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CALDWELL MEMORIAL HOSPITAL INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
CALDWELL MEMORIAL HOSPITAL INC (EIN 56-0554202)
Tax period
2019-07-01 to 2020-06-30
Filed
2021-05-11
IRS object ID
202121319349303122
Schema version
2019v5.1
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)
Return2021-05-11T15:37:24-05:00ReturnTs
Tax Period End2020-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BDO USA LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1421 Fayetteville Street Suite 300AddressLine1Txt
CityRaleighCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27601ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN560554202EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Caldwell Memorial HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% MICHAEL BUNCHInCareOfNm
Business Name ControlCALDBusinessNameControlTxt
Phone8287575100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1321 Mulberry Street SWAddressLine1Txt
CityLenoirCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28645ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL BUNCHPersonNm
Person TitleCFOPersonTitleTxt
Phone8287575100PhoneNum
Signature2021-04-26SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSANDRA L FEINSMITHPreparerPersonNm
PTINP01064157PTIN
Phone9192781936PhoneNum
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLaura J EastonPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1321 Mulberry Street SWAddressLine1Txt
CityLenoirCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28645ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$140,717,562GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.caldwellmemorial.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1945FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTo provide safe, effective, compassionate care and to promote healthy lifestyles to our community.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee1113TotalEmployeeCnt
Total Volunteers97TotalVolunteersCnt
Total Gross UBI$589,790TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$466,704NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$15,872,415PYContributionsGrantsAmt
CY Contributions Grants$7,800,860CYContributionsGrantsAmt
PY Program Service Revenue$136,176,010PYProgramServiceRevenueAmt
CY Program Service Revenue$130,287,669CYProgramServiceRevenueAmt
PY Investment Income$1,107,109PYInvestmentIncomeAmt
CY Investment Income-$409,266CYInvestmentIncomeAmt
PY Other Revenue$889,495PYOtherRevenueAmt
CY Other Revenue$3,038,299CYOtherRevenueAmt
PY Total Revenue$154,045,029PYTotalRevenueAmt
CY Total Revenue$140,717,562CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$68,105,030PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$66,402,178CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$74,247,037PYOtherExpensesAmt
CY Other Expenses$75,474,577CYOtherExpensesAmt
PY Total Expenses$142,352,067PYTotalExpensesAmt
CY Total Expenses$141,876,755CYTotalExpensesAmt
PY Revenues Less Expenses$11,692,962PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,159,193CYRevenuesLessExpensesAmt
Total Assets BOY$97,819,298TotalAssetsBOYAmt
Total Assets EOY$106,154,351TotalAssetsEOYAmt
Total Liabilities BOY$28,653,005TotalLiabilitiesBOYAmt
Total Liabilities EOY$38,147,251TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$69,166,293NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$68,007,100NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO PROVIDE SAFE, EFFECTIVE, COMPASSIONATE CARE AND TO PROMOTE HEALTHY LIFESTYLES TO OUR COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$118,802,611ExpenseAmt
Grant$0GrantAmt
Revenue$132,271,311RevenueAmt
DescSINCE OPENING IN 1951, CALDWELL MEMORIAL HOSPITAL HAS CONTINUED TO GROW AND CHANGE IN ORDER TO BETTER MEET THE NEEDS OF OUR COMMUNITY. THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROVIDE SAFE, EFFECTIVE, COMPASSIONATE CARE AND TO PROMOTE HEALTHY LIFESTYLES TO OUR COMMUNITY. ANCHORED BY A 110-BED ACUTE CARE FACILITY, CALDWELL MEMORIAL HOSPITAL'S SERVICES INCLUDE A VAST ARRAY OF MEDICAL AND SURGICAL SERVICES. AMONG SERVICES OFFERED, BUT BY NO MEANS A COMPLETE LIST, ARE CAROTID ARTERY STENTING; CARDIOVASCULAR AND ENDOVASCULAR CARE; RADIATION ONCOLOGY; COMPUTER-ASSISTED ORTHOPEDIC SURGERY; NEUROLOGY AND MEMORY CARE; PAIN MANAGEMENT; A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT; CALDWELL PHYSICIANS CLINICS CONVENIENTLY LOCATED COUNTY-WIDE; DIAGNOSTIC SERVICES; OUTPATIENT SURGERY; PLUS URGENT CARE; AND THE QUEST 4 LIFE WELLNESS CENTER. MULTIPLE EDUCATIONAL AND COUNSELING PROGRAMS ARE AVAILABLE FOR A WIDE ARRAY OF HEALTHCARE NEEDS INCLUDING CANCER, DIABETES, NUTRITION, JOINT CARE, PRE-NATAL CLASSES AND PARENTING SKILLS. IN LATE DECEMBER 2019, CALDWELL STARTED A 2 CHAMBER HYPERBARIC SERVICE AS PART OF THE WOUND CARE PROGRAM. CALDWELL PHYSICIANS IS A DIVISION OF CALDWELL MEMORIAL HOSPITAL. WITH PRACTICES IN COMMUNITIES COUNTYWIDE, CALDWELL PHYSICIANS PROVIDES THE PRIMARY AND SPECIALTY HEALTHCARE, DIAGNOSTICS AND TREATMENTS THAT OUR COMMUNITY NEEDS IN CONVENIENT LOCATIONS NEAR THEIR HOMES. CALDWELL PHYSICIANS INCLUDES: ANDERSON MEDICAL PARK, ANDERSON PLUS URGENT CARE, BLOWING ROCK MEDICAL, BLOWING ROCK PLUS URGENT CARE, LAUREL PARK WOMEN'S HEALTH - LENOIR, LAUREL PARK WOMEN'S HEALTH - GRANITE FALLS, MULBERRY PEDIATRICS, ROBBINS MEDICAL PARK, ROBBINS PULMONOLOGY, ROBBINS EAR, NOSE, THROAT AND ALLERGY, ROBBINS PLUS URGENT CARE, ROBBINS CARDIOLOGY, ROBBINS SURGICAL, SOUTHFORK MEDICAL PARK, RIVERCREST MEDICAL PARK, RIVERCREST PLUS URGENT CARE, THE FALLS PEDIATRICS, WESTPOINTE MEDICAL PRACTICE, CALDWELL UROLOGY ASSOCIATES, CALDWELL FOOT & ANKLE, AND THE FALLS PEDIATRICS PLUS URGENT CARE. IN SPRING 2000, CALDWELL EMPLOYED AN ORTHOPEDIST TO JOIN CALDWELL PHYSICIAN NETWORK IN THE PODIATRY CLINIC KNOWN AS UNC ORTHO. THE ORTHOPEDIST OFFERS GENERAL ORTHOPEDICS WITH FOCUS ON HANDS. IN RESPONSE TO THE 2020 GLOBAL PANDEMIC, CALDWELL OPENED TWO RESPiratory DIAGNOSTIC CENTERS (RDC) IN THE COUNTY FOR COVID-19 TESTING. ONE CENTER IN LENoir AND THE OTHER IN GRANITE FALLS.Desc
Total Program Service Expenses$118,802,611TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document135IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1113EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMICHAEL BUNCHPersonNm
Phone8287575100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1321 MULBERRY STREET SWAddressLine1Txt
CityLenoirCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28645ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndOfficerOfficerIndKey EmployeeKeyEmployeeInd
Chris Ellington
Director2.058.0Yes (X)$0$1,084,690$184,123
Ralph Duckett
Medical Practice Physician60.00.0$615,533$0$11,592Yes (X)
Thomas Young
Medical Practice Physician60.00.0$462,886$0$33,773Yes (X)
Philip Jenkins
Medical Practice Physician60.00.0$446,409$0$26,645Yes (X)
David Cook
Medical Practice Physician60.00.0$439,178$0$14,807Yes (X)
Timothy Clenney
Medical Practice Physician60.00.0$428,780$0$0Yes (X)
Laura Easton
Director/President & CEO60.00.0Yes (X)$360,506$0$40,408Yes (X)
David Lowery MD
CMO60.00.0$341,680$0$40,645Yes (X)
John Powell MD
Director2.00.0Yes (X)$254,912$0$37,360
Rebecca Smith
COO & CNO60.00.0$248,515$0$21,846Yes (X)
Michael Bunch
CFO60.00.0$238,604$0$17,086Yes (X)
Donita Damron
VP Physician Services60.00.0$173,372$0$14,872Yes (X)
Michael Chamberlain
Director2.00.0Yes (X)$0$0$0
Jerry Church
Director2.00.0Yes (X)$0$0$0
Richard Coffey
Director2.00.0Yes (X)$0$0$0
Joseph Gibbons
Director2.00.0Yes (X)$0$0$0
William Howard III
Director2.00.0Yes (X)$0$0$0
Doug Johnson
Director2.00.0Yes (X)$0$0$0
Jeffrey Keverline MD
Director2.00.0Yes (X)$0$0$0
Diana McClinton MD
Director2.00.0Yes (X)$0$0$0
Edward Pearce MD
Director2.00.0Yes (X)$0$0$0
David Smith
Director2.00.0Yes (X)$0$0$0
Alan Stiles
Director2.00.0Yes (X)$0$0$0
Crystal Thomas
Director2.00.0Yes (X)$0$0$0
Boyd Wilson Jr
Director2.00.0Yes (X)$0$0$0
Janet Aiken
Director2.00.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$4,010,375TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,084,690TotReportableCompRltdOrgAmt
Total Other Compensation$443,157TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K91IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
David E Looper Company Inc
320 15th Street SEHICKORYNC28602Construction$4,490,895
Enduracare Acute Care Services
381 Riverside Drive Suite 440FRANKLINTN37064Therapy Program Mgmt$1,081,052
DLP Cardiac Partners LLC
3700 Arco Corp Office Suite 450CHARLOTTENC27273Cath Lab$1,059,407
Mountain Emergency Physicians
319 Springwood Drive NEVALDESENC28690Physician Services$854,926
Keach Construction Inc
10200 Industrial DrivePINEVILLENC28134Construction$492,606
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K20CntrctRcvdGreaterThan100KCnt
Related Organizations$3,300,860RelatedOrganizationsAmt
Government Grants$4,500,000GovernmentGrantsAmt
Total Contributions$7,800,860TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
PATIENT SERVICES621500$125,488,254$125,488,254
QUEST4LIFE WELLNESS CENTER REVENUE713990$589,790$589,790
OTHER PROGRAM SERVICES REVENUE900099$4,209,625$3,857,101$352,524
FieldValueIRS element (for citing)
Total Program Service Revenue$130,287,669TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column-$409,266TotalRevenueColumnAmt
Exclusion-$409,266ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$702,133RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$702,133RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$702,133TotalRevenueColumnAmt
Exclusion$702,133ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
OTHER REVENUE900099$49,512$49,512
CARES ACT STIMULUS900099$2,286,654$2,286,654
FieldValueIRS element (for citing)
Other Revenue Total$2,336,166OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$140,717,562TotalRevenueColumnAmt
Related Or Exempt Func Income$131,681,521RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$589,790UnrelatedBusinessRevenueAmt
Exclusion$645,391ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,828,439TotalAmt
Management And General$1,828,439ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$52,133,388TotalAmt
Program Services$43,270,711ProgramServicesAmt
Management And General$8,862,677ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$935,547TotalAmt
Program Services$779,385ProgramServicesAmt
Management And General$156,162ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$7,918,092TotalAmt
Program Services$7,224,566ProgramServicesAmt
Management And General$693,526ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,586,712TotalAmt
Program Services$3,272,562ProgramServicesAmt
Management And General$314,150ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$452,034TotalAmt
Management And General$452,034ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$40,141TotalAmt
Management And General$40,141ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$17,721TotalAmt
Management And General$17,721ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$13,691,258TotalAmt
Program Services$8,912,988ProgramServicesAmt
Management And General$4,778,270ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$152,749TotalAmt
Management And General$152,749ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$978,906TotalAmt
Program Services$978,906ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,226TotalAmt
Program Services$1,226ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,478,762TotalAmt
Program Services$4,478,762ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$537,376TotalAmt
Program Services$322,424ProgramServicesAmt
Management And General$214,952ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,235TotalAmt
Management And General$3,235ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$40,924TotalAmt
Program Services$40,924ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$1,282,548TotalAmt
Management And General$1,282,548ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$7,140,272TotalAmt
Program Services$7,140,272ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$831,396TotalAmt
Program Services$831,396ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PATIENT CARE SUPPLIES & SERV$15,881,080$15,881,080
BAD DEBT EXPENSE$12,022,583$12,022,583
MINOR EQUIPMENT AND R&M$1,822,149$1,767,485$54,664
HOME OFFICE ALLOCATION$13,832,616$9,682,832$4,149,784

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,267,601TotalAmt
Program Services$2,194,509ProgramServicesAmt
Management And General$73,092ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$141,876,755TotalAmt
Program Services$118,802,611ProgramServicesAmt
Management And General$23,074,144ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$10,959,818BOYAmt
EOY$14,845,403EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$15,572,996BOYAmt
EOY$16,451,810EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$4,026,377BOYAmt
EOY$4,015,105EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,846,651BOYAmt
EOY$2,345,904EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$156,722,655LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$96,398,497LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$56,012,364BOYAmt
EOY$60,324,158EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,578,594BOYAmt
EOY$1,500,831EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$7,051,223BOYAmt
EOY$6,429,589EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$771,275BOYAmt
EOY$241,551EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$97,819,298BOYAmt
EOY$106,154,351EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$24,325,859BOYAmt
EOY$22,430,646EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$12,557,406EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$1,401,725BOYAmt
EOY$1,033,781EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,925,421BOYAmt
EOY$2,125,418EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$28,653,005BOYAmt
EOY$38,147,251EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$69,166,293BOYAmt
EOY$68,007,100EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$69,166,293BOYAmt
EOY$68,007,100EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$97,819,298BOYAmt
EOY$106,154,351EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,159,193ReconcilationRevenueExpnssAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedfalseFederalGrantAuditPerformedInd

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)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$17,721OtherActivitiesAmt
Total Lobbying Expenditures$17,721TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1, LOBBYING ACTIVITIESFormAndLineReferenceDesc
ExplanationAnnual dues were paid to the American Hospital Association and North Carolina Hospital Association. A percentage, determined by the organizations, was estimated to be expenditures used in lobbying activities by these organizations.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,754,303OtherCostOrOtherBasisAmt
Book Value$2,754,303BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$78,107,589OtherCostOrOtherBasisAmt
Depreciation$39,503,585DepreciationAmt
Book Value$38,604,004BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$65,095,346OtherCostOrOtherBasisAmt
Depreciation$55,478,734DepreciationAmt
Book Value$9,616,612BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,765,417OtherCostOrOtherBasisAmt
Depreciation$1,416,178DepreciationAmt
Book Value$9,349,239BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$60,324,158TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescOTHER ASSETSDesc
Book Value$6,429,589BookValueAmt
Method ValuationCMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$6,429,589TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
THIRD PARTY$701,596
DEFERRED FEE PLAN LIABILITY$455,023
THIRD PARTY$425,193
RAC SETTLEMENT$543,606
FieldValueIRS element (for citing)
Total Liability$2,125,418TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2FormAndLineReferenceDesc
ExplanationTHE HOSPITAL AND FOUNDATION ARE NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT, PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other250.FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CarefalseFPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailablefalseReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,086,169TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,086,169NetCommunityBenefitExpnsAmt
Total Expense0.04690TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$20,793,359TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,113,244DirectOffsettingRevenueAmt
Net Community Benefit Expns$680,115NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$26,879,528TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,113,244DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,766,284NetCommunityBenefitExpnsAmt
Total Expense0.05210TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$149,745TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$149,745NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$149,745TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$149,745NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$27,029,273TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,113,244DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,916,029NetCommunityBenefitExpnsAmt
Total Expense0.05330TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$12,022,583BadDebtExpenseAmt
Bad Debt Expense Attributable$8,320,849BadDebtExpenseAttributableAmt
Reimbursed By Medicare$50,619,012ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$64,322,647CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$13,703,635MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (3 entries)

Primary ActivitiesPrimaryActivitiesTxtOrg Profit Or OwnershipOrgProfitOrOwnershipPctPhysicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
AMERICAN HOME PATIEN
HEALTHCARE0.250.75
LAUREL PARK MOB
MEDICAL OFFICE BUILDING0.1490.851
PRIME SURGICAL SUITE
AMBULATORY SURGERY CENTER0.570.43
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CALDWELL MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1321 MULBERRY STREET SWAddressLine1Txt
CityLenoirCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28645ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.CALDWELLMEMORIAL.ORGWebsiteAddressTxt
State LicenseH0061StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherDISPROPORTIONATE SHARE HOSPITALOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CALDWELL MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)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 Conducted19CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSee Part VOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSee Part VStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care250.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care0.FPGFamilyIncmLmtDscntCarePct
Explained BasisfalseExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART VFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART VFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART VFAPSummaryOnWebsiteURLTxt
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
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, SECTION B, LINE 5Caldwell Memorial Hospital (CMH) developed a broad online survey for the community to participate in. This survey was readily available on several platforms, including CMH's website and Facebook page and provided to CMH employees. A hard copy of the survey was distributed to local pharmacies, businesses, community centers, urgent cares/clinics and Physician practices, with over 800 responses received. After deploying the survey and identifying the significant needs of the community, CMH met with a select diverse group of community members to discuss the initial findings of the survey and CMH's previous CHNA.
PART V, SECTION B, LINE 7ahttps://www.caldwellmemorial.org/about-us/-community-health-needs- assessment/
Part V, SECTION B, LINE 10ahttps://www.caldwellmemorial.org/about-us/-community-health-needs- assessment/
PART V, SECTION B, LINE 11CMH has identified the following three areas as representing the most significant health needs for Caldwell County: Substance Abuse Caldwell services, programs and resources available to respond to this need: - Caldwell will provide lockboxes for patients and family members so that they can secure home medications to prevent misuse or diversion - Caldwell launched an Opioid Stewardship Program in August 2019, which will limit the number of oral opiates dispensed following surgical procedures by an estimated 30% - Caldwell's emergency department is participating in a UNC HCS opioid stewardship program to reduce the number of opioids dispensed following emergency department visits - Caldwell is participating in a UNC HCS initiative to improve the inpatient treatment of inpatients undergoing acute ethanol withdrawal - All licensed medical providers on staff at Caldwell are required to complete training in opioid prescribing per the North Carolina STOP Act Additionally, Caldwell constructed Jonas Hill Behavioral Health Pavilion which opened in the summer of 2020. Jonas Hill will provide inpatient and outpatient behavioral health services but will also treat patients with dual diagnoses of behavioral health illness and substance abuse. Approximately 30% or more of behavioral health patients carry dual diagnoses of behavioral illness and substance abuse. Mental Illness Caldwell services, programs and resources available to respond to this need: - Employee Assistance Program available to employees and family members - five counseling sessions - Outpatient depression screenings available at all clinics; including PHQ2 and PHQ9 screenings - Collaboration with state - Medicaid funded local management entity (LME), Vaya Health, to provide mental health screens in Emergency Department - Crisis Collaborative Team, consisting of various community health stake holders, that meets every other month - Mental Health resource guide available at all clinics - Emergency Department renovation for 5 psychiatric rooms; including one adolescent room - Qualified case management professional who assists with mental health screenings - Partnering with Project Lazarus, to battle prescription drug abuse - Caldwell promotes the use of 'black boxes' to dispose of prescription medications and controlled substances - System wide protocol for the use of Narcan Additionally, Caldwell is firmly positioned and committed to creating an innovative rural behavioral health program for Western NC. Working collaboratively with local mental health partners, Caldwell will achieve the goal of making mental healthcare as routine, accessible and understandable as physical healthcare. The newly opened Jonas Hill Hospital & Clinic will meet a critical need for increased rural inpatient psychiatric hospital beds and new psychiatric outpatient services in our community and region. Chronic Disease Caldwell services, programs and resources available to respond to this need: - Perform numerous screenings and track metrics in clinics to measure and address when statistics are above certain levels - CHAMP program, which evaluates patients fall risk - Provide smoking cessation assessment/counseling for inpatients and referring out patients to Quest for Life - Employee Track Clinic, clinic provided to employees and family members, providers monitor chronic illness - Diabetes and Nutrition services provided through the Quest for Life - Annual Cancer screening day provided by McCreary Cancer Center - CT screenings for Lung Cancer - Providing free high school EKG Screenings and physicals - Provide reduced cost mammography and chest X-Ray interpretations for the health department Additionally, Caldwell will assess population demographics and facilitate specific steps to address top chronic disease outliers in the County. Community outreach and education will be imperative to address this need. Caldwell will implement lean performance improvement initiatives for team to improve population metrics with chronic disease. The remaining top health issues that Caldwell will not be addressing include the following: Obesity, Cancer, Smoking and Tobacco Use, Child Abuse, Domestic Abuse, Violent Behavior, Abusive/Violent Behavior and Suicide. While Caldwell recognizes these health needs, their resources are better used in addressing the top three health priorities listed above.
PART V, LINEs 16A-Chttps://www.caldwellmemorial.org/patients-visitors/billing-financial-servi ces/
FieldValueIRS element (for citing)
Facility10FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
JONAS HILL HOSPITAL AND CLINIC
407 MULBERRY STREET SWLENOIRNC28645BEHAVIORAL HEALTH
COMMUNITY PHARMACY
321 MULBERRY STREET SWLENOIRNC28645RETAIL/EMPLOYEE PHARMACY
QUEST 4 LIFE WELLNESS CENTER
1031 MORGANTON BLVDLENOIRNC28645WELLNESS CENTER
CALDWELL PHYSICIANS NETWORK
321 MULBERRY STREET SWLENOIRNC28645PHYSICIAN PRACTICE
CALDWELL MEMORIAL SLEEP CENTER
270 PINE MOUNTAIN ROADHUDSONNC28638SLEEP CENTER
THE CENTER FOR WOUND MANAGEMENT
401 MULBERRY STREETLENOIRNC28645WOUND CARE CENTER
GEORGE M HANCOCK SURGERY CENTER
1031 MORGANTON BLVDLENOIRNC28645OP SURGERY CENTER
CENTER FOR DIABETES HEALTH
1031 MORGANTON BLVDLENOIRNC28645DIABETES EDUCATION AND SUPPORT
PAIN MANAGEMENT CENTER
1031 MORGANTON BLVDLENOIRNC28645PAIN MANAGEMENT
LAUREL PARK BREAST CENTER
COLLEGE AVENUELENOIRNC28645BREAST HEALTH

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LN 7 COL(F)The bad debt expense included on Form 990, Part IX, Line 25(a) but subtracted for purposes of calculating the percentages in this column, is $12,022,583.
PART III, LINE 2The Cost for bad debt expenses was calculated by applying the cost-to-charge ratio for the year to the gross bad debt charges for the year. Part III, Line 3 THE ESTIMATE FOR BAD DEBT EXPENSES ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS CALCULATED BY APPLYING THE COST-TO-CHARGE RATIO FOR THE YEAR TO THE GROSS BAD DEBT CHARGES ATTRIBUTABLE TO UNINSURED PATIENTS DURING THE YEAR. Part III, Line 3
PART III, LINE 4Net patient service revenue is reported at the estimated net realizable amounts from patients, third-party payors, and others for services rendered, including estimated retroactive adjustments due to future audits, reviews, and investigations. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered, and such amounts are adjusted in future periods as adjustments become known or as years are no longer subject to such audits, reviews, and investigations.
PART III, Line 9bTHE HOSPITAL DOES NOT SUBJECT ANY PATIENTS TO A COLLECTION AGENCY WHO HAS QUALIFIED FOR FINANCIAL ASSISTANCE GUIDELINES.
PART VI, LINE 2Federal regulations surrounding CHNA require local input from representatives of particular demographic sectors. For this reason, Caldwell Memorial Hospital (CMH) developed a standard process of gathering community input. Caldwell Memorial Hospital (CMH) developed a broad online survey for the community to participate in. This survey was readily available on several platforms, including CMH's website and Facebook page and provided to CMH employees. A hard copy of the survey was distributed to local pharmacies, businesses, community centers, urgent cares/clinics and Physician practices, with over 800 responses received. After deploying the survey and identifying the significant needs of the community, CMH met with a select diverse group of community members to discuss the initial findings of the survey and CMH's previous CHNA.
PART VI, LINE 3CALDWELL MEMORIAL HOSPITAL (CMH) PROVIDES NEEDED HEALTHCARE SERVICES TO ANYONE REGARDLESS OF THAT PERSON'S ABILITY TO PAY. CMH'S FINANCIAL ASSISTANCE POLICY IS DESIGNED TO ASSIST PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR HEALTHCARE SERVICES. a link to the POLICY CAN BE FOUND ON THE CMH PUBLIC website. CMH DISPLAYS INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IN ITS EMERGENCY ROOM, REGISTRATION AREAS IN THE HOSPITAL AND CLINICS, and FINANCIAL COUNSELOR OFFICES. A LINK IS ALSO PROVIDED ON THE HOSPITAL'S WEBSITE TO THE AVAILABILITY OF FINANCIAL ASSISTANCE AND ITS FINANCIAL ASSISTANCE POLICY, ALONG WITH AN ON-LINE APPLICATION. INPATIENT CASE MANAGERS ALSO PROVIDE INFORMATION TO THE PATIENTS REGARDING AVAILABLE PROGRAMS AND THE ORGANIZation's FINANCIAL POLICY. CONSULTATION WITH FINANCIAL COUNSELORS IS ALSO AVAILABLE TO ALL PATIENTS AS NEEDED.
PART VI, LINE 4The primary service area for Caldwell Memorial Hospital is Caldwell County with a limited number of patients from the surrounding counties of Burke, Watauga and Catawba. Of the multiple incorporated municipalities in Caldwell County, CMH received 90.03% of its patients from Collettsville, Granite Falls, Hudson and Lenoir. Caldwell County is in the NW section of NC in the foothills of the Blue Ridge mountains and is bounded on the NW by Watauga County, on the NE by Wilkes County, on the East by Alexander County, on the South by Catawba and Burke Counties and on the West by Burke and Avery Counties. The population is just under 80,000 with 51% Female and 49% Male. The population makeup is 87.1% White, 5.4% Hispanic, 4.9% Black or African American and 2.6% Other. The largest income group is $25-50K and largest age group is 35-54 years old.
PART VI, LINE 5CALDWELL MEMORIAL HOSPITAL PROVIDES FINANCIAL SUPPORT TO 2 COMMUNITY AGENCIES: THE HELPING HANDS CLINIC (PROVIDING CARE TO THE UNINSURED) AND THE SATIE AND JE BROYHILL CALDWELL SENIOR CENTER (FOCUS ON THE LIVES AND ADVOCACY OF SENIORS). OTHER COMMUNITY INVOLVEMENT INCLUDES BUT NOT LIMITED TO: ANNUAL PROSTATE SCREENING, HEALTH FAIRS, SUPPORT AND INVOLVEMENT IN THE CALDWELL COMMUNITY GARDEN WHICH HELPS FOSTER COMMUNITY GARDENING, REPRESENTATION BY ORGANIZATION REPRESENTATIVES ON LOCAL HEALTH CARE RELATED BOARDS (BOARD OF HEALTH, HOSPICE, AND CHILD PROTECTION TEAM.) CALDWELL MEMORIAL HEALTHWORKS WHICH IS OCCUPATIONAL, INDUSTRIAL AND WORKER'S COMP MEDICINE DESIGNED TO ASSIST EMPLOYERS TOWARD IMPROVING QUALITY OF HEALTHCARE.
PART VI, LINE 6CALDWELL MEMORIAL HOSPITAL IS PART OF THE UNC HEALTH CARE SYSTEM. UNC HEALTH CARE IS A NOT-FOR-PROFIT INTEGRATED HEALTH CARE SYSTEM OWNED BY THE STATE OF NORTH CAROLINA AND BASED IN CHAPEL HILL. ORIGINALLY ESTABLISHED NOV. 1, 1998, UNC HEALTH CARE CURRENTLY COMPRISES UNC HOSPITALS AND ITS PROVIDER NETWORK, THE CLINICAL PROGRAMS OF THE UNC SCHOOL OF MEDICINE, AND TEN AFFILIATE HOSPITALS AND HOSPITAL SYSTEMS ACROSS THE STATE. COLLECTIVELY, THIS GROUP OF HEALTH CARE PROVIDERS WORKS TOGETHER TO MAKE SURE THAT ALL OF THE COMMUNITIES SERVED RECEIVED THE HIGHEST QUALITY OF CARE.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (true)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (true)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther 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 OrgsCompReportPrior990RltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmt
Chris Ellington
Director$0$714,017$212,800$157,873$0$162,812$0$21,311$0$1,268,813$0$52,405
John Powell MD
Director$232,943$10,715$0$26,645$0$292,272$0$0$0$21,607$362
Laura Easton
Director/President & CEO$325,881$13,763$0$26,645$0$400,914$0$0$0$24,315$10,310
Rebecca Smith
COO & CNO$212,374$13,264$0$8,582$0$270,361$0$0$0$16,126$20,015
Michael Bunch
CFO$221,856$2,084$0$15,002$0$255,690$0$0$0$16,478$270
David Lowery MD
CMO$317,126$14,000$0$26,645$0$382,325$0$0$0$23,780$774
Donita Damron
VP Physician Services$161,217$6,543$0$8,329$0$188,244$0$0$0$11,950$205
Philip Jenkins
Medical Practice Physician$443,667$0$0$26,645$0$473,054$0$0$0$2,248$494
Thomas Young
Medical Practice Physician$449,764$7,128$0$26,645$0$496,659$0$0$0$12,914$208
Ralph Duckett
Medical Practice Physician$503,745$0$0$11,592$0$627,125$0$0$0$110,600$1,188
David Cook
Medical Practice Physician$404,500$0$0$14,807$0$453,985$0$0$0$28,077$6,601
Timothy Clenney
Medical Practice Physician$399,294$0$0$0$0$428,780$0$0$0$28,712$774

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4BDURING THE CALENDAR YEAR 2019, THE FOLLOWING INDIVIDUALS RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (457(F)): CHRIS ELLINGTON (DIRECTOR) $52,405 LAURA EASTON (CEO) HAS A SECURED BENEFIT PLAN WHICH IS INCLUDED IN THE STUDY COMPLETED BY THE INDEPENDENT COMPENSATION CONSULTANT; THE LOAN UNDER THIS ARRANGEMENT IS RECORDED ON THE FINANCIAL STATEMENTS AND FULLY SECURED BY LIFE INSURANCE ON THE LIFE OF THE CEO.
PART I, LINE 6Senior management has an incentive program which is partially earned based on profit margin and days cash on hand. The earned incentive is reviewed by the HR Committee of the Board and approved annually. Employed Physicians are paid on a productivity basis based on RVU's generated in their practice operations and these are tied to MGMA benchmarks.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1:THE EXECUTIVE/FINANCE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 6:THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM IS A MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A:THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM IS A MEMBER AND THEY HAVE THE POWER TO APPOINT BOARD MEMBERS AND APPROVE GOVERNANCE DECISIONS.
FORM 990, PART VI, SECTION A, LINE 7B:THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM AS A MEMBER HAS APPROVAL RIGHTS TO ALL GOVERNANCE DECISIONS.
FORM 990, PART VI, SECTION B, LINE 11B:THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. THE FULL BOARD RECEIVED A COPY OF THE FORM 990 FOR THEIR REVIEW AND FOR ANY QUESTIONS. THE FULL BOARD VOTED FOR A FINAL APPROVAL OF THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C:THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD ANNUALLY REVIEWS THE CONFLICT OF INTEREST STATEMENTS. MINUTES OF BOARD MEETINGS REFLECT ANY DECLARED CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15:THE ORGANIZATION COMPLETES THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DESCRIBED IN TREASURY REGULATION 4958(6)(C) FOR EACH OFFICER AND KEY EMPLOYEE. THIS PROCESS IS PERFORMED BY AN OUTSIDE INDEPENDENT COMPENSATION SPECIALIST. THE CONSULTANT'S FINDINGS ARE PRESENTED TO THE HR COMMITTEE OF THE BOARD AND ARE ULTIMATELY APPROVED BY THE FULL BOARD.
FORM 990, PART VI, SECTION C, LINE 18:PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATIONS ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ON GUIDESTAR.ORG.
FORM 990, PART VI, SECTION C, LINE 19:THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. PLEASE USE THE ORGANIZATIONS "CONTACT US" LINK ON ITS WEBSITE FOR REQUESTS.
FORM 990, PART VII, LINE 1B AVERAGE HOURS PER WEEKBOARD MEMBERS AND OFFICERS CONTRIBUTE THEIR TIME AND SERVICES UPON REQUEST AND ON AN AS-NEEDED BASIS, WHICH, THROUGHOUT THE YEAR, MAY DIFFER FROM THE AVERAGE NUMBER OF HOURS PER WEEK REPORTED ON PART VII, LINE 1B.
FORM 990, PART XII, LINE 2C:NO CHANGE FROM PRIOR YEAR.
Form 990, Part XII, Line 3B:The Organization and auditors were waiting on final guidance from the various federal agencies with respect to funding received under the CARES Act and other government sources. Once the final guidance was released, the Organization and auditors have begun the process of having the Single Audit completed.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
UNC ROCKINGHAM HEALTH CARE INC
117 E KINGS HWYEDENNC27288823745228HEALTHCARENC501(C)(3)LINE 3UNC HEALTH Cfalse
UNC HEALTH CARE SYSTEM
101 MANNING DRIVEChapel HillNC27514562206970HEALTHCARENCSECTION 115UNC HEALTH Cfalse
UNC HOSPITALS
101 Manning DriveCHAPEL HILLNC27514561118388HEALTHCARENCSECTION 115UNC HEALTH Cfalse
THE REX HEALTHCARE FOUNDATION INC
4420 LAKE BOONE TRAILRALEIGHNC27607566052117support rex hNC501(C)(3)LINE 12B iiUNC HEALTH Cfalse
CALDWELL MEMORIAL HOSPITAL FOUNDATION
PO BOX 1890LENOIRNC28645581935514SUPPORT OF CANC501(C)(3)LINE 7CALDWELL MEMfalse
CHATHAM HOSPITAL INC
PO BOX 649SILER CITYNC27344560611546HEALTHCARENC501(C)(3)LINE 3UNC HEALTH Cfalse
PIEDMONT TRIAD HEALTH SERVICES
101 MANNING DR MED WING E 2ND FLOCHAPEL HILLNC27514561497163HEALTHCARENC501(C)(3)LINE 12B IIUNC HEALTH Cfalse
REX HEALTHCARE INC
4420 LAKE BOONE TRAILRALEIGHNC27607561509129HEALTHCARENC501(C)(3)LINE 12A, IUNC HEALTH Cfalse
REX HOSPITAL INC
4420 LAKE BOONE TRAILRALEIGHNC27607561509260HEALTHCARENC501(C)(3)LINE 3UNC HEALTH Cfalse
UNC PHYSICIANS NETWORK
1600 PERIMETER PARK DR STE 225MORRISVILLENC27560271081647HEALTHCARENC501(C)(3)LINE 10UNC HEALTH Cfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1UNC PHYSICIANS NETWORK GROUP PRACTICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11600 PERIMETER PARK DRIVE Ste 225AddressLine1Txt
CityMORRISVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP27560ZIPCd
FieldValueIRS element (for citing)
EIN461416986EIN
Primary ActivitiesHEALTHCAREPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Share Of Total Income$0ShareOfTotalIncomeAmt
Share Of EOY Assets$0ShareOfEOYAssetsAmt
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Caldwell Memorial Hospital FoundationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeCTransactionTypeTxt
Involved$3,300,860InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt