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CALDWELL MEMORIAL HOSPITAL INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
CALDWELL MEMORIAL HOSPITAL INC (EIN 56-0554202)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-05-14
IRS object ID
201901349349302000
Schema version
2017v2.3
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)
Return2019-05-14T08:45:17-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

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 Begin2017-07-01TaxPeriodBeginDt

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
Signature2019-05-13SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMARC BERGERPreparerPersonNm
PTINP01871563PTIN
Phone9192781936PhoneNum
Preparation2019-05-13PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address4.14.250.26IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id69472520191345000000FederalOriginalSubmissionId
Federal Original Submission Id2019-05-14FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id5A93BC6954598A5C499FB6FCEF79B3C90A134D16AtSubmissionCreationDeviceId
At Submission Filing Device Id5476F9B71916CD40FDB4E1086303C323EF876FF3AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

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$131,603,356GrossReceiptsAmt
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 Independent12VotingMembersIndependentCnt
Total Employee989TotalEmployeeCnt
Total Volunteers148TotalVolunteersCnt
Total Gross UBI$1,077,979TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$345,015NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$8,844,951PYContributionsGrantsAmt
CY Contributions Grants$10,056,048CYContributionsGrantsAmt
PY Program Service Revenue$121,063,888PYProgramServiceRevenueAmt
CY Program Service Revenue$120,364,435CYProgramServiceRevenueAmt
PY Investment Income$260,134PYInvestmentIncomeAmt
CY Investment Income$268,004CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$914,869CYOtherRevenueAmt
PY Total Revenue$130,168,973PYTotalRevenueAmt
CY Total Revenue$131,603,356CYTotalRevenueAmt
PY Grants And Similar Paid$150PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$54,282,653PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$62,054,927CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$67,102,843PYOtherExpensesAmt
CY Other Expenses$59,701,984CYOtherExpensesAmt
PY Total Expenses$121,385,646PYTotalExpensesAmt
CY Total Expenses$121,756,911CYTotalExpensesAmt
PY Revenues Less Expenses$8,783,327PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$9,846,445CYRevenuesLessExpensesAmt
Total Assets BOY$80,768,196TotalAssetsBOYAmt
Total Assets EOY$86,425,728TotalAssetsEOYAmt
Total Liabilities BOY$33,141,310TotalLiabilitiesBOYAmt
Total Liabilities EOY$28,952,397TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$47,626,886NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$57,473,331NetAssetsOrFundBalancesEOYAmt
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$104,448,561ExpenseAmt
Grant$0GrantAmt
Revenue$120,412,421RevenueAmt
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 HOSPITALS 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. 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 WOMENS HEALTH - LENOIR, LAUREL PARK WOMENS 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.Desc
Total Program Service Expenses$104,448,561TotalProgramServiceExpensesAmt
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
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
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 With Officer EntfalseBusinessRlnWithOfficerEntInd
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 Document96IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee989EmployeeCnt
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
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
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 (27 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Mark Batts MD
Director2.00.0Yes (X)$86,880$0$0
Michael Chamberlain
Director2.00.0Yes (X)$0$0$0
Richard Coffey
Director/Chairman4.00.0Yes (X)$0$0$0
Chris Ellington
Director2.058.0Yes (X)$0$909,437$275,306
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
Bill Johnson
Director2.00.0Yes (X)$0$0$0
Jeffrey Keverline MD
Director/Vice Chairman4.00.0Yes (X)$0$0$0
Diana McClinton MD
Director2.00.0Yes (X)$0$0$0
Gary Park
Director2.058.0Yes (X)$0$1,019,986$549,846
Edward Pearce MD
Director2.00.0Yes (X)$0$0$0
Gary Shore
Director2.00.0Yes (X)$0$0$0
David Smith
Director2.00.0Yes (X)$0$0$0
Crissy Thomas
Director2.00.0Yes (X)$0$0$0
Boyd Wilson
Director/Sec & Treas4.00.0Yes (X)$0$0$0
John Powell MD
Director/Ex Officio2.00.0Yes (X)$254,393$0$34,483
Laura Easton
Director/CEO60.00.0Yes (X)$344,733$0$39,380Yes (X)
Rebecca Smith
COO & CNO60.00.0$255,216$0$25,533Yes (X)
Shawn Hartley
CFO60.00.0$203,891$0$23,768Yes (X)
David Lowery MD
CMO60.00.0$389,773$0$34,568Yes (X)
Donita Damron
VP Physician Services60.00.0$175,565$0$20,154Yes (X)
Randal Bast MD
Medical Practice Physician60.00.0$661,517$0$27,044Yes (X)
Craig Robson MD
Medical Practice Physician60.00.0$533,646$0$969Yes (X)
Robert Dacus MD
Medical Practice Physician60.00.0$466,213$0$30,813Yes (X)
David Evans MD
Medical Practice Physician60.00.0$407,646$0$32,089Yes (X)
Mark Brady MD
Medical Practice Physician60.00.0$406,285$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$4,185,758TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,929,423TotReportableCompRltdOrgAmt
Total Other Compensation$1,093,953TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K80IndivRcvdGreaterThan100KCnt
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
James R Vannoy Sons Construction
1608 US Hwy 221 NorthJEFFERSONNC28640Construction$5,797,763
Sodexo Inc and Affiliates
9801 Washingtonian BlvdGAITHERSBURGMD20878Wellness Partner$1,294,060
DLP Cardiac Partners LLC
3700 Arco Corp Office Suite 450CHARLOTTENC27273Cath Lab$704,427
AYA Healthcare Inc
5930 Cornerstone Court West SuiteSAN DIEGOCA92121Healthcare Staffing$670,982
Horizon CSA LLC
265 Pit RoadMOORESVILLENC28115Medical Equipment R&$399,445
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K18CntrctRcvdGreaterThan100KCnt
Related Organizations$9,435,063RelatedOrganizationsAmt
All Other Contributions$620,985AllOtherContributionsAmt
Total Contributions$10,056,048TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICES621500$117,690,055$117,690,055
QUEST4LIFE WELLNESS CENTER REVENUE713990$1,064,625$1,064,625
OTHER PROGRAM SERVICE REVENUE900099$1,715,457$1,715,457
JOINT VENTURE INCOME541900-$105,702-$119,056$13,354
FieldValueIRS element (for citing)
Total Program Service Revenue$120,364,435TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$268,004TotalRevenueColumnAmt
Exclusion$268,004ExclusionAmt

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$866,883RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$866,883RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$866,883TotalRevenueColumnAmt
Exclusion$866,883ExclusionAmt

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

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Business900099BusinessCd
Total Revenue Column$47,986TotalRevenueColumnAmt
Related Or Exempt Func Income$47,986RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$47,986OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$131,603,356TotalRevenueColumnAmt
Related Or Exempt Func Income$119,334,442RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,077,979UnrelatedBusinessRevenueAmt
Exclusion$1,134,887ExclusionAmt

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$1,837,469TotalAmt
Management And General$1,837,469ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$50,172,748TotalAmt
Program Services$41,643,380ProgramServicesAmt
Management And General$8,529,368ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$879,411TotalAmt
Program Services$732,619ProgramServicesAmt
Management And General$146,792ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$6,062,600TotalAmt
Program Services$5,531,592ProgramServicesAmt
Management And General$531,008ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,102,699TotalAmt
Program Services$2,830,942ProgramServicesAmt
Management And General$271,757ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$9,162TotalAmt
Management And General$9,162ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$63,098TotalAmt
Management And General$63,098ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$10,326TotalAmt
Management And General$10,326ManagementAndGeneralAmt

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$5,642,818TotalAmt
Program Services$3,673,466ProgramServicesAmt
Management And General$1,969,352ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$317,314TotalAmt
Management And General$317,314ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,046,930TotalAmt
Program Services$1,046,930ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$489,698TotalAmt
Program Services$489,698ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,310,869TotalAmt
Program Services$4,310,869ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$326,280TotalAmt
Program Services$195,767ProgramServicesAmt
Management And General$130,513ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$2,602TotalAmt
Management And General$2,602ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$209,400TotalAmt
Program Services$209,400ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,871,055TotalAmt
Program Services$4,871,055ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$836,156TotalAmt
Program Services$836,156ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtFundraisingFundraisingAmtManagement And GeneralManagementAndGeneralAmt
PATIENT CARE SUPPLIES & SERVIC$17,880,383$17,880,383$0
BAD DEBT EXPENSE$10,542,996$10,542,996
MINOR EQUIPMENT AND R&M$905,567$878,400$27,167
HOME OFFICE ALLOCATION$11,456,712$8,019,699$3,437,013

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$780,618TotalAmt
Program Services$755,209ProgramServicesAmt
Management And General$25,409ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$121,756,911TotalAmt
Program Services$104,448,561ProgramServicesAmt
Management And General$17,308,350ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$7,683,883BOYAmt
EOY$758,086EOYAmt

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$12,052,452BOYAmt
EOY$15,008,376EOYAmt

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$1,064,995BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,737,249BOYAmt
EOY$4,554,741EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,804,036BOYAmt
EOY$2,770,034EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$137,790,766LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$86,507,755LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$41,240,061BOYAmt
EOY$51,283,011EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,712,794BOYAmt
EOY$2,853,865EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$9,112,666BOYAmt
EOY$5,888,065EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$1,119,838BOYAmt
EOY$1,736,825EOYAmt

Intangible Assets IntangibleAssetsGrp

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

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$240,222BOYAmt
EOY$1,572,725EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$80,768,196BOYAmt
EOY$86,425,728EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$24,072,687BOYAmt
EOY$22,032,945EOYAmt

Grants Payable GrantsPayableGrp

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

Deferred Revenue DeferredRevenueGrp

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

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$4,756,818BOYAmt
EOY$3,883,011EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,311,805BOYAmt
EOY$3,036,441EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$33,141,310BOYAmt
EOY$28,952,397EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$47,626,886BOYAmt
EOY$57,473,331EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

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

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

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

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$47,626,886BOYAmt
EOY$57,473,331EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$80,768,196BOYAmt
EOY$86,425,728EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$9,846,445ReconcilationRevenueExpnssAmt
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 RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

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$10,326OtherActivitiesAmt
Total Lobbying Expenditures$10,326TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1, LOBBYING ACTIVITIES:FormAndLineReferenceDesc
ExplanationAnnual dues were paid to the North Carolina Hospital Association and the American 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$1,137,587OtherCostOrOtherBasisAmt
Book Value$1,137,587BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$48,727,941OtherCostOrOtherBasisAmt
Depreciation$35,666,669DepreciationAmt
Book Value$13,061,272BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$60,068,031OtherCostOrOtherBasisAmt
Depreciation$49,322,517DepreciationAmt
Book Value$10,745,514BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$27,857,207OtherCostOrOtherBasisAmt
Depreciation$1,518,569DepreciationAmt
Book Value$26,338,638BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$51,283,011TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescOTHER ASSETSDesc
Book Value$5,888,065BookValueAmt
Method ValuationCMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$5,888,065TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
THIRD PARTY$1,463,716
DEFERRED FEE PLAN LIABILITY$1,572,725
FieldValueIRS element (for citing)
Total Liability$3,036,441TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart X, Line 2:FormAndLineReferenceDesc
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 AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,487,477TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,487,477NetCommunityBenefitExpnsAmt
Total Expense0.05330TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$16,361,117TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,033,487DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$22,848,594TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,033,487DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,487,477NetCommunityBenefitExpnsAmt
Total Expense0.05330TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$22,848,594TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,033,487DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,487,477NetCommunityBenefitExpnsAmt
Total Expense0.05330TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$10,542,996BadDebtExpenseAmt
Bad Debt Expense Attributable$1,470,399BadDebtExpenseAttributableAmt
Reimbursed By Medicare$58,646,221ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$56,708,562CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$1,937,659MedicareSurplusOrShortfallAmt

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 (4 entries)

Primary ActivitiesPrimaryActivitiesTxtOrg Profit Or OwnershipOrgProfitOrOwnershipPctPhysicians Profit Or OwnershipPhysiciansProfitOrOwnershipPct
AMERICAN HOME
PATIENT
HEALTHCARE0.250.75
GUARDIAN HEALTHCARE
HEALTHCARE0.50.5
LAUREL PARK MOB
MEDICAL OFFICE BUILDING0.1490.851
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)
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
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted17CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTP://CALDWELLMEMORIAL.ORG/#PG-ABOUTOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt17ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLHTTP://CALDWELLMEMORIAL.ORG/#PG-ABOUTStrategyWebsiteURLTxt
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 (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
CALDWELL MEMORIAL HOSPITALPART V, SECTION B, LINE 5 CALDWELL MEMORIAL HOSPITAL (CMH) DEPLOYED A SURVEY TO LOCAL EXPERT ADVISORS TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED ACCORDING TO CRITERIA REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS AND THE HOSPITALS DESIRE TO REPRESENT THE REGIONS GEOGRAPHICALLY AND ETHNICALLY DIVERSE POPULATION. CMH RECEIVED INPUT FROM 19 LOCAL EXPERT ADVISORS REPRESENTING THE BROAD INTEREST OF THE COMMUNITY SERVED. IN ADDITION TO SURVEYING THE LOCAL EXPERT ADVISORS, CMH SOLICITED WRITTEN COMMENTS FROM THE COMMUNITY ABOUT ITS 2013 CHNA.
CALDWELL MEMORIAL HOSPITALpart v, section b, line 6b quorum health resources
CALDWELL MEMORIAL HOSPITALPART V, SECTION B, LINE 11 THE HOSPITAL HAS IDENTIFIED THE FOLLOWING AREAS AS REPRESENTING THE SIGNIFICANT HEALTH NEEDS FOR CALDWELL COUNTY: 1. MENTAL HEALTH AND SUBSTANCE ABUSE 2. CHRONIC DISEASE 3. OBESITY 4. CANCER 5. HEART DISEASE THE HOSPITAL HAS DEVELOPED IMPLEMENTATION STRATEGIES FOR THREE OF THE FIVE NEEDS (MENTAL HEALTH & SUBSTANCE ABUSE, CHRONIC DISEASE, AND CANCER; OBESITY AND HEART DISEASE ARE ADDRESSED WITHIN CHRONIC DISEASE) INCLUDING ACTIVITIES TO CONTINUE/PURSUE, COMMUNITY PARTNERS TO WORK ALONGSIDE, AND LEADING AND LAGGING INDICATORS TO TRACK. THE HOSPITAL ALSO IDENTIFIED FOURTEEN OTHER HEALTH NEEDS DURING ITS CHNA PROCESS, BUT DUE TO RESOURCE CONSTRAINTS, DID NOT DEVELOP STRATEGIES TO ADDRESS THOSE ADDITIONAL HEALTH NEEDS. THE HOSPITAL INTENDS TO ADdRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED ABOVE IN THE FOLLOWING WAY: MENTAL HEALTH AND SUBSTANCE ABUSE THE HOSPITAL INTENDS TO ADD AN IN-HOUSE PSYCHIATRIC UNIT THAT WILL RECRUIT PSYCHIATRISTS, COUNSELORS, SOCIAL WORKERS, AND MENTAL HEALTH TECHNICIANS TO MANAGE THE SERVICES AND IMPROVE ACCESS TO MENTAL HEALTH CARE. THE UNIT WILL ALSO INCLUDE AN OUTPATIENT PSYCHIATRIC CLINIC. THE HOSPITAL EXPECTS TO COLLABORATE WITH THE UNC HEALTH SYSTEM TO LEARN FROM OTHER FACILITIES AND IMPLEMENT THE BEST PROGRAM POSSIBLE. THE HOSPITAL WILL ALSO PILOT A PROGRAM WITH ONE PRIMARY CARE PHYSICIAN TO OFFER TELEMEDICINE PSYCHIATRIC SERVICES IN PARTNERSHIP WITH UNC. IF THE PILOT IS SUCCESSFUL, CMH WILL CONSIDER EXPANDING THE PROGRAM TO OTHER PROVIDERS. THE HOSPITAL WILL ALSO CONTINUE DISCUSSING OPTIONS FOR THE USE OF TELEPSYCHIATRY IN THE EMERGENCY DEPARTMENT. THE HOSPITAL WILL DEVELOP A SYSTEM-WIDE PROTOCOL FOR THE USE OF NARCAN IN EMERGENCY DEPARTMENT. CHRONIC DISEASE (ALSO INCLUDES OBESITY AND HEART DISEASE) THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: - WORKING TO HAVE ALL PRACTICES CERTIFIED AS PATIENT-CENTERED MEDICAL HOMES - BRINGING IN INTENSIVIST CARE MANAGER - ADDING OUTPATIENT NUTRITION AND DIABETES SERVICES TO ADDITIONAL PRIMARY CARE PRACTICES - ENHANCING MAMMOGRAPHY SERVICES BY ADDING 3D MAMMOGRAPHY CANCER THE HOSPITAL PLANS TO TAKE THE FOLLOWING STEPS TO ADDRESS THIS NEED: - ENHANCING MAMMOGRAPHY SERVICES BY ADDING 3D MAMMOGRAPHY
CALDWELL MEMORIAL HOSPITALPART V, LINE 16A, FAP WEBSITE HTTP://CALDWELLMEMORIAL.ORG/FINANCIAL-ASSISTANCE-POLICY/
CALDWELL MEMORIAL HOSPITALPART V, LINE 16B, FAP APPLICATION WEBSITE HTTP://CALDWELLMEMORIAL.ORG/FINANCIAL-ASSISTANCE-POLICY/
caldwell memorial hospitalPART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE HTTP://CALDWELLMEMORIAL.ORG/FINANCIAL-ASSISTANCE-POLICY/
FieldValueIRS element (for citing)
Facility9FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
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 (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3CCALDWELL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE CALDWELL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. THE CRITERIA FOR CHARITY CARE, WHILE NOT ALL INCLUSIVE, CONSIDERS THE PATIENTS INCOME, THEIR FINANCIAL STATUS INCLUDING THE EXTENT OF FINANCIAL OBLIGATIONS FOR HEALTH CARE SERVICES, AND ANY OTHER PERTINENT FACTORS DEEMED APPROPRIATE BY CALDWELL IN ASSESSING THE PATIENTS ABILITY TO PAY FOR THEIR SERVICES.
PART I, LINE 7WORKSHEET FROM SCHEDULE H INSTRUCTIONS IS USED TO COMPUTE A COST-TO-CHARGE RATIO TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST.
PART I, LN 7 COL(F)UNCOLLECTIBLE ACCOUNTS - THE HOSPITAL HAS PROVIDED SERVICES TO PERSONS WHO HAVE NOT PAID FOR SUCH SERVICES EITHER BECAUSE THEY HAVE BEEN UNWILLING OR UNABLE TO PAY. EFFORTS ARE MADE BY THE HOSPITAL TO DETERMINE IF A PATIENT MEETS CHARITY POLICY GUIDELINES THAT ARE ESTABLISHED BY THE HOSPITAL. IF THESE GUIDELINES ARE MET AND CAN BE VERIFIED, THEN SUCH AMOUNTS ARE INCLUDED IN CHARITY CARE. UNTIL SUCH TIME, SUCH AMOUNTS ARE COMBINED IN THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS BECAUSE THEY HAVE NOT BEEN VERIFIED OR DOCUMENTED AS CHARITY CARE DUE TO LACK OF SUPPORTING FINANCIAL INFORMATION. IN SOME CASES, PATIENTS WHO WOULD (OR COULD) QUALIFY FOR CHARITY CARE ARE UNWILLING OR UNABLE TO PRODUCE THE NECESSARY INFORMATION TO SUBSTANTIATE THEIR QUALIFICATION. THUS, THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS INCLUDE AMOUNTS THAT WOULD OTHErWISE QUALIFY FOR CHARITY CARE UNDER THE HOSPITAL'S GUIDELINES. THE ESTIMATED COST OF UNREIMBURSED SERVICES ATTRIBUTABLE TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS - EFFECTIVELY "FREE" SERVICES PROVIDED TO PATIENTS - HAS BEEN DETERMINED BY APPLYING A COST TO CHARGE RATIO TO THE AMOUNT OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS.
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 3THE 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 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, THE HOSPITAL DEVELOPED A STANDARD PROCESS OF GATHERING COMMUNITY INPUT. IN ADDITION TO GATHERING DATA FROM THE ABOVE SOURCES: - WE DEPLOYED A CHNA "ROUND 1" SURVEY TO OUR LOCAL EXPERT ADVISORS TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED ACCORDING TO CRITERIA REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS AND THE HOSPITAL'S DESIRE TO REPRESENT THE REGION'S GEOGRAPHICALLY AND ETHNICALLY DIVERSE POPULATION. WE RECEIVED COMMUNITY INPUT FROM 19 LOCAL EXPERT ADVISORS. SURVEY RESPONSES STARTED JUNE 2, 2017, AND ENDED WITH THE LAST RESPONSE ON JUNE 12, 2017. - INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW CALDWELL COUNTY RELATES TO ITS PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS AND OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS. RESPONDENTS COMMENTED ON WHETHER THEY BELIEVE CERTAIN POPULATION GROUPS ("PRIORITY POPULATIONS") NEED HELP TO IMPROVE THEIR CONDITION, AND IF SO, WHO NEEDS TO DO WHAT TO IMPROVE THE CONDITIONS OF THESE GROUPS. WHEN THE ANALYSIS WAS COMPLETE, WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL EXPERT ADVISORS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL COMMENTS OF NEED. CONSULTATION WITH LOCAL EXPERTS OCCURRED AGAIN VIA AN INTERNET-BASED SURVEY (EXPLAINED BELOW) BEGINNING JUNE 22, 2017, AND ENDING JUNE 30, 2017. HAVING TAKEN STEPS TO IDENTIFY POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS THEN PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A "WISDOM OF CROWDS" METHOD. THE PREMISE OF THIS APPROACH RELIES ON A PANEL OF EXPERTS WITH THE ASSUMPTION THAT THE COLLECTIVE WISDOM OF PARTICIPANTS IS SUPERIOR TO THE OPINION OF ANY ONE INDIVIDUAL, REGARDLESS OF THEIR PROFESSIONAL CREDENTIALS. IN THE CALDWELL MEMORIAL HOSPITAL PROCESS, EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. WHILE THERE WERE A FEW OPINIONS OF THE DATA CONCLUSIONS NOT BEING COMPLETELY ACCURATE, MOST OF THE COMMENTS AGREED WITH OUR FINDINGS. WE DEVELOPED A LIST OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE LIST OF HEALTH NEEDS, INCLUDING THE OPPORTUNITY TO LIST ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. WE DIVIDED THE RANKED NEEDS INTO TWO GROUPS: "SIGNIFICANT"OTHER IDENTIFIED NEEDS." THE SIGNIFICANT NEEDS WERE PRIORITIZED BASED ON TOTAL POINTS CAST BY THE LOCAL EXPERTS IN DESCENDING ORDER, FURTHER RANKED BY THE NUMBER OF LOCAL EXPERTS CASTING ANY POINTS FOR THE NEED. BY OUR DEFINITION, A SIGNIFICANT NEED HAD TO INCLUDE ALL RANK ORDERED NEEDS UNTIL AT LEAST FIFTY PERCENT (50%) OF ALL POINTS WERE INCLUDED AND TO THE EXTENT POSSIBLE, REPRESENTED POINTS ALLOCATED BY A MAJORITY OF VOTING LOCAL EXPERTS. THE DETERMINATION OF THE BREAK POINT -- "SIGNIFICANT" AS OPPOSED TO "OTHER" -- WAS A QUALITATIVE INTERPRETATION BY THE CALDWELL MEMORIAL HOSPITAL EXECUTIVE TEAM WHERE A REASONABLE BREAK POINT IN RANK ORDER OCCURRED.
PART VI, LINE 3CALDWELL MEMORIAL HOSPITAL (CMH) PROVIDES NEEDED HEALTHCARE SERVICES TO ANYONE REGARDLESS OF THAT PERSON'S ABILITY TO PAY. CMH'S CHARITY CARE 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 AND CHARITY CARE 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 CHARITY CARE 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. 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. TODAY THERE ARE NINE INCORPORATED MUNICIPALITIES IN THE COUNTY: LENOIR, HUDSON, GRANITE FALLS, CEDAR ROCK, CAJAHS MOUNTAIN, GAMEWELL, SAWMILLS, AND PARTS OF BLOWING ROCK AND RHODHISS. POPULATION IS JUST OVER 81,000. MEDIAN INCOME IS $39,528. POPULATION MAKEUP IS 87.4% WHITE, 5.3% HISPANIC, 4.8% HISPANIC AND 2.4% OTHER. MEDIAN AGE IS 43.9 YEARS. 49.4%% ARE MALES AND 50.6% FEMALES.
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 HEALTHCARE 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 NINE 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.
Part VI, Line 7, List of States Receiving Community Benefit Reportnc

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 (13 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
Chris Ellington
Director$0$554,380$0$93,650$0$261,407$0$254,658$0$20,648$0$1,184,743$0$172,082
Gary Park
Director$0$827,192$0$137,894$0$54,900$0$529,661$0$20,185$0$1,569,832$0$0
John Powell MD
Director/Ex Officio$226,708$0$27,314$0$371$0$10,715$0$23,768$0$288,876$0$0$0
Laura Easton
Director/CEO$294,724$0$49,235$0$774$0$16,200$0$23,180$0$384,113$0$0$0
Rebecca Smith
COO & CNO$197,213$0$33,823$0$24,180$0$12,343$0$13,190$0$280,749$0$0$0
Shawn Hartley
CFO$174,248$0$29,503$0$140$0$0$0$23,768$0$227,659$0$0$0
David Lowery MD
CMO$296,543$0$92,069$0$1,161$0$10,800$0$23,768$0$424,341$0$0$0
Donita Damron
VP Physician Services$149,447$0$25,989$0$129$0$4,635$0$15,519$0$195,719$0$0$0
Randal Bast MD
Medical Practice Physician$660,039$0$984$0$494$0$3,276$0$23,768$0$688,561$0$0$0
Craig Robson MD
Medical Practice Physician$408,459$0$125,000$0$187$0$969$0$0$0$534,615$0$0$0
Robert Dacus MD
Medical Practice Physician$440,925$0$24,794$0$494$0$7,045$0$23,768$0$497,026$0$0$0
David Evans MD
Medical Practice Physician$383,484$0$23,269$0$893$0$8,909$0$23,180$0$439,735$0$0$0
Mark Brady MD
Medical Practice Physician$192,350$0$213,935$0$0$0$0$0$0$0$406,285$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4B:DURING THE CALENDAR YEAR 2017, THE FOLLOWING INDIVIDUALS RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN (457(F)): CHRIS ELLINGTON (DIRECTOR) $172,082 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 6:Employees in managerial roles participate in an incentive compensation plan approved annually by the UNC HCS Board of Directors. The compensation earned under this plan is based partly on the net earnings of the Organization and the UNC HCS. Other performance measures used to determine incentive compensation are patient satisfaction, patient care quality outcomes and innovative initiatives to improve operations and care delivery.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (12 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 AT CHAPEL HILL
211 FRIDAY CENTER DR SUITE 2CHAPEL HILLNC27517561118388HEALTHCARENCSECTION 115UNC HEALTH Cfalse
THE REX HEALTHCARE FOUNDATION INC
4420 LAKE BOONE TRAILRALEIGHNC27607566052117support rex hNC501(C)(3)LINE 12, iiUNC HEALTH Cfalse
CALDWELL MEMORIAL HOSPITAL FOUNDATION
PO BOX 1890LENOIRNC28645581935514SUPPORT OF CANC501(C)(3)LINE 7CALDWELL MEMYes (true)
CHATHAM HOSPITAL INC
PO BOX 649SILER CITYNC27344560611546HEALTHCARENC501(C)(3)LINE 3UNC HEALTH Cfalse
HIGH POINT REGIONAL HEALTH
601 N ELM STREETHIGH POINTNC27261560532309HEALTHCARENC501(C)(3)LINE 3UNC HEALTH Cfalse
HIGH POINT REGIONAL HEALTH SERVICES
601 N ELM STREETHIGH POINTNC27261561497163HEALTHCARENC501(C)(3)LINE 12B,IIUNC HEALTH Cfalse
HIGH POINT REGIONAL HEALTH FOUNDATION
601 N ELM STREETHIGH POINTNC27261272854711support highNC501(C)(3)LINE 12A, IUNC 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 22MORRISVILLENC27560271081647HEALTHCARENC501(C)(3)LINE 10UNC HEALTH Cfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtUBI Code VUBICodeVAmtOwnershipOwnershipPct
Rex Surgery Center of Cary
4420 Lake Boone TrailRaleighNC27607273684056ASCNCnaN/A$0$0$00.00000
JRH Ventures LLC
4420 Lake Boone TrailRaleighNC27607274092967Med Campus DVLTNCNAN/A$0$0$00.00000
Rex Health Ventures I LP
4420 Lake Boone TrailRaleighNC27607371690478Venture Capital INCNAN/A$0$0$00.00000
HIGH POINT SURGERY CENTER
600 NORTH LINDSAY STREETHIGH POINTNC27260561867005HIGH POINT REGIONNCNAN/A$0$0$00.00000
ORTHOPAEDIC SURGERY CENTER OF RALEIGH LL
4420 Lake Boone TrailRaleighNC27607271740526ORTHOPAEDIC SURGENCNAN/A$0$0$00.00000
TRO VENTURES LLC
4420 LAKE BOONE TRAILRALEIGHNC27607821330195HEALTHCARENCNAN/A$0$0$00.00000

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationInd
REX ENTERPRISES COMPANY INC
4420 LAKE BOONE TRAILRALEIGHNC27607561553957OPERATIONS SUPPORNCNAC CORP$0$00.00000false
HIGH POINT HEALTHCARE VENTURES
601 N ELM STREETHIGH POINTNC27261561343468HOLDING COMPANYNCNAC CORP$0$00.00000false
UNC PHYSICIANS NETWORK GROUP PRACTICES L
1600 PERIMETER PARK DRIVE Ste 225MORRISVILLENC27560461416986HEALTHCARENCNAC CORP$0$00.00000false
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 OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
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$602,794InvolvedAmt
Method Of Amount DeterminationCashMethodOfAmountDeterminationTxt