CAROMONT MEDICAL GROUP INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CAROMONT MEDICAL GROUP INC (EIN 56-1479712)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-07
- IRS object ID
- 201821279349301922
- Schema version
- 2016v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-07T15:37:00-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1Txt |
| City | ASHEVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561479712 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAROMONT MEDICAL GROUP INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CARO | BusinessNameControlTxt |
| Phone | 7048342000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1Txt |
| City | GASTONIA | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 280531747 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Signing officer | PersonNm |
| Person Title | EVP, CFO | PersonTitleTxt |
| Phone | 7048342000 | PhoneNum |
| Signature | 2018-05-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Amy Bibby | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID O'CONNOR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1Txt |
| City | GASTONIA | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 280531747 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $108,372,408 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CAROMONT.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1985 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | To provide exceptional health care to the communities we serve. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 928 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $103,630,436 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $104,382,115 | CYProgramServiceRevenueAmt |
| PY Investment Income | $253,838 | PYInvestmentIncomeAmt |
| CY Investment Income | $573,854 | CYInvestmentIncomeAmt |
| PY Other Revenue | $4,261,534 | PYOtherRevenueAmt |
| CY Other Revenue | $3,416,439 | CYOtherRevenueAmt |
| PY Total Revenue | $108,145,808 | PYTotalRevenueAmt |
| CY Total Revenue | $108,372,408 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,500 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $97,033,165 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $96,953,392 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $27,441,826 | PYOtherExpensesAmt |
| CY Other Expenses | $29,511,178 | CYOtherExpensesAmt |
| PY Total Expenses | $124,476,491 | PYTotalExpensesAmt |
| CY Total Expenses | $126,466,070 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$16,330,683 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$18,093,662 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $35,002,246 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,426,567 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,135,521 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,096,974 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $25,866,725 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,329,593 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To provide exceptional health care to the communities we serve. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $118,973,781 | ExpenseAmt |
| Grant | $1,500 | GrantAmt |
| Revenue | $107,056,703 | RevenueAmt |
| Desc | SEE SCHEDULE O.CaroMont Medical Group owns and operates a network of more than 40 primary care and specialty physician practices and two urgent care centers. The group employs more than 200 physicians and over 70 advanced practitioners in twenty-four different specialties. CaroMont Medical Group is committed to providing high quality care to its patients, with 100% of its primary care practices recognized as a Level 3 Patient-Centered Medical Home. This highest level of recognition available to primary care practices by the National Center for Quality Assurance (NCQA) identifies practices that emphasize care coordination and communication to improve quality outcomes for their patients.CaroMont Medical Group is active in its communities in a number of ways. The practices make monetary and in-kind contributions to community non-profit organizations, physicians and staff volunteer at community events and health fairs, and leaders serve on community boards. | Desc |
| Total Program Service Expenses | $118,973,781 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 179 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 928 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID O'CONNOR | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7048342000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE | AddressLine1Txt |
| City | GASTONIA | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28054 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Mr Donnie Loftis | ||||||||
| Chairman | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MR MICHAEL DICKSON | ||||||||
| DIRECTOR (THRU. DECEMBER '16) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DR PATRICK RUSSO | ||||||||
| DIRECTOR/PHYSICIAN | 1.00 | 2.00 | Yes (X) | $618,820 | $0 | $37,077 | ||
| MR TIM GAUSE | ||||||||
| DIRECTOR (BEG. JANUARY '17) | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JACQUELINE FOLKS | ||||||||
| Director (THRU. DECEMBER '16)/PHYSICIAN | 1.00 | Yes (X) | $195,966 | $0 | $25,798 | |||
| MARK THOMPSON MD | ||||||||
| DIRECTOR/PHYSICIAN | 1.00 | Yes (X) | $794,285 | $0 | $35,287 | |||
| DR ANDREW DYKSTERHOUSE | ||||||||
| DIRECTOR(BEG. JANUARY '17)/PHYSICIAN | 1.00 | Yes (X) | $535,662 | $0 | $27,996 | |||
| TONY SISSONS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $1,635 | $0 | |||
| DOUG LUCKETT | ||||||||
| CEO/PRESIDENT (THRU. MAR '17) | 1.00 | 54.00 | Yes (X) | $0 | $942,496 | $185,029 | ||
| DAVID O'CONNOR | ||||||||
| EVP/CFO/Asst. Treasurer | 1.00 | 54.00 | Yes (X) | $0 | $565,374 | $108,958 | ||
| MARIA LONG | ||||||||
| EVP CLO/AS (THRU. APRIL '17) | 1.00 | 54.00 | Yes (X) | $0 | $470,930 | $81,698 | ||
| LEIGH HICKMAN | ||||||||
| CLO/AS (BEG. MAY '17) | 1.00 | 54.00 | Yes (X) | $0 | $195,813 | $20,451 | ||
| TODD DAVIS | ||||||||
| INTERIM CEO/PRES.(MAR'17-MAY'17) | 1.00 | 54.00 | Yes (X) | $0 | $465,740 | $100,433 | ||
| K CHRISTOPHER PEEK | ||||||||
| CEO/PRES. BEG. MAY '17 | 1.00 | 54.00 | Yes (X) | $0 | $0 | $0 | ||
| DR WALTER H CAULFIELD | ||||||||
| Physcian | 40.00 | $804,849 | $0 | $29,200 | Yes (X) | |||
| Dr Omer L Shedd | ||||||||
| Physcian | 40.00 | $770,762 | $0 | $31,400 | Yes (X) | |||
| Dr Dustin P Letts | ||||||||
| Physcian | 40.00 | $849,085 | $0 | $32,349 | Yes (X) | |||
| Dr James P Greelish | ||||||||
| Physcian | 40.00 | $923,615 | $0 | $34,778 | Yes (X) | |||
| Dr Alec Akbarov | ||||||||
| Physcian | 40.00 | $810,024 | $0 | $31,206 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $6,303,068 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,641,988 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $781,660 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 201 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ATHENA HEALTH INC | |||||
| PO BOX 415615 | BOSTON | MA | 022415615 | SOFTWARE SERVICES | $2,315,960 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 753972633 | PHYSICIAN STAFFING | $1,212,169 |
| STAFF CARE INC | |||||
| PO BOX 281923 | ATLANTA | GA | 30384 | PHYSICIAN STAFFING | $414,134 |
| AJAYKUMAR PATEL | |||||
| 16529 SILVERSWORD DRIVE | CHARLOTTE | NC | 28213 | PHYSICIAN STAFFING | $406,700 |
| CHARMAINE LUVIS | |||||
| 912 KIRKCALDY YARD | GASTONIA | NC | 28054 | PHYSICIAN STAFFING | $260,875 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $104,382,115 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $104,382,115 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $104,382,115 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $173,338 | TotalRevenueColumnAmt |
| Exclusion | $173,338 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $400,516 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $400,516 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $400,516 | TotalRevenueColumnAmt |
| Exclusion | $400,516 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| SHARED SAVINGS | 900099 | $1,701,877 | $1,701,877 | |
| COORDINATION REVENUE | 900099 | $972,711 | $972,711 | |
| MISCELLANEOUS | 621400 | $482,093 | $482,093 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $259,758 | TotalRevenueColumnAmt |
| Exclusion | $259,758 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,416,439 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $108,372,408 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $107,056,703 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,315,705 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,500 | TotalAmt |
| Program Services | $1,500 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,707,232 | TotalAmt |
| Program Services | $1,707,232 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,645,409 | TotalAmt |
| Program Services | $74,606,988 | ProgramServicesAmt |
| Management And General | $5,038,421 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,180,692 | TotalAmt |
| Program Services | $2,840,417 | ProgramServicesAmt |
| Management And General | $340,275 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,061,437 | TotalAmt |
| Program Services | $7,019,805 | ProgramServicesAmt |
| Management And General | $1,041,632 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,358,622 | TotalAmt |
| Program Services | $4,029,931 | ProgramServicesAmt |
| Management And General | $328,691 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,050 | TotalAmt |
| Program Services | $1,000 | ProgramServicesAmt |
| Management And General | $3,050 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,943 | TotalAmt |
| Management And General | $8,943 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $399,015 | TotalAmt |
| Program Services | $195,247 | ProgramServicesAmt |
| Management And General | $203,768 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,055 | TotalAmt |
| Program Services | $34,965 | ProgramServicesAmt |
| Management And General | $90 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,066,375 | TotalAmt |
| Program Services | $1,955,514 | ProgramServicesAmt |
| Management And General | $110,861 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,793,251 | TotalAmt |
| Program Services | $5,467,569 | ProgramServicesAmt |
| Management And General | $325,682 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,974 | TotalAmt |
| Program Services | $44,612 | ProgramServicesAmt |
| Management And General | $17,362 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1 | TotalAmt |
| Program Services | $1 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,322,957 | TotalAmt |
| Program Services | $2,262,283 | ProgramServicesAmt |
| Management And General | $60,674 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,808,767 | TotalAmt |
| Program Services | $1,796,085 | ProgramServicesAmt |
| Management And General | $12,682 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $10,181,589 | $10,181,431 | $158 |
| BAD DEBT | $6,582,762 | $6,582,762 | |
| BIOMED | $246,439 | $246,439 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,466,070 | TotalAmt |
| Program Services | $118,973,781 | ProgramServicesAmt |
| Management And General | $7,492,289 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $590,546 | BOYAmt |
| EOY | -$357,693 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,533,810 | BOYAmt |
| EOY | $7,221,845 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $981,977 | BOYAmt |
| EOY | $832,223 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,684 | BOYAmt |
| EOY | $382,701 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $27,135,546 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,579,016 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,243,568 | BOYAmt |
| EOY | $15,556,530 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,882,773 | BOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,448,153 | BOYAmt |
| EOY | $3,448,153 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $206,735 | BOYAmt |
| EOY | $342,808 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,002,246 | BOYAmt |
| EOY | $27,426,567 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,131,478 | BOYAmt |
| EOY | $7,092,676 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,043 | BOYAmt |
| EOY | $4,298 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,135,521 | BOYAmt |
| EOY | $7,096,974 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,866,725 | BOYAmt |
| EOY | $20,329,593 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,866,725 | BOYAmt |
| EOY | $20,329,593 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,002,246 | BOYAmt |
| EOY | $27,426,567 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$18,093,662 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $435,405 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $12,121,125 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $25,293 | CurrentTaxYearMinus4YearsAmt |
| Total | $25,293 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $87,106,169 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $92,461,244 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $101,328,540 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $103,630,436 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $107,056,703 | CurrentTaxYearAmt |
| Total | $491,583,092 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,333,958 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,068,263 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,760,180 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,261,534 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $741,851 | CurrentTaxYearAmt |
| Total | $13,165,786 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $89,465,420 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $95,529,507 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $104,088,720 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $107,891,970 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $107,798,554 | CurrentTaxYearAmt |
| Total | $504,774,171 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $504,774,171 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,435,414 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $781,626 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $658,129 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $653,148 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $173,338 | CurrentTaxYearAmt |
| Total | $3,701,655 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,435,414 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $781,626 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $658,129 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $653,148 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $173,338 | CurrentTaxYearAmt |
| Total | $3,701,655 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $90,900,834 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $96,311,133 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $104,746,849 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $108,545,118 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $107,971,892 | CurrentTaxYearAmt |
| Total | $508,475,826 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99270 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98990 | PublicSupportPY509Pct |
| Investment Income CY | 0.00730 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,443,480 | OtherCostOrOtherBasisAmt |
| Book Value | $1,443,480 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,499,889 | OtherCostOrOtherBasisAmt |
| Depreciation | $761,452 | DepreciationAmt |
| Book Value | $4,738,437 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,273,667 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,770,253 | DepreciationAmt |
| Book Value | $2,503,414 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,699,345 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,972,005 | DepreciationAmt |
| Book Value | $6,727,340 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $219,165 | OtherCostOrOtherBasisAmt |
| Depreciation | $75,306 | DepreciationAmt |
| Book Value | $143,859 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $15,556,530 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THIRD PARTY SETTLEMENTS | Desc |
| Amt | $4,298 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,298 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $114,287,002 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $435,405 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $12,121,125 | OtherRevenueAmt |
| Revenue Not Reported | $12,556,530 | RevenueNotReportedAmt |
| Revenue Subtotal | $101,730,472 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $8,943 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $6,632,993 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $6,641,936 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $108,372,408 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $119,824,134 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $119,824,134 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $8,943 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $6,632,993 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $6,641,936 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $126,466,070 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The System is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The System has determined that it does not have any unrecognized tax benefits or obligations as of June 30, 2017 and 2016. |
| Part XI, Line 2d - Other Adjustments: | EQUITY TRANSFER 12,121,125. |
| Part XI, Line 4b - Other Adjustments: | MANAGEMENT FEES NET WITH EXPENSES 50,231. BAD DEBT EXPENSE 6,582,762. |
| Part XII, Line 4b - Other Adjustments: | BAD DEBT EXPENSE 6,582,762. MANAGEMENT FEES NET WITH EXPENSES 50,231. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR PATRICK RUSSO | ||||||||||||||
| DIRECTOR/PHYSICIAN | $569,318 | $0 | $47,387 | $0 | $2,115 | $0 | $0 | $0 | $37,077 | $0 | $655,897 | $0 | $0 | $0 |
| DR JACQUELINE FOLKS | ||||||||||||||
| Director (THRU. DECEMBER '16)/PHYSIC | $133,610 | $0 | $61,180 | $0 | $1,176 | $0 | $0 | $0 | $25,798 | $0 | $221,764 | $0 | $0 | $0 |
| MARK THOMPSON MD | ||||||||||||||
| DIRECTOR/PHYSICIAN | $566,247 | $0 | $224,958 | $0 | $3,080 | $0 | $0 | $0 | $35,287 | $0 | $829,572 | $0 | $0 | $0 |
| DR ANDREW DYKSTERHOUSE | ||||||||||||||
| DIRECTOR(BEG. JANUARY '17)/PHYSICIAN | $143,326 | $0 | $391,213 | $0 | $1,123 | $0 | $10,689 | $0 | $17,307 | $0 | $563,658 | $0 | $0 | $0 |
| DOUG LUCKETT | ||||||||||||||
| CEO/PRESIDENT (THRU. MAR '17) | $0 | $618,606 | $0 | $202,993 | $0 | $120,897 | $0 | $167,333 | $0 | $17,696 | $0 | $1,127,525 | $0 | $119,305 |
| DAVID O'CONNOR | ||||||||||||||
| EVP/CFO/Asst. Treasurer | $0 | $387,072 | $0 | $96,743 | $0 | $81,559 | $0 | $91,314 | $0 | $17,644 | $0 | $674,332 | $0 | $77,497 |
| MARIA LONG | ||||||||||||||
| EVP CLO/AS (THRU. APRIL '17) | $0 | $327,957 | $0 | $79,402 | $0 | $63,571 | $0 | $80,385 | $0 | $1,313 | $0 | $552,628 | $0 | $63,064 |
| LEIGH HICKMAN | ||||||||||||||
| CLO/AS (BEG. MAY '17) | $0 | $173,521 | $0 | $21,634 | $0 | $658 | $0 | $8,690 | $0 | $11,761 | $0 | $216,264 | $0 | $0 |
| TODD DAVIS | ||||||||||||||
| INTERIM CEO/PRES.(MAR'17-MAY'17) | $0 | $337,568 | $0 | $79,573 | $0 | $48,599 | $0 | $82,815 | $0 | $17,618 | $0 | $566,173 | $0 | $47,780 |
| DR WALTER H CAULFIELD | ||||||||||||||
| Physcian | $336,840 | $0 | $466,228 | $0 | $1,781 | $0 | $16,942 | $0 | $12,258 | $0 | $834,049 | $0 | $0 | $0 |
| Dr Omer L Shedd | ||||||||||||||
| Physcian | $569,590 | $0 | $200,225 | $0 | $947 | $0 | $13,909 | $0 | $17,491 | $0 | $802,162 | $0 | $0 | $0 |
| Dr Dustin P Letts | ||||||||||||||
| Physcian | $569,318 | $0 | $278,802 | $0 | $965 | $0 | $14,858 | $0 | $17,491 | $0 | $881,434 | $0 | $0 | $0 |
| Dr James P Greelish | ||||||||||||||
| Physcian | $793,908 | $0 | $127,596 | $0 | $2,111 | $0 | $17,242 | $0 | $17,536 | $0 | $958,393 | $0 | $0 | $0 |
| Dr Alec Akbarov | ||||||||||||||
| Physcian | $725,686 | $0 | $80,691 | $0 | $3,647 | $0 | $13,691 | $0 | $17,515 | $0 | $841,230 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | COMPENSATION PAID TO CEO OF CAROMONT HEALTH, INC. WAS PAID BY CAROMONT REGIONAL MEDICAL CENTER, A RELATED ORGANIZATION. CAROMONT REGIONAL MEDICAL CENTER UTILIZED THE FOLLOWING METHODS TO DETERMINE APPROPRIATE COMPENSATION FOR CEO THAT HAD INFLUENCE OVER THE ORGANIZATION'S ACTIVITIES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACTS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| Part I, Line 4b | The following individuals received deferred compensation allocations by related organization CaroMont Regional Medical Center from a Supplemental Executive Retirement Plan (SERP): David O'Connor - $ 75,414 Maria Long - 63,307 Doug Luckett - 151,347 Todd Davis, MD - 66,915 |
| Part I, Line 6 | Certain CaroMont Medical Group Inc. Physician's Compensation packages are based on the individual physician's net results from operations as calculated based soley on his/her net charges less his/her allocable share of clinic overhead costs. Executive Incentive Compensation Plan for all key employees based on the achievement of annual Business Objectives which include a financial goal attributable to operating margin. Manager Incentive Plan based on consolidated corporate and individual performance goals. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The sole member of the Corporation shall be CaroMont Health, Inc., a North Carolina not-for-profit corporation. |
| Form 990, Part VI, Section A, line 7a | The Board of Directors shall consist of six (6) members; all of whom shall be appointed by the board of directors of CaroMont Health. Three (3) members also serve as members of the CaroMont Health Board, one (1) member is the Chair of the Physician Leadership Council, one (1) member is a member of the physician leadership council, and one (1) member is a community member who is an active recipient of services provided by CaroMont Medical Group. |
| Form 990, Part VI, Section A, line 7b | The following powers of the Corporation shall be reserved to CaroMont Health, Inc., the parent corporation and holding company of the Corporation: (a) Financial powers, including the power to approve an operating budget for the Corporation, power to approve compensation plans, and power to assume debt on behalf of the Corporation; (b) Governing powers, including the power to approve all changes to the governing documents of the Corporation and power to approve the mission, vision and values of the Corporation; and (c) Strategic powers, including the power to approve all Certificate of Need applications which the Corporation may file in any state, and the power to approve all sale or lease transactions of the Corporation. |
| Form 990, Part VI, Section B, line 11b | The organization's Form 990 was reviewed by the Audit Finance Investment committee of the Board of Directors of CaroMont Health and by the full Board before the Form was filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF SENIOR LEADERSHIP, ANY PHYSICIAN HOLDING A LEADERSHIP OR ADMINISTRATIVE POSITION WITHIN THE ORGANIZATION, DIRECTORS, MANAGERS AND ALL STAFF MEMBERS OF THE PURCHASING AND MARKETING DEPARTMENTS AND ANY OTHER DEPARTMENT DEEMED TO HAVE MATERIAL DECISION MAKING RESPONSIBILITIES ON BEHALF OF CAROMONT HEALTH SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE INDIVIDUAL'S OBLIGATION TO IMMEDIATELY MAKE THE CORPORATE RESPONSIBILITY OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID INDIVIDUAL'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. QUESTIONNAIRES SUBMITTED BY DIRECTORS ARE REVIEWED ANNUALLY BY THE NOMINATING COMMITTEE OF THE BOARD. |
| Form 990, Part VI, Section B, line 15 | THE CEO, CFO, COO, CMO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY CaroMont Regional Medical Center, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. A majority of the board members who serve on the compensation committee are independent and all are free from any conflict of interest. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE MANAGEMENT, UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. |
| Form 990, Part VI, Section C, line 18 | The organization's Form 990 is made available to the public upon request. |
| Form 990, Part VI, Section C, line 19 | At this time, the organization's governing documents and conflict of interest policy are not made available to the public. The entire organization's combined financial statements are made available upon request. |
| Form 990, Part XI, line 9: | EQUITY TRANSFER 12,121,125. |
| PART XII, LINE 2C | RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT: THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| CAROMONT SPECIALITY GROUP LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 522451748 | MEDICAL SERVICES | NC | $0 | $0 | CaroMont Medical Group Inc |
| CAROMONT SOUTH POINT LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 205453221 | MEDICAL SERVICES | NC | $20,734,168 | $1,066,917 | CaroMont Medical Group Inc |
| CMG - GASTON WOMENS HEALTHCARE LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 205894683 | MEDICAL SERVICES | NC | $5,863,869 | $112,775 | CaroMont Medical Group Inc |
| CMG - FAMILY MEDICINE OF CLEVELAND COUNTY LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 205925671 | MEDICAL SERVICES | NC | $0 | $0 | CaroMont Medical Group Inc |
| Ashley Womens CMG LLC | |||||||||
| 2240 REMOUNT RD | gASTONIA | NC | 28054 | 264369018 | MEDICAL SERVICES | NC | $12,447,930 | $981,690 | CaroMont Medical Group Inc |
| CS CMG LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 272146660 | MEDICAL SERVICES | NC | $0 | $0 | CaroMont Medical Group Inc |
| GS CMG LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 272146801 | MEDICAL SERVICES | NC | $1,939,383 | $92,757 | CaroMont Medical Group Inc |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CaroMont Health Inc | |||||||||||
| 2525 Court Drive | Gastonia | NC | 28054 | 581636959 | MEDICAL SERVICES | NC | 501(c)(3) | Line 11B, II | N/A | 0 | |
| CaroMont Health Services Inc | |||||||||||
| 2526 Court Drive | Gastonia | NC | 28054 | 561455630 | OUTPATIENT SERVICES | NC | 501(c)(3) | Line 3 | 0 | CaroMont Health Inc | |
| Gaston Memorial Hospital Foundation Inc | |||||||||||
| 2527 Court Drive | Gastonia | NC | 28054 | 561479699 | FOUNDATION | NC | 501(c)(3) | Line 9 | 0 | CaroMont Health Inc | |
| Hospice of Gaston County Inc | |||||||||||
| 2529 Court Drive | Gastonia | NC | 28054 | 581341530 | HOSPICE CARE | NC | 501(c)(3) | Line 7 | 0 | CaroMont Health Inc | |
| Gaston Memorial Hospital Inc | |||||||||||
| 2530 Court Drive | Gastonia | NC | 28054 | 560619359 | HOSPITAL | NC | 501(c)(3) | Line 3 | 0 | CaroMont Health Inc | |
| Gaston Emergency Physicians Inc | |||||||||||
| 2531 Court Drive | Gastonia | NC | 28054 | 562209423 | Supporting Organization | NC | 501(c)(3) | Line 11A, I | 0 | CaroMont Health Inc | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |