GASTON MEMORIAL HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- GASTON MEMORIAL HOSPITAL INC (EIN 56-0619359)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-04-18
- IRS object ID
- 201701099349301150
- Schema version
- 2015v3.0
- 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 B
- 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 | 2017-04-18T00:00:00-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | 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 | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560619359 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GASTON MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GAST | BusinessNameControlTxt |
| 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 |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID O'CONNOR | PersonNm |
| Person Title | EVP, CFO | PersonTitleTxt |
| Phone | 7048342000 | PhoneNum |
| Signature | 2017-04-19 | 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 | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAROMONT REGIONAL MEDICAL CTR | BusinessNameLine1Txt |
| 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 | AddressLine1Txt |
| City | GASTONIA | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28054 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $465,507,489 | 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 | 1945 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 3485 | TotalEmployeeCnt |
| Total Volunteers | 202 | TotalVolunteersCnt |
| Total Gross UBI | $366,070 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $83,797 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $403,474 | PYContributionsGrantsAmt |
| CY Contributions Grants | $425,622 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $426,753,833 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $460,065,910 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$1,432 | PYInvestmentIncomeAmt |
| CY Investment Income | $331,205 | CYInvestmentIncomeAmt |
| PY Other Revenue | $5,300,270 | PYOtherRevenueAmt |
| CY Other Revenue | $4,437,368 | CYOtherRevenueAmt |
| PY Total Revenue | $432,456,145 | PYTotalRevenueAmt |
| CY Total Revenue | $465,260,105 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,154,560 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,196,625 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $177,029,770 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $183,770,425 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $214,914,529 | PYOtherExpensesAmt |
| CY Other Expenses | $250,673,308 | CYOtherExpensesAmt |
| PY Total Expenses | $393,098,859 | PYTotalExpensesAmt |
| CY Total Expenses | $435,640,358 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $39,357,286 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $29,619,747 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $398,347,138 | TotalAssetsBOYAmt |
| Total Assets EOY | $434,982,179 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $322,645,715 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $330,366,723 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $75,701,423 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $104,615,456 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $405,306,513 | ExpenseAmt |
| Grant | $1,196,625 | GrantAmt |
| Revenue | $460,336,287 | RevenueAmt |
| Desc | CAROMONT'S PHILOSOPHY OF CARE PLAYS THREE DISTINCT ROLES. IT'S A HEALTH SYSTEM THAT STRATEGICALLY INVESTS IN THE FUTURE OF HEALTHCARE, FROM RESEARCH TO EDUCATION. IT'S AN ACTIVE COMMUNITY PARTNER, DRIVING PROGRAMS THAT ENCOURAGE HEALTHY CHOICES EVEN BEFORE PATIENTS WALK THROUGH OUR DOORS. IT'S A DYNAMIC ORGANIZATION ON A PATH OF CONTINUOUS IMPROVEMENT, DELIVERING BOTH WORLD-CLASS MEDICINE AND COMPASSIONATE, PERSONAL CARE. THE FISCAL YEAR ENDING JUNE 30, 2016 SAW CAROMONT HEALTH LIVING ITS VISION TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED COMMUNITY PARTNER. THE COMPLETE 2016 COMMUNITY REPORT CAN BE FOUND AT WWW.CAROMONTHEALTH.ORG | Desc |
| Total Program Service Expenses | $405,306,513 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | 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 | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 800 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3485 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| 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 | 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 (29 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MR K CHRISTOPHER PEEK | ||||||||||
| CHAIR - 2016 | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MR WILLIAM ANTHONY | ||||||||||
| CHAIR - 2015 | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MR DONNIE LOFTIS | ||||||||||
| VICE CHAIR - 2016 | 1.00 | 2.00 | Yes (X) | Yes (X) | $957 | $0 | $0 | |||
| MR W MICHAEL DICKSON | ||||||||||
| VICE CHAIR - 2015 | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MR BARRY M POMEROY | ||||||||||
| SECRETARY - 2016 | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MS ANNETTE CARTER | ||||||||||
| SECRETARY - 2014 | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MR JAMES R BEAM | ||||||||||
| TREASURER - 2016 | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MR JOSEPH B DAVIS JR | ||||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MR TIMOTHY E GAUSE | ||||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MR HOLT D ROBINSON | ||||||||||
| DIRECTOR (THROUGH 6/15) | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| MR JAMES W BAILEY | ||||||||||
| DIRECTOR (THROUGH 8/15) | 1.00 | Yes (X) | $0 | $0 | $0 | |||||
| DR CHARLES MEAKIN III | ||||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||||
| MS PEARL BURRIS FLOYD | ||||||||||
| DIRECTOR | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MR J CHRISTOPHER HOWELL | ||||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||||
| MR R JASON WILLIAMS | ||||||||||
| DIRECTOR (THROUGH 5/16) | 1.00 | 1.00 | Yes (X) | $0 | $16,439 | $0 | ||||
| DR PATRICK RUSSO | ||||||||||
| CHIEF-OF-STAFF | 1.00 | 2.00 | Yes (X) | $0 | $625,603 | $37,373 | ||||
| MR TOM KEIGHER | ||||||||||
| DIRECTOR (BEGAN 6/16) | 1.00 | 1.00 | Yes (X) | $0 | $18,515 | $0 | ||||
| DAVID O'CONNOR | ||||||||||
| EVP/CFO/ASST. TREASURER | 40.00 | 15.00 | Yes (X) | $581,461 | $0 | $107,692 | ||||
| MARIA LONG | ||||||||||
| EVP CHIEF LEGAL OFFICER/AS | 40.00 | 15.00 | Yes (X) | $458,895 | $0 | $80,718 | ||||
| DOUG LUCKETT | ||||||||||
| CEO/PRESIDENT | 40.00 | 15.00 | Yes (X) | $939,128 | $0 | $180,413 | ||||
| KATHLEEN K BESSON | ||||||||||
| EVP/COO | 40.00 | $472,479 | $0 | $101,235 | Yes (X) | |||||
| TODD DAVIS MD | ||||||||||
| EVP/CMO | 40.00 | $469,837 | $0 | $88,168 | Yes (X) | |||||
| ANDREA K SERRA | ||||||||||
| VP WELLNESS DEVELOPMENT | 40.00 | $330,036 | $0 | $59,991 | Yes (X) | |||||
| ELIZABETH MCCRAW | ||||||||||
| VP HUMAN RESOURCES | 40.00 | $327,432 | $0 | $68,702 | Yes (X) | |||||
| MICHAEL R JOHNSON | ||||||||||
| VP CIO | 40.00 | $489,467 | $0 | $58,734 | Yes (X) | |||||
| RICHARD C BLACKBURN | ||||||||||
| VP SUPPORT SERVICES | 40.00 | $295,598 | $0 | $64,728 | Yes (X) | |||||
| BONNIE FAUST | ||||||||||
| VP/CNO | 40.00 | $305,407 | $0 | $14,512 | Yes (X) | |||||
| RANDALL L KELLEY | ||||||||||
| FORMER OFFICER | 0.00 | $502,177 | $0 | $0 | Yes (X) | |||||
| JERRY LEVINE | ||||||||||
| FORMER KEY EMPLOYEE | 0.00 | $380,890 | $0 | $0 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,553,764 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $660,557 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $862,266 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 140 | 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 |
|---|---|---|---|---|---|
| BRASFIELD AND GORRIE LLC | |||||
| PO BOX 11407 | BIRMINGHAM | AL | 352460351 | CONSTRUCTION MANAGEMENT | $12,824,416 |
| MERCY SPECIALIZED BILLINGS SERVICES | |||||
| 14528 S OUTER FORTY RD | CHESTERFIELD | MO | 63017 | CONSULTING | $11,536,341 |
| MORRISON'S MANAGEMENT SPECIALISTS | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | CAFETERIA MANAGEMENT | $4,509,041 |
| ARAMARK CTS | |||||
| 12483 COLLECTION CENTER DR | CHICAGO | IL | 60693 | BIOMED EQUIPMENT SERVICES | $4,305,457 |
| EPIC SYSTEMS CORP | |||||
| 1979 MILKY WAY | VERONA | WI | 53593 | PHARMACY SERVICES | $4,141,703 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 59 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $419,786 | RelatedOrganizationsAmt |
| All Other Contributions | $5,836 | AllOtherContributionsAmt |
| Total Contributions | $425,622 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES REVENUE | 621500 | $457,521,798 | $457,521,798 |
| ANCILLARY REVENUE | 621500 | $2,544,112 | $2,544,112 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $460,065,910 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $326,870 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $11,484 | UnrelatedBusinessRevenueAmt |
| Exclusion | $315,386 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,335 | 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 | $4,335 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,335 | TotalRevenueColumnAmt |
| Exclusion | $4,335 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $276,863 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $247,384 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,479 | TotalRevenueColumnAmt |
| Exclusion | $29,479 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA & VENDING INCOME | 722210 | $2,136,940 | $2,136,940 |
| MEANINGFUL USE | 621500 | $986,609 | $986,609 |
| MISCELLANEOUS | 900099 | $680,613 | $680,613 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $603,727 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $185,449 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $354,586 | UnrelatedBusinessRevenueAmt |
| Exclusion | $63,692 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,407,889 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $465,260,105 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $460,251,359 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $366,070 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,217,054 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,076,622 | TotalAmt |
| Program Services | $1,076,622 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,003 | TotalAmt |
| Program Services | $120,003 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,348,307 | TotalAmt |
| Program Services | $469,662 | ProgramServicesAmt |
| Management And General | $1,878,645 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $137,793 | TotalAmt |
| Program Services | $137,793 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,554,711 | TotalAmt |
| Program Services | $129,052,548 | ProgramServicesAmt |
| Management And General | $15,502,163 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,996,994 | TotalAmt |
| Program Services | $7,051,718 | ProgramServicesAmt |
| Management And General | $945,276 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,332,265 | TotalAmt |
| Program Services | $16,165,318 | ProgramServicesAmt |
| Management And General | $2,166,947 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,400,355 | TotalAmt |
| Program Services | $9,170,992 | ProgramServicesAmt |
| Management And General | $1,229,363 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $490,205 | TotalAmt |
| Program Services | $490,205 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $638,613 | TotalAmt |
| Management And General | $638,613 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,820 | TotalAmt |
| Management And General | $149,820 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,074 | TotalAmt |
| Management And General | $7,074 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,747,674 | TotalAmt |
| Program Services | $33,425,696 | ProgramServicesAmt |
| Management And General | $5,321,978 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,886 | TotalAmt |
| Program Services | $92,896 | ProgramServicesAmt |
| Management And General | $154,990 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,917,615 | TotalAmt |
| Program Services | $2,338,824 | ProgramServicesAmt |
| Management And General | $1,578,791 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,847,300 | TotalAmt |
| Program Services | $2,847,300 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,257,955 | TotalAmt |
| Program Services | $10,257,955 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,512 | TotalAmt |
| Program Services | $79,544 | ProgramServicesAmt |
| Management And General | $65,968 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $475,566 | TotalAmt |
| Program Services | $108,103 | ProgramServicesAmt |
| Management And General | $367,463 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,060,400 | TotalAmt |
| Program Services | $7,060,400 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,540,115 | TotalAmt |
| Program Services | $35,540,115 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,344,903 | TotalAmt |
| Program Services | $2,344,903 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| UBI TAX | $30,549 | $30,549 | |
| SUPPLIES | $75,687,108 | $75,687,108 | |
| BAD DEBT | $61,540,469 | $61,540,469 | |
| R&M EQUIPMENT | $4,999,347 | $6,138 | $4,993,209 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,545,197 | TotalAmt |
| Program Services | $5,255,130 | ProgramServicesAmt |
| Management And General | $290,067 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $435,640,358 | TotalAmt |
| Program Services | $405,306,513 | ProgramServicesAmt |
| Management And General | $30,333,845 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,897 | BOYAmt |
| EOY | $34,281 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,995,088 | BOYAmt |
| EOY | $58,169,462 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,407,651 | BOYAmt |
| EOY | $7,784,308 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,161,745 | BOYAmt |
| EOY | $7,985,020 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $590,364,092 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $315,412,593 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $257,496,124 | BOYAmt |
| EOY | $274,951,499 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,020 | BOYAmt |
| EOY | $9,539 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,559,270 | BOYAmt |
| EOY | $4,919,920 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,311,646 | BOYAmt |
| EOY | $2,311,646 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,386,697 | BOYAmt |
| EOY | $78,816,504 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $398,347,138 | BOYAmt |
| EOY | $434,982,179 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,957,674 | BOYAmt |
| EOY | $41,809,328 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $189,837,913 | BOYAmt |
| EOY | $183,724,702 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $87,850,128 | BOYAmt |
| EOY | $104,832,693 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $322,645,715 | BOYAmt |
| EOY | $330,366,723 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,691,404 | BOYAmt |
| EOY | $104,605,917 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,019 | BOYAmt |
| EOY | $9,539 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,701,423 | BOYAmt |
| EOY | $104,615,456 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $398,347,138 | BOYAmt |
| EOY | $434,982,179 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $29,619,747 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$558 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$705,156 | 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 B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | Yes (1) | 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 | Yes (1) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $44,987 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $90,334 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $135,321 | 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 | ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $27,678 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. AN ADDITIONAL $62,656 IN LEGAL FEES WERE PAID FOR LOBBYING EXPENDITURES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,002 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$278 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $203 | OtherExpendituresAmt |
| End Year Balance | $9,521 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,186 | BeginningYearBalanceAmt |
| Contributions | $630 | ContributionsAmt |
| Investment Earnings Or Losses | $405 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,219 | OtherExpendituresAmt |
| End Year Balance | $10,002 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $9,488 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,251 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $553 | OtherExpendituresAmt |
| End Year Balance | $10,186 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $8,149 | BeginningYearBalanceAmt |
| Contributions | $1,500 | ContributionsAmt |
| Investment Earnings Or Losses | $962 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,123 | OtherExpendituresAmt |
| End Year Balance | $9,488 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,999 | BeginningYearBalanceAmt |
| Contributions | $1,500 | ContributionsAmt |
| Investment Earnings Or Losses | $221 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $571 | OtherExpendituresAmt |
| End Year Balance | $8,149 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,512,106 | OtherCostOrOtherBasisAmt |
| Book Value | $4,512,106 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $310,567,935 | OtherCostOrOtherBasisAmt |
| Depreciation | $147,711,511 | DepreciationAmt |
| Book Value | $162,856,424 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,836,590 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,274,704 | DepreciationAmt |
| Book Value | $2,561,886 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $262,905,194 | OtherCostOrOtherBasisAmt |
| Depreciation | $166,426,378 | DepreciationAmt |
| Book Value | $96,478,816 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,542,267 | OtherCostOrOtherBasisAmt |
| Book Value | $8,542,267 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $274,951,499 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (7 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| NET PENSION ASSET & PENSION DEFERRAL | $14,826,018 |
| DEFERRED FINANCING COSTS | $1,607,654 |
| OTHER RECEIVABLES | $2,612,454 |
| 457B PLAN ASSETS | $8,298,264 |
| DEFERRED CHARGE - INTEREST RATE SWAP | $33,702,180 |
| 457F PLAN ASSETS | $1,384,934 |
| PREPAID COUNTY LEASE | $16,385,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $78,816,504 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| 457B PLAN LIABILITY | $8,298,264 |
| ESTIMATED 3RD PARTY SETTLEMENTS | $48,431,281 |
| INTEREST RATE SWAP LIABILITY | $33,702,180 |
| 457F PLAN LIABILITY | $1,384,934 |
| PENSION DEFERRED INFLOW | $5,816,641 |
| NET PENSION LIABILITY | $7,199,393 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $104,832,693 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $402,945,107 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$558 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $565,950 | OtherRevenueAmt |
| Revenue Not Reported | $565,392 | RevenueNotReportedAmt |
| Revenue Subtotal | $402,379,715 | RevenueSubtotalAmt |
| Other Revenues Not Included | $62,880,390 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $62,880,390 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $465,260,105 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $374,037,541 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $374,037,541 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $61,602,817 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $61,602,817 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $435,640,358 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR ONCOLOGY MEDICATIONS FOR INDIGENT PATIENTS. |
| 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, 2016 AND 2015. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | INTERCOMPANY TRANSFER FROM AFFILIATE 565,950. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT 61,540,469. CHANGE IN VALUE OF INTEREST RATE SWAP 1,271,106. AUXILIARY REVENUES 68,815. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT 61,540,469. AUXILIARY EXPENSES 62,348. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| 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 | 0 | ExpensesExceedBudgetInd |
| 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 | $9,861,044 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,861,044 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $64,443,491 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $48,611,349 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,832,142 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04230 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $74,304,535 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $48,611,349 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $25,693,186 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06870 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,634,032 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $20,629 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,613,403 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,396,787 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $251,954 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,144,833 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 75 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $1,076,833 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $296,905 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $779,928 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,787,229 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,787,229 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 75 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $6,894,881 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $569,488 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,325,393 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01690 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 75 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $81,199,416 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $49,180,837 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $32,018,579 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08560 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,392,205 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,392,205 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,392,205 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,392,205 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $61,540,469 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $2,786,034 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $91,558,073 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $105,793,092 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$14,235,019 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | CAROMONT REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
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 |
| 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 | 3 DIAGNOSTIC IMAGING CENTERS AND 6 OP SERIVCE CENTER | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAROMONT REGIONAL MEDICAL CENTER | 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 |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CAROMONTHEALTH.ORG | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMAN-SERVICES | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| 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 |
| 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 |
| Other Method | Yes (X) | OtherMethodInd |
| 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 5: GASTON COUNTY COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY THE FOLLOWING PARTNERS: THE GASTON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES, GASTON TOGETHER, UNITED WAY OF GASTON COUNTY AND CAROMONT HEALTH. DATA IN THIS ASSESSMENT IS DERIVED FROM THREE SOURCES: 1) GASTON COUNTY HEALTH DATA, 2) COUNTY HEALTH RANKINGS AND 3) GASTON COUNTY QUALITY OF LIFE SURVEY, 2015. THE QUALITY OF LIFE SURVEY WAS CONDUCTED TO ASSESS THE OPINIONS OF GASTON COUNTY RESIDENTS REGARDING THEIR PERSONAL HEALTH. TO GET A COMPREHENSIVE PICTURE OF THESE OPINIONS, FOUR DIVERSE GROUPS WERE INTERVIEWED: 1) COMMUNITY LEADERS, 2) COMMUNITY RESIDENTS, 3) HIGH SCHOOL JUNIORS AND 4) PERSONS LIVING IN LOW-INCOME AREAS THROUGHOUT THE COUNTY. |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 6B: THE HOSPITAL CONDUCTED THEIR CHNA WITH THE FOLLOWING ORGANIZATIONS: GASTON COUNTY HEALTH DEPARTMENT, GASTON TOGETHER, AND UNITED WAY OF GASTON COUNTY. |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 7D: 1) HOSPITAL'S FACEBOOK PAGE 2) PRESENTED FINDINGS TO COMMUNITY AT VARIOUS MEETINGS 3) COPY IN GASTON COUNTY LIBRARY - HAD ADS PROMOTING THIS |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 11: THE CHNA WAS PRESENTED TO THE CAROMONT HEALTH BOARD ON 5/23/16 WHICH LED INTO A DISCUSSION RESULTING IN THE FOLLOWING PRIORITIES BEING APPROVED: 1) INCREASE MENTAL HEALTH SERVICES PROVIDED BY LCSWS IN CAROMONT MEDICAL GROUP PRACTICES AND 2) STANDARDIZATION OF CHRONIC OPIOID MANAGEMENT IN CAROMONT MEDICAL GROUP. THESE PRIORITIES ARE A PART OF CAROMONT HEALTH'S CORPORATE GOALS. IDENTIFIED NEEDS THAT ARE NOT BEING ADDRESSED ARE: 1) ILLEGAL DRUG ABUSE, 2) TEEN PREGNANCY AND 3) ALCOHOL ABUSE. THESE CAN BE BETTER ADDRESSED BY OTHER LOCAL ORGANIZATIONS. |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 13B: REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY: EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO ONE ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE ALSO EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION. |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 15E: CAROMONT HEALTH HAS A TEAM DEDICATED TO EDUCATING AND/OR ASSISTING PATIENTS WITH OTHER STATE OR GOVERNMENT AGENCIES THAT MAY BE A SOURCE OF ASSISTANCE. |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 16I: PLAIN LANGUAGE BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBALLY OR IN WRITING TO SCHEDULED PATIENTS PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER SERVICE TO THOSE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 18D: COLLECTION ACTIONS ARE TAKEN AFTER REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE PATIENT'S ELIGIBILITY FOR ASSISTANCE. |
| CAROMONT REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 20E: PLAIN LANGUAGE BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBIALLY OR IN WRITING TO SCHEDULED PATIENT PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER SERVICE TO THOSE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. |
| PART V, SECTION B, LINE 16A: | HTTP://WWW.CAROMONTHEALTH.ORG/DOCUMENTS/REGISTRATION_CHARITYCAREPOLICY .PDF |
| PART V, SECTION B, LINE 16B: | HTTP://WWW.CAROMONTHEALTH.ORG/DOCUMENTS/CHARITY-CARE-APPLICATION-ENGLIS H.PDF |
| PART V, SECTION B, LINE 16C: | HTTP://WWW.CAROMONTHEALTH.ORG/DOCUMENTS/REGISTRATION_CHARITYCAREPOLICY .PDF |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY:EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO (1) ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION.PART 1, LINE 6A:COMMUNITY BENEFIT REPORT: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT MADE AVAILABLE TO THE PUBLIC CONTAINS COMMUNITY BENEFITS FOR ALL RELATED ORGANIZATIONS TO THE HOSPITAL. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED IS A COST ACCOUNTING SYSTEM. ALL PATIENT SEGMENTS ARE INCLUDED. THIS SYSTEM ASSIGNS DIRECT COSTS TO SUPPLIES, PROCEDURES, ROUTINE AND SPECIALTY ROOM RATES BASED ON THE DEPARTMENT OF ORIGINATION. FIXED COSTS ARE ALLOCATED BASED ON STATISTICAL BASIS. THESE COSTS ARE THEN AGGREGATED AT THE PATIENT LEVEL AND TABULATED BY PAYOR TYPE. NO COST TO CHARGE RATIOS WERE USED IN THE CALCULATIONS. |
| PART I, LN 7 COL(F): | 61,540,469 BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES PRIOR TO CALCULATING PERCENT OF TOTAL EXPENSE. |
| PART I, LINE 7H: | RESEARCH ACTIVITIES: CAROMONT HEALTH IS INVOLVED IN APPROXIMATELY 65 RESEARCH STUDIES, APPROXIMATELY 50% OF WHICH ARE CLINICAL TRIALS COOPERATIVE GROUP PROGRAM STUDIES SPONSORED BY THE NATIONAL CANCER INSTITUTE (NCI). CAROMONT HEALTH ALSO PARTICIPATES IN DRUG AND DEVICE STUDIES SPONSORED BY VARIOUS PHARMACEUTICAL, BIOTECHNOLOGY, AND DEVICE COMPANIES, AS WELL AS UNFUNDED ONCOLOGY, NURSING AND PHARMACY RESEARCH STUDIES. |
| PART I, LINE 3B: | UNINSURED PATIENTS WHO DO NOT QUALIFY FOR A CHARITY CARE DISCOUNT WILL BE ELIGIBLE FOR AN UNINSURED DISCOUNT. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | WORKFORCE DEVELOPMENT - CAROMONT HEALTH'S RECRUITMENT OF EMPLOYEES, PHYSICIANS AND ADVANCED CARE PRACTITIONERS INTO THE FIVE COUNTIES THE SYSTEM SERVES IS DRIVEN BY THE CHANGING LANDSCAPE OF HEALTH CARE REFORM. THE SYSTEM RECRUITS BASED ON A MEDICAL STAFF DEVELOPMENT PLAN THAT IDENTIFIES COMMUNITY HEALTH CARE NEEDS FOR THE NEXT FIVE YEARS. THE SYSTEM'S GOAL IS TO BE PRO-ACTIVE AND ANTICIPATORY SO THAT THE HEALTH CARE NEEDS OF THE COMMUNITY ARE MET IN A QUALITY-DRIVEN AND CONVENIENT MANNER. |
| PART III, LINE 2: | CHARGES WRITTEN OFF TO BAD DEBT WERE TABULATED AT THE PATIENT LEVEL AND ARE REPORTED AT THE AMOUNT CHARGED TO PATIENTS. ACCOUNTS ARE RESERVED AS BAD DEBT BASED ON AN ACCOUNTS RECEIVABLE AGING METHODOLOGY. WHEN ACCOUNTS ARE SENT TO A COLLECTION AGENCY, THEY ARE WRITTEN OFF THE ACCOUNTS RECEIVABLE SYSTEM. ANY SUBSEQUENT COLLECTIONS ON THE ACCOUNTS ARE POSTED AS RECOVERIES AND REDUCE THE EXPENSE. ALL UNINSURED PATIENTS RECEIVE A DISCOUNT ON THEIR BILL, WHICH IS RECORDED AS A CONTRACTUAL ADJUSTMENT. THE AMOUNT OF THE UNINSURED DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE. PART III, LINE 3: CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPARTMENT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING AND/OR APPLICATIONS FILED BY THE PATIENTS. IF NO MEANS TESTING IS DONE AND NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPARTMENT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. BAD DEBT EXPENSE IS REPORTED AS A DEDUCTION FROM PATIENT REVENUE. |
| PART III, LINE 8: | THE MEDICARE COST REPORT STANDARD COSTING METHODOLOGY WAS FOLLOWED WHEN FILING THE COST REPORT. THIS IS A STEP DOWN METHODOLOGY THAT APPLIES THE AVERAGE PATIENT COST TO MEDICARE PATIENTS. THE COST REPORT DOES NOT ALLOW HOSPITALS TO REPORT ALL OPERATING COSTS. BECAUSE OF THESE TWO ISSUES, THE MEDICARE COST REPORT METHODOLOGY UNDERSTATES THE TRUE COST OF TREATING MEDICARE PATIENTS. USING TOTAL COSTS FROM MEDICARE PATIENTS, THE HOSPITAL HAD AN ACUTAL MEDICARE SHORTFALL OF $21.0 MILLION. |
| PART III, LINE 9B: | THE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BELOW IS VERBIAGE FROM THE CHARITY POLICY:CAROMONT REGIONAL MEDICAL CENTER OFFERS MEDICAL SERVICES FREE OR AT A REDUCED RATE THROUGH THE CHARITY CARE PROGRAM. DETERMINATION OF FULL OR PARTIAL CHARITY CARE WILL BE BASED ON THE PATIENT'S INCOME, FAMILY SIZE, AND ASSETS. POTENTIAL ELIGIBILITY EXISTS ONLY AFTER REIMBURSEMENT EFFORTS FROM ALL OTHER THIRD PARTY RESOURCES, FEDERAL, STATE, AND LOCAL ASSISTANCE PROGRAMS HAVE BEEN EXHAUSTED. |
| PART VI, LINE 2: | CAROMONT HEALTH ESTABLISHES COMMUNITY PRIORITIES THROUGH A NUMBER OF MECHANISMS, INCLUDING FEEDBACK AND INPUT FROM INTERNAL AND EXTERNAL STAKEHOLDERS AND COMMUNITY LEADERSHIP, COMMUNITY NEEDS ASSESSMENTS AND QUALITY OF LIFE SURVEYS, AND THE ANALYZATION OF SERVICE AREA AND PATIENT POPULATION-SPECIFIC DATA. |
| PART VI, LINE 3: | THE ORGANIZATION INFORMS AND EDUCATES THE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE IN SEVERAL WAYS. A CHARITY AND FINANCIAL SUMMARY IS ON OUR WEBSITE, AND BROCHURES ARE DISTRIBUTED IN THE EMERGENCY ROOM AND ALL OTHER REGISTRATION SITES. SPECIFICALLY TRAINED STAFF (FINANCIAL COUNSELORS AND BENEFIT ELIGIBILITY SPECIALISTS) PROACTIVELY MAKE CONTACT WITH PATIENTS PRIOR TO, AT TIME OF SERVICE, AND/OR AFTER DISCHARGE TO DISCUSS ELIGIBILITY FOR MEDICAID AND OTHER INSURANCE BENEFITS AND OFFER ASSISTANCE WITH THE APPLICATIONS. THE COMMUNICATION IS ATTEMPTED AS SOON AS POSSIBLE. WRITTEN COMMUNICATION IS MADE PRIOR TO COLLECTION AGENCY PLACEMENT. |
| PART VI, LINE 4: | GASTON COUNTY, LOCATED IN THE PIEDMONT REGION OF NORTH CAROLINA, IS THE ORGANIZATION'S PRIMARY MARKET. LINCOLN, CLEVELAND AND YORK COUNTY, AS WELL AS THE NORTHWEST PORTION OF MECKLENBURG COUNTY, MAKE UP THE HEALTH SYSTEM'S SECONDARY MARKET. ACCORDING TO THE U.S. CENSUS BUREAU, GASTON COUNTY HAD AN ESTIMATED POPULATION OF 213,442 (2015), A MEDIAN HOUSEHOLD INCOME OF $42,429 (2011-2015) AND 16.7% OF PERSONS IN POVERTY (2011-2015). THE ETHIC/RACIAL DEMOGRAPHICS STATE THAT 79.7% OF THE POPULATION IDENTIFY THEMSELVES AS WHITE, 16.4% AS BLACK OR AFRICAN AMERICAN, 6.6% AS HISPANIC AND 1.5% AS ASIAN. |
| PART VI, LINE 5: | OUR COMMUNITY HEALTH INITIATIVES ARE FOCUSED PRIMARILY ON DISEASE PREVENTION AND BETTER MANAGEMENT OF CHRONIC ILLNESSES. THAT INCLUDES WORKING WITH LOCAL EMPLOYERS ON INNOVATIVE PROGRAMS AND COLLABORATING WITH OUR HEALTH CARE NEIGHBORS, MANAGING ILLNESS WITHIN OUR OWN WORKFORCE AND HEAVILY FOCUSING ON SUCCESSFUL CARE COORDINATION FOR PATIENTS WITH CHRONIC DISEASE. ADDITIONALLY, CAROMONT PROVIDES MORE THOUSANDS OF DOLLARS ANNUALLY IN SPONSORSHIP AND GRANT SUPPORT FOR LOCAL NON-PROFITS, COMMUNITY PROGRAMS AND SERVICES, AND OTHER COMMUNITY INITIATIVES AIMED AT IMPROVING THE HEALTH OF OUR COMMUNITY. THROUGH INNOVATION AND A FOCUS ON COMMUNITY WELLNESS, CAROMONT HEALTH IS DETERMINED TO MAKE POSITIVE IMPACT ON HEALTH AND WELLNESS OF THE POPULATIONS WE SERVE. |
| PART VI, LINE 6: | CAROMONT REGIONAL MEDICAL CENTER IS A 435-BED ACUTE CARE HOSPITAL ASSOCIATED WITH CAROMONT HEALTH, A REGIONAL, INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE SYSTEM LOCATED IN GASTONIA, NC. THE SYSTEM IS ALSO COMPRISED OF COURTLAND TERRACE, A 96-BED SKILLED NURSING FACILITY; GASTON HOSPICE, WHICH INCLUDES THE 12-BED ROBIN JOHNSON HOUSE INPATIENT FACILITY; AND CAROMONT MEDICAL GROUP, A NETWORK OF 42 PRIMARY AND SPECIALTY PHYSICIAN OFFICES. CAROMONT HEALTH'S VISION IS TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED PARTNER IN PROMOTING INDIVIDUAL HEALTH AND VIBRANT COMMUNITIES.CAROMONT HEALTH HAS 3 OFF-SITE IMAGING LOCATIONS, 2 SAME-DAY SURGERY CENTERS, 1 FREE-STANDING ENDOSCOPY CENTER, 1 OCCUPATIONAL MEDICINE CLINIC, AND 1 OFF-SITE EMERGENCY DEPARTMENT. |
| 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 (30 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|---|---|---|---|---|
| GASTON FAMILY HEALTH SERVICES | ||||||||||
| 991 WEST HUDSON BOULEVARD | GASTONIA | NC | 28052 | 581958398 | 501(C)(3) | $338,286 | FEDERALLY QUALIFIED HEALTH DEPARTMENT OFFERING MEDICAL CARE TO LOW INCOME RESIDENTS | |||
| MOUNT HOLLY COMMUNITY DEVELOPMENT FOUNDATION | ||||||||||
| 1068 SOUTH MAIN STREET | MOUNT HOLLY | NC | 28120 | 200738339 | 501(C)(3) | $100,000 | COMMUNITY ASSISTANCE | |||
| GASTON REGIONAL CHAMBER | ||||||||||
| 601 W FRANKLIN BLVD | GASTONIA | NC | 28053 | 560232990 | 501(C)(6) | $22,805 | COMMUNITY ASSISTANCE | |||
| GASTON TOGETHER | ||||||||||
| PO BOX 817 | GASTONIA | NC | 28053 | 562048064 | 501(C)(3) | $40,625 | COMMUNITY ASSISTANCE | |||
| CITY OF BELMONT RAIL TRAIL | ||||||||||
| 115 N MAIN STREET | BELMONT | NC | 28012 | 770338658 | GOVERNMENT | $20,000 | COMMUNITY ASSISTANCE | |||
| COMMUNITY FOUNDATION | ||||||||||
| 1201 E GARRISON BLVD | GASTONIA | NC | 28052 | 581340834 | 501(C)(3) | $20,000 | COMMUNITY ASSISTANCE | |||
| MONTCROSS AREA CHAMBER OF COMMERCE | ||||||||||
| PO BOX 368 | BELMONT | NC | 28012 | 560710166 | 501(C)(6) | $21,500 | COMMUNITY ASSISTANCE | |||
| GASTONIA GRIZZLIES | ||||||||||
| PO BOX 177 | GASTONIA | NC | 28053 | 421554288 | 501(C)(3) | $36,500 | COMMUNITY ASSISTANCE | |||
| HOLY ANGELS FOUNDATION | ||||||||||
| 660 WILKINSON BLVD | BELMONT | NC | 28012 | 561762654 | 501(C)(3) | $17,160 | COMMUNITY ASSISTANCE | $10,735 | FMV | MISC MED EQUIPMENT |
| UNITED WAY | ||||||||||
| 200 EAST FRANKLIN BLVD | GASTONIA | NC | 28052 | 560653356 | 501(C)(3) | $12,000 | COMMUNITY ASSISTANCE | |||
| GIRLS ON THE RUN OF GASTON COUNTY | ||||||||||
| 190 S OAKLAND STREET | GASTONIA | NC | 28052 | 474179257 | 501(C)(3) | $10,000 | COMMUNITY ASSISTANCE | |||
| NC PHYSICIANS HEALTH PROGRAM | ||||||||||
| 220 HORIZON DR SUITE 201 | RALEIGH | NC | 27615 | 561846599 | 501(C)(3) | $10,000 | COMMUNITY ASSISTANCE | |||
| MCADENVILLE FOUNDATION | ||||||||||
| PO BOX 1939 | MCADENVILLE | NC | 28101 | 560623961 | 501(C)(3) | $10,000 | COMMUNITY ASSISTANCE | |||
| AS ONE MINISTRIES | ||||||||||
| 805 WEST AIRLINE AVENUE | GASTONIA | NC | 28054 | 562180931 | 501(C)(3) | $16,200 | COMMUNITY ASSISTANCE | |||
| BOYS & GIRLS CLUBS OF GREATER GASTON | ||||||||||
| PO BOX 23 | GASTONIA | NC | 28053 | 561419498 | 501(C)(3) | $6,000 | COMMUNITY ASSISTANCE | |||
| BELMONT ABBEY COLLEGE PARTNERSHIP | ||||||||||
| 100 BELMONT-MT HOLLY ROAD | BELMONT | NC | 28012 | 560547498 | 501(C)(3) | $7,500 | COMMUNITY ASSISTANCE | |||
| AMERICAN CANCER SOCIETY | ||||||||||
| 1901 BURNSWICK AVE SUITE 100 | CHARLOTTE | NC | 28207 | 131788491 | 501(C)(3) | $6,000 | COMMUNITY ASSISTANCE | |||
| MT HOLLY FARMERS MARKET | ||||||||||
| PO BOX 352 | MT HOLLY | NC | 28120 | 260464156 | 501(C)(3) | $6,000 | COMMUNITY ASSISTANCE | |||
| 27 FOREVER FOUNDATION | ||||||||||
| 2030 LINDA STREET | GASTONIA | NC | 28054 | 461843123 | 501(C)(3) | $5,000 | COMMUNITY ASSISTANCE | |||
| BACKPACK FOOD PROGRAM | ||||||||||
| PO BOX 551030 | GASTONIA | NC | 28055 | 471591744 | 501(C)(3) | $5,000 | COMMUNITY ASSISTANCE | |||
| GASTON GAZETTE | ||||||||||
| 1893 REMOUNT RD | GASTONIA | NC | 28054 | 472464986 | 501(C)(3) | $5,000 | COMMUNITY ASSISTANCE | |||
| LET ME RUN OF GASTON COUNTY - GASTON COUNTY HEALTH DEPARTMENT | ||||||||||
| 991 WEST HUDSON BOULEVARD | GASTONIA | NC | 28052 | 566000300 | GOVERNMENT | $5,000 | COMMUNITY ASSISTANCE | |||
| DANIEL STOWE BOTANICAL GARDEN | ||||||||||
| 6500 S NEW HOPE RD | BELMONT | NC | 28012 | 208362933 | 501(C)(3) | $32,500 | COMMUNITY ASSISTANCE | |||
| LUMIERE MEDICAL MINISTRIES | ||||||||||
| PO BOX 26 | LOWELL | NC | 28098 | 561574483 | 501(C)(3) | COMMUNITY ASSISTANCE | $40,045 | FMV | MISC MED EQUIPMENT | |
| GASTON COLLEGE | ||||||||||
| 201 HIGHWAY 321 SOUTH | DALLAS | NC | 28034 | 560792292 | 501(C)(3) | COMMUNITY ASSISTANCE | $5,600 | FMV | MISC MED EQUIPMENT | |
| GASTON COUNTY HEALTH DEPARTMENT | ||||||||||
| 991 W HUDSON BLVD | GASTONIA | NC | 28052 | 566000300 | 501(C)(3) | COMMUNITY ASSISTANCE | $26,786 | FMV | MISC MED SUPPLIES | |
| MEDASSIST OF MECKLENBURG | ||||||||||
| 601 E 5TH STREET SUITE 350 | CHARLOTTE | NC | 28202 | 562018957 | 501(C)(3) | $5,000 | COMMUNITY ASSISTANCE | |||
| GASTON FAMILY YMCA | ||||||||||
| 3210 UNION ROAD | GASTONIA | NC | 28056 | 560655420 | 501(C)(3) | $60,000 | COMMUNITY ASSISTANCE | |||
| BELMONT DEVELOPMENT ASSOC | ||||||||||
| PO BOX 431 | BELMONT | NC | 28012 | 474333734 | 501(C)(3) | $25,000 | COMMUNITY ASSISTANCE | |||
| GREATER GASTON DEVELOPMENT CORPORATION | ||||||||||
| 620 NORTH MAIN STREET | BELMONT | NC | 28012 | 471726248 | 501(C)(3) | $25,000 | COMMUNITY ASSISTANCE | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 28 | Total501c3OrgCnt |
| Total Other Org | 2 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| AUXILIARY SCHOLARSHIPS | 38 | $59,900 |
| ONCOLOGY PHARMACY ASSISTANCE | 6 | $203 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2: | OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED. |
| SCHEDULE I, PART III | THE PURPOSE OF THE GERTRUDE CLINTON HEALTH CAREERS SCHOLARSHIP IS TO ENCOURAGE MEDICAL AND HEALTH-RELATED PROFESSIONALS IN THE FIELD OF HUMAN SERVICES TO PRACTICE THEIR SPECIALTIES AT CAROMONT REGIONAL MEDICAL CENTER OR IN GASTON COUNTY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| 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 | 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 (13 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 | ||||||||||||||
| CHIEF-OF-STAFF | $0 | $569,569 | $0 | $55,341 | $0 | $693 | $0 | $18,390 | $0 | $18,983 | $0 | $662,976 | $0 | $0 |
| DAVID O'CONNOR | ||||||||||||||
| EVP/CFO/ASST. TREASURER | $380,983 | $0 | $117,308 | $0 | $83,170 | $0 | $89,652 | $0 | $18,040 | $0 | $689,153 | $0 | $78,545 | $0 |
| MARIA LONG | ||||||||||||||
| EVP CHIEF LEGAL OFFICER/AS | $318,608 | $0 | $97,039 | $0 | $43,248 | $0 | $78,567 | $0 | $2,151 | $0 | $539,613 | $0 | $42,762 | $0 |
| DOUG LUCKETT | ||||||||||||||
| CEO/PRESIDENT | $604,074 | $0 | $251,233 | $0 | $83,821 | $0 | $161,259 | $0 | $19,154 | $0 | $1,119,541 | $0 | $82,868 | $0 |
| KATHLEEN K BESSON | ||||||||||||||
| EVP/COO | $329,672 | $0 | $100,855 | $0 | $41,952 | $0 | $83,444 | $0 | $17,791 | $0 | $573,714 | $0 | $37,526 | $0 |
| TODD DAVIS MD | ||||||||||||||
| EVP/CMO | $318,090 | $0 | $94,200 | $0 | $57,547 | $0 | $70,451 | $0 | $17,717 | $0 | $558,005 | $0 | $56,956 | $0 |
| ANDREA K SERRA | ||||||||||||||
| VP WELLNESS DEVELOPMENT | $229,176 | $0 | $67,127 | $0 | $33,733 | $0 | $51,136 | $0 | $8,855 | $0 | $390,027 | $0 | $32,818 | $0 |
| ELIZABETH MCCRAW | ||||||||||||||
| VP HUMAN RESOURCES | $224,628 | $0 | $69,566 | $0 | $33,238 | $0 | $51,438 | $0 | $17,264 | $0 | $396,134 | $0 | $28,528 | $0 |
| MICHAEL R JOHNSON | ||||||||||||||
| VP CIO | $257,319 | $0 | $80,037 | $0 | $152,111 | $0 | $41,837 | $0 | $16,897 | $0 | $548,201 | $0 | $146,338 | $0 |
| RICHARD C BLACKBURN | ||||||||||||||
| VP SUPPORT SERVICES | $201,715 | $0 | $61,996 | $0 | $31,887 | $0 | $47,592 | $0 | $17,136 | $0 | $360,326 | $0 | $19,792 | $0 |
| BONNIE FAUST | ||||||||||||||
| VP/CNO | $73,604 | $0 | $0 | $0 | $231,803 | $0 | $10,776 | $0 | $3,736 | $0 | $319,919 | $0 | $92,737 | $0 |
| RANDALL L KELLEY | ||||||||||||||
| FORMER OFFICER | $0 | $0 | $0 | $0 | $502,177 | $0 | $0 | $0 | $0 | $0 | $502,177 | $0 | $214,052 | $0 |
| JERRY LEVINE | ||||||||||||||
| FORMER KEY EMPLOYEE | $0 | $0 | $0 | $0 | $380,890 | $0 | $0 | $0 | $0 | $0 | $380,890 | $0 | $141,121 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO, CFO, CMO, COO, 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. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND FREE OF 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 INDEPENDENT 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 DIRECTORS AND 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. |
| PART I, LINES 4A-B | DURING THE YEAR THE ORGANIZATION PAID SEVERANCE PAYMENTS TO THE FORMER OFFICER, KEY EMPLOYEE, AND HIGHLY COMPENSATED EMPLOYEE IDENTIFIED BELOW: RANDALL L. KELLEY, FORMER OFFICER $502,177 JERRY LEVINE, FORMER KEY EMPLOYEE $380,890 THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM THE FILING ORGANIZATION FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 73,752 MARIA LONG - 61,467 DOUG LUCKETT - 146,940 ANDREA K. SERRA - 34,538 KATHLEEN K. BESSON - 64,339 ELIZABETH MCCRAW - 35,034 TODD DAVIS, MD - 55,876 MICHAEL R. JOHNSON - 19,665 RICHARD C. BLACKBURN - 31,222 BONNIE H. FAUST - 7,965 |
| PART I, LINE 6 | 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. CERTAIN CAROMONT MEDICAL GROUP, INC. PHYSICIAN'S COMPENSATION PACKAGES ARE BASED ON THE INDIVIDUAL PHYSICIANS NET RESULTS FROM OPERATIONS AS CALCULATED BASED SOLELY ON HIS/HER NET CHARGES LESS HIS/HER ALLOCABLE SHARE OF CLINIC OVERHEAD COSTS. |
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 | 65820HVF7 | 2003-01-23 | $120,000,000 | SEE PART VI | 0 | 0 | 0 |
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||||
| B | 521309402 | 65820HG64 | 2008-01-31 | $118,400,000 | SEE PART VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Capitalized InterestCapitalizedInterestAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Credit EnhancementCreditEnhancementAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $1,200,000 | $123,594,002 | $5,150,936 | $1,256,069 | $3,386,000 | $91,583,288 | $22,217,709 | 2005 | 0 | Yes (1) | Yes (1) | Yes (1) |
| B | $50,320,000 | $118,649,846 | $610,174 | $917,471 | $1,553,718 | $28,952,424 | $86,616,059 | 2009 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Engage Bond Counsel ContractsEngageBondCounselContractsInd | Any Research AgreementsAnyResearchAgreementsInd | Engage Bond Counsel ResearchEngageBondCounselResearchInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropPct | Remedial Action TakenRemedialActionTakenInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd | Private Bus Concerning UBIPrivateBusConcerningUBIPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | 0.00220 | 0.00220 | 0 | Yes (1) | 0.00110 | 0 | Yes (1) | |
| B | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | Yes (1) | 0.00010 | 0.00020 | 0 | Yes (1) | 0.00040 | 0 | Yes (1) | 0.00010 |
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 | Business Name Line2HedgeProviderName/BusinessNameLine2Txt | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MERRILL LYNCH | |||||||||||||
| A | 0 | 0 | 0 | Yes (1) | Yes (1) | Yes (1) | CAPITAL SERVICES | 31.600000000000 | Yes (1) | 0 | 0 | 0 | Yes (1) |
| MERRILL LYNCH | |||||||||||||
| B | 0 | 0 | Yes (1) | Yes (1) | 0 | Yes (1) | DERIVATIVE PRODUCTS | 21.000000000000 | Yes (1) | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DATE REBATE COMPUTATION PERFORMED | ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 03/18/2013 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 02/25/2013 |
| SCHEDULE K SUPPLENTAL INFORMATION | THREE 501(C)(3) ORGANIZATIONS WITHIN THE PARENT-SUBSIDIARY CONTROLLED GROUP BENEFIT FROM THE BONDS AS FOLLOWS: GASTON MEMORIAL HOSPITAL, INC. (56-0619359) CAROMONT HEALTH, INC. (58-1636959) CAROMONT HEALTH SERVICES, INC. (56-1455630) CAROMONT REGIONAL MEDICAL CENTER HOLDS THE LIABILITY FOR THE BONDS, PER AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE K, PART I, LINE A, COLUMN (C): | THIS BOND ISSUE INCLUDES TWO CUSIPS MATURING ON THE SAME DATE: 65820HVG5 AND 65820HVF7. |
| SCHEDULE K, PART I, COLUMN (F); DESCRIPTION OF PURPOSE: | ISSUE A - THE SYSTEM USED THE PROCEEDS FROM THESE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO A NEW WOMEN'S CENTER AND PARKING DECK, RENOVATIONS TO EXISTING FACILITIES, AND EQUIPMENT. IN ADDITION, PROCEEDS WERE USED TO REFUND IN ADVANCE OF THEIR MATURITIES $17,000,000 IN PRINCIPAL AMOUNT OF THE SERIES 1998 HOSPITAL REVENUE BONDS, ISSUED ON AUGUST 27, 1998. ISSUE B - THE SYSTEM USED THE PROCEEDS FROM THE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO, THE RENOVATION OF CERTAIN FLOORS OF THE PATIENT TOWER, RENOVATION OF THE DAY OF SURGERY UNIT, INSTALLATION OF FIRE SPRINKLERS IN NON-SPRINKLED AREAS, AND THE UPGRADE OF LIFE SAFETY AND CRITICAL POWER. IN ADDITION, THE HOSPITAL USED THE PROCEEDS TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1995 REVENUE BONDS, ISSUED ON NOVEMBER 15, 1995, IN THE AMOUNT OF $41,210,000 AND TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1998 REVENUE BONDS, ISSUED ON AUGUST 27, 1998, IN THE AMOUNT OF $49,710,000. |
| SCHEDULE K, PART II, LINE 3 COLUMN (A): | LINE 3 COLUMN (A) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 3,594,002. |
| SCHEDULE K, PART II, LINE 3 COLUMN (B): | LINE 3 COLUMN (B) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 249,846. |
| SCHEDULE K, PART II, LINE 11; OTHER SPENT PROCEEDS: | OTHER SPENT PROCEEDS INCLUDE DEPOSITS MADE INTO A REFUNDING ESCROW ACCOUNT ALONG WITH INTEREST EARNED ON THE ACCOUNT, BOTH OF WHICH WERE SUBSEQUENTLY USED TO PAY PRINCIPLE AND INTEREST ON THE REFUNDED BONDS. SEE THE RESPONSE FOR PART I, COLUMN (F) FOR DETAILS. |
| SCHEDULE K, PART IV, LINES 3 AND 4A, COLUMN (B): | THE SERIES 2008 BONDS WERE ORIGINALLY ISSUED AS VARIABLE BONDS BEARING INTEREST AT WEEKLY RATES. CAROMONT HEALTH, INC. ENTERED INTO INTEREST SWAP AGREEMENTS TO HEDGE ITS INTEREST RISK WITH RESPECT TO A PORTION OF THE SERIES 2008 BONDS. ON SEPTEMBER 1, 2010, THE SERIES 2008 BONDS WERE CONVERTED TO FIXED INTEREST RATES TO MATURITY. HOWEVER, THE INTEREST RATE SWAPS WERE NOT TERMINATED IN CONNECTION WITH SUCH FIXED RATE CONVERSION AND REMAIN IN EFFECT. |
| SCHEDULE K, PART IV, LINE 4C, COLUMN (B): | THIS BOND ISSUE HAS TWO HEDGE TERMS: 11.0 YEARS AND 21.0 YEARS. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| GENA POMEROY | |||
| FAMILY RELATIONSHIP WITH BOARD MEMBER | $48,053 | COMPENSATION FOR EMPLOYEE SERVICES | 0 |
| STEPHEN O'CONNOR | |||
| FAMILY RELATIONSHIP WITH OFFICER | $17,486 | COMPENSATION FOR EMPLOYEE SERVICES | 0 |
| SUZANNE HOWELL | |||
| FAMILY RELATIONSHIP WITH BOARD MEMBER | $72,254 | COMPENSATION FOR EMPLOYEE SERVICES | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 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 FOURTEEN (14) MEMBERS, ALL OF WHOM SHALL BE THE MEMBERS OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC., AND ALL OF WHOM SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF CAROMONT HEALTH. |
| 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 11 | THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH EMPLOYEE AND DIRECTOR 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 COMPLIANCE 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 COMPLIANCE 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. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE DO NOT HAVE SUBSTANTIAL INFLUENCE OVER THE CORPORATION'S BUSINESS AND ARE FREE OF 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: | INTERCOMPANY TRANSFER FROM AFFILIATE 565,950. CHANGE IN VALUE OF INTEREST RATE SWAP -1,271,106. |
| PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM LAST YEAR. |
| FORM 990, PART V AND PART VII | COMMON PAYMASTER: THE FILING ORGANIZATION USES A RELATED ORGANIZATION FOR ITS PAYROLL FUNCTION. ALL W-2S ARE FILED BY THE COMMON PAYMASTER. HOWEVER, AMOUNTS PAID BY THE COMMON PAYMASTER ARE TREATED AS IF PAID DIRECTLY BY THE ORGANIZATION FOR WHICH SERVICES ARE PERFORMED. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 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 | |
| CAROMONT MEDICAL GROUP INC | |||||||||||
| 2528 COURT DRIVE | GASTONIA | NC | 28054 | 561479712 | MEDICAL GROUP | 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 EMERGENCY PHYSICIANS INC | |||||||||||
| 2531 COURT DRIVE | GASTONIA | NC | 28054 | 562209423 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | 0 | CAROMONT HEALTH INC | |
| GASTON COUNTY | |||||||||||
| PO BOX 1578 | GASTONIA | NC | 280531578 | 566000300 | GOVERNMENT ADMINISTRATION | NC | N/A | 0 | |||
| 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 | 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 | 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 |