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ST LUKES PHYSICIAN NETWORK INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
ST LUKES PHYSICIAN NETWORK INC (EIN 26-3082073)
Tax period
2019-10-01 to 2020-09-30
Filed
2021-08-12
IRS object ID
202142249349302114
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)
Return2021-08-12T12:35:34-05:00ReturnTs
Tax Period End2020-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1227 WEST TRADE STREET SUITE 800AddressLine1Txt
CityCHARLOTTECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28202ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN263082073EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S PHYSICIAN NETWORK INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTLUBusinessNameControlTxt
Phone8288943311PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1Txt
CityCOLUMBUSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28722ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonELIZABETH PRESNELLPersonNm
Person TitleCFOPersonTitleTxt
Phone8288943311PhoneNum
Signature2021-08-12SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOHN NORMANPreparerPersonNm
PTINP01506766PTIN
Phone7049985200PhoneNum
Preparation2021-08-10PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerELIZABETH PRESNELLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1Txt
CityCOLUMBUSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28722ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$5,430,794GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2008FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO PROVIDE QUALITY, PATIENT-FOCUSED HEALTHCARE TO POLK COUNTY AND SURROUNDING COUNTIES.ActivityOrMissionDesc
Voting Members Governing Body3VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee50TotalEmployeeCnt
Total Volunteers3TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$527,100CYContributionsGrantsAmt
PY Program Service Revenue$4,994,569PYProgramServiceRevenueAmt
CY Program Service Revenue$4,898,464CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$19,879PYOtherRevenueAmt
CY Other Revenue$5,230CYOtherRevenueAmt
PY Total Revenue$5,014,448PYTotalRevenueAmt
CY Total Revenue$5,430,794CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$74,424CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,893,505PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,132,401CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,039,199PYOtherExpensesAmt
CY Other Expenses$1,775,140CYOtherExpensesAmt
PY Total Expenses$7,932,704PYTotalExpensesAmt
CY Total Expenses$7,981,965CYTotalExpensesAmt
PY Revenues Less Expenses-$2,918,256PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,551,171CYRevenuesLessExpensesAmt
Total Assets BOY$440,911TotalAssetsBOYAmt
Total Assets EOY$1,108,723TotalAssetsEOYAmt
Total Liabilities BOY$15,494,706TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,713,689TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$15,053,795NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$17,604,966NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO PROMOTE COMMUNITY HEALTH THROUGH THE PROVISION OF HEALTH CARE SERVICES TO THE RESIDENTS OF POLK COUNTY, NC AND SURROUNDING COUNTIES, AS WELL AS TO PROMOTE, IMPROVE, AND ENHANCE THE QUALITY OF HEALTH CARE SERVICES IN POLK COUNTY, NC AND SURROUNDING COUNTIES.MissionDesc
Significant New Program SrvcYes (1)SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$7,801,986ExpenseAmt
Grant$74,424GrantAmt
Revenue$4,920,050RevenueAmt
DescST. LUKE'S PHYSICIAN NETWORK (SLPN) PROVIDES HEALTH CARE SERVICES TO CITIZENS OF POLK COUNTY, NC, AND SURROUNDING COUNTIES, THROUGH VARIOUS CLINICS ACROSS A WIDE VARIETY OF MEDICAL SPECIALTIES. SLPN PROVIDES HEALTH CARE SERVICES TO CITIZENS OF POLK COUNTY, NC AND SURROUNDING COUNTIES, THROUGH A TOTAL OF FOUR CLINICS. THE FOUR CLINICS ARE COMPRISED OF TWO RURAL HEALTH CLINIC'S (SALUDA FAMILY MEDICINE AND FOOTHILLS FAMILY MEDICINE AND GENERAL SURGERY) ALONG WITH ROSENBERG BONE AND JOINT AND ST. LUKE'S UROLOGY CLINIC. FOR FY 2020, THE CLINICS HAD A COMBINED TOTAL OF 22,776 VISITS.Desc
Total Program Service Expenses$7,801,986TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
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 Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
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 Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee50EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
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 Members3GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org DocumentsYes (1)ChangeToOrgDocumentsInd
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 Body0Form990ProvidedToGvrnBodyInd
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 Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ELIZABETH PRESNELLBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone8288940954PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1Txt
CityCOLUMBUSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28722ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
TOMMY MELTON
TRUSTEE1.001.00Yes (X)$0$0$0
LINDA GREENSFELDER PHD
CHAIR1.00Yes (X)$0$0$0Yes (X)
BRIAN ROSENBURG MD
PHYSICIAN45.00$1,636,871$0$58,845Yes (X)
JEFFREY VIAR DO
PHYSICIAN45.00$204,954$0$41,728Yes (X)
THOMAS CADIER MD
PHYSICIAN45.00$232,719$0$8,786Yes (X)
WILLIAM SAVAGE DO
PHYSICIAN45.00$304,004$0$44,224Yes (X)
THOMAS DASHIELL JR MD
PHYSICIAN45.00$330,496$0$38,354Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,709,044TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$191,937TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K5IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ATRIUM HEALTHBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 32861AddressLine1Txt
CityCHARLOTTECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28232ZIPCd
FieldValueIRS element (for citing)
ServicesMANAGEMENT AND BILLING SERVICESServicesDesc
Compensation$497,466CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$527,100GovernmentGrantsAmt
Total Contributions$527,100TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REVENUE621110$4,694,192$4,694,192
OTHER OPERATING621110$204,272$204,272
FieldValueIRS element (for citing)
Total Program Service Revenue$4,898,464TotalProgramServiceRevenueAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$5,230RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$5,230RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,230TotalRevenueColumnAmt
Exclusion$5,230ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$5,430,794TotalRevenueColumnAmt
Related Or Exempt Func Income$4,898,464RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$5,230ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$74,424TotalAmt
Program Services$74,424ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,676,416TotalAmt
Program Services$5,563,129ProgramServicesAmt
Management And General$113,287ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$36,240TotalAmt
Program Services$35,516ProgramServicesAmt
Management And General$724ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$381,613TotalAmt
Program Services$373,997ProgramServicesAmt
Management And General$7,616ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$38,132TotalAmt
Program Services$37,371ProgramServicesAmt
Management And General$761ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$184,086TotalAmt
Program Services$126,495ProgramServicesAmt
Management And General$57,591ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$16,907TotalAmt
Program Services$16,907ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$313,773TotalAmt
Program Services$313,773ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,028TotalAmt
Program Services$5,028ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$53,715TotalAmt
Program Services$53,715ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$159,600TotalAmt
Program Services$159,600ProgramServicesAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
MEDICAL SUPPLIES$939,425$939,425
BAD DEBT EXPENSE$102,606$102,606

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$7,981,965TotalAmt
Program Services$7,801,986ProgramServicesAmt
Management And General$179,979ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$275,421BOYAmt
EOY$104,330EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$80,043BOYAmt
EOY$965,578EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$11,035BOYAmt
EOY$17,205EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$302,230LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$280,620LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$74,412BOYAmt
EOY$21,610EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$440,911BOYAmt
EOY$1,108,723EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$329,640BOYAmt
EOY$181,585EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,165,066BOYAmt
EOY$18,532,104EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,494,706BOYAmt
EOY$18,713,689EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow FASB117Yes (X)OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

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

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

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

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY-$2,551,171EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$15,053,795BOYAmt
EOY-$17,604,966EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$440,911BOYAmt
EOY$1,108,723EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$2,551,171ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
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 D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$302,230OtherCostOrOtherBasisAmt
Depreciation$280,620DepreciationAmt
Book Value$21,610BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$21,610TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS-$1,520
ADVANCED MEDICARE AND MEDICAID PAYMENTS$317,155
DUE TO RELATED PARTIES$18,216,469
FieldValueIRS element (for citing)
Total Liability$18,532,104TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL, THE FOUNDATION, AND SLPN ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE PROFESSIONAL BUILDING IS A FOR-PROFIT CORPORATION SUBJECT TO FEDERAL AND STATE INCOME TAXES. THE HOSPITAL AND THE AFFILIATES HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATOINS AS OF SEPTEMBER 30, 2020.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 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
BRIAN ROSENBURG MD
PHYSICIAN$1,060,398$0$553,404$0$23,069$0$35,731$0$23,114$0$1,695,716$0$0$0
JEFFREY VIAR DO
PHYSICIAN$178,931$0$25,081$0$942$0$17,020$0$24,708$0$246,682$0$0$0
THOMAS CADIER MD
PHYSICIAN$232,719$0$0$0$0$0$8,630$0$156$0$241,505$0$0$0
WILLIAM SAVAGE DO
PHYSICIAN$274,594$0$28,437$0$973$0$31,627$0$12,597$0$348,228$0$0$0
THOMAS DASHIELL JR MD
PHYSICIAN$289,813$0$4,262$0$36,421$0$36,112$0$2,242$0$368,850$0$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 2DURING THE YEAR, THE ORGANIZATION OPENED UP A UROLOGY CLINIC AND MOVED THE GENERAL SURGERY CLINIC INTO THE PROVIDER BASED RURAL HEALTH CARE CLINIC, FOOTHILLS.
FORM 990, PART VI, SECTION A, LINE 4DURING THE YEAR, THE ORGANIZATION AMENDED ITS ARTICLES AND BYLAWS. A SUMMARY OF THE SIGNIFICANT CHANGES FOLLOWS: ARTICLES OF INCORPORATION: 1. THE NUMBER OF BOARD DIRECTORS SHALL BE GOVERNED BY THE CORPORATE BYLAWS, BUT BE NO LESS THAN THREE (3). BYLAWS: 1. ARTICLE 1.4.C. WAS AMENDED TO STATE THAT, UPON DISSOLUTION, AND AFTER DISTRIBUTING ASSETS TO ST. LUKE'S HEALTH CARE (IF IN EXISTENCE AS A 501(C)(3) ORGANIZATION), THE ASSETS WOULD THEN BE DISTRIBUTED TO "SUCH ORGANIZATIONS IN POLK COUNTY, NORTH CAROLINA HAVING A HEALTH CARE OR HEALTH AND WELLNESS PURPOSES SUBSTANTIALLY SIMILAR TO THOSE OF THE CORPORATION...." 2. ARTICLE 2.3.2 WAS AMENDED TO PROVIDE FOR THE ELECTION OF DIRECTORS TO TWO (2) ADDITIONAL THREE (3) YEAR TERMS, NOT TO EXCEED 9 CONSECUTIVE YEARS. THE CHIEF OF THE MEDICAL STAFF IS NOT SUBJECT TO THOSE LIMITATIONS. 3. ARTICLE 2.3.3. NOW REQUIRES DIRECTOR ATTENDANCE AT TWO-THIRDS OF THE REGULAR MEETINGS OF THE BOARD (NOT INCLUDING ABSENCES EXCUSED BY THE CHAIRPERSON). 4. ARTICLE 2.3.5.1 NOW STATES THAT A DIRECTOR THAT FAILS THE ATTENDANCE REQUIREMENT OF ARTICLE 2.3.3 SHALL BE AUTOMATICALLY REMOVE BY THE BOARD UNLESS THE DIRECTOR ASKS THE BOARD TO EXCUSE SOME OR ALL OF THE UNEXCUSED ABSENCES AND THE BOARD APPROVES THE EXCUSED ABSENCES. 5. ARTICLE 2.4.6 NOW INDICATES THAT THE CHIEF OF MEDICAL STAFF OF THE HOSPITAL AND THE CHAIRPERSON OF THE FOUNDATION BOARD SHALL BE COUNTED IN THE TOTAL NUMBER OF BOARD MEMBERS REQUIRED TO ESTABLISH A QUORUM (BUT DIRECTORS WHO HAVE A CONFLICT OF INTEREST AND CANNOT VOTE SHALL NOT BE COUNTED TOWARD THE QUORUM). 6. ARTICLE IV WAS AMENDED TO PROVIDE MORE DEFINITION ABOUT THE ROLES OF THE BOARD, AND TO ALLOW FOR THE APPOINTMENT OF MORE OFFICERS BEYOND THE CHAIRPERSON, VICE-CHAIRPERSON, SECRETARY AND TREASURER (AS THE BOARD DEEMS NECESSARY). 7. ARTICLES 4.2 STATES THAT EACH OFFICER SERVES FOR A ONE YEAR TERM, OR UNTIL A SUCCESSOR IS ELECTED. NO OFFICERS MAY SERVE MORE THAN THREE CONSECUTIVE YEARS IN THE SAME OFFICE.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE ORGANIZATION IS ST. LUKE'S HEALTH CARE, INC., A SECTION 501(C)(3) NORTH CAROLINA ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7AST. LUKE'S PHYSICIAN NETWORK'S BOARD IS APPOINTED BY THE BOARD OF DIRECTORS OF ST. LUKE'S HEALTH CARE, INC. (THE SOLE MEMBER OF ST. LUKE'S PHYSICIAN NETWORK).
FORM 990, PART VI, SECTION A, LINE 7BST. LUKE'S HEALTH CARE, THE SOLE MEMBER OF ST. LUKE'S PHYSICIAN NETWORK, HAS THE FOLLOWING POWERS: 1. TO MERGE, CONSOLIDATE, OR SELL SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; 2. TO ACQUIRE OR CREATE ANOTHER CORPORATION; 3. TO APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATIN AND BYLAWS OF THE CORPORATION; 4. TO GRANT PERMISSION TO DISSOLVE THIS CORPORATION; AND 5. TO APPOINT THE MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE FORM 990 WILL BE MADE AVAILABLE TO EACH VOTING BOARD MEMBER FOR REVIEW PRIOR TO A REQUEST FOR A VOTE. AFTER THE BOARD MEMBERS HAVE HAD AN OPPORTUNITY TO REVIEW AND ALL QUESTIONS HAVE BEEN ANSWERED SATISFACTORILY, THE BOARD WILL BE ASKED TO VOTE TO APPROVE FOR SUBMISSION.
FORM 990, PART VI, SECTION B, LINE 12COFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLLICT OF INTEREST STATEMENT UPON HIRE OR APPOINTMENT. ANY DIRECTOR, OFFICER, COMMITTEE MEMBER OR EMPLOYEE DEPARTMENT HEAD HAVING A CONFLICT OF INTEREST IN A CONTRACT OR THE TRANSACTION PRESENTED TO THE BOARD OR A BOARD COMMITTEE FOR AUTHORIZATION, APPROVAL, OR RATIFICATION SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE OF HIS/HER INTEREST TO THE BOARD OR BOARD COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL INCLUDE ANY RELEVANT AND MATERIAL FACTS, KNOWN TO SUCH PERSON, ABOUT THE CONTRACT OR TRANSACTION THAT MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE TO THE CORPORATION'S INTEREST. A DIRECTOR, COMMITTEE MEMBER, OFFICER OF THE BOARD OR CORPORATION OR EMPLOYEE DEPARTMENT HEAD WHO HAS A DIRECT OR INDIRECT INTEREST IN ANY TRANSACTION PRESENTED TO THIS BOARD OR A BOARD COMMITTEE SHALL DISCLOSE HIS OR HER INTEREST AND SHALL ABSENT HIMSELF OR HERSELF FROM ALL DISCUSSION OF AND ANY VOTE UPON SUCH MATTER. A CONFLICT OF INTEREST TRANSACTION MUST BE AUTHORIZED, APPROVED OR RATIFIED BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THE DIRECTORS OR COMMITTEE MEMBERS WHO HAVE NO DIRECT OR INDIRECT INTEREST IN THE TRANSACTION AND TO WHOM THE MATERIAL FACTS OF THE TRANSACTION AND OF ANY PERSON'S INTEREST IN THE TRANSACTION WERE DISCLOSED OR KNOWN. IF A MAJORITY OF THE MEMBERS WHO HAVE NO DIRECT OR INDIRECT INTEREST IN THE TRANSACTION VOTE TO AUTHORIZE, APPROVE OR RATIFY THE TRANSACTION, A QUORUM IS PRESENT FOR THE PURPOSE OF TAKING SUCH ACTION.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION FOR KEY TEAMMATES GOES THROUGH A REVIEW PROCESS. FOR PROVIDERS, FMV AND LOCAL MARKET CONDITIONS ARE TAKEN INTO CONSIDERATION TO DETERMINE THE APPROPRIATE COMPENSATION. ATRIUM HEALTH HAS AN APPROVED COMPENSATION COMMITTEE THAT RETAINS INDEPENDENT EXPERTS TO DESIGN COMPLETE COMPENSATION PACKAGES. THE COMPENSATION COMMITTEE REVIEWS COMPARABILITY DATA, REVIEWS EXECUTIVE OFFICERS' PERFORMANCE AND RECOMMENDATIONS FOR SENIOR OFFICERS. EXECUTIVE COMPENSATION IS APPROVED AND AN OFFICIAL REPORT IS GIVEN TO THE BOARD ALONG WITH DOCUMENTATION IN THE MINUTES OF MEETINGS.
FORM 990, PART VI, SECTION C, LINE 18RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABE ONLINE AT GUIDESTAR.ORG.
FORM 990, PART VI, SECTION C, LINE 19PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
ST LUKE'S HEALTH CARE INC
101 HOSPITAL DRCOLUMBUSNC28722561423318CONTROLLING ENTITYNC501(C)(3)PF0
ST LUKE'S FOUNDATION INC
101 HOSPITAL DRCOLUMBUSNC28722561757097FUNDRAISING FOR ST. LUKE'S HOSPITALNC501(C)(3)LINE 70ST LUKE'S HEALTH CARE INC
ST LUKE'S HOSPITAL INC
101 HOSPITAL DRCOLUMBUSNC28722560554222HEALTH CARE SERVICES FOR POLKE COUNTY, NC RESIDENTSNC501(C)(3)LINE 30ST LUKE'S HEALTH CARE INC

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S PROFESSIONAL BUILDING INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRAddressLine1Txt
CityCOLUMBUSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP28722ZIPCd
FieldValueIRS element (for citing)
EIN561423404EIN
Primary ActivitiesRENTAL REAL ESTATEPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
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 Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd