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GASTON MEMORIAL HOSPITAL INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
GASTON MEMORIAL HOSPITAL INC (EIN 56-0619359)
Tax period
2019-07-01 to 2020-06-30
Filed
2021-05-05
IRS object ID
202101259349301900
Schema version
2019v5.2
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 ReturnHeader

FieldValueIRS element (for citing)
Return2021-05-05T10:37:02-05:00ReturnTs
Tax Period End2020-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN560747981PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1Txt
CityASHEVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28806ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN560619359EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GASTON MEMORIAL HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlGASTBusinessNameControlTxt
Phone7048342000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVEAddressLine1Txt
CityGASTONIACityNm
State AbbreviationNCStateAbbreviationCd
ZIP28054ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID O'CONNORPersonNm
Person TitleEVP, CFOPersonTitleTxt
Phone7048342000PhoneNum
Signature2021-05-05SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAMY BIBBYPreparerPersonNm
PTINP00445891PTIN
Phone8282542254PhoneNum
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1CAROMONT REGIONAL MEDICAL CTRBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerDAVID O'CONNORPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVEAddressLine1Txt
CityGASTONIACityNm
State AbbreviationNCStateAbbreviationCd
ZIP28054ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$583,581,267GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CAROMONT.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1945FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO PROVIDE COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee3912TotalEmployeeCnt
Total Volunteers177TotalVolunteersCnt
Total Gross UBI$117,355TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$79,825NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$294,834PYContributionsGrantsAmt
CY Contributions Grants$642,684CYContributionsGrantsAmt
PY Program Service Revenue$544,024,173PYProgramServiceRevenueAmt
CY Program Service Revenue$569,291,318CYProgramServiceRevenueAmt
PY Investment Income-$369,974PYInvestmentIncomeAmt
CY Investment Income$109,185CYInvestmentIncomeAmt
PY Other Revenue$3,058,549PYOtherRevenueAmt
CY Other Revenue$13,455,701CYOtherRevenueAmt
PY Total Revenue$547,007,582PYTotalRevenueAmt
CY Total Revenue$583,498,888CYTotalRevenueAmt
PY Grants And Similar Paid$1,366,506PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,172,657CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$225,013,059PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$226,010,355CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$269,560,015PYOtherExpensesAmt
CY Other Expenses$299,315,037CYOtherExpensesAmt
PY Total Expenses$495,939,580PYTotalExpensesAmt
CY Total Expenses$526,498,049CYTotalExpensesAmt
PY Revenues Less Expenses$51,068,002PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$57,000,839CYRevenuesLessExpensesAmt
Total Assets BOY$440,718,400TotalAssetsBOYAmt
Total Assets EOY$442,215,147TotalAssetsEOYAmt
Total Liabilities BOY$306,850,039TotalLiabilitiesBOYAmt
Total Liabilities EOY$337,638,253TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$133,868,361NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$104,576,894NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$489,491,875ExpenseAmt
Grant$1,172,657GrantAmt
Revenue$569,335,799RevenueAmt
DescCAROMONT HEALTH'S PHILOSOPHY OF CARE IS FOUNDED IN THREE DISTINCT WAYS.IT IS A HEALTH SYSTEM THAT INVESTS IN THE FUTURE OF HEALTHCARE FROM RESEARCH TO EDUCATION.IT IS AN ACTIVE COMMUNITY PARTNER, SUPPORTING AND DRIVING PROGRAMS THAT ENCOURAGE HEALTHIER LIFESTYLES. IT IS ALSO A DYNAMIC ORGANIZATION FOCUSED ON CONTINUOUS DAILY IMPROVEMENT, ADVANCED MEDICINE AND THE DELIVERY OF COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE. THE FISCAL YEAR ENDING JUNE 30, 2020 SAW CAROMONT HEALTH LIVING ITS VISION TO BE OUR COMMUNITY'S MOST TRUSTED HEALTHCARE PARTNER. THE COMPLETE 2020 COMMUNITY BENEFIT REPORT CAN BE FOUND ATWWW.CAROMONTHEALTH.ORG.Desc
Total Program Service Expenses$489,491,875TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document255IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee3912EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldNCStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1THE ORGANIZATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7048342000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVEAddressLine1Txt
CityGASTONIACityNm
State AbbreviationNCStateAbbreviationCd
ZIP28054ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MR DONNIE LOFTIS
CHAIR (THRU MAY 2020)1.002.00Yes (X)Yes (X)$0$0$0
MR DAVID PAYSEUR
VICE CHAIR/CHAIR(BEG. 05/20)1.001.00Yes (X)Yes (X)$0$0$0
DR ANDREW LIGHT
SECRETARY1.002.00Yes (X)Yes (X)$0$0$0
MR BARRY M POMEROY
TREASURER1.001.00Yes (X)Yes (X)$0$0$0
MR JOSEPH B DAVIS JR
DIRECTOR1.001.00Yes (X)$0$0$0
MR TIMOTHY E GAUSE
DIRECTOR (THRU DEC 2019)1.002.00Yes (X)$0$0$0
MR WILLIAM ANTHONY
DIRECTOR1.002.00Yes (X)$0$0$0
DR CHARLES MEAKIN III
DIRECTOR1.003.00Yes (X)$0$0$0
MS PEARL BURRIS FLOYD
DIRECTOR1.001.00Yes (X)$0$0$0
MS ANNETTE CARTER
DIRECTOR1.001.00Yes (X)$0$0$0
MR JEFFREY CASH
DIRECTOR1.001.00Yes (X)$0$0$0
DR TIMOTHY D CONNER
DIRECTOR1.001.00Yes (X)$0$0$0
FRANK STEWART
DIRECTOR1.002.00Yes (X)$0$0$0
MR BOB HOVIS
(COMMISSIONER LIASON)1.002.00Yes (X)$0$18,699$0
DR PATRICK RUSSO
PAST-CHIEF-OF-STAFF (NON-VOTING)2.0040.00Yes (X)$0$654,411$40,208
DR ERIC T EMERSON
IMMEDIATE PAST-CHIEF-OF-STAFF (NON-VOTING)1.001.00Yes (X)$30,000$0$0
DR MICHEAL GASLIN
CHIEF-OF-STAFF1.001.00Yes (X)$26,632$0$0
DR JAY HENDLER
CHIEF-OF-STAFF ELECT (NON-VOTING)1.001.00Yes (X)$0$464,199$29,613
K CHRISTOPHER PEEK
CEO45.0010.00Yes (X)$858,440$0$194,798
DAVID M O'CONNOR
EVP/ASST. TREASURER45.0010.00Yes (X)$643,022$0$127,057
LEIGH K HICKMAN
CLO/ASST. SEC.45.0010.00Yes (X)$268,134$0$26,264
KATHLEEN K BESSON
EVP/COO45.0010.00$611,712$0$150,413Yes (X)
TODD R DAVIS
EVP CHIEF MEDICAL OFFICER45.0010.00$619,368$0$121,597Yes (X)
GEORGE E ADCOCK III
VP40.0010.00$472,617$0$83,287Yes (X)
SHADI HIJJAWI
CHIEF MEDICAL INFO OFFICER40.0010.00$0$339,513$36,106Yes (X)
RICHARD C BLACKBURN
VP SUPPORT SERVICES40.0010.00$346,117$0$71,281Yes (X)
SCOTT E WELLS
VP PATIENT CARE SERVICES40.0010.00$369,784$0$68,211Yes (X)
ROBIN L LANG
VP INFORMATION SERVICES40.0010.00$337,991$0$74,739Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$4,583,817TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,476,822TotReportableCompRltdOrgAmt
Total Other Compensation$1,023,574TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K200IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
EPIC SYSTEMS CORPORATION
PO BOX 88314MILWAUKEEWI532880314SOFTWARE SYSTEMS$3,224,631
BEAM CONSTRUCTION COMPANY INC
PO BOX 129CHERRYVILLENC28021CONSTRUCTION MANAGEMENT$2,952,069
FEREBEE LANE CO
3 N LARENS STREETGREENVILLESC29601ADVERTISING/AGENCY FEES$2,512,154
DPR HARDIN CONSTRUCTION
3301 WINDY RIDGE PKWY 400ATLANTAGA303395618CONSTRUCTION MANAGEMENT$1,923,824
MICROSOFT LICENSING
1950 N STEMMONS FWY STE 5010DALLASTX75207MICROSOFT 365 LICENSES$1,285,318
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K65CntrctRcvdGreaterThan100KCnt
Related Organizations$642,684RelatedOrganizationsAmt
Total Contributions$642,684TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICE REVENUE621500$566,983,371$566,983,371
ANCILLARY REVENUE621500$2,307,947$2,190,592$117,355
FieldValueIRS element (for citing)
Total Program Service Revenue$569,291,318TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$48,383TotalRevenueColumnAmt
Exclusion$48,383ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$60,802OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$60,802OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$60,802TotalRevenueColumnAmt
Exclusion$60,802ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$137,602GrossSalesOfInventoryAmt
Cost Of Goods Sold$82,379CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$55,223TotalRevenueColumnAmt
Exclusion$55,223ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
ECONOMIC IMPACT STIMULUS PAYMENT900099$10,192,890$10,192,890
CAFETERIA & VENDING INCOME722210$1,761,672$1,761,672
MISCELLANEOUS REVENUE900099$1,324,598$1,324,598

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$121,318TotalRevenueColumnAmt
Exclusion$121,318ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$13,400,478OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$583,498,888TotalRevenueColumnAmt
Related Or Exempt Func Income$569,173,963RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$117,355UnrelatedBusinessRevenueAmt
Exclusion$13,564,886ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,104,011TotalAmt
Program Services$1,104,011ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$68,646TotalAmt
Program Services$68,646ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$3,952,476TotalAmt
Program Services$26,632ProgramServicesAmt
Management And General$3,925,844ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$170,407,151TotalAmt
Program Services$153,038,824ProgramServicesAmt
Management And General$17,368,327ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$6,352,345TotalAmt
Program Services$5,576,547ProgramServicesAmt
Management And General$775,798ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$33,330,218TotalAmt
Program Services$29,259,669ProgramServicesAmt
Management And General$4,070,549ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$11,968,165TotalAmt
Program Services$10,506,518ProgramServicesAmt
Management And General$1,461,647ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$796,836TotalAmt
Management And General$796,836ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$163,000TotalAmt
Management And General$163,000ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$1,970TotalAmt
Management And General$1,970ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$20TotalAmt
Management And General$20ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$56,590,412TotalAmt
Program Services$51,617,890ProgramServicesAmt
Management And General$4,972,522ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,434,833TotalAmt
Program Services$74,991ProgramServicesAmt
Management And General$1,359,842ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,220,191TotalAmt
Program Services$2,790,622ProgramServicesAmt
Management And General$1,429,569ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$2,229,819TotalAmt
Program Services$2,229,819ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$10,584,760TotalAmt
Program Services$10,584,760ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$156,744TotalAmt
Program Services$115,521ProgramServicesAmt
Management And General$41,223ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$386,463TotalAmt
Program Services$188,156ProgramServicesAmt
Management And General$198,307ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$6,527,097TotalAmt
Program Services$6,527,097ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$39,528,628TotalAmt
Program Services$39,528,628ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$2,218,827TotalAmt
Program Services$2,218,827ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$100,247,072$100,247,072
UBI TAX$41,218$41,218
BAD DEBT$63,547,583$63,547,583
MEDICAID ASSESSMENT FEE$5,018,579$5,018,579

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$5,620,985TotalAmt
Program Services$5,221,483ProgramServicesAmt
Management And General$399,502ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$526,498,049TotalAmt
Program Services$489,491,875ProgramServicesAmt
Management And General$37,006,174ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$110,927BOYAmt
EOY$101,676EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$61,425,767BOYAmt
EOY$52,785,755EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$9,580,547BOYAmt
EOY$9,919,291EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$8,166,096BOYAmt
EOY$9,162,934EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$610,687,112LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$369,163,835LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$250,345,983BOYAmt
EOY$241,523,277EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$67,066BOYAmt
EOY$71,979EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$8,599,275BOYAmt
EOY$7,313,661EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$102,422,739BOYAmt
EOY$121,336,574EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$440,718,400BOYAmt
EOY$442,215,147EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$45,898,050BOYAmt
EOY$63,226,340EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$165,247,253BOYAmt
EOY$157,789,480EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$95,704,736BOYAmt
EOY$116,622,433EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$306,850,039BOYAmt
EOY$337,638,253EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$111,594,819BOYAmt
EOY$49,902,739EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$22,273,542BOYAmt
EOY$54,674,155EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$133,868,361BOYAmt
EOY$104,576,894EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$440,718,400BOYAmt
EOY$442,215,147EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$57,000,839ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$107NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$86,292,199OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersYes (1)VolunteersInd
Paid Staff Or ManagementYes (1)PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$63,684DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$44,906OtherActivitiesAmt
Total Lobbying Expenditures$108,590TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $44,906 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. THE ORGANIZATION HAD AN ADDITIONAL $45,666 IN LOBBYING COSTS FOR FISCAL YEAR 2020. LOBBYING REGISTRATION IS IN THE NAME OF CAROMONT HEALTH, INC. LOBBYING EXPENDITURES ARE REPORTED ON THE GASTON MEMORIAL HOSPITAL, INC FORM 990.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$10,310BeginningYearBalanceAmt
Investment Earnings Or Losses$228InvestmentEarningsOrLossesAmt
Other Expenditures$348OtherExpendituresAmt
End Year Balance$10,190EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$10,049BeginningYearBalanceAmt
Investment Earnings Or Losses$655InvestmentEarningsOrLossesAmt
Other Expenditures$394OtherExpendituresAmt
End Year Balance$10,310EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$9,841BeginningYearBalanceAmt
Investment Earnings Or Losses$703InvestmentEarningsOrLossesAmt
Other Expenditures$495OtherExpendituresAmt
End Year Balance$10,049EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$9,521BeginningYearBalanceAmt
Investment Earnings Or Losses$1,013InvestmentEarningsOrLossesAmt
Other Expenditures$693OtherExpendituresAmt
End Year Balance$9,841EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$10,002BeginningYearBalanceAmt
Investment Earnings Or Losses-$278InvestmentEarningsOrLossesAmt
Other Expenditures$203OtherExpendituresAmt
End Year Balance$9,521EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,736,410OtherCostOrOtherBasisAmt
Book Value$8,736,410BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$326,966,593OtherCostOrOtherBasisAmt
Depreciation$184,697,708DepreciationAmt
Book Value$142,268,885BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,746,642OtherCostOrOtherBasisAmt
Depreciation$8,370,790DepreciationAmt
Book Value$1,375,852BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$244,301,811OtherCostOrOtherBasisAmt
Depreciation$171,557,897DepreciationAmt
Book Value$72,743,914BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$20,935,656OtherCostOrOtherBasisAmt
Depreciation$4,537,440DepreciationAmt
Book Value$16,398,216BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$241,523,277TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (7 entries)

DescDescBook ValueBookValueAmt
NET PENSION ASSET/DEFERRAL$55,859,083
DEFERRED FINANCING COSTS$1,081,272
OTHER RECEIVABLES$4,232,799
457B PLAN ASSETS$14,620,472
DEFERRED CHARGE-INTEREST RATE SWAP$28,638,074
457F PLAN ASSETS$2,259,874
PREPAID COUNTY LEASE$14,645,000
FieldValueIRS element (for citing)
Total Book Value Other Assets$121,336,574TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
457B PLAN LIABILITY$14,620,472
ESTIMATED 3RD PARTY SETTLEMENTS$62,997,194
INTEREST RATE SWAP LIABILITY$28,638,074
457F PLAN LIABILITY$2,259,874
PENSION DEFERRED INFLOW$8,106,819
FieldValueIRS element (for citing)
Total Liability$116,622,433TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$433,605,366TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$107NetUnrealizedGainsInvstAmt
Revenue Not Reported-$107RevenueNotReportedAmt
Revenue Subtotal$433,605,473RevenueSubtotalAmt
Investment Expenses Not Incld$20InvestmentExpensesNotIncldAmt
Other Revenues Not Included$149,893,395OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$149,893,415RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$583,498,888TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$462,882,148TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$462,882,148ExpensesSubtotalAmt
Investment Expenses Not Incld2$20InvestmentExpensesNotIncld2Amt
Other Expenses Not Included$63,615,881OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$63,615,901ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$526,498,049TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR ONCOLOGY MEDICATIONS FOR INDIGENT PATIENTS.
PART X, LINE 2:THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2020 AND 2019.
PART XI, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT 63,547,583. INTERCOMPANY TRANSFER FROM AFFILIATE 86,290,589. CHANGE IN VALUE OF INTEREST RATE SWAP AUXILIARY REVENUES 55,223.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT 63,547,583. AUXILIARY SCHOLARSHIPS 68,298.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,542,967TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$13,542,967NetCommunityBenefitExpnsAmt
Total Expense0.02930TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$74,551,861TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$67,409,263DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,142,598NetCommunityBenefitExpnsAmt
Total Expense0.01540TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$88,094,828TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$67,409,263DirectOffsettingRevenueAmt
Net Community Benefit Expns$20,685,565NetCommunityBenefitExpnsAmt
Total Expense0.04470TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,501,563TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,026DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,499,537NetCommunityBenefitExpnsAmt
Total Expense0.00320TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,185,812TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$210,412DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,975,400NetCommunityBenefitExpnsAmt
Total Expense0.00430TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$405,247TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$139,797DirectOffsettingRevenueAmt
Net Community Benefit Expns$265,450NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,168,283TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,168,283NetCommunityBenefitExpnsAmt
Total Expense0.00250TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,260,905TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$352,235DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,908,670NetCommunityBenefitExpnsAmt
Total Expense0.01060TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$93,355,733TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$67,761,498DirectOffsettingRevenueAmt
Net Community Benefit Expns$25,594,235NetCommunityBenefitExpnsAmt
Total Expense0.05530TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,414,236TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,414,236NetCommunityBenefitExpnsAmt
Total Expense0.00310TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,414,236TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,414,236NetCommunityBenefitExpnsAmt
Total Expense0.00310TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense$63,547,583BadDebtExpenseAmt
Bad Debt Expense Attributable$15,845,682BadDebtExpenseAttributableAmt
Reimbursed By Medicare$103,864,631ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$117,420,451CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$13,555,820MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CAROMONT REGIONAL MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVEAddressLine1Txt
CityGASTONIACityNm
State AbbreviationNCStateAbbreviationCd
ZIP28054ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Other3 DIAGNOSTIC IMAGING CENTERS AND 6 OP SERIVCE CENTEROtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CAROMONT REGIONAL MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted18CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.CAROMONTHEALTH.ORGOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLWWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMAN-SERVICESOtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt18ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLHTTP://WWW.CAROMONTHEALTH.ORG/DOCUMENTS/FOR-HEALTHCARE-PROFESSIONALS/GASTONStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE DISCLOSUREFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE DISCLOSUREFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE DISCLOSUREFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 5: GASTON COUNTY COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY THE FOLLOWING PARTNERS: THE GASTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, GASTON TOGETHER, UNITED WAY OF GASTON COUNTY, CAROMONT HEALTH, AND STAKEHOLDER ORGANIZATIONS. THE ASSESSMENT INCLUDES THE COLLECTION AND ANALYSIS OF EXISTING STATISTICAL DATA, QUALITY OF LIFE SURVEY DATA COLLECTED DIRECTLY FROM RESIDENTS AND INPUT FROM COMMUNITY FOCUS GROUPS.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 6B: THE HOSPITAL CONDUCTED THEIR CHNA WITH THE FOLLOWING ORGANIZATIONS: GASTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, CAROMONT HEALTH, GASTON TOGETHER, THE UNITED WAY OF GASTON COUNTY AND REPRESENTATIVES OF OTHER STAKEHOLDER ORGANIZATIONS.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 7D: PARTNERING AGENCIES PRESENTED THE CHNA AT WORKSHOPS, MEETINGS AND ON AGENCY WEBSITES TO ENCOURAGE COMMUNITY STAKEHOLDERS TO USE THEM TO ENHANCE THE WELLBEING OF GASTON COUNTY AND ITS RESIDENTS.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 11: CAROMONT HEALTH PRIORITIES (2019-2021) ARE TO PROACTIVELY MANAGE MENTAL HEALTH ISSUES IN PRIMARY CARE OFFICES THROUGH THE HIRE OF MORE LCSWS, ENHANCE OPIOID AND PRESCRIPTION DRUG ABUSE INTERVENTION AND MANAGEMENT PROTOCOLS AND TO IMPROVE ACCESS TO AFFORDABLE HEALTH FOOD IN LOW INCOME COMMUNITIES THROUGH WORK WITH LOCAL STAKEHOLDERS.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 13B: REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY: EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO ONE ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE ALSO EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 15E: CAROMONT HEALTH HAS A TEAM DEDICATED TO EDUCATING AND/OR ASSISTING PATIENTS WITH OTHER STATE OR GOVERNMENT AGENCIES THAT MAY BE A SOURCE OF ASSISTANCE.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 16J: PLAIN LANGUAGE BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBALLY OR IN WRITING TO SCHEDULED PATIENTS PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER SERVICE TO THOSE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. VERBIAGE IS ALSO ON THE PATIENT BILLING STATEMENTS. SPANISH INSTRUCTIONS ON WEBSITE FOR CHARITY CARE AND IN PERSON INTERPRETER STAFF AVAILABLE TO ASSIST.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 18E: COLLECTION ACTIONS ARE TAKEN AFTER REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE PATIENT'S ELIGIBILITY FOR ASSISTANCE.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 20E: PLAIN LANGUAGE BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBIALLY AND/OR IN WRITING TO SCHEDULED PATIENTS PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER SERVICE TO THOSE MOST LIKELY TO QUALIFY FOR ASSISTANCE.
PART V, SECTION B, LINE 16ATHE PLAIN LANGUAGE SUMMARY AND CHARITY CARE APPLICATION CAN BE FOUND USING THE LINKS BELOW:PLAIN LANGUAGE SUMMARY: HTTP://WWW.CAROMONTHEALTH.ORG/DOCUMENTS/REGISTRATION_CHARITYCAREPOLICYCHARITY CARE APPLICATION: HTTP://WWW.CAROMONTHEALTH.ORG/DOCUMENTS/CHARITY-CARE-APPLICATION-ENGLISH

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:FREE CARE IS PROVIDED TO PATIENTS WITH A FPG OF 200% OR LESS. ALL OTHER PATIENTS RECEIVE AN INSURANCE DISCOUNT BASED ON THEIR INDIVIDUAL INSURANCE PLAN AGREEMENT OR AN UNINSURED DISCOUNT FOR SELF PAY PATIENTS. UNINSURED DISCOUNTS ARE COMPARABLE TO OUR INSURANCE DISCOUNTS.REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY:EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO ONE ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS UP TO $25,000 INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS ARE ALSO EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION.PART 1, LINE 6A:COMMUNITY BENEFIT REPORT: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT MADE AVAILABLE TO THE PUBLIC CONTAINS COMMUNITY BENEFITS FOR ALL RELATED ORGANIZATIONS TO THE HOSPITAL.
PART I, LINE 7:THE COSTING METHODOLOGY USED IS A COST ACCOUNTING SYSTEM. ALL PATIENT SEGMENTS ARE INCLUDED. THIS SYSTEM ASSIGNS DIRECT COSTS TO SUPPLIES, PROCEDURES, ROUTINE AND SPECIALTY ROOM RATES BASED ON THE DEPARTMENT OF ORIGINATION. FIXED COSTS ARE ALLOCATED BASED ON STATISTICAL BASIS. THESE COSTS ARE THEN AGGREGATED AT THE PATIENT LEVEL AND TABULATED BY PAYOR TYPE. NO COST TO CHARGE RATIOS WERE USED IN THE CALCULATIONS.
PART I, LN 7 COL(F):63,547,583 BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES PRIOR TO CALCULATING PERCENT OF TOTAL EXPENSE.
PART I, LINE 7H:CAROMONT HEALTH IS INVOLVED IN APPROXIMATELY 40 RESEARCH STUDIES, APPROXIMATELY 55% OF WHICH ARE CLINICAL TRIALS COOPERATIVE GROUP PROGRAM STUDIES SPONSORED BY THE NATIONAL CANCER INSTITUTE (NCI). CAROMONT HEALTH ALSO PARTICIPATES IN DRUG AND DEVICE STUDIES SPONSORED BY VARIOUS PHARMACEUTICAL, BIOTECHNOLOGY, AND DEVICE COMPANIES, AS WELL AS UNFUNDED ONCOLOGY, NURSING AND PHARMACY RESEARCH STUDIES.
PART II, COMMUNITY BUILDING ACTIVITIES:WORKFORCE DEVELOPMENT - CAROMONT HEALTH'S RECRUITMENT OF PHYSICIANS AND ADVANCED CARE PRACTITIONERS INTO THE FIVE COUNTIES THE SYSTEM SERVES IS DRIVEN BY THE CHANGING POPULATION OF THE REGION AND THE SPECIFIC HEALTH NEEDS OF PATIENTS. THE SYSTEM RECRUITS BASED ON A MEDICAL STAFF DEVELOPMENT PLAN THAT IDENTIFIES COMMUNITY HEALTH CARE NEEDS FOR THE NEXT FIVE YEARS. THE SYSTEM'S GOAL IS TO BE PRO-ACTIVE AND ANTICIPATORY SO THAT THE HEALTH CARE NEEDS OF THE COMMUNITY ARE MET IN A QUALITY-DRIVEN AND CONVENIENT MANNER. ADDITIONALLY, CAROMONT HEALTH OFFERS A FULL PROGRAM FOCUSED ON JOB COMPETENCY TRAINING AND PROFESSIONAL DEVELOPMENT OPPORTUNITIES FOR EMPLOYEES AT ALL LEVELS OF THE ORGANIZATION.
PART III, LINE 2:CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPARTMENT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING AND/OR APPLICATIONS FILED BY THE PATIENTS. IF NO MEANS TESTING IS DONE AND NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPARTMENT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY.
PART III, LINE 2:CHARGES WRITTEN OFF TO BAD DEBT WERE TABULATED AT THE PATIENT LEVEL AND ARE REPORTED AT THE AMOUNT CHARGED TO PATIENTS. ACCOUNTS ARE RESERVED AS BAD DEBT BASED ON AN ACCOUNTS RECEIVABLE AGING METHODOLOGY. WHEN ACCOUNTS ARE SENT TO A COLLECTION AGENCY, THEY ARE WRITTEN OFF THE ACCOUNTS RECEIVABLE SYSTEM. ANY SUBSEQUENT COLLECTIONS ON THE ACCOUNTS ARE POSTED AS RECOVERIES AND REDUCE THE EXPENSE. ALL UNINSURED PATIENTS RECEIVE A DISCOUNT ON THEIR BILL, WHICH IS RECORDED AS A CONTRACTUAL ADJUSTMENT. THE AMOUNT OF THE UNINSURED DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE. PART III, LINE 3: CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPARTMENT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING AND/OR APPLICATIONS FILED BY THE PATIENTS. IF NO MEANS TESTING IS DONE AND NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPARTMENT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. BAD DEBT EXPENSE IS REPORTED AS A DEDUCTION FROM PATIENT REVENUE.
PART III, LINE 1:THE ORGANIZATION COMPLIES WITH THE REPORTING REQUIREMENTS OF GASB. STATEMENT NO. 15 IS NOT APPLICABLE.
PART III, LINE 8:THE MEDICARE COST REPORT STANDARD COSTING METHODOLOGY WAS FOLLOWED WHEN FILING THE COST REPORT. THIS IS A STEP DOWN METHODOLOGY THAT APPLIES THE AVERAGE PATIENT COST TO MEDICARE PATIENTS. THE COST REPORT DOES NOT ALLOW HOSPITALS TO REPORT ALL OPERATING COSTS. BECAUSE OF THESE TWO ISSUES, THE MEDICARE COST REPORT METHODOLOGY UNDERSTATES THE TRUE COST OF TREATING MEDICARE PATIENTS.
PART III, LINE 9B:THE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BELOW IS VERBIAGE FROM THE CHARITY POLICY:CAROMONT REGIONAL MEDICAL CENTER OFFERS MEDICAL SERVICES FREE OF CHARGE THROUGH THE CHARITY CARE PROGRAM. DETERMINATION OF CHARITY CARE WILL BE BASED ON THE PATIENT'S INCOME, FAMILY SIZE, AND ASSETS. POTENTIAL ELIGIBILITY EXISTS ONLY AFTER THE REIMBURSEMENT EFFORTS FROM ALL OTHER THIRD PARTY RESOURCES, FEDERAL, STATE, AND LOCAL ASSISTANCE PROGRAMS HAVE BEEN EXHAUSTED.
PART VI, LINE 2:CAROMONT HEALTH ESTABLISHES COMMUNITY PRIORITIES THROUGH A NUMBER OF MECHANISMS:1. LEADERSHIP OPINIONS ARE SOUGHT TO HELP IDENTIFY NEEDED SERVICES IN THE COMMUNITY VIA PARTNERSHIPS WITH THE GASTON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, LOCAL NON-PROFIT ORGANIZATIONS FOCUSED ON HEALTH IMPROVEMENT IN OUR COMMUNITIES AND OTHER HEALTH-FOCUSED ENTITIES. CAROMONT HEALTH ALSO WORKS WITH COMMUNITY AGENCIES TO CONDUCT COMMUNITY NEEDS ASSESSMENTS AND QUALITY OF LIFE SURVEYS EVERY TWO TO THREE YEARS. 2. PATIENT SATISFACTION DATA IS ANALYZED TO DETERMINE WHERE AND/OR HOW SERVICES NEED TO BE IMPROVED.3. SERVICE AREA DATA (VITAL STATISTICS, DEMOGRAPHICS AND UTILIZATION) ARE ANALYZED FOR TRENDS. THIS INFORMATION IS COORDINATED WITH PUBLIC HEALTH DATA TO DETERMINE VOIDS AND SERVICE AREA HEALTH PROBLEMS.4. FINDINGS FROM COMMUNITY SURVEYS/REPORTS PUBLISHED BY OTHER ORGANIZATIONS (UNITED WAY, CHAMBER OF COMMERCE, PARTNERSHIP FOR CHILDREN, GASTON COUNTY GOVERNMENT, ETC.) ARE GATHERED AND REVIEWED FOR PERTINENCE TO COMMUNITY HEALTH PROBLEMS.5. BOARD MEMBERS, SENIOR LEADERS AND DEPARTMENT DIRECTORS ARE INVOLVED IN NUMEROUS ORGANIZATIONS IN THE COMMUNITY. THROUGH THIS NETWORK OF RELATIONSHIPS, INFORMATION ABOUT THE COMMUNITY AND THE NEEDS OF AREA RESIDENTS AND ORGANIZATIONS IS USED IN THE DEVELOPMENT OF PROGRAMS AND SERVICES AVAILABLE THOUGH CAROMONT HEALTH.
PART VI, LINE 3:THE ORGANIZATION INFORMS AND EDUCATES THE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE IN SEVERAL WAYS. A CHARITY AND FINANCIAL SUMMARY IS ON OUR WEBSITE, AND BROCHURES ARE DISTRIBUTED IN THE EMERGENCY ROOM AND ALL OTHER REGISTRATION SITES. SPECIFICALLY TRAINED STAFF (FINANCIAL COUNSELORS AND BENEFIT ELIGIBILITY SPECIALISTS) PROACTIVELY MAKE CONTACT WITH PATIENTS PRIOR TO, AT TIME OF SERVICE, AND/OR AFTER DISCHARGE TO DISCUSS ELIGIBILITY FOR MEDICAID AND OTHER INSURANCE BENEFITS AND OFFER ASSISTANCE WITH THE APPLICATIONS. THE COMMUNICATION IS ATTEMPTED AS SOON AS POSSIBLE. WRITTEN COMMUNICATION IS MADE PRIOR TO COLLECTION AGENCY PLACEMENT.
PART VI, LINE 4:GASTON COUNTY, COVERING 355.9 SQUARE MILES IN THE SOUTHERN PORTION OF THE PIEDMONT REGION OF NORTH CAROLINA, IS THE ORGANIZATION'S PRIMARY MARKET. LINCOLN, CLEVELAND AND YORK COUNTY, AS WELL AS PARTS OF WESTERN MECKLENBURG COUNTY, MAKE UP THE HEALTH SYSTEM'S SECONDARY MARKET. ACCORDING TO THE U.S. CENSUS BUREAU, GASTON COUNTY HAD AN ESTIMATED POPULATION OF 224,529, A MEDIAN HOUSEHOLD INCOME OF $49,384 AND 14.2% OF PERSONS IN POVERTY. RACE AND ETHNIC DEMOGRAPHICS STATE THAT 77.6% OF THE POPULATION IDENTIFY THEMSELVES AS WHITE, 17.9% AS BLACK OR AFRICAN AMERICAN, 7.6% AS HISPANIC, 2.2% AS TWO OR MORE RACES AND 1.6% AS ASIAN.
PART VI, LINE 5:COMMUNITY HEALTHCOMMUNITY HEALTH INITIATIVES ARE FOCUSED PRIMARILY ON DISEASE PREVENTION AND BETTER MANAGEMENT OF CHRONIC ILLNESSES. THAT INCLUDES WORKING WITH LOCAL EMPLOYERS ON INNOVATIVE PROGRAMS AND COLLABORATING WITH OUR HEALTH CARE NEIGHBORS, MANAGING ILLNESS WITHIN THE HEALTH SYSTEM'S WORKFORCE AND INTENSE FOCUS ON SUCCESSFUL CARE COORDINATION FOR PATIENTS WITH CHRONIC DISEASE. ADDITIONALLY, CAROMONT PROVIDES NEARLY $1 MILLION ANNUALLY IN SPONSORSHIP AND GRANT SUPPORT FOR LOCAL NON-PROFITS, COMMUNITY PROGRAMS AND SERVICES, AND OTHER COMMUNITY INITIATIVES AIMED AT IMPROVING THE HEALTH OF OUR COMMUNITY. THROUGH INNOVATION AND A FOCUS ON COMMUNITY WELLNESS, CAROMONT HEALTH IS DETERMINED TO MAKE POSITIVE IMPACT ON HEALTH AND WELLNESS OF THE POPULATIONS WE SERVE.
PART VI, LINE 6:ESTABLISHED IN 1946, CAROMONT REGIONAL MEDICAL CENTER IS A 435-BED, NOT-FOR-PROFIT ACUTE CARE FACILITY OFFERING COMPREHENSIVE INPATIENT HOSPITAL SERVICES. CAROMONT REGIONAL MEDICAL CENTER IS THE ANCHOR OF CAROMONT HEALTH, A HEALTH CARE SYSTEM WITH FIVE AFFILIATE COMPANIES INCLUDING A NETWORK OF 55 PRIMARY AND SPECIALTY PHYSICIAN OFFICES.CAROMONT REGIONAL MEDICAL CENTER HAS 3 DIAGNOSTIC IMAGING CENTERS, A SAME-DAY SURGERY CENTER, AND 1 OFF-SITE EMERGENCY DEPARTMENT. CAROMONT HEALTH ALSO HAS A FREE-STANDING ENDOSCOPY CENTER, 1 AMBULATORY SURGERY CENTER, AND 1 OCCUPATIONAL MEDICINE CLINIC.
PART VI, LINE 7, REPORTS FILED WITH STATESNC

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (20 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
GASTON COUNTY LEASE
128 WEST MAIN AVEGASTONIANC28052566000300GOVERNMENTAL$472,987COMMUNITY ASSISTANCE
KINTEGRA HEALTH
991 WEST HUDSON BLVDGASTONIANC28052581958398501(C)(3)$262,524COMMUNITY ASSISTANCE
GASTON COUNTY FAMILY YMCA
201 SOUTH CLAY STREETGASTONIANC28052560655420501(C)(3)$107,500COMMUNITY ASSISTANCE
GASTON COUNTY SCHOOLS
PO BOX 1397GASTONIANC280531397566001032GOVERNMENTAL$75,000COMMUNITY ASSISTANCE
GASTON REGIONAL CHAMBER
601 W FRANKLIN BLVDGASTONIANC28053560232990501(C)(6)$33,000COMMUNITY ASSISTANCE
GASTON TOGETHER
P O BOX 817GASTONIANC28053562048064501(C)(3)$22,000COMMUNITY ASSISTANCE
CITY OF MT HOLLY MUNICIPAL COMPLEX
400 EAST CENTRAL AVEMT HOLLYNC28120566001295501(C)(3)$16,000COMMUNITY ASSISTANCE
DOWNTOWN BELMONT DEVELOPMENT ASSOCIATION
PO BOX 431BELMONTNC28012474333734501(C)(3)$15,000COMMUNITY ASSISTANCE
MONTCROSS AREA CHAMBER OF COMMERCE
PO BOX 368BELMONTNC28012560710166501(C)(3)$13,000COMMUNITY ASSISTANCE
THE CATHERINE PHARR CARSTARPHEN
PO BOX 1939MCADENVILLENC28101560623961501(C)(3)$12,500COMMUNITY ASSISTANCE
HEART SOCIETY OF GASTON COUNTY
1201 EAST GARRISON BLVDGASTONIANC28054561330921501(C)(3)$12,000COMMUNITY ASSISTANCE
HOLY ANGELS INC
660 WILKINSON BLVDBELMONTNC28012561762654501(C)(3)$10,000COMMUNITY ASSISTANCE
UNITED WAY OF GASTON COUNTY
200 EAST FRANKLIN BLVDGASTONIANC28052560653356501(C)(3)$10,000COMMUNITY ASSISTANCE
BOYS AND GIRLS CLUB OF GREATER GASTON
PO BOX 23GASTONIANC28053561419498501(C)(3)$8,000COMMUNITY ASSISTANCE
GIRLS ON THE RUN OF GASTON COUNTY
190 S OAKLAND STREETGASTONIANC28052474179257501(C)(3)$7,500COMMUNITY ASSISTANCE
CITY OF BESSEMER CITY
125 EAST VIRGINA AVEBESSEMER CITYNC28016566001177GOVERNMENTAL$7,000COMMUNITY ASSISTANCE
CANCER SERVICES OF GASTON COUNTY
306 SOUTH COLUMBIA STGASTONIANC28054561164253501(C)(3)$5,000COMMUNITY ASSISTANCE
CITY OF GASTONIA
PO BOX 1748GASTONIANC28053566000227GOVERNMENTAL$5,000COMMUNITY ASSISTANCE
CITY OF LOWELL
101 WEST FIRST STLOWELLNC28098GOVERNMENTAL$5,000COMMUNITY ASSISTANCE
GASTON COUNTY EDUCATION FOUNDATION
PO BOX 1397GASTONIANC28053561764830501(C)(3)$5,000COMMUNITY ASSISTANCE
FieldValueIRS element (for citing)
Total501c3 Org19Total501c3OrgCnt
Total Other Org1TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
ONCOLOGY PHARMACY FUND7$348
SCHOLARSHIPS38$68,298

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 2:OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED.
SCHEDULE I, PART IIITHE PURPOSE OF THE GERTRUDE CLINTON HEALTH CAREERS SCHOLARSHIP IS TO ENCOURAGE MEDICAL AND HEALTH-RELATED PROFESSIONALS IN THE FIELD OF HUMAN SERVICES TO PRACTICE THEIR SPECIALTIES AT CAROMONT REGIONAL MEDICAL CENTER OR IN GASTON COUNTY.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation Required0SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR PATRICK RUSSO
PAST-CHIEF-OF-STAFF (NON-VOTING)$0$550,856$0$102,260$0$1,295$0$19,600$0$20,608$0$694,619$0$0
DR JAY HENDLER
CHIEF-OF-STAFF ELECT (NON-VOTING)$0$426,012$0$34,238$0$3,949$0$9,800$0$19,813$0$493,812$0$0
K CHRISTOPHER PEEK
CEO$657,863$0$192,930$0$7,647$0$174,008$0$20,790$0$1,053,238$0$0$0
DAVID M O'CONNOR
EVP/ASST. TREASURER$449,942$0$101,741$0$91,339$0$106,289$0$20,768$0$770,079$0$75,414$0
LEIGH K HICKMAN
CLO/ASST. SEC.$238,796$0$28,618$0$720$0$12,366$0$13,898$0$294,398$0$0$0
KATHLEEN K BESSON
EVP/COO$437,101$0$99,423$0$75,188$0$129,650$0$20,763$0$762,125$0$67,556$0
TODD R DAVIS
EVP CHIEF MEDICAL OFFICER$431,578$0$98,673$0$89,117$0$100,835$0$20,762$0$740,965$0$66,915$0
GEORGE E ADCOCK III
VP$299,767$0$170,087$0$2,763$0$62,603$0$20,684$0$555,904$0$0$0
SHADI HIJJAWI
CHIEF MEDICAL INFO OFFICER$0$317,855$0$21,433$0$225$0$16,536$0$19,570$0$375,619$0$0
RICHARD C BLACKBURN
VP SUPPORT SERVICES$251,660$0$54,709$0$39,748$0$50,603$0$20,678$0$417,398$0$32,783$0
SCOTT E WELLS
VP PATIENT CARE SERVICES$267,343$0$57,961$0$44,480$0$55,370$0$12,841$0$437,995$0$36,086$0
ROBIN L LANG
VP INFORMATION SERVICES$275,435$0$61,931$0$625$0$64,497$0$10,242$0$412,730$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ATHE ORGANIZATION HAS A POLICY TO ADDRESS WHEN SPOUSAL TRAVEL IS PERMITTED AND PAYS CLUB DUES FOR THE PRESIDENT/CEO FOR BUSINESS PURPOSES AS PART OF THE EMPLOYMENT CONTRACT.
PART I, LINE 4BTHE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM THE FILING ORGANIZATION FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 86,689 KATHLEEN K. BESSON - 84,713 TODD DAVIS, MD - 84,067 K. CHRISTOPHER PEEK - 158,940 DR. G.E. WARD ADCOCK III- 46,463 SCOTT E. WELLS- 41,182 ROBIN LANG- 41,655
PART I, LINE 6EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES WHICH INCLUDE A FINANCIAL GOAL ATTRIBUTABLE TO OPERATING MARGIN. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS. CERTAIN CAROMONT MEDICAL GROUP, INC. PHYSICIAN'S COMPENSATION PACKAGES ARE BASED ON THE INDIVIDUAL PHYSICIANS NET RESULTS FROM OPERATIONS AS CALCULATED BASED SOLELY ON HIS/HER NET CHARGES LESS HIS/HER ALLOCABLE SHARE OF CLINIC OVERHEAD COSTS.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
NORTH CAROLINA MEDICAL CARE COMMISSION
A5213094022003-01-23$120,000,000SEE PART VI000
NORTH CAROLINA MEDICAL CARE COMMISSION
B5213094022019-11-19$41,460,000SEE PART VI000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtCapitalized InterestCapitalizedInterestAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$1,700,000$123,594,002$5,150,936$1,256,069$3,386,000$91,583,288$22,217,70920050Yes (1)Yes (1)Yes (1)
B$5,000$41,460,0000Yes (1)Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndEngage Bond Counsel ContractsEngageBondCounselContractsIndAny Research AgreementsAnyResearchAgreementsIndEngage Bond Counsel ResearchEngageBondCounselResearchIndPrivate Bus Use By OthersPrivateBusUseByOthersPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndChange In Use Bond Financed PropChangeInUseBondFinancedPropPctRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00Yes (1)Yes (1)Yes (1)Yes (1)0.001500.001500Yes (1)0.001100Yes (1)
B00000.000000.0000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndBusiness Name Line2HedgeProviderName/BusinessNameLine2TxtTerm Of HedgeTermOfHedgePctSuperintegrated HedgeSuperintegratedHedgeIndHedge TerminatedHedgeTerminatedIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
MERRILL LYNCH
A000Yes (1)Yes (1)Yes (1)CAPITAL SERVICES31.600000000000Yes (1)000Yes (1)
(no name)
B0000Yes (1)000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
DATE REBATE COMPUTATION PERFORMEDISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 12/05/2017
SCHEDULE K SUPPLENTAL INFORMATIONTHREE 501(C)(3) ORGANIZATIONS WITHIN THE PARENT-SUBSIDIARY CONTROLLED GROUP BENEFIT FROM THE BONDS AS FOLLOWS: GASTON MEMORIAL HOSPITAL, INC. (56-0619359) CAROMONT HEALTH, INC. (58-1636959) CAROMONT HEALTH SERVICES, INC. (56-1455630) CAROMONT REGIONAL MEDICAL CENTER HOLDS THE LIABILITY FOR THE BONDS, PER AUDITED FINANCIAL STATEMENTS.
SCHEDULE K, PART I, COLUMN (F); DESCRIPTION OF PURPOSE:ISSUE A - THE SYSTEM USED THE PROCEEDS FROM THESE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO, A NEW WOMEN'S CENTER AND PARKING DECK, RENOVATIONS TO EXISTING FACILITIES, AND EQUIPMENT. IN ADDITION, PROCEEDS WERE USED TO REFUND IN ADVANCE OF THEIR MATURITIES $17,000,000 IN PRINCIPAL AMOUNT OF THE SERIES 1998 HOSPITAL REVENUE BONDS. ISSUE B - ON NOVEMBER 19, 2019 THE BANK EXCHANGED THE 2018 TAXABLE BONDS FOR FIXED RATE TAX-EXEMPT BONDS (THE "2019 TAX-EXEMPT BONDS") ISSUED BY THE NCMCC. THIS EXCHANGE OF THE SERIES 2018 BONDS FOR THE SERIES 2019 TAX-EXEMPT BONDS CONSTITUTES A CURRENT REFUNDING OF THE SERIES 2018 BONDS AND PROVIDES CAROMONT WITH INCREMENTAL INTEREST COST SAVINGS.
SCHEDULE K, PART II, LINE 3 COLUMN (A):LINE 3 COLUMN (A) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 3,594,002.
SCHEDULE K, PART II, LINE 11; OTHER SPENT PROCEEDS:OTHER SPENT PROCEEDS INCLUDE DEPOSITS MADE INTO A REFUNDING ESCROW ACCOUNT ALONG WITH INTEREST EARNED ON THE ACCOUNT, BOTH OF WHICH WERE SUBSEQUENTLY USED TO PAY PRINCIPLE AND INTEREST ON THE REFUNDED BONDS. SEE THE RESPONSE FOR PART I, COLUMN (F) FOR DETAILS.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonGENA POMEROYPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionFAMILY RELATIONSHIP WITH BOARD MEMBERRelationshipDescriptionTxt
Transaction$49,410TransactionAmt
TransactionCOMPENSATION FOR EMPLOYEE SERVICESTransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE CORPORATION IS CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF DIRECTORS CONSISTS OF FOURTEEN (14) MEMBERS, ALL OF WHOM ARE THE MEMBERS OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC., AND ALL OF WHOM ARE APPOINTED BY THE BOARD OF DIRECTORS OF CAROMONT HEALTH.
FORM 990, PART VI, SECTION A, LINE 7BTHE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11BTHE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CMEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF SENIOR LEADERSHIP, ANY PHYSICIAN HOLDING A LEADERSHIP OR ADMINISTRATIVE POSITION WITHIN THE ORGANIZATION, DIRECTORS, RESEARCH STUDY PERSONNEL, MANAGERS AND ALL STAFF MEMBERS OF THE PURCHASING AND MARKETING DEPARTMENTS AND ANY OTHER DEPARTMENT DEEMED TO HAVE MATERIAL DECISION MAKING RESPONSIBILITIES ON BEHALF OF CAROMONT HEALTH SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE INDIVIDUAL'S OBLIGATION TO IMMEDIATELY MAKE THE CORPORATE RESPONSIBILITY OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID INDIVIDUAL'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. QUESTIONNAIRES SUBMITTED BY DIRECTORS ARE REVIEWED ANNUALLY BY THE NOMINATING COMMITTEE OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15THE CEO, CFO, COO, CMO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY CAROMONT REGIONAL MEDICAL CENTER, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. A MAJORITY OF BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND ALL ARE FREE FROM ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE MANAGEMENT UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE.
FORM 990, PART VI, SECTION C, LINE 18THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11GHOSPITALIST FEES: PROGRAM SERVICE EXPENSES 8,335,038. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,335,038. PHYSICIAN LEADERSHIP FEES: PROGRAM SERVICE EXPENSES 269,449. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 269,449. INTEGRATION & PERFORMANCE IMPROVEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 583,225. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 583,225. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 28,041,906. MANAGEMENT AND GENERAL EXPENSES 2,139,613. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,181,519. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,742,020. MANAGEMENT AND GENERAL EXPENSES 514,612. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,256,632. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 5,737,270. MANAGEMENT AND GENERAL EXPENSES 60,758. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,798,028. CTS BIOMED: PROGRAM SERVICE EXPENSES 1,276,826. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,276,826. CONSULTING FEES: PROGRAM SERVICE EXPENSES 139,172. MANAGEMENT AND GENERAL EXPENSES 1,382,362. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,521,534. LICENSE FEES: PROGRAM SERVICE EXPENSES 76,209. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,209. TAX EXEMPT BOND FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 291,952. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 291,952.
FORM 990, PART XI, LINE 9:INTERCOMPANY TRANSFER FROM AFFILIATE -86,290,589. AUXILIARY NET ASSET ADJUSTMENT -1,610.
PART XII, LINE 2CTHE PROCESS HAS NOT CHANGED FROM LAST YEAR.
FORM 990, PART V AND PART VIICOMMON PAYMASTER: THE FILING ORGANIZATION USES A RELATED ORGANIZATION FOR ITS PAYROLL FUNCTION. ALL W-2S ARE FILED BY THE COMMON PAYMASTER. HOWEVER, AMOUNTS PAID BY THE COMMON PAYMASTER ARE TREATED AS IF PAID DIRECTLY BY THE ORGANIZATION FOR WHICH SERVICES ARE PERFORMED.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
CAROMONT HEALTH INC
2525 COURT DRIVEGASTONIANC28054581636959MEDICAL SERVICESNC501(C)(3)LINE 12C, III-FIN/A0
CAROMONT HEALTH SERVICES INC
2526 COURT DRIVEGASTONIANC28054561455630OUTPATIENT SERVICESNC501(C)(3)LINE 30CAROMONT HEALTH INC
GASTON MEMORIAL HOSPITAL FOUNDATION INC
2527 COURT DRIVEGASTONIANC28054561479699FOUNDATIONNC501(C)(3)LINE 110CAROMONT HEALTH INC
CAROMONT MEDICAL GROUP INC
2528 COURT DRIVEGASTONIANC28054561479712MEDICAL GROUPNC501(C)(3)LINE 110CAROMONT HEALTH INC
HOSPICE OF GASTON COUNTY INC
2529 COURT DRIVEGASTONIANC28054581341530HOSPICE CARENC501(C)(3)LINE 70CAROMONT HEALTH INC
GASTON COUNTY
PO BOX 1578GASTONIANC280531578566000300GOVERNMENT ADMINISTRATIONNCN/A0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd