2020-08-28T11:26:11-05:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2019-01-01 560773039 NORTH CAROLINA HEALTHCARE FOUNDATION INC NORT 9196772400 PO BOX 4449 CARY NC 27519 STEPHEN J LAWLER PRESIDENT 9196772400 2020-08-27 1 JOHN NORMAN P01506766 7049985200 2020-08-27 67.137.57.251 2020-08-27 06:08:46 ED P 0FA37CE34EDFE58DB410E6F490D69C2898079F18 CEA045B55A74C437D2AB286F4B0AF1DA82127741 2019 2020-11-19 02:30:22Z STEPHEN J LAWLER PO BOX 4449 CARY NC 27519 7314113 0 X NCHA.ORG X 1961 NC TO FOSTER AND ACCELERATE THE COLLECTIVE IMPACT OF HOSPITALS, HEALTH SYSTEMS AND COMMUNITY PARTNERS TO IMPROVE THE HEALTH OF NORTH CAROLINIANS. 11 10 0 10 0 0 4299952 5008294 0 721413 195702 143416 0 0 4495654 5873123 873896 1817387 0 0 945437 1782823 0 0 0 1597538 1903075 3416871 5503285 1078783 369838 6284607 6804352 1232155 1577357 5052452 5226995 TO FOSTER AND ACCELERATE THE COLLECTIVE IMPACT OF HOSPITALS, HEALTH SYSTEMS AND COMMUNITY PARTNERS TO IMPROVE THE HEALTH OF NORTH CAROLINIANS. 0 0 4983281 1817387 721413 THE NORTH CAROLINA HOSPITAL FOUNDATION CARRIES OUT ACTIVITIES THAT FOSTER AND ACCELERATE THE COLLECTIVE IMPACT OF HOSPITALS, HEALTH SYSTEMS AND COMMUNITY PARTNERS TO IMPROVE THE HEALTH OF NORTH CAROLINIANS. 4983281 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 15 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NC X JEFFREY WEEGAR 9196774231 2400 WESTON PARKWAY CARY NC 27513 STEPHEN J LAWLER PRESIDENT 7.50 30.00 X X 0 784957 49175 TERRY AKIN BOARD CHAIR 2.00 X 0 0 0 BLAIR CHILDS BOARD MEMBER 1.00 X 0 0 0 PAUL CUNNINGHAM MD BOARD MEMBER 1.00 X 0 0 0 VANESSA ERVIN BOARD MEMBER 1.00 X 0 0 0 GREG GOMBAR BOARD MEMBER 1.00 X 0 0 0 LIN HOLLOWELL BOARD MEMBER 1.00 X 0 0 0 CHUCK MANTOOTH BOARD MEMBER 1.00 X 0 0 0 LEAH MCCALL DEVLIN DDS BOARD MEMBER 1.00 X 0 0 0 ALLEN SMART BOARD MEMBER 1.00 X 0 0 0 CASSIUS WILLIAMS BOARD MEMBER 1.00 X 0 0 0 JULIA WACKER VICE PRESIDENT 37.50 X 0 180702 13409 JEFFREY WEEGAR VP FIN. POLICY/CFO 7.50 30.00 X 0 165914 18214 0 1131573 80798 0 0 1 0 TSNE MISSIONWORKS 88 SOUTH STREET STUIE 700 BOSTON MA 02111 CONSULTING SERVICES 159538 1 2557436 2450858 5008294 MEETING REGISTRATION 621300 721413 721413 721413 141742 141742 1442664 1440990 1674 1674 1674 5873123 721413 0 143416 1817387 1817387 1429441 1290118 139323 49948 45080 4868 198678 179313 19365 104756 94546 10210 499556 331319 168237 34931 34931 414833 414833 5936 5936 4831 1873 2958 227433 155355 72078 225669 176134 49535 47411 41147 6264 423886 422508 1378 4658 4658 3197 3197 DUES, SUBSCRIPTIONS, ET 7732 7732 GENERAL & ADMIN 3002 3002 5503285 4983281 520004 0 2501730 2512953 297517 434383 1500 0 49557 49557 4658 0 3479202 3857016 6284607 6804352 329741 379568 0 165984 902414 1031805 1232155 1577357 X 830947 1047409 4221505 4179586 5052452 5226995 6284607 6804352 X 369838 277317 -472612 X X 0 1 X 1 1 1 X 7163940 4834711 3595190 4299952 5008294 24902087 721413 721413 7163940 4834711 3595190 4299952 5729707 25623500 0 0 0 25623500 115886 131529 133417 137147 141742 659721 115886 131529 133417 137147 141742 659721 7279826 4966240 3728607 4437099 5871449 26283221 0.97490 0.97930 0.02510 0.02070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 49557 49557 0 0 DUE TO AFFILIATE 974001 ACCRUED COMPENSATION 57804 1031805 X 6150440 277317 277317 5873123 0 5873123 5503285 0 5503285 0 5503285 PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE FOUNDATION FOLLOWS THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. MANAGEMENT HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2019. 1 GRANVILLE HEALTH INC PO BOX 947 OXFORD NC 27565 264073395 509(A)(1) 16599 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM TRUVEN HEALTH ANALYTICS IBM WATSON HEALTH 1 N DEARBORN ST 1400 CHICAGO IL 60602 130871925 7625 EMERGENCY DEPARTMENT DATABASE INITIATIVE LIFEBRITE COMMUNITY HOSPITAL OF STOKES 1570 NC 8 89 HWY NORTH DANBURY NC 27016 561793620 13278 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM SOUTHEASTERN REGIONAL MEDICAL CENTER PO BOX 1408 LUMBERTON NC 28359 560530233 509(A)(1) 136936 NC EMERGENCY DEPARTMENT PEER SUPPORT PILOT PROGRAM EAST CAROLINA HEALTH-BEAUFORT INC (VIDANT BEAUFORT HOSPITAL) 628 E 12TH STREET WASHINGTON NC 27889 452436270 509(A)(1) 5118 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM ALLEGHANY COUNTY MEMORIAL HOSPITAL INC PO BOX 947 SPARTA NC 28675 560525657 509(A)(1) 7029 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM CHATHAM HOSPITAL INC PO BOX 649 SILER CITY NC 27344 560611546 509(A)(1) 6753 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM UNC HEALTH CARE SYSTEM 211 FRIDAY CENTER DRIVE SUITE 2108 CHAPEL HILL NC 27517 562206970 163378 NC EMERGENCY DEPARTMENT PEER SUPPORT PILOT PROGRAM CHOWAN INC (VIDANT CHOWAN HOSPITAL) 211 VIRGINIA ROAD EDENTON NC 27932 562101090 509(A)(1) 12327 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD WINSTON SALEM NC 27157 510190238 509(A)(3) 188798 NC EMERGENCY DEPARTMENT PEER SUPPORT PILOT PROGRAM CAPE FEAR VALLEY HOKE HEALTHCARE 210 MEDICAL PAVILION DRIVE RAEFORD NC 28376 560845796 509(A)(1) 26999 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM NOVANT HEALTH FOUNDATION PRESBYTERIAN MEDICAL CENTER 200 HAWTHORNE LANE BELK HOUSE CHARLOTTE NC 28204 581413074 509(A)(1) 53324 NC EMERGENCY DEPARTMENT PEER SUPPORT PILOT PROGRAM CONE HEALTH BEHAVIORAL HEALTH HOSPITAL 1200 N ELM STREET GREENSBORO NC 27401 560532302 509(A)(1) 132776 NC EMERGENCY DEPARTMENT PEER SUPPORT PILOT PROGRAM ATRIUM HEALTH FOUNDATION 208 EAST BLVD CHARLOTTE NC 28203 566060481 509(A)(2) 93028 NC EMERGENCY DEPARTMENT PEER SUPPORT PILOT PROGRAM J ARTHUR DOSHER MEMORIAL HOSPITAL 924 N HOWE ST SOUTHPORT NC 28461 560845824 509(A)(1) 11450 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM VIDANT BERTIE HOSPITAL 1403 SOUTH KING ST WINDSOR NC 279839666 562003393 509(A)(1) 12327 SMALL RURAL HEALTH IMPROVEMENT PROGRAM FIRST HEALTH MONTGOMERY MEMORIAL HOSPITAL 520 ALLEN STREET TROY NC 27932 561936354 509(A)(1) 13170 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM ASHE MEMORIAL HOSPITAL 200 HOSPITAL AVE JEFFERSON NC 28640 560603900 509(A)(1) 14567 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM CHARLES A CANNON JR MEMORIAL HOSPITAL PO BOX 767 LINVILLE NC 28646 560529974 509(A)(1) 5700 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM PERSON MEMORIAL HOSPITAL 615 RIDGE ROAD ROXBORO NC 27573 560543247 509(A)(1) 8000 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM MARTIN GENERAL HOSPITAL 310 S MCCASKEY ROAD WILLIAMSTON NC 27892 999999999 509(A)(1) 7062 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM ERLANGER WESTERN CAROLINA HOSPITAL 3990 E HWY 64 ALT MURPHY NC 28906 561844262 509(A)(1) 11624 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM PENDER MEMORIAL HOSPITAL 507 E FREMONT ST BURGAW NC 28425 560653348 509(A)(1) 8281 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM MISSION DEPARTMENT OF PHILANTHROPY 890 HENDERSONVILLE ROAD SUITE 300 ASHEVILLE NC 28803 561881331 55933 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM FIRST HEALTH MOORE REGIONAL HOSPITAL - HOKE CAMPUS 6408 FAYETTEVILLE RD RAEFORD NC 28376 561936354 509(A)(1) 16599 SMALL RURAL HEALTH IMPROVEMENT GRANT PROGRAM J ARTHUR DOSHER MEMORIAL HOSPITAL 924 N HOWE ST SOUTHPORT NC 28461 560845824 509(A)(1) 183605 HURRICANE FLORENCE RECOVERY GRANT SOUTHEASTERN REGIONAL MEDICAL CENTER PO BOX 1408 LUMBERTON NC 28359 560530233 509(A)(1) 86949 HURRICANE FLORENCE RECOVERY GRANT CAROLINAEAST MEDICAL CENTER PO BOX 12157 2000 NEUSE BLVD NEW BERN NC 28561 562649056 509(A)(1) 125000 HURRICANE FLORENCE RECOVERY GRANT CARTERET GENERAL HOSPITAL 3500 ARENDELL ST MOREHEAD CITY NC 28557 560884724 509(A)(1) 104446 HURRICANE FLORENCE RECOVERY GRANT 26 3 PART I, LINE 2: ALL GRANTS RECEIVED BY NCHF ARE GOVERNED BY CONTRACTS WITH THE GRANTOR WHICH OUTLINE GRANT TERMS AND CONDITIONS INCLUDING DETAILED MONITORING, REPORTING, PERFORMANCE AND PAYMENT REQUIREMENTS. FOR ANY GRANT THAT INVOLVES A SUB-AWARD, OR RE-GRANTING OF FUNDS TO ANOTHER ORGANIZATION TO PERFORM A BODY OF WORK UNDER THE PRIMARY GRANT, NCHF COLLECTS APPLICATIONS AND EXECUTES DETAILED CONTRACTS WITH SUB-AWARD RECIPIENTS. EACH NCHF GRANT HAS AN ASSIGNED PROGRAM LEAD WHO IS RESPONSIBLE FOR PROVIDING PROGRAM OVERSIGHT TO ENSURE THAT ALL CONTRACT EXPECTATIONS ARE MET AND THAT ALL SUB-AWARD RECIPIENTS ARE ALSO MEETING THEIR CONTRACT OBLIGATIONS. NCHF DIRECTOR OF OPERATIONS ALSO HAS BUDGET OVERSIGHT OF ALL GRANT CONTRACTS AND ENSURES COMPLIANCE WITH CONTRACT TERMS AND CONDITIONS. GRANT SUB-AWARD RECIPIENTS MUST PRODUCE PERFORMANCE REPORTS AND DETAILED INVOICES, WITH SUPPORTING DOCUMENTATION, IN ORDER TO RECEIVE GRANT FUNDS. 0 1 0 0 0 0 0 0 0 STEPHEN J LAWLER PRESIDENT 0 592457 0 192500 0 0 0 37500 0 11675 0 834132 0 0 JULIA WACKER VICE PRESIDENT 0 150702 0 30000 0 0 0 3774 0 9635 0 194111 0 0 JEFFREY WEEGAR VP FIN. POLICY/CFO 0 150026 0 15888 0 0 0 8579 0 9635 0 184128 0 0 PART I, LINE 3 THE EXECUTIVE COMPENSATION COMMITTEE OF THE NCHA, INC., A RELATED ORGANIZATION, REVIEWS THE COMPENSATION OF THE PRESIDENT AND OTHER KEY EXECUTIVES. IN ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THE EXECUTIVE COMPENSATION COMMITTEE MAY ENGAGE THE PROFESSIONAL SERVICES OF INDEPENDENT LEGAL COUNSEL, COMPENSATION EXPERTS, ACCOUNTANTS, AND OTHER EXPERTS AND ADVISORS. PART I, LINE 4B A RELATED ORGANIZATION MAINTAINS A NON-QUALIFIED RETENTION BENEFIT PLAN UNDER SECTION 457(F) COVERING FIVE KEY EMPLOYEES. THE COVERED EMPLOYEES RECEIVE AN ANNUAL BENEFIT EQUAL TO A CERTAIN PERCENTAGE OF THEIR ORDINARY SALARY. THE PARTICIPANTS CAN ELECT TO INVEST THEIR ANNUAL BENEFIT IN A CAPITAL ACCUMULATION ACCOUNT OR CHOOSE OTHER FRINGE BENEFITS. FOR THE CURRENT YEAR, THE ORGANIZATION ACCRUED $25,000 TO THE PLAN FOR STEPHEN J. LAWLER. THIS AMOUNT IS INCLUDED IN SCHEDULE J, PART II. FORM 990, PART VI, SECTION A, LINE 7A THE POWER AND AUTHORITY OF THE CORPORATION SHALL BE VESTED IN ITS BOARD OF TRUSTEES WHICH SHALL HAVE NOT LESS THAN TEN MEMBERS, CONSISTING OF HEALTHCARE, COMMUNITY, PHILANTHROPIC, FINANCIAL, AND CORPORATE LEADERS. ALL MEMBERS SHALL BE APPOINTED BY THE BOARD OF TRUSTEES OF NCHA, INC. AT LEAST TWO MEMBERS WILL ALSO SERVE ON THE BOARD OF TRUSTEES OF NCHA, INC. EACH MEMBER SHALL SERVE A THREE-YEAR TERM. A MEMBER MAY SERVE NO MORE THAN TWO FULL CONSECUTIVE TERMS. THE INITIAL TERMS BEGINNING IN 2019 SHALL BE STAGGERED SO THAT APPROXIMATELY ONE-THIRD OF THE TERMS EXPIRE IN 2020, ONE THIRD IN 2021, AND ONE-THIRD IN 2022. THE BOARD OF TRUSTEES OF NCHA, INC. SHALL ALSO FILL ANY VACANCY FOR THE UNEXPIRED TERM. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF THE 990 WAS SUBMITTED TO THE FOUNDATION BOARD FOR REVIEW PRIOR TO THE FORM 990 BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES SIGN A CONFLICT OF INTEREST POLICY ANNUALLY DISCLOSING ANY POSSIBLE CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE OF NCHA, INC., A RELATED ORGANIZATION, WILL ANNUALLY MONITOR AND REVIEW EXECUTIVE COMPENSATION AND BENEFIT PROGRAMS, IN AGGREGATE, TO ENSURE CONSISTENCY WITH THE OVERALL COMPENSATION PHILOSOPHY AND GUIDING PRINCIPLES AND OBJECTIVES. AT ITS DISCRETION, THE EXECUTIVE COMPENSATION COMMITTEE MAY DELEGATE "DAY TO DAY" RESPONSIBILITY TO ADMINISTER COMPENSATION AND BENEFIT PROGRAMS TO NCHA'S PRESIDENT FOR ALL OTHER EXECUTIVE OR ADMINISTRATIVE POSITIONS NOT COVERED UNDER THIS POLICY, I.E., ALL POSITIONS BELOW VICE PRESIDENT. THE EXECUTIVE COMPENSATION POLICY WILL BE ANNUALLY REVIEWED AND ANY PROPOSED MODIFICATIONS, PRESENTED FOR APPROVAL TO THE FULL BOARD. IN SETTING AN EXAMPLE FOR ITS MEMBER ORGANIZATIONS, THE EXECUTIVE COMPENSATION COMMITTEE WILL ALSO UNDERTAKE THE RESPONSIBILITY FOR COMPLIANCE WITH THE 1996 TAXPAYER BILLS OF RIGHTS 2 AND THE ESTABLISHMENT OF THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" THAT IS DEFINED IN SECTION 4958 OF THE INTERNAL REVENUE CODE. IN ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS, THE EXECUTIVE COMPENSATION COMMITTEE MAY ENGAGE THE PROFESSIONAL SERVICES OF INDEPENDENT LEGAL COUNSEL, COMPENSATION EXPERTS, ACCOUNTANTS, AND OTHER EXPERTS AND ADVISORS. FOR EXTERNAL COMPARISON PURPOSES, COMPENSATION IS REVIEWED AGAINST THE COMPENSATION PACKAGES OF OTHER STATE ASSOCIATIONS THAT FAIRLY REPRESENT THE MARKET FOR EXECUTIVE TALENT, AND MAY INCLUDE SOME OR ALL OF THE FOLLOWING CHARACTERISTICS: -- SIMILAR INDUSTRY AND/OR ANNUAL REVENUES SIZE -- SIMILAR STATE SIZE (POPULATION) AND MEMBERSHIP SIZE -- EMPLOYERS THAT ARE PRIMARILY FOCUSED ON THE SOUTHEAST REGION OF THE UNITED STATES -- ORGANIZATIONS WITH WHICH WE COMPETE FOR TALENT INDIVIDUAL SALARIES WILL BE BASED UPON SUCH FACTORS AS COMPETENCIES, CREDENTIALS, EXPERIENCE, PERFORMANCE, RELEVANT PRIOR EARNINGS HISTORY, AND MARKETABILITY. ANNUAL SALARY INCREASES WILL REFLECT SUCH FACTORS AS MARKET MOVEMENT OR INFLATION, INDIVIDUAL PERFORMANCE, COMPANY PERFORMANCE, GENERAL ECONOMIC CONDITIONS, AND THE AVAILABILITY OF FUNDS. IF A SALARY EXCEEDS THE RANGE MAXIMUM OR 75TH PERCENTILE, THE EXECUTIVE COMPENSATION COMMITTEE MUST APPROVE AND DOCUMENT ITS RATIONALE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION PROVIDES COPIES UPON REQUEST AND ALLOWS INSPECTION AT THE ADMINISTRATIVE OFFICE OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES COPIES UPON REQUEST AND ALLOWS INSPECTION AT THE ADMINISTRATIVE OFFICE OF THE ORGANIZATION. FORM 990, PART XI, LINE 9: CUMULATIVE EFFECT OF A CHANGE IN ACCOUNTING PRINCIPLE -472,612. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. NCHA INC PO BOX 4449 CARY NC 27519 560641290 PROVIDES LEADERSHIP TO HOSPITALS IN NC & PROMOTES QUALITY HEALTHCARE NC 501(C)(6) 0 NORTH CAROLINA HEALTHCARE ENTERPRISES INC PO BOX 4449 CARY NC 27519 561653026 SUPPORT SERVICES RELATED TO FOR-PROFIT ACTIVITIES. NC C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0