CALDWELL MEMORIAL HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CALDWELL MEMORIAL HOSPITAL INC (EIN 56-0554202)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-09
- IRS object ID
- 201701299349301980
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-09T13:41:30-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 WEST TRADE STREET SUITE 800 | AddressLine1Txt |
| City | CHARLOTTE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28202 | 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 | 560554202 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CALD | BusinessNameControlTxt |
| Phone | 8287575100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1Txt |
| City | LENOIR | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28645 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | OFFICER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 8287575100 | PhoneNum |
| Signature | 2017-05-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN NORMAN | PreparerPersonNm |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | PhoneNum |
| Preparation | 2017-05-08 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | LAURA J EASTON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1Txt |
| City | LENOIR | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28645 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $126,983,926 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CALDWELLMEMORIAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO PROMOTE SAFE, EFFECTIVE, COMPASSIONATE MEDICAL CARE AND TO PROMOTE HEALTHY LIFESTYLES FOR OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 1017 | TotalEmployeeCnt |
| Total Volunteers | 91 | TotalVolunteersCnt |
| Total Gross UBI | $1,204,030 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$249,914 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,997,460 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,678,503 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $118,623,846 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $115,869,333 | CYProgramServiceRevenueAmt |
| PY Investment Income | $101,536 | PYInvestmentIncomeAmt |
| CY Investment Income | $130,862 | CYInvestmentIncomeAmt |
| PY Other Revenue | $450,238 | PYOtherRevenueAmt |
| CY Other Revenue | $305,228 | CYOtherRevenueAmt |
| PY Total Revenue | $125,173,080 | PYTotalRevenueAmt |
| CY Total Revenue | $126,983,926 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $425 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $56,141,069 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $55,744,608 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $67,061,932 | PYOtherExpensesAmt |
| CY Other Expenses | $66,219,649 | CYOtherExpensesAmt |
| PY Total Expenses | $123,203,001 | PYTotalExpensesAmt |
| CY Total Expenses | $121,964,682 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,970,079 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,019,244 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $59,327,623 | TotalAssetsBOYAmt |
| Total Assets EOY | $71,662,461 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $24,931,229 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $32,818,902 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $34,396,394 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $38,843,559 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROVIDE SAFE, EFFECTIVE, COMPASSIONATE MEDICAL CARE AND TO PROMOTE HEALTHY LIFESTYLES FOR OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $106,360,560 | ExpenseAmt |
| Grant | $425 | GrantAmt |
| Revenue | $115,869,333 | RevenueAmt |
| Desc | SINCE OPENING IN 1951, CALDWELL MEMORIAL HOSPITAL HAS CONTINUED TO GROW AND CHANGE IN ORDER TO BETTER MEET THE NEEDS OF OUR COMMUNITY. THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROVIDE SAFE, EFFECTIVE, COMPASSIONATE CARE AND TO PROMOTE HEALTHY LIFESTYLES TO OUR COMMUNITY. ANCHORED BY A 110-BED ACUTE CARE FACILITY, CALDWELL MEMORIAL HOSPITAL'S SERVICES INCLUDE A VAST ARRAY OF MEDICAL AND SURGICAL SERVICES. AMONG SERVICES OFFERED, BUT BY NO MEANS A COMPLETE LIST, ARE CAROTID ARTERY STENTING; CARDIOVASCULAR AND ENDOVASCULAR CARE; RADIATION ONCOLOGY; COMPUTER-ASSISTED ORTHOPEDIC SURGERY; NEUROLOGY AND MEMORY CARE; PAIN MANAGEMENT; A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT; CALDWELL PHYSICIANS CLINICS CONVENIENTLY LOCATED COUNTY-WIDE; DIAGNOSTIC SERVICES; OUTPATIENT SURGERY; PLUS URGENT CARE; AND THE QUEST 4 LIFE WELLNESS CENTER. MULTIPLE EDUCATIONAL AND COUNSELING PROGRAMS ARE AVAILABLE FOR A WIDE ARRAY OF HEALTHCARE NEEDS INCLUDING CANCER, DIABETES, NUTRITION, JOINT CARE, PRE-NATAL CLASSES AND PARENTING SKILLS. CALDWELL PHYSICIANS IS A DIVISION OF CALDWELL MEMORIAL HOSPITAL. WITH PRACTICES IN COMMUNITIES COUNTYWIDE, CALDWELL PHYSICIANS PROVIDES THE PRIMARY AND SPECIALTY HEALTHCARE, DIAGNOSTICS AND TREATMENTS THAT OUR COMMUNITY NEEDS IN CONVENIENT LOCATIONS NEAR THEIR HOMES. CALDWELL PHYSICIANS INCLUDES: CALDWELL ACUTE CARE SPECIALISTS, EMPLOYER GROUP CLINIC, FALLS MEDICAL PRACTICE, FALLS PEDIATRICS, FALLS PLUS URGENT CARE, HALLMARK FAMILY PRACTICE, LAUREL PARK WOMEN'S CLINIC, MAIN STREET MEDICAL PRACTICE, MCBURNEY PRIMARY CARE, MULBERRY PEDIATRICS, OCCUPATIONAL HEALTH, ROBBINS CARDIOLOGY, ROBBINS PIEDMONT VISTA ENT, ROBBINS FAMILY PRACTICE, ROBBINS INTERNAL MEDICINE, ROBBINS PULMONOLOGY, ROBBINS PLUS URGENT CARE, ROBBINS SURGICAL, SOUTHFORK MEDICAL PRACTICE AND WESTPOINTE MEDICAL PRACTICE. | Desc |
| Total Program Service Expenses | $106,360,560 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 139 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1017 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHAWN HARTLEY CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8287575100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1Txt |
| City | LENOIR | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28645 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| MARK BATTS MD | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $113,876 | $0 | $0 | |||
| MICHAEL CHAMBERLAIN | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD COFFEY | ||||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| JOSEPH GIBBONS | ||||||||
| DIRECTOR (AS OF 1/1/16) | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| WILLIAM HOWARD III | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| BILL JOHNSON | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JEFFREY KEVERLINE MD | ||||||||
| DIRECTOR (AS OF 1/1/16) | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| LEE LAYTON | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| EDWARD PEARCE MD | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| PETER PURCELL MD | ||||||||
| DIRECTOR (LEFT 12/31/15) | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| GARY SHORE | ||||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| CRISSY THOMAS | ||||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| BOYD WILSON | ||||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| DAVID MASTERS MD | ||||||||
| EX OFFICIO DIRECTOR | 2.00 | Yes (X) | $226,256 | $0 | $23,904 | |||
| JOHN POWELL MD | ||||||||
| EX OFFICIO DIRECTOR | 2.00 | Yes (X) | $216,173 | $0 | $25,338 | |||
| LAURA EASTON | ||||||||
| CEO | 60.00 | Yes (X) | $319,802 | $0 | $31,345 | Yes (X) | ||
| REBECCA SMITH | ||||||||
| COO & CNO | 60.00 | $204,663 | $0 | $15,350 | Yes (X) | |||
| STEPHEN RINALDI | ||||||||
| CFO (LEFT 11/4/15) | 60.00 | $0 | $203,300 | $42,349 | Yes (X) | |||
| DONITA DAMRON | ||||||||
| VP PHYSICIAN SERVICES | 60.00 | $158,623 | $0 | $11,805 | Yes (X) | |||
| DAVID HORN | ||||||||
| VP RECRUITMENT/MARKETING | 60.00 | $148,046 | $0 | $16,659 | Yes (X) | |||
| TERRI JAGGERS MD | ||||||||
| PHYSICIAN | 60.00 | $494,417 | $0 | $24,483 | Yes (X) | |||
| ROBERT DACUS MD | ||||||||
| PHYSICIAN | 60.00 | $463,090 | $0 | $17,083 | Yes (X) | |||
| DAVID EVANS MD | ||||||||
| PHYSICIAN | 60.00 | $438,849 | $0 | $24,191 | Yes (X) | |||
| RUIHAI ZHOU MD | ||||||||
| PHYSICIAN | 60.00 | $420,319 | $0 | $16,561 | Yes (X) | |||
| THOMAS PEZZI MD | ||||||||
| PHYSICIAN | 60.00 | $383,935 | $0 | $23,611 | Yes (X) | |||
| DAVID STRONG | ||||||||
| DIRECTOR (FORMER - LEFT 3/27/15) | 0.00 | $0 | $1,226,662 | $16,758 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,588,049 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,429,962 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $289,437 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 65 | 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 |
|---|---|---|---|---|---|
| DLP CARDIAC PARTNERS LLC | |||||
| 3700 ARCO CORP OFFICE SUITE 450 | CHARLOTTE | NC | 28273 | CATH LAB PARTNER | $1,492,394 |
| SIMPLER NORTH AMERICA LP | |||||
| PO BOX 643979 | PITTSBURGH | PA | 15264 | CONSULTING | $527,079 |
| UNIFOUR ANESTHESIA ASSOC PA | |||||
| 415 NORTH CENTER STREET SUITE 201 | HICKORY | NC | 28601 | ANESTHESIOLOGY GROUP | $360,000 |
| CLARUS LINEN SYSTEMS | |||||
| 60 GRIDER STREET | BUFFALO | NY | 14215 | LINEN SERVICES | $312,492 |
| ARNAUD PIERRE FELIX | |||||
| 905 HIGHWAY 321 SUITE 222 | HICKORY | NC | 28601 | HOSPITALIST | $303,830 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $9,718,481 | RelatedOrganizationsAmt |
| All Other Contributions | $960,022 | AllOtherContributionsAmt |
| Total Contributions | $10,678,503 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 621500 | $106,019,800 | $106,019,800 | |
| QUEST4LIFE WELLNESS CENTER REVENU | 713990 | $1,204,030 | $1,204,030 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,645,503 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,645,503 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $115,869,333 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $130,862 | TotalRevenueColumnAmt |
| Exclusion | $130,862 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $305,228 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $305,228 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $305,228 | TotalRevenueColumnAmt |
| Exclusion | $305,228 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $126,983,926 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $114,665,303 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,204,030 | UnrelatedBusinessRevenueAmt |
| Exclusion | $436,090 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $425 | TotalAmt |
| Program Services | $425 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,387,440 | TotalAmt |
| Management And General | $1,387,440 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,032,705 | TotalAmt |
| Program Services | $38,671,675 | ProgramServicesAmt |
| Management And General | $6,361,030 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $844,556 | TotalAmt |
| Program Services | $703,582 | ProgramServicesAmt |
| Management And General | $140,974 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,584,481 | TotalAmt |
| Program Services | $5,095,350 | ProgramServicesAmt |
| Management And General | $489,131 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,895,426 | TotalAmt |
| Program Services | $2,641,823 | ProgramServicesAmt |
| Management And General | $253,603 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,031 | TotalAmt |
| Management And General | $49,031 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,492 | TotalAmt |
| Management And General | $123,492 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,545,529 | TotalAmt |
| Program Services | $4,904,594 | ProgramServicesAmt |
| Management And General | $2,640,935 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $323,987 | TotalAmt |
| Management And General | $323,987 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,103,682 | TotalAmt |
| Program Services | $1,103,682 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $610,926 | TotalAmt |
| Program Services | $610,926 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,171,806 | TotalAmt |
| Program Services | $3,171,806 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $296,492 | TotalAmt |
| Program Services | $177,895 | ProgramServicesAmt |
| Management And General | $118,597 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $274,754 | TotalAmt |
| Program Services | $274,754 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,561,625 | TotalAmt |
| Program Services | $4,561,625 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $723,819 | TotalAmt |
| Program Services | $723,819 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PATIENT CARE SUPPLIES & | $18,025,889 | $18,025,889 | $0 |
| BAD DEBT EXPENSE | $14,545,802 | $14,545,802 | $0 |
| HOME OFFICE ALLOCATION | $11,991,548 | $8,394,085 | $3,597,463 |
| MINOR EQUIPMENT AND R&M | $1,184,509 | $1,066,070 | $118,439 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,686,758 | TotalAmt |
| Program Services | $1,686,758 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,964,682 | TotalAmt |
| Program Services | $106,360,560 | ProgramServicesAmt |
| Management And General | $15,604,122 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,512,829 | BOYAmt |
| EOY | $13,146,362 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,754,921 | BOYAmt |
| EOY | $9,881,208 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $855,014 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,251,676 | BOYAmt |
| EOY | $3,760,277 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $891,268 | BOYAmt |
| EOY | $647,788 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $109,446,728 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $78,238,336 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,837,944 | BOYAmt |
| EOY | $31,208,392 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,628,544 | BOYAmt |
| EOY | $2,428,311 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,291,127 | BOYAmt |
| EOY | $8,453,639 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,159,314 | BOYAmt |
| EOY | $1,281,470 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,327,623 | BOYAmt |
| EOY | $71,662,461 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,992,503 | BOYAmt |
| EOY | $21,867,437 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,973,185 | BOYAmt |
| EOY | $5,671,435 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $965,541 | BOYAmt |
| EOY | $5,280,030 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,931,229 | BOYAmt |
| EOY | $32,818,902 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,396,394 | BOYAmt |
| EOY | $38,843,559 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,396,394 | BOYAmt |
| EOY | $38,843,559 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,327,623 | BOYAmt |
| EOY | $71,662,461 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,019,244 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$572,079 | 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 | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $8,812 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $8,812 | 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 A PERCENTAGE WAS USED IN LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,137,587 | OtherCostOrOtherBasisAmt |
| Book Value | $1,137,587 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $47,147,870 | OtherCostOrOtherBasisAmt |
| Depreciation | $32,568,639 | DepreciationAmt |
| Book Value | $14,579,231 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $53,268,717 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,194,422 | DepreciationAmt |
| Book Value | $9,074,295 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,892,554 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,475,275 | DepreciationAmt |
| Book Value | $6,417,279 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $31,208,392 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| DEFERRED FEE PLAN ASSETS | $1,027,725 | C |
| OTHER ASSETS | $7,425,914 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $8,453,639 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED FEE PLAN LIABILITY | $1,027,725 |
| ESTIMATED THIRD PARTY | $4,252,305 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,280,030 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING TAX FOOTNOTE COMES FROM THE CONSOLIDATED AUDIT REPORT FOR THE TAX PERIOD ENDING JUNE 30, 2016: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT, PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS. THE HOSPITAL AND FOUNDATION HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2016 AND 2015. FISCAL YEARS ENDED ON OR AFTER SEPTEMBER 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 225.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $3,163,139 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,163,139 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02940 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,852,955 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,211,468 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$2,358,513 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,016,094 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,211,468 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $804,626 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02940 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $72,085 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $72,085 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,086 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,086 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $591,190 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $591,190 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00550 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $668,361 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $668,361 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00620 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,684,455 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,211,468 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,472,987 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03560 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,031,097 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,422,085 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $50,184,819 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $58,313,092 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$8,128,273 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (3 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct |
|---|---|
| 1 AMERICAN HOME PATIENT | |
| HOME HEALTHCARE | 0.25000 |
| 2 GUARDIAN HEALTHCARE | |
| HEALTHCARE STAFFING FIRM | 0.50000 |
| 3 LAUREL PARK MOB | |
| JOINT VENTURE | 0.14900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | CALDWELL MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW PO BOX 1890 | AddressLine1Txt |
| City | LENOIR | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28645 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DISPROPORTIONATE SHARE HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | 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 | HTTP://CALDWELLMEMORIAL.ORG/#PG-ABOUT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://CALDWELLMEMORIAL.ORG/#PG-ABOUT | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V | 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 |
| 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 |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CALDWELL MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: PRIMARY DATA COLLECTED USING A TWO-STAGE CLUSTER SAMPLING SYSTEM TO IDENTIFY 7 INTERVIEW SITES. TWO-PERSON TEAMS THEN CONDUCTED SITE SURVEYS/INTERVIEWS IN THE 7 LOCATIONS INCLUDING DEMOGRAPHICS (RACE, EDUCATION, INCOME, EMPLOYMENT LEVEL) QUALITY OF LIFE, COMMUNITY IMPROVEMENT, HEALTH INFORMATION, PERSONAL HEALTH, ACCESS TO CARE AND EMERGENCY PREPAREDNESS. OVER 200 SURVEYS WERE COLLECTED. OTHER DATA USED IN ANALYZING THE COMMUNITY NEEDS INCLUDED NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, US CENSUS BUREAU, US ENVIRONMENTAL PROTECTION AGENCY, NC DEPARTMENT OF LABOR, NC PUBLIC HEALTH. INFORMATION FROM VARIOUS LOCAL EDUCATION, LAW ENFORCEMENT, AND SOCIAL SERVICE AGENCIES WAS ALSO INCLUDED IN THE ANALYSIS. |
| CALDWELL MEMORIAL HOSPITAL | PART V, SECTION B, LINE 6B: CALDWELL COUNTY HEALTH DEPARTMENT |
| CALDWELL MEMORIAL HOSPITAL | PART V, SECTION B, LINE 7D: PRESENTED AT THE COUNTY BOARD OF HEALTH MEETING, PUBLIC FORUM |
| CALDWELL MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE ORGANIZATION IS ADDRESSING THE FOLLOWING TOP IDENTIFIED AREAS:CHRONIC DISEASE: CHRONIC DISEASES, SUCH AS HEART DISEASE, RESPIRATORY DISEASE AND DIABETES, HAVE CONTINUED TO BE SOME OF THE LEADING CAUSES OF DEATH IN CALDWELL COUNTY. THROUGH EDUCATION IN THE COMMUNITY, CHRONIC DISEASES CAN BE PREVENTED AND THIS EDUCATION CAN BE IMPLEMENTED WITH ANY AGE GROUP THROUGH PARTNERSHIPS IN SCHOOLS, SENIOR CENTERS, CHURCHES, ETC. TEEN HEALTH: TEEN HEALTH IS AN IMPORTANT PIECE OF THE PUZZLE TO IMPROVE HEALTH WITHIN CALDWELL COUNTY. THE FOCUS OF TEEN HEALTH INCLUDES TEEN PREGNANCY AND REPRODUCTIVE HEALTH, A LACK OF HEALTHY AND SAFE ACTIVITIES FOR TEENS AND ISSUES SURROUNDING BULLYING. BRINGING AWARENESS OF THESE ISSUES TO THE FOREFRONT OF HEALTH PRIORITIES WILL HELP INSURE THE YOUTH OF CALDWELL COUNTY BECOME PRODUCTIVE CITIZENS.MENTAL HEALTH AND SUBSTANCE ABUSE: IN CALDWELL COUNTY, MENTAL HEALTH AND SUBSTANCE ABUSE HAS BEEN ON THE RISE WHILE RESOURCES HAVE CONTINUED TO BE LIMITED IN THE COMMUNITY. COMMUNITY PARTNERS WILL FOCUS ON PROVIDING ADEQUATE RESOURCES TO THE PUBLIC WITH THE GOAL OF REDUCING THE STIGMA SURROUNDING THESE CONDITIONS. THEY WILL ALSO WORK TOWARDS INCREASING THE SUPPORT THAT IS IN PLACE TO PROVIDE HELP TO THOSE SUFFERING FROM MENTAL HEALTH AND SUBSTANCE ABUSE ISSUES. EDUCATING INDIVIDUALS NEEDING SERVICES AND THOSE IN THE COMMUNITY WILL BE A NECESSITY.THE ORGANIZATION DID NOT ADDRESS THE FOLLOWING FOCUS AREAS IDENTIFIED IN THE CHNA: ACCESS TO CARE AND EDUCATION/ECONOMY. AS A HEALTHCARE ORGANIZATION, CALDWELL MEMORIAL HOSPITAL'S RESOURCES ARE MORE READILY AVAILABLE TO ADDRESS THE AREAS IDENTIFIED ABOVE. |
| PART V, SECTION B, LINES 16A-C | HTTP://WWW.UNCMEDICALCENTER.ORG/UNCMC/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE-PROGRAMS/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 10 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - COMMUNITY PHARMACY | ||||
| 321 MULBERRY STREET SW | LENOIR | NC | 28645 | RETAIL/EMPLOYEE PHARMACY |
| 2 - MCCREARY CANCER CENTER | ||||
| 212 MULBERRRY STREET SW | LENOIR | NC | 28645 | CANCER TREATMENT FACILITY |
| 3 - QUEST 4 LIFE WELLNESS CENTER | ||||
| 1031 MORGANTON BLVD | LENOIR | NC | 28645 | WELLNESS CENTER |
| 4 - CALDWELL PHYSICIANS NETWORK | ||||
| 321 MULBERRY STREET SW | LENOIR | NC | 28645 | PHYSICIAN PRACTICE |
| 5 - CALDWELL MEMORIAL SLEEP CENTER | ||||
| 270 PINE MOUNTAIN ROAD | HUDSON | NC | 28638 | SLEEP CENTER |
| 6 - THE CENTER FOR WOUND MANAGEMENT | ||||
| 401 MULBERRY STREET | LENOIR | NC | 28645 | WOUND CARE CENTER |
| 7 - GEORGE M HANCOCK SURGERY CENTER | ||||
| 1031 MORGANTON BLVD | LENOIR | NC | 28645 | OP SURGERY CENTER |
| 8 - CENTER FOR DIABETES HEALTH | ||||
| 1031 MORGANTON BLVD | LENOIR | NC | 28645 | DIABETES EDUCATION AND SUPPORT |
| 9 - PAIN MANAGEMENT CENTER | ||||
| 1031 MORGANTON BLVD | LENOIR | NC | 28645 | PAIN MANAGEMENT |
| 10 - LAUREL PARK BREAST CENTER | ||||
| COLLEGE AVENUE | LENOIR | NC | 28645 | BREAT HEALTH |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CALDWELL PROVIDES CARE TO PAITNETS WHO MEET CERTAIN CRITERIA UNDERS ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE CALDWELL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. THE CRITERIA FOR CHARITY CARE, WHILE NOT ALL INCLUSIVE, CONSIDERS THE PATIENT'S INCOME, THEIR FINANCIAL STATUS INCLUDING THE EXTENT OF FINANCIAL OBLIGATIONS FOR HEALTH CARE SERVICES, AND ANY OTHER PERTINENT FACTORS DEEMED APPROPRIATE BY CALDWELL IN ASSESSING THE PATIENT'S ABILITY TO PAY FOR THEIR SERVICES. |
| PART I, LINE 7: | WORKSHEET FROM SCHEDULE H INSTRUCTIONS IS USED TO COMPUTE A COST-TO-CHARGE RATIO TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. |
| PART I, LN 7 COL(F): | UNCOLLECTIBLE ACCOUNTS - THE HOSPITAL HAS PROVIDED SERVICES TO PERSONS WHO HAVE NOT PAID FOR SUCH SERVICES EITHER BECAUSE THEY HAVE BEEN UNWILLING OR UNABLE TO PAY. EFFORTS ARE MADE BY THE HOSPITAL TO DETERMINE IF A PATIENT MEETS CHARITY POLICY GUIDELINES THAT ARE ESTABLISHED BY THE HOSPITAL. IF THESE GUIDELINES ARE MET AND CAN BE VERIFIED, THEN SUCH AMOUNTS ARE INCLUDED IN CHARITY CARE. UNTIL SUCH TIME, SUCH AMOUNTS ARE COMBINED IN THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS BECAUSE THEY HAVE NOT BEEN VERIFIED OR DOCUMENTED AS CHARITY CARE DUE TO LACK OF SUPPORTING FINANCIAL INFORMATION. IN SOME CASES, PATIENTS WHO WOULD (OR COULD) QUALIFY FOR CHARITY CARE ARE UNWILLING OR UNABLE TO PRODUCE THE NECESSARY INFORMATION TO SUBSTANTIATE THEIR QUALIFICATION. THUS, THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS INCLUDE AMOUNTS THAT WOULD OTHEWISE QUALIFY FOR CHARITY CARE UNDER THE HOSPITAL'S GUIDELINES.THE ESTIMATED COST OF UNREIMBURSED SERVICES ATTRIBUTABLE TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS - EFFECTIVELY "FREE" SERVICES PROVIDED TO PATIENTS - HAS BEEN DETERMINED BY APPLYING A COST TO CHARGE RATIO TO THE AMOUNT OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS. |
| PART III, LINE 9B: | THE HOSPITAL DOES NOT SUBMIT THE OUTSTANDING BALANCES FOR ANY PATIENTS WHO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE TO COLLECTION AGENCIES. |
| PART VI, LINE 2: | IN COLLABORATION WITH THE CALDWELL COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY AGENCIES (SCHOOL SYSTEM, SOCIAL SERVICES, TOWNSHIPS/MUNICIPALITIES AND UNINSURED CLINIC) CALDWELL MEMORIAL HOSPITAL COMPLETED A FORMAL 2014-2017 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). COMMUNITY SURVEYS (FACE TO FACE SURVEYS WITH RESIDENTS) WERE CONDUCTED IN AREAS OF THE COUNTY IDENTIFIED USING A TWO CLUSTER SAMPLING METHOD. OTHER DATA USED IN ANALYZING THE COMMUNITY NEEDS INCLUDED NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, U.S. CENSUS BUREAU, U. S. ENVIRONMENTAL PROTECTION AGENCY, NORTH CAROLINA DEPARTMENT OF LABOR AND NORTH CAROLINA PUBLIC HEALTH. INFORMATION FROM VARIOUS LOCAL EDUCATION, LAW ENFORCEMENT AND SOCIAL SERVICE AGENCIES WAS ALSO INCLUDED IN ANALYSIS. THE NORTH CAROLINA HEALTHY PEOPLE 20/20 OBJECTIVES WERE ALSO PART OF THE ANALYSIS. ONGOING FEEDBACK FROM THE COMMUNITY AND OTHER HEALTH CARE AGENCIES (MENTAL HEALTH SERVICES, SCHOOL SYSTEM, SOCIAL SERVICE AGENCIES, HEALTH CARE CLINICS AND ECONONIC DEVELOPMENT GROUPS WAS ALSO CONSIDERED IN THE DEVELOPMENT OF COMMUNITY PLANS. A COMMUNITY ADVISORY GROUP (COMPRISED OF AGENCIES NOTED ABOVE AND COMMUNITY MEMBERS) REVIEWED DATA AND IDENTIFED THREE HEALTH OBJECTIVES FOR THE COUNTY BOARD OF HEALTH; SUBSTANCE ABUSE, TEEN PREGNANCY, AND HIGH SCHOOL DROP OUT RATE. IT WAS FELT THAT EACH OF THESE DIRECTLY CONTRIBUTE TO THE HEALTH OF OUR RESIDENTS.IN ADDITION TO THE NOTED THREE OBJECTIVES CMH HAS ADOPTED OTHER AREAS OF FOCUS FOR THE HEALTH OF OUR COMMUNITY. THESE INCLUDE HEALTHY LIVING (EXERCISE AND NUTRITION), OCCUPATIONAL HEALTH, MENTAL HEALTH AND HEALTH SCREEINGS BASED ON THE DATA COLLECTED IN THE COMMUNITY HEALTH ASSESSMENT. |
| PART VI, LINE 3: | CALDWELL MEMORIAL HOSPITAL (CMH) PROVIDES NEEDED HEALTHCARE SERVICES TO ANYONE REGARDLESS OF THAT PERSON'S ABILITY TO PAY. CMH'S CHARITY CARE POLICY IS DESIGNED TO ASSIST PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR HEALTHCARE SERVICES. THE POLICY CAN BE FOUND ON THE CMH PUBLIC WEBSITE. CMH DISPLAYS INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE IN ITS EMERGENCY ROOM, REGISTRATION AREAS IN THE HOSPITAL AND CLINICS, FINANCIAL COUNSELOR OFFICES. A LINK IS ALSO PROVIDED ON THE HOSPITAL'S WEBSITE TO THE AVAILABILITY OF FINANCIAL ASSISTANCE AND ITS CHARITY CARE POLICY, ALONG WITH AN ON-LINE APPLICATION. INPATIENT CASE MANAGERS ALSO PROVIDE INFORMATION TO THE PATIENTS REGARDING AVAILABLE PROGRAMS AND THE ORGANIZAITONS FINANCIAL POLICY. CONSULTATION WITH FINANCIAL COUNSELORS IS ALSO AVAILABLE TO ALL PATIENTS AS NEEDED. |
| PART VI, LINE 4: | THE PRIMARY SERVICE AREA FOR CALDWELL MEMORIAL HOSPITAL IS CALDWELL COUNTY WITH A LIMITED NUMBER OF PAITENTS FROM THE SURROUNDING COUNTIES OF BURKE, WATAUGA, AND CATAWBA. CALDWELL COUNTY IS IN THE NW SECTION OF NC IN THE FOOTHILLS FO THE BLUE RIDGE MOUNTAINS AND IS BOUNDED ON THE NW BY WATAUGA COUNTY, ON THE NE BY WILKES COUNTY, ON THE EAST BY ALEXANDER COUNTY, ON THE SOUTH BY CATAWBA AND BURKE COUNTIES, AND ON THE WEST BY BURKE AND AVERY COUNTIES. TODAY THERE ARE NINE INCORPORATED MUNICIPALITIES IN THE COUNTY: LENOIR, HUDSON, GRANITE FALLS, CEDAR ROCK, CAJAHS MOUNTAIN, GAMEWELL, SAWMILLS, AND PARTS OF BLOWING ROCK AND RHODHISS. POPULATION IS JUST OVER 80,000. MEDIAN INCOME IS $36,936. POPULATION MAKEUP IS 92.2% WHITE, 5.2% BLACK, 4.7% HISPANIC AND 2.6% OTHER. MEDIAN AGE IS 37.5 YEARS. 49.4%% ARE MALES AND 50.6% FEMALES. |
| PART VI, LINE 5: | CALDWELL MEMORIAL HOSPITAL PROVIDES FINANCIAL SUPPORT TO 2 COMMUNITY AGENCIES: THE HELPING HANDS CLINIC (PROVIDING CARE TO THE UNINSURED) AND THE SATIE AND JE BROYHILL CALDWELL SENIOR CENTER (FOCUS ON THE LIVES AND ADVOCACY OF SENIORS). OTHER COMMUNITY INVOLVEMENT INCLUDES BUT NOT LIMITED TO: ANNUAL PROSTATE SCREENING, HEALTH FAIRS, SUPPORT AND INVOLVEMENT IN THE CALDWELL COMMUNITY GARDEN WHICH HELPS FOSTER COMMUNITY GARDENING, REPRESENTATION BY ORGANIZATION REPRESENTATIVES ON LOCAL HEALTH CARE RELATED BOARDS (BOARD OF HEALTH, HOSPICE, AND CHILD PROTECTION TEAM.) CALDWELL MEMORIAL HEALTHWORKS WHICH IS OCCUPATIONSL, INDUSTRIAL AND WORKER'S COMP MEDICINE DESIGNED TO ASSIST EMPLOYERS TOWARD IMPROVING QUALITY OF HEALTHCARE. |
| PART VI, LINE 6: | CALDWELL MEMORIAL HOSPITAL IS PART OF THE UNC HEALTHCARE SYSTEM. A COMMUNITY AVISORY GROUP (COMPRISED OF AGENCIES AND COMMUNITY MEMBERS) REVIEWED DATA AND IDENTIFIED 3 HEALTH OBJECTIVES FOR THE COUNTY BOARD OF HEALTH: SUBSTANCE ABUSE, TEEN PREGNANCY, AND HIGH SCHOOL DROPOUT RATE. IT WAS FELT THAT EACH OF THESE DIRECTLY CONTRIBUTES TO THE HELATH OF OUR RESIDENTS. IN ADDTION TO THE 3 NOTED OBJECTIVES, CMH HAS ADOPTED OTHER AREAS OF FOCUS FOR THE HEALTH OF OUR COMMUNITY. THESE INCLUDE HEALTH LIVING (EXERCISE AND NUTRITION), OCCUPATIONAL HEALTH, MENTAL HEALTH, AND HEALTH SCREENINGS BASED ON THE DATA COLLECTED. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NC |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID MASTERS MD | ||||||||||||||
| EX OFFICIO DIRECTOR | $208,981 | $0 | $16,773 | $0 | $502 | $0 | $8,239 | $0 | $15,665 | $0 | $250,160 | $0 | $0 | $0 |
| JOHN POWELL MD | ||||||||||||||
| EX OFFICIO DIRECTOR | $199,083 | $0 | $16,866 | $0 | $224 | $0 | $9,382 | $0 | $15,956 | $0 | $241,511 | $0 | $0 | $0 |
| LAURA EASTON | ||||||||||||||
| CEO | $257,089 | $0 | $55,820 | $0 | $6,893 | $0 | $15,389 | $0 | $15,956 | $0 | $351,147 | $0 | $0 | $0 |
| REBECCA SMITH | ||||||||||||||
| COO & CNO | $169,623 | $0 | $19,938 | $0 | $15,102 | $0 | $10,244 | $0 | $5,106 | $0 | $220,013 | $0 | $0 | $0 |
| STEPHEN RINALDI | ||||||||||||||
| CFO (LEFT 11/4/15) | $0 | $179,779 | $0 | $20,529 | $0 | $2,992 | $0 | $36,956 | $0 | $5,393 | $0 | $245,649 | $0 | $0 |
| DONITA DAMRON | ||||||||||||||
| VP PHYSICIAN SERVICES | $142,782 | $0 | $15,718 | $0 | $123 | $0 | $4,462 | $0 | $7,343 | $0 | $170,428 | $0 | $0 | $0 |
| DAVID HORN | ||||||||||||||
| VP RECRUITMENT/MARKETING | $131,647 | $0 | $14,221 | $0 | $2,178 | $0 | $6,645 | $0 | $10,014 | $0 | $164,705 | $0 | $0 | $0 |
| TERRI JAGGERS MD | ||||||||||||||
| PHYSICIAN | $489,860 | $0 | $3,693 | $0 | $864 | $0 | $8,527 | $0 | $15,956 | $0 | $518,900 | $0 | $0 | $0 |
| ROBERT DACUS MD | ||||||||||||||
| PHYSICIAN | $447,465 | $0 | $15,179 | $0 | $446 | $0 | $2,826 | $0 | $14,257 | $0 | $480,173 | $0 | $0 | $0 |
| DAVID EVANS MD | ||||||||||||||
| PHYSICIAN | $423,208 | $0 | $15,179 | $0 | $462 | $0 | $8,235 | $0 | $15,956 | $0 | $463,040 | $0 | $0 | $0 |
| RUIHAI ZHOU MD | ||||||||||||||
| PHYSICIAN | $419,905 | $0 | $0 | $0 | $414 | $0 | $605 | $0 | $15,956 | $0 | $436,880 | $0 | $0 | $0 |
| THOMAS PEZZI MD | ||||||||||||||
| PHYSICIAN | $375,284 | $0 | $8,189 | $0 | $462 | $0 | $9,173 | $0 | $14,438 | $0 | $407,546 | $0 | $0 | $0 |
| DAVID STRONG | ||||||||||||||
| DIRECTOR (FORMER - LEFT 3/27/15) | $0 | $153,361 | $0 | $0 | $0 | $1,073,301 | $0 | $13,919 | $0 | $2,839 | $0 | $1,243,420 | $0 | $246,929 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | DURING THE CALENDAR YEAR 2015, DAVID STRONG, FORMER DIRECTOR, RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN TOTALING $246,929, FROM A RELATED PARTY. LAURA EASTON (CEO) HAS A SECURED BENEFIT PLAN WHICH IS INCLUDED IN THE STUDY COMPLETED BY THE INDEPENDENT COMPENSATION CONSULTANT. THE LOAN UNDER THIS ARRANGEMENT IS RECORDED ON THE FINANCIAL STATEMENTS AND FULLY SECURED BY LIFE INSURANCE ON THE LIFE OF THE CEO. |
| PART I, LINE 5 | SENIOR MANAGEMENT HAS AN INCENTIVE PROGRAM WHICH IS PARTIALLY EARNED BASED ON PROFIT MARGIN AND DAYS CASH ON HAND. THE EARNED INCENTIVE IS REVIEWED BY THE HR COMMITTEE OF THE BOARD AND APPROVED ANNUALLY; EMPLOYED PHYSICIANS ARE PAID ON A PRODUCTIVITY BASIS BASED ON RVU'S GENERATED IN THEIR PRACTICE OPERATIONS. THESE ARE TIED TO MGMA BENCHMARKS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE/FINANCE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM IS A MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM IS A MEMBER AND THEY HAVE THE POWER TO APPOINT BOARD MEMBERS AND APPROVE GOVERNANCE DECISIONS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM IS A MEMBER AND APPROVES ALL GOVERNANCE DECISIONS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. THE FULL BOARD RECEIVED A COPY OF THE FORM 990 FOR THEIR REVIEW AND FOR ANY QUESTIONS. THE FULL BOARD VOTED FOR A FINAL APPROVAL OF THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD ANNUALLY REVIEWS THE CONFLICT OF INTEREST STATEMENTS. MINUTES OF BOARD MEETINGS REFLECT ANY DECLARED CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION COMPLETES THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DESCRIBED IN TREASURY REGULATION 4958(6)(C) FOR EACH OFFICER AND KEY EMPLOYEE. THIS PROCESS IS PERFORMED BY AN OUTSIDE INDEPENDENT COMPENSATION SPECIALIST. THE CONSULTANT'S FINDINGS ARE PRESENTED TO THE HR COMMITTEE OF THE BOARD AND ARE ULTIMATELY APPROVED BY THE FULL BOARD. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ON GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. PLEASE USE THE ORGANIZATION'S "CONTACT US" LINK ON ITS WEBSITE FOR REQUESTS. |
| FORM 990, PART XI, LINE 9: | EXPENDED FOR RESTRICTED PURPOSES -572,079. |
| FORM 990, PART XII, LINE 2C | NO CHANGE FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| UNC HEALTH CARE SYSTEM | ||||||||||
| 101 MANNING DRIVE | CHAPEL HILL | NC | 27514 | 562206970 | HEALTHCARE | NC | SECTION 115 | NO | 0 | |
| UNC HOSPITALS | ||||||||||
| 211 FRIDAY CENTER DRIVE SUITE 2029 | CHAPEL HILL | NC | 27517 | 561118388 | HEALTHCARE | NC | SECTION 115 | NO | 0 | |
| CALDWELL MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| PO BOX 1890 | LENOIR | NC | 28645 | 581935514 | SUPPORT OF CALDWELL MEMORIAL HOSPITAL | NC | 501(C )(3) | NO | 0 | 7 |
| CHATHAM HOSPITAL INC | ||||||||||
| PO BOX 649 | SILER CITY | NC | 27344 | 560611546 | HEALTHCARE | NC | 501(C )(3) | NO | 0 | 3 |
| HIGH POINT REGIONAL HEALTH | ||||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 560532309 | HEALTHCARE | NC | 501(C )(3) | NO | 0 | 3 |
| HIGH POINT REGIONAL HEALTH SERVICES INC | ||||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 561497163 | HEALTHCARE | NC | 501(C )(3) | NO | 0 | 11 |
| HIGH POINT REGIONAL HEALTH FOUNDATION INC | ||||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 272854711 | SUPPORT OF HIGH POINT REGIONAL HEALTH | NC | 501(C )(3) | NO | 0 | 11 |
| REX HEALTHCARE INC | ||||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 561509129 | HEALTHCARE | NC | 501(C )(3) | NO | 0 | 11 |
| REX HOSPITAL INC | ||||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 561509260 | HEALTHCARE | NC | 501(C )(3) | NO | 0 | 3 |
| THE REX HEALTHCARE FOUNDATION INC | ||||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 566052117 | SUPPORT OF REX HOSPITAL, INC. | NC | 501(C )(3) | NO | 0 | 11 |
| UNCPN | ||||||||||
| 1600 PERIMETER PARK DRIVE STE 225 | MORRISVILLE | NC | 27560 | 271081647 | HEALTHCARE | NC | SECTION 115/501(C )( | NO | 0 | 9 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| HIGH POINT SURGERY CENTER | |||||||||
| 600 NORTH LINDSAY STREET | HIGH POINT | NC | 27260 | 561867005 | HEALTHCARE | NC | RELATED | 0 | 0 |
| REGIONAL WELLNESS LLC | |||||||||
| 861 OLD WINSTON ROAD | KERNERSVILLE | NC | 27284 | 204475769 | HEALTHCARE | NC | RELATED | 0 | 0 |
| REX SURGERY CENTER OF CARY | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 273684056 | ASC | NC | RELATED | 0 | 0 |
| JRH VENTURES LLC | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 274092967 | MED CAMPUS DEVELOPMENT | NC | RELATED | 0 | 0 |
| REX HEALTH VENTURES I LP | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 371690478 | VENTURE CAPITAL INVST | NC | RELATED | 0 | 0 |
| ORTHOPAEDIC SURGERY CENTER OF RALEIGH LLC | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 271740526 | ORTHOPAEDIC SURGERY | NC | RELATED | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|
| HIGH POINT HEALTHCARE VENTURES INC | ||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 561343468 | HOLDING COMPANY | NC | C | 0 |
| REX ENTERPRISES COMPANY INC | ||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 271740526 | OPERATIONS SUPPORT | NC | C | 0 |
| UNC PHYSICIANS NETWORK GROUP PRACTICES LLC | ||||||||
| 1600 PERIMETER PARK DRIVE SUITE 225 | MORRISVILLE | NC | 27560 | 461416986 | HEALTHCARE | NC | C | 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 | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $704,164 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |