146 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,955,682 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,366,464 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01070 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,582,365 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,955,682 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,626,683 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02050 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,673 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,673 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $46,520 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $46,520 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $154,631 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $154,631 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $207,824 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $207,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,790,189 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,955,682 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,834,507 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02220 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $88,197 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $88,197 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $88,197 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $88,197 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $17,484,373 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,910,324 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $71,477,303 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $71,477,303 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DRIVE | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DISPROPORTIONATE SHARE HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE DISCLOSURE | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE DISCLOSURE | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE DISCLOSURE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE DISCLOSURE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE DISCLOSURE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HUGH CHATHAM MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: EXPERTS IN THE FIELD OF PUBLIC HEALTH, HOSPICE CARE, NURSES, PHYSICIANS, CASE MANAGEMENT, EDUCATION, AND PHILANTHROPY WERE CHOSEN FOR THE FOCUS GROUP. THE FOCUS GROUPS WERE DESIGNED AROUND THE KEY ISSUES THAT EMERGED FROM THE MEETINGS. |
| HUGH CHATHAM MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: HUGH CHATHAM MEMORIAL HOSPITAL WILL CONTINUE TO PLAY A LEADING ROLE IN ADDRESSING THE HEALTH NEEDS OF THOSE WITHIN OUR COMMUNITY, WITH A SPECIAL FOCUS ON THE UNDERSERVED. AS SUCH, COMMUNITY BENEFIT PLANNING IS INTEGRATED INTO OUR HOPSITAL'S ANNUAL PLANNING AND BUDGETING PROCESSES TO ENSURE WE CONTINUE TO EFFECTIVELY SUPPORT COMMUNITY BENEFITS. |
| PART V, SECTION B, LINE 7A AND 10A: | WEBSITE ADDRESSES FOR CHNA AND IMPLEMENTATION STRATEGYHTTPS://WWW.HTTPS://HUGHCHATHAM.ORG/WP-CONTENT/UPLOADS/2023/01/2022_COMMUNITYHEALTHNEEDS-PLAN_1.PDFHTTPS://WWWHTTPS://HUGHCHATHAM.ORG/WP-CONTENT/UPLOADS/2023/01/2022-COMMUNITY-HEALTH-NEEDS-ASSESSMENT-IMPLEMENTATION-PLAN.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 25 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (25 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - YADKIN VALLEY HOME HEALTH | ||||
| 213 WINSTON RD | ELKIN | NC | 28642 | HOME HEALTH |
| 2 - TRI COUNTY ORTHOPEDIC AND SPORTS MEDICIN | ||||
| 400 JOHNSON RIDGE RD | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 3 - YADKIN VALLEY UROLOGY | ||||
| 200 JOHNSON RIDGE MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 4 - YADKIN VALLEY ADULT MEDICINE | ||||
| 500 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 5 - CLINGMAN MEDICAL CENTER | ||||
| 3369 CLINGMAN RD | ELKIN | NC | 28670 | PHYSICIAN OFFICE |
| 6 - YADKIN VALLEY GASTROENTEROLOGY | ||||
| 201 WEST MAIN STREET | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 7 - JONESVILLE URGENT CARE CENTER | ||||
| 546 WINSTON ROAD | JONESVILLE | NC | 28642 | PHYSICIAN OFFICE |
| 8 - G I CLINIC | ||||
| 201 WEST MAIN STREET | ELKIN | NC | 28621 | PROCEDURE CLINIC |
| 9 - YADKIN VALLEY DERMATOLOGY | ||||
| 201A ELDON PARK DRIVE | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 10 - HUGH CHATHAM FAMILY MEDICINE ELKIN | ||||
| 600 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 11 - HUGH CHATHAM SURICAL | ||||
| 201B ELDON PARK DRIVE | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 12 - HUGH CHATHAM NEUROLOGY | ||||
| 100 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 13 - HUGH CHATHAM BEHAVIORAL | ||||
| 690 PARKWOOD MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 14 - YADKIN VALLEY PULMONARY | ||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 15 - HUGH CHATHAM FAMILY MED BOOMER | ||||
| 156 BOOMER COMMUNITY CENTER RD | BOOMER | NC | 28606 | PHYSICIAN OFFICE |
| 16 - HUGH CHATHAM FAMILY MED MT VIEW | ||||
| 5229 ROCK CREEK RD | MT VIEW | NC | 28602 | PHYSICIAN OFFICE |
| 17 - HUGH CHATHAM WOMEN'S CENTER | ||||
| 150 PARKWOOD DRIVE | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 18 - HUGH CHATHAM PODIATRIC MEDICINE AND SURG | ||||
| 150 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 19 - HUGH CHATHAM EXPRESS CARE DOBSON | ||||
| 911 E ATKINS ST | DOBSON | NC | 28621 | PHYSICIAN OFFICE |
| 20 - PARKWOOD PLACE RETIREMENT CENTER | ||||
| 601 JOHNSON RIDGE RD ELKIN | ELKIN | NC | 28621 | RETIREMENT CENTER |
| 21 - HUGH CHATHAM FAMILY MEDICINE INDEPEDENCE | ||||
| 127 EAST MAIN STREET | INDEPENENCE | VA | 24348 | PHYSICIAN OFFICE |
| 22 - HUGH CHATHAM FAMILY MEDICINE WOODLAWN | ||||
| 22 TRAINING CENTER RD | WOODLAWN | VA | 24381 | PHYSICIAN OFFICE |
| 23 - HUGH CHATHAM FAMILY MEDICINE DOBSON | ||||
| 911 E ATKINS ST | DOBSON | NC | 28621 | PHYSICIAN OFFICE |
| 24 - HUGH CHATHAM FAMILY MEDICINE JONESVILLE | ||||
| 546 WINSTON ROAD | JONESVILLE | NC | 28642 | PHYSICIAN OFFICE |
| 25 - HUGH CHATHAM ENDOCRINOLOGY AND DIABETES | ||||
| 500 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM WAS USED TO COMPUTE A COST-TO-CHARGES RATIO THAT WAS USED TO CALCULATE COSTS USED IN PART I, LINE 7. |
| PART I, LN 7 COL(F): | THE TOTAL EXPENSE AMOUNT LISTED ON FORM 990, PART IX, LINE 26 CONTAINS BAD DEBT EXPENSE OF $17,484,373 THAT WAS REMOVED FOR THE PURPOSE OF CALCULATING TOTAL CHARITY CARE PERCENTAGE ON LINE 7, COLUMN (F). |
| PART II, COMMUNITY BUILDING ACTIVITIES: | HUGH CHATHAM ACKNOWLEDGED THAT HELPING OUR COMMUNITY WAS ESSENTIAL IN COMBATTING COVID 19 AND TO PROTECT THE PEOPLE WHO MAKE HUGH CHATHAM'S HEALTH SYSTEM SO IMPACTFUL. THE ORGANIZAITON PROVIDED COVID-10 VACCINE CLINICS FOR EMPLOYEES AND THE COMMUNITY. IN ADDTION HCMH PROVIDED EDUCATION TO DECREASE THE SPREAD OF THE VIRUS TO COMMUNITY MEMBERS. HCMH ALSO OPENED THREE NEW PHYSICIAN PRACTICES AND EXPANDED EXPRESS CARE SERVICES. WE RALLIED TO ENSURE SAFETY FOR ALL. WE CREATED PARTNERSHIPS WITH LOCAL ORGANIZATIONS TO PROVIDE PERSONAL PROTECTION EQUIPMENT. |
| PART III, LINE 2: | THE OUTSTANDING ACCTS RECEIVABLE IS SEGREGATED BY AGE. A PERCENTAGE, DETERMINED BY HISTORICAL DATA, OF EACH AGING GROUP IS RESERVED FOR BAD DEBT AND EXPENSED MONTHLY. WHAT WE CALL TRADITIONAL MEDICARE AND CROSSOVER BAD DEBT ARE EXPENSED AT 100%. |
| PART III, LINE 3: | $5,458,069 WHICH IS THE BAD DEBT AMOUNT STATED ABOVE TIMES THE COST TO CHARGE RATIO. 35% WOULD QUALIFY FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE GROSS BAD DEBT EXPENSE PER AUDITED FINANCIAL STATEMENTS REDUCED TO COST USING AN INTERNALLY COMPUTED COST-TO-CHARGES RATIO FROM THE ORGANIZATION'S COST ACCOUNTING SYSTEMS.DUE TO THE FACT THAT APPROXIMATELY 30% OF THE SURROUNDING COMMUNITY'S RESIDENTS ARE CONSIDERED TO BE LIVING BELOW THE POVERTY LINE, IN COMBINATION WITH THE FACT THAT THE UNEMPLOYMENT PERCENTAGE FOR THE AREA IS APPROXIMATELY 12.7%, THE ORGANIZATION FEELS THAT APPROXIMATELY 35% OF BAD DEBT IS AN APPROPRIATE ESTIMATION OF THE AMOUNT OF BAD DEBT THAT MAY CONSTITUTE A COMMUNITY BENEFIT. |
| PART III, LINE 8: | AN INTERNAL COST-TO-CHARGE RATIO WAS USED TO COMPUTE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6. |
| PART III, LINE 9B: | HCMH MAKES EVERY EFFORT TO EVALUATE PATIENTS PRIOR TO PLACEMENT WITH A COLLECTIONS AGENCY TO SEE IF THEY ARE QUALIFIED FOR MEDICAID OR HOSPITAL CHARITY CARE. WE HAVE AN IN-HOUSE EMPLOYEE DESIGNATED TO ASSISTING PATIENTS ELIGIBLE FOR MEDICAID AND/OR FINANCIAL ASSISTANCE. AT THE POINT OF THE PATIENT NOT BEING ELIGIBLE AND FAILURE TO RESPOND FOR OUR PAYMENT PLAN OPTIONS, THE ACCOUNT IS PLACED WITH A COLLECTION AGENCY AND THE AGENCY MAKES AN EFFORT FOR 30 DAYS PRIOR TO PLACING ON THE CREDIT SCORE, TO OBTAIN PAYMENT. |
| PART VI, LINE 2: | THE ORGANIZATION TRACKS THE RESULTS OF HEALTH SCREENINGS PROVIDED THROUGH ITS HEALTH FAIRS AND LOOKS FOR TRENDS. THESE SCREENINGS PROVIDE INSIGHT INTO FURTHER MEDICAL NEEDS OF THE COMMUNITY MEMBERS. THE FAIRS ARE HELD PERIODICALLY THROUGH THE YEAR AND ARE ATTENDED BY HUNDREDS OF PEOPLE WHO ARE OFFERED VARIOUS HEALTH SCREENINGS. THIS YEAR OUR SCREENINGS WERE COVID RELATED. THE ORGANIZATION ALSO SUBSCRIBES TO NATIONAL AFFILIATED ORGANIZATIONS THAT PROVIDE DATA ON REGIONAL HEALTH NEEDS. THE LAST COUPLE OF YEARS OUR FOCUS HAS BEEN ON STROKE EDUCATION, WITH STROKE CERTIFICATION FOR OUR FACILITY. WE RECEIVED THE STROKE SILVER WITH HONOR ROLL ELITE AND TARGET. WE ALSO RECEIVED JOINT COMMSIONS'S GOLD SEAL OF APRROVAL FOR THE ADVANCED CERTIFICATION FOR TOTAL HIP AND KNEE REPLACEMENT. REACHING INTO THE BUSINESS COMMUNITY WITH EDUCATIONAL MATERIALS AND SCREENINGS BEING PROVIDED. THE HUGH CHATHAM VIRTUAL CARE PROGRAM ALLOWS ACCESS TO PROVIDERS VIA WEBSITE OR APPLICATION IN ORDER TO PROVIDE CARE TO PATIENTS THAT DO NOT WANT TO BE AT RISK FOR COVID-19 OR OTHERWISE HOMEBOUND.THE 2022 CHNA PRIMARILY FOCUSED ON SURRY, WILKES, YADKIN, AND ALLEGHANY COUNTIES. THESE COUNTIES ARE CONSIDERED OUR "COMMUNITY" AS GREATER THAN EIGHTY-EIGHT (88) PERCENT OF THE HCMH INPATIENT POPULATION RESIDES WITHIN THESE FOUR COUNTIES. PRIMARY DATA FOR THE ASSESSMENT WAS GATHERED THROUGH A SURVEY TOOL WITH MORE THAN TWO HUNDRED AND EIGHTY-FIVE (285) SUBMISSIONS. PARTICIPANTS REPRESENTED MULTIPLE ORGANIZATIONS AND INCLUDED INDIVIDUALS WHO HAVE A BROAD KNOWLEDGE OF THE COMMUNITY AND/OR HAD SPECIFIC EXPERTISE OR KNOWLEDGE. SECONDARY DATA WAS OBTAINED FROM LOCAL AND NATIONAL DATA PUBLISHED IN GOVERNMENT AND PRIVATE SOURCES. A COMPREHENSIVE LIST OF IDENTIFIED HEALTH ISSUES WAS COMPILED AND RECOMMENDATIONS WERE MADE TO HCMH'S EXECUTIVE LEADERSHIP FOR FURTHER REVIEW AND PRIORITIZATION. PRIORITIES WERE ASSESSED AND RANKED BASED ON ISSUE PREVALENCE, ISSUE SEVERITY, AND ABILITY TO IMPACT. FINAL PRIORITIZATION AS DETERMINED BY THE EXECUTIVE LEADERSHIP WAS APPROVED BY THE HCMH BOARD OF TRUSTEES.THE UNPRECEDENTED PANDEMIC OF COVID-19, SHOCKED OUR NATION AND HAD AN UNFATHOMABLE IMPACT ON HEALTHCARE SYSTEMS. HCMH UTILIZED THEIR STRENGTHS AS A COMMUNITY HEALTHCARE SYSTEM TO QUICKLY PIVOT TO PRIORITIZE CARE THAT EMBRACED NEW STRATEGIES TO DIAGNOSE AND TREAT THIS EMERGING INFECTIOUS DISEASE. WHILE MANY ELECTIVE SERVICES WERE LIMITED IN ORDER TO PROVIDE ADEQUATE RESOURCES OF SUPPLIES AND PERSONNEL WHERE THEY WERE MOST NEEDED, HCMH WAS CONSIDERED A LEADER IN THEIR RESPONSE TO PATIENT AND COMMUNITY NEEDS. |
| PART VI, LINE 3: | FINANCIAL ASSISTANCE EDUCATION IS MADE AVAILABLE AT ADMISSION AND ON THE WEBSITE. AT REGISTRATION THERE ARE BROCHURES WITH FINANCIAL ASSISTANCE INFORMATION MADE AVAILABLE. SIGNAGE IS LOCATED THROUGHOUT THE FACILITY TO INFORM AND EDUCATE THE PUBLIC OF THEIR FINANCIAL RIGHTS. HUGH CHATHAM MEMORIAL HOSPITAL OFFERS A LANGUAGE LINE FOR THE NON-ENGLISH SPEAKING COMMUNITY AND PHONETREE ASSISTANCE WHERE NEEDED. |
| PART VI, LINE 4: | THE PRIMARY SERVICE AREA OF THE HOSPITAL INCLUDES NINE ZIP CODES. ROUGHLY A FIFTEEN MILE DIAMETER AROUND ELKIN, NC. THE SECONDARY SERVICE AREA INCLUDES AN ADDITIONAL FIVE ZIP CODES WIDENING THE DIAMTER TO THIRTY MILES AROUND ELKIN. BOTH OF THESES MARKETS INCLUDE PART, BUT NOT ALL, OF THE NORTH CAROLINA COUNTIES OF WILKES, ALLEGHANY, YADKIN AND SURRY. SOUTHERN VIRGINIA COUNTIES OF GRAYSON, PATRICK, AND CARROLL ARE ALSO INCLUDED. |
| PART VI, LINE 5: | HCMH SPENT OVER 2.1 MILLION IN UPDATES TO CAPITAL PROJECTS RELATED TO PATIENT CARE.NEW RADIOLOGY EQUIPMENT ADDED INTO OPERATION TO FURTHER ENHANCE OUR IMAGING DEPARTMENTS, LAB SERVICES AND EQUIPMENT TO ENHANCE OUR PATIENT TESTING AND MONITORING SYSTEMS IN PATIENT CARE AREAS THAT WILL ENABLE OUR STAFF TO MONITOR AND IMPROVE PATIENT OUTCOMES. |
| PART VI, LINE 6: | THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NC |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | TUITION LOAN ASSISTANCE | GrantTypeTxt |
| Recipient | 4 | RecipientCnt |
| Cash Grant | $5,848 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE MADE IN ACCORDANCE WITH HUGH CHATHAM MEMORIAL HOSPITAL'S MISSION STATEMENT TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR SARBA KUNDU | ||||||||||||||
| PHYSICIAN | $590,813 | $0 | $302,833 | $0 | $360 | $0 | $39,000 | $0 | $30,251 | $0 | $963,257 | $0 | $0 | $0 |
| DR DOMINICK CARBONE | ||||||||||||||
| PHYSICIAN | $721,814 | $0 | $66,979 | $0 | $1,032 | $0 | $39,000 | $0 | $31,251 | $0 | $860,076 | $0 | $0 | $0 |
| DR JOHNATHAN WHITAKER | ||||||||||||||
| PHYSICIAN | $470,760 | $0 | $292,055 | $0 | $216 | $0 | $39,000 | $0 | $27,051 | $0 | $829,082 | $0 | $0 | $0 |
| DR JONATHAN SNYDER | ||||||||||||||
| PHYSICIAN | $551,440 | $0 | $188,493 | $0 | $360 | $0 | $37,310 | $0 | $26,051 | $0 | $803,654 | $0 | $0 | $0 |
| DR MURUG SUBBIAH | ||||||||||||||
| BOARD MEMBER | $503,135 | $0 | $170,625 | $0 | $552 | $0 | $38,973 | $0 | $30,251 | $0 | $743,536 | $0 | $0 | $0 |
| PAUL HAMMES | ||||||||||||||
| CEO | $391,810 | $0 | $90,532 | $0 | $6,028 | $0 | $39,000 | $0 | $27,974 | $0 | $555,344 | $0 | $0 | $0 |
| DR MARC STEVENS | ||||||||||||||
| PHYSICIAN | $86,892 | $0 | $395,860 | $0 | $552 | $0 | $19,508 | $0 | $29,551 | $0 | $532,363 | $0 | $0 | $0 |
| MARY BLACKBURN | ||||||||||||||
| CNO | $218,934 | $0 | $42,923 | $0 | $1,156 | $0 | $32,394 | $0 | $30,901 | $0 | $326,308 | $0 | $0 | $0 |
| ANDREW TATE | ||||||||||||||
| CPO & VP AMB SERVICES | $214,286 | $0 | $10,474 | $0 | $183 | $0 | $9,207 | $0 | $17,907 | $0 | $252,057 | $0 | $0 | $0 |
| KENT THOMPSON | ||||||||||||||
| CFO | $210,586 | $0 | $0 | $0 | $846 | $0 | $12,600 | $0 | $12,087 | $0 | $236,119 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE HOSPITAL JOINED HIGH MEADOWS COUNTRY CLUB. THERE HAS BEEN NO CHANGE IN THE POLICY SINCE ITS INCEPTION IN 2018. IT IS USED FOR BUSINESS PURPOSES ONLY. |
| PART I, LINE 6 | THE PHYSICIANS IN CHARGE OF THE UROLOGY PRACTICE, GASTROENTEROLOGY PRACTICE, AND DERMATOLOGY CLINIC ARE ELIGIBLE TO RECEIVE A PORTION OF THE NET PROFIT FROM THEIR PRACTICE. ANY PROFITS RESULTING FROM PHYSICIANS' PROFESSIONAL SERVICES AFTER ALL THE PRACTICE AND PHYSICIAN EXPENSES, SHALL BE SHARED. THE PHYSICIANS RECEIVE UP TO AN 85% ALLOCATION WITH THE REMAINDER GOING TO THE EMPLOYER. THE HOSPITALIST BONUS IS BASED ON PERFORMANCE GOALS AND MAY BE UP TO AS MUCH AS 20% OF THEIR SALARY. ANOTHER PHYSICIAN IN CHARGE OF THE HOSPITALIST GROUP IS ELIGIBLE TO RECEIVE UP TO 20% OF THEIR BASE SALARY DEPENDING ON PERFORMANCE MEASURES OF THE HOSPITALIST GROUP. AMOUNTS PAID OUT TO INDIVIDUALS LISTED ON PART VII OF THE FORM 990 FOR 2021 WERE: $66,979 DOMINICK CARBONE, MD $188,493 JONATHAN SNYDER, MD $302,833 SARBA KUNDU, MD $292,055 JONATHAN WHITAKER, DO $395,860 MARC STEVENS, MD |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||||
| A | 521309402 | 65821DAF8 | 2008-09-24 | $45,455,000 | NEW STRUCTURES, EQUIPMENT | Yes (1) | 0 | 0 |
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||||
| B | 521309402 | 2015-12-16 | $25,495,000 | REFUNDING REVENUE BONDS | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | Capitalized InterestCapitalizedInterestAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Other Spent ProceedsOtherSpentProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $8,940,000 | $42,235,000 | $46,276,755 | $3,493,414 | $435,743 | $513,249 | $42,448,072 | 2010 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $11,760,000 | $25,214,951 | $280,049 | 0 | 0 | Yes (1) | Yes (1) | $25,214,951 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WELLS FARGO | ||||||||||||
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 30.000000000000 | Yes (1) | 0 | 0 | 0 | 0 |
| (no name) | ||||||||||||
| B | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | 0 | |||
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DATE REBATE COMPUTATION PERFORMED | ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 08/28/2018 |
| SCH K, PART II, LINE 11, COLUMN B | THE OTHER SPENT PROCEEDS OF $25,214,951 WERE USED TO CURRENTLY REFUND PRIOR BONDS ISSUED. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURA OAKES | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | RELATED TO BOARD MEMBER BOB MIDKIFF | RelationshipDescriptionTxt |
| Transaction | $78,786 | TransactionAmt |
| Transaction | COMPENSATED AS DIRECTOR OF MARKETING | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE IMMEDIATE PAST CHAIRMAN AND ONE (1) OR MORE ADDITIONAL MEMBERS WHO WILL BE NOMINATED BY THE CHAIRMAN FOR THE ELECTION BY THE BOARD OF TRUSTEES. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. THE EXECUTIVE COMMITTEE SHALL ALSO ANNUALLY REVIEW THE PERFORMANCE, COMPENSATION AND TERMS OF EMPLOYEMENT OF THE CHIEF EXECUTIVE OFFICER AND MAKE RECOMMENDATIONS TO THE BOARD CONCERNING COMPENSATION AND TERMS OF THE EMPLOYMENT OF THE CHIEF EXECUTIVE OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH SUPERVISION AND ASSISTANCE BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DELIVERED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL. THE RETURN WAS THEN PRESENTED AT A SCHEDULED MEETING OF THE BOARD OF DIRECTORS BY A REPRESENTATIVE OF THE ACCOUNTING FIRM, AND EACH VOTING MEMBER OF THE BOARD WAS PROVIDED A COPY FOR DISCUSSION AND QUESTIONS. FOLLOWING THE MEETING AND A PERIOD OF TIME FOR COMMENT, THE RETURN WAS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, ALL VOTING BOARD MEMBERS ARE PRESENTED WITH THE GOVERNANCE POLICIES CONCERNING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. UPON REVIEW AND DISCUSSION CONCERNING RELATIONSHIPS WITH THE ORGANIZATION, ITS AFFILIATES, OR AMONGST EACH OTHER, THE BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE POLICY STATEMENT TO THE ADMINISTRATION. THESE STATEMENTS ARE REVIEWED BY THE BOARD CHAIR AND ARE PRESENTED TO THE AUDITORS DURING THE ANNUAL AUDIT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD USES MERCER, WHO USES DATA TO BENCHMARK HUGH CHATHAM'S COMPENSATION AGAINST SIMILAR ORGANIZATIONS. THE SALARIES OF THE TOP EXECUTIVES AND OTHER MEMBERS OF THE ADMINISTRATIVE DEPARTMENT ARE DETERMINED IN THE CONTRACT NEGOTIATIONS. A REVIEW OF ALL SALARIES, TOP TO BOTTOM, WAS ULTIMATELY APPROVED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| FORM 990, PART IX, LINE 11G | CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 7,193,630. MANAGEMENT AND GENERAL EXPENSES 1,880,910. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,074,540. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 7,013,105. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,013,105. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 4,379,216. MANAGEMENT AND GENERAL EXPENSES 653. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,379,869. CENTRALIZED BILLING: PROGRAM SERVICE EXPENSES 1,431,347. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,431,347. OTHER FEES: PROGRAM SERVICE EXPENSES 318,806. MANAGEMENT AND GENERAL EXPENSES 491,601. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 810,407. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF SWAP AGREEMENT 5,647,413. LOSS ON IMPAIRMENT OF GOODWILL -48,255. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | 562049537 | FUNDRAISING | NC | 501(C)(3) | LINE 12A, I | HUGH CHATHAM MEMORIAL HOSPITAL | Yes (1) |
| HUGH CHATHAM MEMORIAL HOSPITAL AUXILIARY | ||||||||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | 561199949 | THRIFT/GIFT SHOP | NC | 501(C)(3) | LINE 12A, I | HUGH CHATHAM MEMORIAL HOSPITAL | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |