HUGH CHATHAM MEMORIAL HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- HUGH CHATHAM MEMORIAL HOSPITAL INC (EIN 56-0642846)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-08-03
- IRS object ID
- 201822159349300512
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-08-03T08:59:28-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | 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 | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560642846 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HUGH | BusinessNameControlTxt |
| Phone | 3365277000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PARKWOOD DR | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DONALD E TRIPPEL | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3365277000 | PhoneNum |
| Signature | 2018-08-03 | 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 |
| Preparation | 2018-07-31 | PreparationDt |
| 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 | DONALD E TRIPPEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PARKWOOD DR | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $121,599,270 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HUGHCHATHAM.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1930 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE BIRTHING AND ACUTE CARE SERVICES IN ADDITION TO SKILLED NURSING, RETIREMENT COMMUNITY, HOME HEALTH, AND HOSPICE SERVICES PRIMARILY TO THE RESIDENTS OF AND SURROUNDING COUNTIES TO SURRY COUNTY, NORTH CAROLINA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 981 | TotalEmployeeCnt |
| Total Volunteers | 90 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $40,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $558,003 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $104,351,357 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $106,949,671 | CYProgramServiceRevenueAmt |
| PY Investment Income | $8,712,152 | PYInvestmentIncomeAmt |
| CY Investment Income | $12,744,415 | CYInvestmentIncomeAmt |
| PY Other Revenue | $978,243 | PYOtherRevenueAmt |
| CY Other Revenue | $1,013,688 | CYOtherRevenueAmt |
| PY Total Revenue | $114,081,752 | PYTotalRevenueAmt |
| CY Total Revenue | $121,265,777 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $110,597 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $78,120 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $48,573,058 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $49,426,206 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $52,453 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $59,263,212 | PYOtherExpensesAmt |
| CY Other Expenses | $58,122,535 | CYOtherExpensesAmt |
| PY Total Expenses | $107,946,867 | PYTotalExpensesAmt |
| CY Total Expenses | $107,626,861 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,134,885 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $13,638,916 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $216,831,875 | TotalAssetsBOYAmt |
| Total Assets EOY | $233,899,728 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $91,384,923 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $85,557,057 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $125,446,952 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $148,342,671 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $99,835,200 | ExpenseAmt |
| Grant | $78,120 | GrantAmt |
| Revenue | $106,949,671 | RevenueAmt |
| Desc | HUGH CHATHAM MEMORIAL HOSPITAL (HCMH) IS A NOT-FOR-PROFIT HOSPITAL LOCATED IN ELKIN, SURRY COUNTY, NORTH CAROLINA. IT IS THE SIXTH LARGEST EMPLOYER IN SURRY COUNTY AND IS RANKED AMONG TOP HOSPITALS NATIONWIDE FOR QUALITY BY THE JOINT COMMISSION. HCMH CARES FOR PATIENTS IN THE YADKIN VALLEY REGION IN NORTH CAROLINA, AND ALSO FOR THOSE WHO CHOOSE OUR CARE FROM SEVERAL COUNTIES IN VIRGINIA, INCLUDING CARROLL, GRAYSON AND PATRICK COUNTIES. HCMH IS FOCUSED ON PROVIDING COMMUNITY SUPPORT, CONSISTENT QUALITY, EXCELLENT SERVICE AND A REMARKABLE WORK ENVIRONMENT FOR OUR STAFF. DURING THE FISCAL YEAR, HCMH WAS NAMED AS A FINALIST IN THE "BEST PLACE TO WORK" BY THE TRIAD BUSINESS JOURNAL, BASED LARGELY ON A RANDOM SAMPLE OF 200 EMPLOYEES' RESPONSES TO A SURVEY THAT MEASURED 10 EMPLOYEE ENGAGEMENT CATEGORIES. HCMH HAS A WORKFORCE OF OVER 800 EMPLOYEES.In 2016, HCMH reported $114,081,752 in revenues. HCMH's community benefit was approximately $13,868,325 including $5,107,267 in charity care. THE HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF OUR COMMUNITIES IN THE YADKIN VALLEY REGION OF NORTH CAROLINA, ONE PERSON AT A TIME. IT OFFERS A FULL CONTINUUM OF EMERGENCY, MEDICAL, SURGICAL, REHABILITATIVE AND BEHAVIORAL HEALTH SERVICES. TOP PROGRAMS INCLUDE CANCER SERVICES, CARDIOLOGY, GENERAL SURGERY, GASTROENTEROLOGY, IMAGING, NEUROLOGY, OBSTETRICS AND GYNECOLOGY, ORTHOPEDIC AND SPORTS MEDICINE, PULMONOLOGY AND REHABILITATION SERVICES. THE HOSPITAL ALSO HAS A CERTIFIED PRIMARY STROKE CENTER THAT HAS GOLD PLUS LEVEL DISTINCTION FROM THE AMERICAN HEART ASSOCIATION AND AMERICAN STROKE ASSOCIATION THE ONLY HOSPITAL IN REGION CERTIFIED AT THAT LEVEL. OUR COMMITMENT TO EXCELLENCE IN PATIENT CARE CONTINUED DURING THE YEAR. FOR EXAMPLE, HCMH EARNED "HEALTHCARE'S MOST WIRED" HOSPITAL STATUS AS ONE OF THE NATION'S HEALTH LEADERS IN INFORMATION TECHNOLOGY. DURING THE FISCAL YEAR, HCMH CONTINUED TO FOCUS ON ITS "GOING FOR ZERO" PATIENT SAFETY INITIATIVE GUIDED BY A VISION STATEMENT ENCOURAGING ALL EMPLOYEES AND MEDICAL STAFF TO, "IMAGINE PLACE WHERE COMMUNICATION IS CLEAR, EVERYONE CARES AND PATIENTS ARE ALWAYS SAFE." EDUCATION WAS PROVIDED TO STAFF IN THE USE OF BEST PRACTICE SAFETY COMMUNICATION METHODS "GREAT CATCHES" WAS CREATIVELY FACILITATED.ADDITIONALLY, WE WERE NAMED A "100 SAFE CARE HOSPITAL BY THE SAFECARE GROUP AS WELL AS THE 2016 REGION'S BEST HOSPITAL BY THE WOMEN'S CERTIFIED GROUP. THE AMERICAN HEART/STROKE ASSOCIATION AWARDED THE HUGH CHATHAM PRIMARY STROKE CENTER WITH THE HONOR, "GET WITH THE GUIDELINES GOLD PLUS STROKE CENTER: TARGET STROKE HONOR ROLL."FISCAL YEAR 2016 HIGHLIGHTS:DURING THE YEAR, HCMH HANDLED MORE THAN 30,000 EMERGENCY ROOM VISITS; 20,265 HOME HEALTH VISITS; AND MORE THAN 173,322 PATIENT VISITS TO ITS MEDICAL GROUP PRIMARY AND SPECIALTY CARE PRACTICES. THE HOSPITAL ALSO HANDLED MORE THAN 54,000 OUTPATIENT IMAGING VISITS; 6,406 RADIATION ONCOLOGY PROCEDURES AND MORE THAN 4,000 INPATIENT ADMISSIONS. TO HELP PATIENTS AND LOCAL COMMUNITIES TO GET BETTER AND STAY HEALTHY, HCMH EXPANDED ACCESS TO MEDICAL CARE BY OPENING AN EXPRESS CARE FACILITY IN DOBSON, NC, AND URGENT CARE CLINICS IN JONESVILLE AND YADKINVILLE, NC. THE JONESVILLE LOCATION INCLUDES X-RAY AND LABORATORY SERVICES AS WELL AS OCCUPATIONAL HEALTH SERVICES.HCMH ALSO HAS A HOME HEALTH PRACTICE, YADKIN VALLEY HOME HEALTH, TO SERVE HOMEBOUND PATIENTS IN SURRY, ALLEGHANY, WILKES AND YADKIN COUNTIES. THESE COUNTIES HAVE HIGH PERCENTAGES OF THE POPULATION WHO ARE ELDERLY, LOW-INCOME AND WHO LIVE IN RURAL AREAS OR SMALL TOWNS WHERE TRANSPORTATION TO MEDICAL CARE CAN BE DIFFICULT BECAUSE OF A LACK OF PUBLIC TRANSPORTATION OR MOUNTAINOUS ROADS THAT CAN BE HARD FOR ILL, ELDERLY PATIENTS AND THEIR CAREGIVERS TO NAVIGATE. REHABILITATION AND WELLNESS SERVICES DELIVERED THE COMMUNITY INCLUDED STROKE SCREENINGS AND THE ADDITION OF LAND- AND WATER-BASED EXERCISE CLASSES AT THE HCMH AQUATIC AND WELLNESS CENTER INCLUDING TAI CHI FOR ARTHRITIS AND YOGA CLASSES.HCMH ALSO CONTINUED TO OWN AND MANAGE PARKWOOD PLACE SENIOR INDEPENDENT LIVING APARTMENTS IN ELKIN, NORTH CAROLINA. AMENITIES AND SERVICES ARE DESIGNED TO GIVE RESIDENTS A SAFE, COMFORTABLE APARTMENT LIVING ENVIRONMENT THAT IS ALSO AFFORDABLE. ACTIVITIES INCLUDED SPONSORSHIP OF A FREE HEALTH FAIR AT YADKIN VALLEY SENIOR CENTER IN JONESVILLE.DURING THE YEAR, THE HOSPITAL DID SEVERAL OUTREACH ACTIVITIES. ONE EXAMPLE WAS PROVIDING BASELINE CONCUSSION SCREENINGS FOR ATHLETES FROM THREE HIGH SCHOOLS (ELKIN, STARMOUNT AND SURRY CENTRAL) IN A VARIETY OF SPORTS INCLUDING BASKETBALL, CHEERLEADING, FOOTBALL, SOCCER AND TENNIS. THROUGHOUT THE YEAR, TO TEACH PEOPLE TO RECOGNIZE STROKE WARNING SIGNS THAT OFTEN COME ON SUDDENLY, HCMH EDUCATED THE PUBLIC ABOUT AN ACRONYM CALLED F.A.S.T. FACE DROOPING, ARM WEAKNESS, SPEECH DIFFICULTY AND TIME TO CALL 9-1-1. THE HOSPITAL ALSO SUBSIDIZED LABORATORY AND IMAGING EXPENSES FOR GRACE CLINIC OF THE YADKIN VALLEY, A FREE CLINIC LOCATED IN ELKIN, NORTH CAROLINA THAT SEES PATIENTS AGES 18 TO 64 WITH NO MEDICAL INSURANCE AND WHO FALL UNDER THE INCOME AT OR LESS THAN 200 PERCENT OF THE FEDERAL POVERTY LEVEL. A FREE, MONTHLY SERIES OF CLASSES TAUGHT BY A REGISTERED DIETITIAN AND CERTIFIED DIABETES EDUCATOR WERE HELD AT THE HOSPITAL TO EDUCATE ADULTS ABOUT HOW TO KEEP DIABETES IN CONTROL. CLASSES LASTED 90 MINUTES AND MORE THAN 100 PEOPLE ATTENDED.SUPPORT FOR CANCER PATIENTS INCLUDED MASTECTOMY FITTERS GOING TO PATIENT'S HOMES AFTER SURGERY FOR A PROSTHESIS FITTING. THEY PROVIDE A "SOFTIE AND PILLOW FOR THE PATIENT'S COMFORT DURING THE RECOVERY PERIOD UNTIL THE PROSTHESIS IS READY FOR FITTING. OTHER WOMEN'S SERVICES COMMUNITY OUTREACH INCLUDED BIRTHING CLASSES AND BREASTFEEDING EDUCATION.HUGH CHATHAM CONTINUES TO BE A REGIONAL LEADER IN PROVIDING QUALITY, COMPASSIONATE CARE TO ITS PATIENTS. THE HEALTH SYSTEM PRIDES ITSELF ON ITS 2016 ACHIEVEMENTS IN ITS ADOPTED VISION, "TO BE THE BEST COMMUNITY HOSPITAL IN THE NATION, WITH SERVICE AS ITS GUIDING PRINCIPLE." | Desc |
| Total Program Service Expenses | $99,835,200 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | Yes (1) | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | 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 | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 118 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 981 | 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 |
| States Where Copy Of Return Is Fld | NC | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHERYL PARDUE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3365277595 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 560 | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Darnell Terry | ||||||||||
| Chairman | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||||
| Ashman Ann | ||||||||||
| Vice Chairman | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||||
| Cline David | ||||||||||
| Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||||
| Thompson Donna | ||||||||||
| Secretary | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 1.00 | |||
| Johnson Dr Bill | ||||||||||
| Asst Secretary/Treasurer | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||||
| Austin Kevin | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Ball Bob | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Cartwright Dr Stephanie | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Castillejo Dr Alvaro | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Midkiff Bob | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Norman Mike | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Parker Raymond | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Robertson David | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Smith Willena | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Snyder Dr Jonathan | ||||||||||
| BOARD MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| Paul Hammes | ||||||||||
| CEO | 40.00 | Yes (X) | $325,000 | $0 | $22,900 | 2.00 | ||||
| Donald Trippel | ||||||||||
| CFO | 40.00 | Yes (X) | $234,705 | $0 | $24,987 | |||||
| Mary Blackburn | ||||||||||
| CPO | 40.00 | $153,852 | $0 | $31,211 | Yes (X) | |||||
| Paula Moore | ||||||||||
| Former CNO | 0.00 | $191,505 | $0 | $25,558 | Yes (X) | |||||
| Carbone Dominick MD | ||||||||||
| Physician | 40.00 | $732,548 | $0 | $33,631 | 1.00 | Yes (X) | ||||
| Jonathan Snyder MD | ||||||||||
| Physician | 40.00 | $552,121 | $0 | $37,903 | 1.00 | Yes (X) | ||||
| Sarba Kundu MD | ||||||||||
| Physician | 40.00 | $680,214 | $0 | $39,076 | Yes (X) | |||||
| Muragananthan Subbiah MD | ||||||||||
| Physician | 40.00 | $541,548 | $0 | $38,966 | Yes (X) | |||||
| Marc Stevens MD | ||||||||||
| Physician | 40.00 | $530,909 | $0 | $12,018 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,942,402 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $266,250 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 54 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | 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 |
|---|---|---|---|---|---|
| SODEXO INC | |||||
| PO BOX 536922 | ATLANTA | GA | 30353 | DIETARY & HOUSEKEEPING SERVICES | $3,138,750 |
| CARDINAL HEALTH | |||||
| PO BOX 905867 | CHARLOTTE | NC | 28290 | PATIENT & HOSPITAL SUPPLIES | $1,984,222 |
| CARDINAL DISTRIBUTION PHARMACY | |||||
| 25025 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY SUPPLIES & MEDICATIONS | $1,888,391 |
| HORIZON CSA LLC | |||||
| 265 PITT ROAD | MOORESVILLE | NC | 28115 | EQUIPMENT MAINTENANCE | $1,740,792 |
| SMITH AND NEPHEW ORTHO | |||||
| PO BOX 933782 | ATLANTA | GA | 31933 | MEDICAL SUPPLIES | $1,291,885 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 75 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $558,003 | RelatedOrganizationsAmt |
| Total Contributions | $558,003 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT CARE SERVICES | 621400 | $106,619,156 | $106,619,156 |
| OTHER OPERATING REVENUE | 621400 | $351,465 | $351,465 |
| EHR MEANINGFUL USE REVENUE | 621400 | $156,372 | $156,372 |
| NET HOSPICE INVESTMENT | 623000 | -$177,322 | -$177,322 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $106,949,671 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,811,450 | TotalRevenueColumnAmt |
| Exclusion | $3,811,450 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,304,037 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $298,702 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,005,335 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,005,335 | TotalRevenueColumnAmt |
| Exclusion | $1,005,335 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,967,756 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $34,791 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $8,967,756 | SecuritiesAmt |
| Other | -$34,791 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,932,965 | TotalRevenueColumnAmt |
| Exclusion | $8,932,965 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA & VENDING | Desc |
| Business | 722210 | BusinessCd |
| Total Revenue Column | $8,353 | TotalRevenueColumnAmt |
| Exclusion | $8,353 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $8,353 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $121,265,777 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $106,949,671 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $13,758,103 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,120 | TotalAmt |
| Program Services | $78,120 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $865,235 | TotalAmt |
| Program Services | $216,309 | ProgramServicesAmt |
| Management And General | $605,665 | ManagementAndGeneralAmt |
| Fundraising | $43,261 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,319 | TotalAmt |
| Program Services | $56,319 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,842,981 | TotalAmt |
| Program Services | $37,525,019 | ProgramServicesAmt |
| Management And General | $2,317,962 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $663,339 | TotalAmt |
| Program Services | $615,060 | ProgramServicesAmt |
| Management And General | $47,575 | ManagementAndGeneralAmt |
| Fundraising | $704 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,385,009 | TotalAmt |
| Program Services | $4,993,082 | ProgramServicesAmt |
| Management And General | $386,212 | ManagementAndGeneralAmt |
| Fundraising | $5,715 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,613,323 | TotalAmt |
| Program Services | $2,423,123 | ProgramServicesAmt |
| Management And General | $187,427 | ManagementAndGeneralAmt |
| Fundraising | $2,773 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $302,140 | TotalAmt |
| Management And General | $302,140 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,227 | TotalAmt |
| Management And General | $56,227 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,701 | TotalAmt |
| Management And General | $198,701 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,335 | TotalAmt |
| Management And General | $587,335 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,748,364 | TotalAmt |
| Program Services | $13,192,267 | ProgramServicesAmt |
| Management And General | $1,556,097 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $252,825 | TotalAmt |
| Program Services | $111,620 | ProgramServicesAmt |
| Management And General | $141,205 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,536,656 | TotalAmt |
| Program Services | $8,169,724 | ProgramServicesAmt |
| Management And General | $366,932 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,681,778 | TotalAmt |
| Program Services | $1,681,778 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,491 | TotalAmt |
| Program Services | $207,115 | ProgramServicesAmt |
| Management And General | $29,376 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,495,480 | TotalAmt |
| Program Services | $2,495,480 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,444,072 | TotalAmt |
| Program Services | $6,444,072 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$183,065 | TotalAmt |
| Program Services | -$183,065 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $14,305,066 | $14,305,066 | |
| MEDICAL SUPPLIES | $4,062,640 | $4,062,640 | |
| PROVIDER TAX | $2,977,432 | $2,977,432 | |
| MISCELLANEOUS | $985,280 | $464,039 | $521,241 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $435,113 | TotalAmt |
| Management And General | $435,113 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,626,861 | TotalAmt |
| Program Services | $99,835,200 | ProgramServicesAmt |
| Management And General | $7,739,208 | ManagementAndGeneralAmt |
| Fundraising | $52,453 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,215,793 | BOYAmt |
| EOY | $12,693,512 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,651,796 | BOYAmt |
| EOY | $9,526,802 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $915,540 | BOYAmt |
| EOY | $907,403 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,193,722 | BOYAmt |
| EOY | $1,746,165 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $152,501,168 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $87,508,775 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,655,569 | BOYAmt |
| EOY | $64,992,393 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $117,274,977 | BOYAmt |
| EOY | $136,591,000 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,656,695 | BOYAmt |
| EOY | $5,332,400 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,267,783 | BOYAmt |
| EOY | $2,110,053 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $216,831,875 | BOYAmt |
| EOY | $233,899,728 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,909,143 | BOYAmt |
| EOY | $10,285,634 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,005,000 | BOYAmt |
| EOY | $64,465,427 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,470,780 | BOYAmt |
| EOY | $10,805,996 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $91,384,923 | BOYAmt |
| EOY | $85,557,057 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $122,440,964 | BOYAmt |
| EOY | $145,238,124 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,005,988 | BOYAmt |
| EOY | $3,104,547 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,446,952 | BOYAmt |
| EOY | $148,342,671 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $216,831,875 | BOYAmt |
| EOY | $233,899,728 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $13,638,916 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $6,082,202 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $3,174,601 | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Total Lobbying Expenditures | $0 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS TO LEGISLATIVE BODIES ON BEHALF OF THEIR MEMBERSHIP BASES. EACH YEAR, A PORTION OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ENDEAVORS. FOR THE CURRENT YEAR, THE PORTION OF DUES PAID ALLOCATED TO LOBBYING IS APPROXIMATELY $ 11,900. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,546,331 | OtherCostOrOtherBasisAmt |
| Book Value | $2,546,331 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $89,727,476 | OtherCostOrOtherBasisAmt |
| Depreciation | $38,031,677 | DepreciationAmt |
| Book Value | $51,695,799 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,186,285 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,116,230 | DepreciationAmt |
| Book Value | $1,070,055 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $50,119,443 | OtherCostOrOtherBasisAmt |
| Depreciation | $41,360,868 | DepreciationAmt |
| Book Value | $8,758,575 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $921,633 | OtherCostOrOtherBasisAmt |
| Book Value | $921,633 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $64,992,393 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| INTEREST PAYABLE | $477,225 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $5,076,214 |
| PHYSICIAN GUARANTEE | $218,651 |
| INTEREST RATE SWAP | $4,970,979 |
| RESIDENT TRUST FUNDS | $62,927 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,805,996 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL, FOUNDATION, AND AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE HOSPITAL HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2017. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2013 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| Most Hospitals Policy | Yes (X) | MostHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,667,708 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,667,708 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01790 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,943,952 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,792,460 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $151,492 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,611,660 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,792,460 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,819,200 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01950 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,390 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,390 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $132,587 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $132,587 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $640,227 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $640,227 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00690 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $780,204 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $780,204 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00840 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,391,864 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,792,460 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,599,404 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02790 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 2541 | PersonsServedCnt |
| Total Community Benefit Expns | $895 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $895 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 2541 | PersonsServedCnt |
| Total Community Benefit Expns | $895 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $895 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,119,859 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,441,951 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $78,020,286 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $77,501,741 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $518,545 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DRIVE | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DISPROPORTIONATE SHARE HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE DISCLOSURE | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE DISCLOSURE | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | see disclosure | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE DISCLOSURE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE DISCLOSURE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HUGH CHATHAM MEMORIAL HOSPITAL | Part V, Section B, Line 5: EXPERTS IN THE FIELD OF PUBLIC HEALTH, HOSPICE CARE, NURSES, PHYSICIANS, CASE MANAGEMENT, EDUCATION, AND PHILANTHROPY WERE CHOSEN FOR THE FOCUS GROUP. THE FOCUS GROUPS WERE DESIGNED AROUND THE KEY ISSUES THAT EMERGED FROM THE MEETINGS. |
| HUGH CHATHAM MEMORIAL HOSPITAL | Part V, Section B, Line 11: Hugh Chatham Memorial Hospital will continue to play a leading role in addressing the health needs of those within our community, with a special focus on the underserved. As such, community benefit planning is integrated into our hopsital's annual planning and budgeting processes to ensure we continue to effectively support community benefits. |
| PART V, SECTION B, LINE 7A: | http://www.hughchatham.org/assets/forms/2016-Community-Health-Needs-Assessment |
| PART V, SECTION B, LINE 10a | http://www.hughchatham.org/about/community-health/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 21 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (21 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - YADKIN VALLEY HOME HEALTH | ||||
| 213 WINSTON RD | ELKIN | NC | 28642 | HOME HEALTH |
| 2 - TRI COUNTY ORTHOPEDIC AND SPORTS MEDICINE | ||||
| 400 JOHNSON RIDGE RD | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 3 - YADKIN VALLEY UROLOGY | ||||
| 200 JOHNSON RIDGE MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 4 - YADKIN VALLEY ADULT MEDICINE | ||||
| 500 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 5 - CLINGMAN MEDICAL CENTER | ||||
| 3369 CLINGMAN RD | ELKIN | NC | 28670 | PHYSICIAN OFFICE |
| 6 - YADKIN VALLEY GASTROENTEROLOGY | ||||
| 201 WEST MAIN STREET | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 7 - JONESVILLE URGENT CARE CENTER | ||||
| 546 WINSTON ROAD | MT VIEW | NC | 28642 | PHYSICIAN OFFICE |
| 8 - G I CLINIC | ||||
| 201 WEST MAIN STREET | ELKIN | NC | 28621 | PROCEDURE CLINIC |
| 9 - YADKIN VALLEY DERMATOLOGY | ||||
| 201A ELDON PARK DRIVE | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 10 - HUGH CHATHAM FAMILY MEDICINE ELKIN | ||||
| 600 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 11 - HUGH CHATHAM SURICAL | ||||
| 201B ELDON PARK DRIVE | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 12 - HUGH CHATHAM NEUROLOGY | ||||
| 100 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 13 - HUGH CHATHAM BEHAVIORAL | ||||
| 690 PARKWOOD MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 14 - YADKIN VALLEY PULMONARY | ||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | PHYSICIAN OFFICE |
| 15 - HUGH CHATHAM FAMILY MED BOOMER | ||||
| 156 BOOMER COMMUNITY CENTER RD | BOOMER | NC | 28606 | PHYSICIAN OFFICE |
| 16 - HUGH CHATHAM FAMILY MED MT VIEW | ||||
| 5229 ROCK CREEK RD | MT VIEW | NC | 28602 | PHYSICIAN OFFICE |
| 17 - HUGH CHATHAM WOMEN'S CENTER | ||||
| 150 PARKWOOD DRIVE | MT VIEW | NC | 28621 | PHYSICIAN OFFICE |
| 18 - HUGH CHATHAM PODIATRIC MEDICINE AND SURGER | ||||
| 150 CHATHAM MEDICAL PARK | MT VIEW | NC | 28621 | PHYSICIAN OFFICE |
| 19 - HUGH CHATHAM EXPRESS CARE DOBSON | ||||
| 911 E ATKINS ST | DOBSON | NC | 28621 | PHYSICIAN OFFICE |
| 20 - PARKWOOD PLACE RETIREMENT CENTER | ||||
| 601 JOHNSON RIDGE RD | ELKIN | NC | 28621 | RETIREMENT CENTER |
| 21 - HUGH CHATHAM FAMILY MEDICINE INDEPEDENCE | ||||
| 127 EAST MAIN STREET | INDEPENDENCE | VA | 24348 | PHYSICIAN OFFICE |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | THE ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM WAS USED TO COMPUTE A COST-TO-CHARGES RATIO THAT WAS USED TO CALCULATE COSTS USED IN PART I, LINE 7. |
| Part I, Ln 7 Col(f): | THE TOTAL EXPENSE AMOUNT LISTED ON FORM 990, PART IX, LINE 26 CONTAINS BAD DEBT EXPENSE OF $14,305,066 THAT WAS REMOVED FOR THE PURPOSE OF CALCULATING TOTAL CHARITY CARE PERCENTAGE ON LINE 7, COLUMN (F). |
| PART I, LINE 6A: | THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS FILED THROUGH THE MEDICAL CARE COMMISSION OF NORTH CAROLINA. |
| Part II, Community Building Activities: | HUGH CHATHAM MEMORIAL HOSPITAL PROVIDES ALL LOCAL SCHOOLS WITH FREE HAND SANITIZERS WITH FLU PREVENTION BROCHURES EVERY FALL AND SUNCREEN WITH MELANOMA AWARENESS BROCHURES EVERY SPRING. |
| Part III, Line 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE GROSS BAD DEBT EXPENSE PER AUDITED FINANCIAL STATEMENTS REDUCED TO COST USING AN INTERNALLY COMPUTED COST-TO-CHARGES RATIO FROM THE ORGANIZATION'S COST ACCOUNTING SYSTEMS.DUE TO THE FACT THAT APPROXIMATELY 30% OF THE SURROUNDING COMMUNITY'S RESIDENTS ARE CONSIDERED TO BE LIVING BELOW THE POVERTY LINE, IN COMBINATION WITH THE FACT THAT THE UNEMPLOYMENT PERCENTAGE FOR THE AREA IS APPROXIMATELY 12.7%, THE ORGANIZATION FEELS THAT APPROXIMATELY 35% OF BAD DEBT IS AN APPROPRIATE ESTIMATION OF THE AMOUNT OF BAD DEBT THAT MAY CONSTITUTE A COMMUNITY BENEFIT. |
| Part III, Line 8: | AN INTERNAL COST-TO-CHARGE RATIO WAS USED TO COMPUTE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6. |
| Part III, Line 9b: | HCMH MAKES EVERY EFFORT TO EVALUATE PATIENTS PRIOR TO PLACEMENT WITH A COLLECTIONS AGENCY TO SEE IF THEY ARE QUALIFIED FOR MEDICAID OR HOSPITAL CHARITY CARE. WE HAVE AN IN-HOUSE EMPLOYEE DESIGNATED TO ASSISTING PATIENTS ELIGIBLE FOR MEDICAID AND/OR FINANCIAL ASSISTANCE. AT THE POINT OF THE PATIENT NOT BEING ELIGIBLE AND FAILURE TO RESPOND FOR OUR PAYMENT PLAN OPTIONS, THE ACCOUNT IS PLACED WITH A COLLECTION AGENCY AND THE AGENCY MAKES AN EFFORT FOR 30 DAYS PRIOR TO PLACING ON THE CREDIT SCORE, TO OBTAIN PAYMENT. |
| Part VI, Line 2: | The organization tracks the results of Health Screenings provided through its health fairs and looks for trends. These screenings provide insight into further medical needs of the community members. The fairs are held periodically through the year and are attended by hundreds of people who are offered various health screenings. The organization also subscribes to national affiliated organizations that provide data on regional health needs. The last couple of years our focus has been on stroke education, with stroke certification for our facility. Various health fairs for specific groups, reaching into the business community with educational materials and screenings being provided. We have provided presentations to the senior center in our area concerning diseases that affect their age groups. |
| Part VI, Line 3: | FINANCIAL ASSISTANCE EDUCATION IS MADE AVAILABLE AT ADMISSION AND ON THE WEBSITE. AT REGISTRATION THERE ARE BROCHURES WITH FINANCIAL ASSISTANCE INFORMATION MADE AVAILABLE. SIGNAGE IS LOCATED THROUGHOUT THE FACILITY TO INFORM AND EDUCATE THE PUBLIC OF THEIR FINANCIAL RIGHTS. HUGH CHATHAM MEMORIAL HOSPITAL OFFERS A LANGUAGE LINE FOR THE NON-ENGLISH SPEAKING COMMUNITY AND PHONETREE ASSISTANCE WHERE NEEDED. |
| Part VI, Line 4: | The primary service area of the hospital includes nine zip codes. Roughly a fifteen mile diameter around Elkin, NC. The secondary service area includes an additional five zip codes widening the diamter to thirty miles around Elkin. Both of theses markets include part, but not all, of the North Carolina counties of Wilkes, Alleghany, Yadkin and Surry. Southern Virginia counties of Grayson, Patrick, and Carroll are also included. |
| Part VI, Line 5: | A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, INDEPENDENT CONTRAcTORS, NOR FAMILY MEMBERS OF EMPLOYEES OR INDEPENDENT CONTRACTORS. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OF ITS DEPARTMENTS.HCMH OFFERS A WIDE VARIEY OF SERVICES TO OUR COMMUNITY, SUCH AS WOMEN'S HEALTH EDUCATION SEMINARS,INFANT AND CHILD CPR CLASSES, LAMAZE AND CHILDBIRTH CLASSES, CARDIAC REHABILITATION, AND VARIOUS PATIENT EDUCATIONAL PROGRAMS. THE HOSPITAL PARTICIPATES IN AND HOSTS MANY COMMUNITY HEALTH SCREENINGS AND IMMUNIZATIONS, CANCER SCREENINGS (PROSTATE, BREAST, SKIN, AND COLON), AS WELL AS SCREENINGS IN THE FOLLOWING AREAS: CHOLESTEROL/GLUCOSE, BLOOD PRESSURE, HEART RATE,OXYGEN SATURATION, WEIGHT AND BODY MASS INDEX ASSESSMENT, FALLS ASSESSMENT, BONE DENSITY TESTING, TETANUS AND FLU CLINICS. THE EMPLOYEES AT HCMH ARE COMMITTED TO THE AREA'S NEEDS. COMMITTMENT IS DEMONSTRATED THROUGH PARTICIPATION IN THE FOLLOWING: THE STOP HUNGER FOOD DRIVE, MARCH OF DIMES, UNITED WAY, TRI C MINISTRIES, SUSAN G. KOMEN WALKATHONS, SPECIAL OLYMPICS, THE AMERICAN CANCER SOCIETY, THE NATIONAL MS SOCIETY, AND A LOCAL ORGANIZATION TRIAD FIRST IN FAMILIES THAT HELPS CHILDREN IN NEED.HCMH IS COMMITTED TO THE PROMOTION OF HEALTH, OUTREACH, AND SUPPORT GROUPS. THE HOSPITAL SPONSORS THE FOLLOWING:CANCER HEART AND SOUL, LOOK GOOD FEEL BETTER CANCER SUPPORT, HOSPICE GRIEF CAMP FOR CHILDREN, BEREAVEMENT AND THE GRIEF PROCESS, STROKE SUPPORT, AMPUTEE SUPPORT, ALZHEIMER'S SUPPORT, CPR FOR INDUSTRY, DAY CARE WORKERS, AND LIFEGUARDS, SENIOR FITNESS CLASSES, AND CARDIAC REHABILITATION CLASSES. HCMH ALSO HOLDS "LUNCH AND LEARNS" WHICH ARE OFFERED TO THE COMMUNITY PROMOTING DIFFERENT TOPICS OF HEALTH RELATED INTEREST.THE HOSPITAL ALSO SPONSORS THE GRACE CLINIC WHICH IS A LOCAL FREE CLINIC WHICH OPERATES ON DONATED SERVICES AND SUPPLIES. |
| Part VI, Line 6: | THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| Part VI, Line 7, Reports Filed With States | NC |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DRIVE | AddressLine1Txt |
| City | ELKIN | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28621 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 562049537 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $69,863 | CashGrantAmt |
| Purpose Of Grant | OPERATIONAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE MADE IN ACCORDANCE WITH HUGH CHATHAM MEMORIAL HOSPITAL'S MISSION STATEMENT TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Paul Hammes | ||||||||||||||
| CEO | $325,000 | $0 | $0 | $0 | $0 | $0 | $7,878 | $0 | $15,022 | $0 | $347,900 | $0 | $0 | $0 |
| Donald Trippel | ||||||||||||||
| CFO | $209,705 | $0 | $25,000 | $0 | $0 | $0 | $8,459 | $0 | $16,528 | $0 | $259,692 | $0 | $0 | $0 |
| Mary Blackburn | ||||||||||||||
| CPO | $153,852 | $0 | $0 | $0 | $0 | $0 | $6,836 | $0 | $24,375 | $0 | $185,063 | $0 | $0 | $0 |
| Paula Moore | ||||||||||||||
| Former CNO | $191,505 | $0 | $0 | $0 | $0 | $0 | $7,361 | $0 | $18,197 | $0 | $217,063 | $0 | $0 | $0 |
| Carbone Dominick MD | ||||||||||||||
| Physician | $514,502 | $0 | $218,046 | $0 | $0 | $0 | $16,932 | $0 | $16,699 | $0 | $766,179 | $0 | $0 | $0 |
| Jonathan Snyder MD | ||||||||||||||
| Physician | $455,789 | $0 | $96,332 | $0 | $0 | $0 | $12,788 | $0 | $25,115 | $0 | $590,024 | $0 | $0 | $0 |
| Sarba Kundu MD | ||||||||||||||
| Physician | $509,890 | $0 | $170,324 | $0 | $0 | $0 | $13,879 | $0 | $25,197 | $0 | $719,290 | $0 | $0 | $0 |
| Muragananthan Subbiah MD | ||||||||||||||
| Physician | $493,288 | $0 | $48,260 | $0 | $0 | $0 | $13,265 | $0 | $25,701 | $0 | $580,514 | $0 | $0 | $0 |
| Marc Stevens MD | ||||||||||||||
| Physician | $444,890 | $0 | $47,019 | $0 | $39,000 | $0 | $12,018 | $0 | $0 | $0 | $542,927 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | Highest paid employee, Dr. Stevens, received a housing allowance in his contract, for a specified amount which was taxable in his income. |
| Part I, Line 4a | Paula Moore, CNO: $61,542 |
| Part I, Line 6 | THE PHYSICIANS IN CHARGE OF THE UROLOGY PRACTICE, GASTROENTEROLOGY PRACTICE, AND DERMATOLOGY CLINIC ARE ELIGIBLE TO RECEIVE A PORTION OF THE NET PROFIT FROM THEIR PRACTICE. ANY PROFITS RESULTING FROM PHYSICIANS' PROFESSIONAL SERVICES AFTER ALL THE PRACTICE AND PHYSICIAN EXPENSES, SHALL BE SHARED. THE PHYSICIANS RECEIVE UP TO AN 85% ALLOCATION WITH THE REMAINDER GOING TO THE EMPLOYER. THE HOSPITALIST BONUS IS BASED ON PERFORMANCE GOALS AND MAY BE UP TO AS MUCH AS 20% OF THEIR SALARY. ANOTHER PHYSICIAN IN CHARGE OF THE HOSPITALIST GROUP IS ELIGIBLE TO RECEIVE UP TO 20% OF THEIR BASE SALARY DEPENDING ON PERFORMANCE MEASURES OF THE HOSPITALIST GROUP. AMOUNTS PAID OUT TO INDIVIDUALS LISTED ON PART VII OF THE FORM 990 FOR 2015 WERE: DOMINICK CARBONE, MD $217,725 JONATHAN SNYDER, MD 12,000 MARC STEVENS, MC 100,000 SARBA KUNDA, MD 198,600 MURUGANANTHAN SUBBIAH, MD 54,548 |
| FORM 990, PART VII, SECTION A, LINE 1: | COMPENSATION FROM AN UNRELATED ORGANIZATION: CEO PAUL HAMES IS COMPENSATED BY AN OUTSIDE MANAGEMENT COMPANY, ALLIANT MANAGEMENT GROUP. THE COMPENSATION PAID BY THE UNRELATED ORGANIZATION IS INCLUDED ON FORM 990, PART VII, SECTION A, LINE 1. THE DETAILS ARE AS FOLLOWS: PAUL HAMES: $ 300,000 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||||
| A | 521309402 | 65821DAF8 | 2008-09-24 | $45,455,000 | NEW STRUCTURES, EQUIPMENT | Yes (1) | 0 | 0 |
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||||
| B | 521309402 | 2015-12-16 | $25,495,000 | REFUNDING REVENUE BONDS | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Bond DefeasedBondDefeasedAmt | Total ProceedsTotalProceedsAmt | Capitalized InterestCapitalizedInterestAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | UnspentUnspentAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $4,695,000 | $42,235,000 | $46,276,755 | $3,493,414 | $435,743 | $513,249 | $42,448,072 | 2010 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $1,650,000 | $25,214,951 | $280,049 | 0 | 0 | Yes (1) | Yes (1) | $25,214,951 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WELLS FARGO | ||||||||||||
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | 30.000000000000 | Yes (1) | 0 | 0 | 0 | 0 |
| (no name) | ||||||||||||
| B | 0 | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | 0 | |||
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Date Rebate Computation Performed | Issuer Name: NORTH CAROLINA MEDICAL CARE COMMISSION Date the Rebate Computation was Performed: 08/28/2013 |
| SCH K, PART II, LINE 11, COLUMN A | THE OTHER SPENT PROCEEDS OF $11,100,000 WERE USED TO CURRENTLY REFUND PRIOR BONDS ISSUED ON 05-08-1996. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURA OAKES | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | RELATED TO BOARD MEMBER BOB MIDKIFF | RelationshipDescriptionTxt |
| Transaction | $56,319 | TransactionAmt |
| Transaction | COMPENSATED AS DIRECTOR OF MARKETING | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE OFFICERS OF THE BOARD, THE IMMEDIATE PAST CHAIRMAN AND ONE (1) OR MORE ADDITIONAL MEMBERS WHO WILL BE NOMINATED BY THE CHAIRMAN FOR THE ELECTION BY THE BOARD OF TRUSTEES. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. THE EXECUTIVE COMMITTEE SHALL ALSO ANNUALLY REVIEW THE PERFORMANCE, COMPENSATION AND TERMS OF EMPLOYEMENT OF THE CHIEF EXECUTIVE OFFICER AND MAKE RECOMMENDATIONS TO THE BOARD CONCERNING COMPENSATION AND TERMS OF THE EMPLOYMENT OF THE CHIEF EXECUTIVE OFFICER. |
| Form 990, Part VI, Section A, line 3 | THE HOSPITAL ENTERED INTO A MANAGEMENT AGREEMENT IN JUNE 2006 WITH ALLIANT, AN UNRELATED CORPORATION WHEREBY THE MANAGEMENT COMPANY WILL PERFORM MANAGEMENT AND ADMINISTRATION SERVICES ON A DAY-TO-DAY BASIS AND PROVIDE A CHIEF EXECUTIVE OFFICER. THE AGREEMENT CALLS FOR A BASE MANAGEMENT FEE OF APPROXIMATELY $220,000 IN THE FIRST YEAR WITH ANNUAL INCREASES TO APPROXIMATE THE INCREASE IN CONSUMER PRICE INDEX. IN ADDITION TO THE ANNUAL FEE, THE HOSPITAL IS REQUIRED TO PAY THE SALARIES, BONUSES AGREED UPON BY THE BOARD, AND ALL FRINGE BENEFITS OF THE MANAGEMENT COMPANY'S KEY PERSONNEL WHO PERFORM THE ADMINISTRATIVE DUTIES. |
| Form 990, Part VI, Section B, line 11b | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH SUPERVISION AND ASSISTANCE BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DELIVERED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL. THE RETURN WAS THEN PRESENTED AT A SCHEDULED MEETING OF THE BOARD OF DIRECTORS BY A REPRESENTATIVE OF THE ACCOUNTING FIRM, AND EACH VOTING MEMBER OF THE BOARD WAS PROVIDED A COPY FOR DISCUSSION AND QUESTIONS. FOLLOWING THE MEETING AND A PERIOD OF TIME FOR COMMENT, THE RETURN WAS FILED WITH THE IRS. |
| Form 990, Part VI, Section B, line 12c | ANNUALLY, ALL VOTING BOARD MEMBERS ARE PRESENTED WITH THE GOVERNANCE POLICIES CONCERNING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. UPON REVIEW AND DISCUSSION CONCERNING RELATIONSHIPS WITH THE ORGANIZATION, ITS AFFILIATES, OR AMONGST EACH OTHER, THE BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE POLICY STATEMENT TO THE ADMINISTRATION. THESE STATEMENTS ARE REVIEWED BY THE BOARD CHAIR AND ARE PRESENTED TO THE AUDITORS DURING THE ANNUAL AUDIT. |
| Form 990, Part VI, Section B, line 15 | A REPRESENTATIVE FROM ALLIANT, THE OUTSIDE MANAGEMENT COMPANY, MEETS WITH THE BOARD TO REVIEW AND APPROVE SALARIES FOR THE CEO AND OTHER OFFICERS. THE SALARIES OF THE TOP EXECUTIVE AND OTHER MEMBERS OF THE ADMINISTRATIVE DEPARTMENT ARE DETERMINED IN THE CONTRACT NEGOTIATIONS. A REVIEW OF ALL SALARIES, TOP TO BOTTOM, WAS DONE THROUGH THE ADMINISTRATIVE TEAM. |
| Form 990, Part VI, Section C, line 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| Form 990, Part VI, Section C, line 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| Form 990, Part IX, line 11g | CONTRACT SERVICES: Program service expenses 5,554,893. Management and general expenses 797,787. Fundraising expenses 0. Total expenses 6,352,680. CONTRACT LABOR: Program service expenses 2,829,045. Management and general expenses 335,191. Fundraising expenses 0. Total expenses 3,164,236. MAINTENANCE CONTRACTS: Program service expenses 3,581,435. Management and general expenses 436. Fundraising expenses 0. Total expenses 3,581,871. CENTRALIZED BILLING: Program service expenses 1,035,155. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,035,155. OTHER FEES: Program service expenses 191,739. Management and general expenses 422,683. Fundraising expenses 0. Total expenses 614,422. |
| Form 990, Part XI, line 9: | CHANGE IN VALUE OF SWAP AGREEMENT 3,447,664. RECOGNIZED LOSSES ON IMPAIRMENTS -709,009. JV INCOME FROM ACCOUNT WITH SWAP 295,024. RELEASE OF RESTRICTED ASSETS 101,270. PRIOR PERIOD ADJUSTMENT 39,652. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | 562049537 | FUNDRAISING | NC | 501(c)(3) | Line 12a, I | HUGH CHATHAM MEMORIAL HOSPITAL | Yes (1) |
| HUGH CHATHAM MEMORIAL HOSPITAL AUXILIARY | ||||||||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | 561199949 | THRIFT/GIFT SHOP | NC | 501(c)(3) | Line 12a, I | HUGH CHATHAM MEMORIAL HOSPITAL | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | 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 | 0 | 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 | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |