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GASTON MEMORIAL HOSPITAL INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
GASTON MEMORIAL HOSPITAL INC (EIN 56-0619359)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-05-01
IRS object ID
201511219349300801
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-05-01T09:36:37-05:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN560747981PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN560619359EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GASTON MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlGASTBusinessNameControlTxt
Phone7048342000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVE PO BOX 1747AddressLine1
CityGASTONIACity
StateNCState
ZIP Code280531747ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID O'CONNORPersonNm
Person TitleEVP, CFOPersonTitleTxt
Phone7048342000PhoneNum
Signature2015-04-30SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAMY BIBBYPreparerPersonNm
PTINP00445891PTIN
Phone8282542254PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1CAROMONT REGIONAL MEDICAL CTRBusinessNameLine1
FieldValueIRS element (for citing)
Principal OfficerDAVID O'CONNORPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVE PO BOX 1747AddressLine1
CityGASTONIACity
StateNCState
ZIP Code280531747ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$424,191,094GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CAROMONT.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1945FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE.ActivityOrMissionDesc
Voting Members Governing Body14VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee3269TotalEmployeeCnt
Total Volunteers259TotalVolunteersCnt
Total Gross UBI$376,650TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$100,276NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$608,905PYContributionsGrantsAmt
CY Contributions Grants$440,277CYContributionsGrantsAmt
PY Program Service Revenue$405,334,757PYProgramServiceRevenueAmt
CY Program Service Revenue$414,500,109CYProgramServiceRevenueAmt
PY Investment Income$90,192PYInvestmentIncomeAmt
CY Investment Income$98,660CYInvestmentIncomeAmt
PY Other Revenue$6,249,575PYOtherRevenueAmt
CY Other Revenue$8,902,747CYOtherRevenueAmt
PY Total Revenue$412,283,429PYTotalRevenueAmt
CY Total Revenue$423,941,793CYTotalRevenueAmt
PY Grants And Similar Paid$628,195PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,026,120CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$173,879,833PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$170,707,984CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$206,686,229PYOtherExpensesAmt
CY Other Expenses$211,881,223CYOtherExpensesAmt
PY Total Expenses$381,194,257PYTotalExpensesAmt
CY Total Expenses$383,615,327CYTotalExpensesAmt
PY Revenues Less Expenses$31,089,172PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$40,326,466CYRevenuesLessExpensesAmt
Total Assets BOY$350,012,184TotalAssetsBOYAmt
Total Assets EOY$372,724,775TotalAssetsEOYAmt
Total Liabilities BOY$304,823,821TotalLiabilitiesBOYAmt
Total Liabilities EOY$316,668,651TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$45,188,363NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$56,056,124NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$358,438,679ExpenseAmt
Grant$1,026,120GrantAmt
Revenue$414,647,704RevenueAmt
DescCAROMONT REGIONAL MEDICAL CENTER PROVIDES INPATIENT, OUTPATIENT, EMERGENCY, SURGICAL, WELLNESS AND PREVENTIVE CARE SERVICES TO THE RESIDENTS OF GASTON COUNTY AND SURROUNDING AREAS AT ITS 435 BED ACUTE CARE FACILITY.PLEASE SEE SCHEDULE O FOR A CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS.Desc
Total Program Service Expenses$358,438,679TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document448IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee3269EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members14GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldNCStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DAVID O'CONNORBusinessNameLine1
FieldValueIRS element (for citing)
Phone7048342000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVEAddressLine1
CityGASTONIACity
StateNCState
ZIP Code28054ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
MR H SPURGEON MACKIE JR
CHAIR - 20131.001.00Yes (X)Yes (X)$0$0$0
SHEILA S REILLY PHD
CHAIR - 20141.001.00Yes (X)Yes (X)$0$0$0
MR DONNIE LOFTIS
VICE CHAIR - 20141.001.00Yes (X)Yes (X)$0$0$0
MR W BARRY SMITH
SECRETARY THROUGH 20131.001.00Yes (X)Yes (X)$0$0$0
MS ANNETTE CARTER
SECRETARY AS OF 20141.001.00Yes (X)Yes (X)$0$7,340$0
MR M VINCENT QUINN
TREASURER1.001.00Yes (X)Yes (X)$0$0$0
MR JAMES R BEAM
DIRECTOR1.001.00Yes (X)$0$0$0
MR JAMES W BAILEY
DIRECTOR1.001.00Yes (X)$0$0$0
MR WILLIAM ANTHONY
DIRECTOR1.001.00Yes (X)$0$0$0
MR W MICHAEL DICKSON
DIRECTOR1.001.00Yes (X)$0$0$0
MRS MARY FRANCES FORRESTER
DIRECTOR1.001.00Yes (X)$0$0$0
DR CHARLES MEAKIN III
DIRECTOR1.001.00Yes (X)$0$0$0
MS SUSIE BROWN
DIRECTOR THROUGH 20131.001.00Yes (X)$0$0$0
MR DAVID ALLEN SMITH
DIRECTOR1.001.00Yes (X)$0$0$0
MR R JASON WILLIAMS
DIRECTOR1.001.00Yes (X)$0$0$0
DR GE WARD ADCOCK III
CHIEF-OF-STAFF1.0039.00Yes (X)$20,000$272,180$26,803
DOUG LUCKETT
CEO/PRESIDENT40.0010.00Yes (X)$712,139$0$129,918
DAVID O'CONNOR
EVP/CFO/ASST. TREASURER40.0010.00Yes (X)$475,002$0$98,510
MARIA LONG
EVP CHIEF LEGAL OFFICER/ASST. SECRETARY40.0010.00Yes (X)$381,516$0$72,932
KATHLEEN K BESSON
EVP/COO40.0010.00$329,336$0$74,874Yes (X)
TODD DAVIS MD
VP MEDICAL AFFAIRS40.0010.00$380,097$0$71,032Yes (X)
MICHAEL R JOHNSON
VP CIO40.0010.00$330,900$0$71,226Yes (X)
W K HARWELL
VP PATIENT CARE40.0010.00$305,239$0$34,104Yes (X)
ELIZABETH MCCRAW
VP HUMAN RESOURCES40.0010.00$265,947$0$60,415Yes (X)
ANDREA K SERRA
VP WELLNESS DEVELOPMENT40.0010.00$264,048$0$51,785Yes (X)
RANDALL L KELLEY
FORMER OFFICER0.00$690,063$0$48,062Yes (X)
JERRY LEVINE
FORMER KEY EMPLOYEE0.00$597,216$0$35,613Yes (X)
PENNY P COWDEN
FORMER HIGHLY COMPENSATED0.00$222,507$0$13,214Yes (X)
CRAIG A DUNKER
FORMER HIGHLY COMPENSATED0.00$188,045$0$2,368Yes (X)
STEVEN A RUBIN
FORMER HIGHLY COMPENSATED0.00$109,009$0$175Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$5,271,064TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$279,520TotReportableCompRltdOrgAmt
Total Other Compensation$791,031TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K124IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
MORRISONS MANAGEMENT SPECIALISTS
5801 PEACHTREE DRIVEATLANTAGA30342FOOD SERVICES$4,230,542
ARAMARK HEALTHCARE
1101 MARKET STREETPHILADELPHIAPA19107BIOMED SERVICES$4,005,153
DUNN SOUTHEAST INC
6101 CARNEGIE BLVD STE 400CHARLOTTENC28209CONSTRUCTION$3,836,762
SHARED (SIEMENS) MEDICAL SOLUTIONS
51 VALLEY STREAM PARKWAYMALVERNPA19355INFORMATION SYSTEMS$2,721,452
MONTEITH CONSTRUCTION CORP
223 NORTH GRAHAM STREET STE 100CHARLOTTENC28202CONSTRUCTION$1,807,402
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K74CntrctRcvdGreaterThan100KCnt
Related Organizations$406,982RelatedOrganizationsAmt
All Other Contributions$33,295AllOtherContributionsAmt
Total Contributions$440,277TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICES REVENUE621500$411,831,855$411,831,855
PREMIER PSHP INCOME541900$2,349,001$2,363,022-$14,021
ANCILLARY REVENUE621500$319,253$319,253
FieldValueIRS element (for citing)
Total Program Service Revenue$414,500,109TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$259,811TotalRevenueColumnAmt
Exclusion$259,811ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$2,685SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$2,125SecuritiesAmt
Other$161,711OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$560SecuritiesAmt
Other-$161,711OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$161,151TotalRevenueColumnAmt
Exclusion-$161,151ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$98,043GrossSalesOfInventoryAmt
Cost Of Goods Sold$85,465CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,578TotalRevenueColumnAmt
Exclusion$12,578ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
MEANINGFUL USE621500$3,644,017$3,644,017
PHARMACY REVENUE621500$2,359,882$2,359,882
CAFETERIA & VENDING INCOME722210$2,018,627$2,018,627

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$867,643TotalRevenueColumnAmt
Related Or Exempt Func Income$133,574RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$390,671UnrelatedBusinessRevenueAmt
Exclusion$343,398ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$8,890,169OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$423,941,793TotalRevenueColumnAmt
Related Or Exempt Func Income$414,647,704RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$376,650UnrelatedBusinessRevenueAmt
Exclusion$8,477,162ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$985,567TotalAmt
Program Services$985,567ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$40,553TotalAmt
Program Services$40,553ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,274,227TotalAmt
Program Services$454,845ProgramServicesAmt
Management And General$1,819,382ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$135,508,050TotalAmt
Program Services$122,847,672ProgramServicesAmt
Management And General$12,660,378ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$6,817,430TotalAmt
Program Services$6,100,975ProgramServicesAmt
Management And General$716,455ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$16,211,620TotalAmt
Program Services$14,507,915ProgramServicesAmt
Management And General$1,703,705ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$9,896,657TotalAmt
Program Services$8,856,601ProgramServicesAmt
Management And General$1,040,056ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$429,669TotalAmt
Program Services$429,669ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$634,949TotalAmt
Management And General$634,949ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$121,604TotalAmt
Management And General$121,604ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$160,914TotalAmt
Management And General$160,914ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$36,035,135TotalAmt
Program Services$31,977,701ProgramServicesAmt
Management And General$4,057,434ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$367,729TotalAmt
Program Services$96,047ProgramServicesAmt
Management And General$271,682ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,857,681TotalAmt
Program Services$1,496,767ProgramServicesAmt
Management And General$1,360,914ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$641,449TotalAmt
Program Services$641,449ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$9,228,504TotalAmt
Program Services$9,228,504ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$131,036TotalAmt
Program Services$94,913ProgramServicesAmt
Management And General$36,123ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$571,715TotalAmt
Program Services$304,284ProgramServicesAmt
Management And General$267,431ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$8,451,179TotalAmt
Program Services$8,451,179ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$23,620,785TotalAmt
Program Services$23,620,785ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,221,709TotalAmt
Program Services$3,221,709ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
UBI TAX$7,268$7,268
SUPPLIES$72,911,696$72,911,696
BAD DEBT$43,014,968$43,014,968
EQUIPMENT$4,423,388$4,423,388

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$5,049,845TotalAmt
Program Services$4,731,492ProgramServicesAmt
Management And General$318,353ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$383,615,327TotalAmt
Program Services$358,438,679ProgramServicesAmt
Management And General$25,176,648ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$27,684BOYAmt
EOY$677EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$44,345,810BOYAmt
EOY$52,885,169EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
EOY$2,499EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$6,668,612BOYAmt
EOY$7,251,509EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$9,382,675BOYAmt
EOY$9,145,373EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$475,878,478LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$265,194,064LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$198,570,572BOYAmt
EOY$210,684,414EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$9,490BOYAmt
EOY$10,190EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$472,338BOYAmt
EOY$1,664,300EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$2,311,646BOYAmt
EOY$2,311,646EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$88,223,357BOYAmt
EOY$88,768,998EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$350,012,184BOYAmt
EOY$372,724,775EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$40,942,536BOYAmt
EOY$47,356,576EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$201,369,253BOYAmt
EOY$195,717,418EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$62,512,032BOYAmt
EOY$73,594,657EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$304,823,821BOYAmt
EOY$316,668,651EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$45,178,875BOYAmt
EOY$56,045,938EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$9,488BOYAmt
EOY$10,186EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$45,188,363BOYAmt
EOY$56,056,124EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$350,012,184BOYAmt
EOY$372,724,775EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$40,326,466ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$562NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$29,459,267OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersYes (1)VolunteersInd
Paid Staff Or ManagementYes (1)PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$81,033DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$79,881OtherActivitiesAmt
Total Lobbying Expenditures$160,914TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $28,472 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. AN ADDITIONAL $51,409 IN LEGAL FEES WERE PAID FOR LOBBYING EXPENDITURES.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$9,488BeginningYearBalanceAmt
Investment Earnings Or Losses$1,251InvestmentEarningsOrLossesAmt
Other Expenditures$553OtherExpendituresAmt
End Year Balance$10,186EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$8,149BeginningYearBalanceAmt
Contributions$1,500ContributionsAmt
Investment Earnings Or Losses$962InvestmentEarningsOrLossesAmt
Other Expenditures$1,123OtherExpendituresAmt
End Year Balance$9,488EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$6,999BeginningYearBalanceAmt
Contributions$1,500ContributionsAmt
Investment Earnings Or Losses$221InvestmentEarningsOrLossesAmt
Other Expenditures$571OtherExpendituresAmt
End Year Balance$8,149EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$6,513BeginningYearBalanceAmt
Investment Earnings Or Losses$966InvestmentEarningsOrLossesAmt
Administrative Expenses$480AdministrativeExpensesAmt
End Year Balance$6,999EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,218,480OtherCostOrOtherBasisAmt
Book Value$2,218,480BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$258,338,072OtherCostOrOtherBasisAmt
Depreciation$127,590,035DepreciationAmt
Book Value$130,748,037BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,437,153OtherCostOrOtherBasisAmt
Depreciation$755,803DepreciationAmt
Book Value$681,350BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$186,341,598OtherCostOrOtherBasisAmt
Depreciation$136,848,226DepreciationAmt
Book Value$49,493,372BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$27,543,175OtherCostOrOtherBasisAmt
Book Value$27,543,175BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$210,684,414TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
PREPAID PENSION OBLIGATION$50,143,969
DEFERRED FINANCING COSTS$1,871,511
OTHER RECEIVABLES$4,578,967
457B PLAN ASSETS$7,042,331
DEFERRED CHARGE - INTEREST RATE SWAP$23,495,262
457F PLAN ASSETS$1,636,958
FieldValueIRS element (for citing)
Total Book Value Other Assets$88,768,998TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
457B PLAN LIABILITY$7,042,331
ESTIMATED 3RD PARTY SETTLEMENTS$41,420,106
INTEREST RATE SWAP LIABILITY$23,495,262
457F PLAN LIABILITY$1,636,958
FieldValueIRS element (for citing)
Total Liability$73,594,657TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$353,586,504TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$562NetUnrealizedGainsInvstAmt
Other Revenue-$70,355,851OtherRevenueAmt
Revenue Not Reported-$70,355,289RevenueNotReportedAmt
Revenue Subtotal$423,941,793RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$423,941,793TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$340,600,359TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$340,600,359ExpensesSubtotalAmt
Other Expenses Not Included$43,014,968OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$43,014,968ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$383,615,327TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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, 2014 AND 2013, RESPECTIVELY. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT -43,014,968. CHANGE IN VALUE OF INTEREST RATE SWAP -1,674,321. INTERCOMPANY TRANSFERS -25,666,562.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT 43,014,968.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,562,088TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,562,088NetCommunityBenefitExpnsAmt
Total Expense0.02810TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$57,653,495TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$46,918,229DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,735,266NetCommunityBenefitExpnsAmt
Total Expense0.03150TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$67,215,583TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$46,918,229DirectOffsettingRevenueAmt
Net Community Benefit Expns$20,297,354NetCommunityBenefitExpnsAmt
Total Expense0.05960TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,554,228TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$8,540DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,545,688NetCommunityBenefitExpnsAmt
Total Expense0.00450TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,022,483TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$215,304DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,807,179NetCommunityBenefitExpnsAmt
Total Expense0.00820TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Activities Or Programs70ActivitiesOrProgramsCnt
Total Community Benefit Expns$1,515,337TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$706,440DirectOffsettingRevenueAmt
Net Community Benefit Expns$808,897NetCommunityBenefitExpnsAmt
Total Expense0.00240TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,343,874TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,343,874NetCommunityBenefitExpnsAmt
Total Expense0.00390TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs70ActivitiesOrProgramsCnt
Total Community Benefit Expns$7,435,922TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$930,284DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,505,638NetCommunityBenefitExpnsAmt
Total Expense0.01900TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs70ActivitiesOrProgramsCnt
Total Community Benefit Expns$74,651,505TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$47,848,513DirectOffsettingRevenueAmt
Net Community Benefit Expns$26,802,992NetCommunityBenefitExpnsAmt
Total Expense0.07860TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,211,764TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,211,764NetCommunityBenefitExpnsAmt
Total Expense0.00360TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,211,764TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,211,764NetCommunityBenefitExpnsAmt
Total Expense0.00360TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$43,014,968BadDebtExpenseAmt
Bad Debt Expense Attributable$3,461,698BadDebtExpenseAttributableAmt
Reimbursed By Medicare$104,168,004ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$102,498,777CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$1,669,227MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CAROMONT REGIONAL MEDICAL CENTERBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line12525 COURT DRIVEAddressLine1
CityGASTONIACity
StateNCState
ZIP Code28054ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Other4 DIAGNOSTIC IMAGING CENTERS AND 6 OP SERIVCE CENTEROtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CAROMONT REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.CAROMONTHEALTH.ORGOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLWWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMANOtherWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
Other Needs AddressedYes (X)OtherNeedsAddressedInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
ResidencyYes (X)ResidencyInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Provided On AdmissionYes (X)ProvidedOnAdmissionInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 3: GASTON COUNTY COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY THE FOLLOWING PARTNERS: THE GASTON COUNTY HEALTH DEPT, 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; 3) GASTON COUNTY QUALITY OF LIFE SURVEY, 2012. 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 SURVEYED: COMMUNITY LEADERS, COMMUNITY RESIDENTS, HIGH SCHOOL STUDENTS, AND PERSONS LIVING IN LOW-INCOME AREAS THROUGHOUT THE COUNTY.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 5D: OTHER WEBSITE'S FULL URL: HTTP://WWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMAN-SERVICES/PUBLIC-HEALTHDIVISION/COMMUNITY-HEALTH-DATA1) HOSPITAL'S FACEBOOK PAGE 2) PRESENTED FINDINGS TO COMMUNITY AT VARIOUS MEETINGS AT HOSPITAL IN JUNE, 2013 3) COPY IN GASTON COUNTY LIBRARY - HAD ADS PROMOTING THIS
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 6I: MANY COMMUNITY ORGANIZATIONS INCLUDING GASTON COUNTY BOARD OF HEALTH AND CAROMONT HEALTH HAVE COMMITTED TO REDUCE THE INCIDENCE OF OBESITY IN GASTON COUNTY, TO PREVENT AND REDUCE THE INCIDENCE OF TOBACCO USE AND TO DEVELOP, IMPLEMENT, AND ADVOCATE FOR THE INTEGRATION OF BEHAVIORAL HEALTH RESOURCES INTO THESE INITIATIVES. THE EXISTING GASTON COMMUNITY HEALTHCARE COMMISSION STRUCTURE WILL BE THE VEHICLE FOR THIS WORK AND IS COMPOSED OF THE FOLLOWING 5 RESOURCE TEAMS: 1) HEALTHY BEHAVIORS; 2) PUBLIC POLICY AND ENVIRONMENT; 3) CLINICAL CARE; 4) MENTAL AND EMOTIONAL HEALTH; 5) MARKETING.A PILOT SITE, BETHLEHEM CHURCH, WEST CAMPUS, HAS BEEN IDENTIFIED. REPRESENTATIVES OF THE PILOT SITE AND THE RESOURCES TEAMS HAVE BEGUN COLLABORATING ON HEALTH INITIATIVES FOR THIS PILOT SITE. HOLY WELL, AN 8 WEEK HEALTHY BEHAVIORS INITIATIVE WITH A SPIRITUAL ASPECT HAS BEEN PROVIDED TO THIS POPULATION TWICE, WITH SUCCESS. THIS INITIATIVE WILL BE PROVIDED AGAIN IN FY'15.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 7: THE NEEDS IDENTIFIED AND NOT ADDRESSED IN THIS WORK ARE: A) PREVENT ALCOHOL AND SUBSTANCE ABUSE; B) REDUCING TEEN PREGNANCY. PARTNERS HEALTH CARE IS A LOCAL PUBLIC AUTHORITY THAT MANAGES MENTAL HEALTH IN GASTON COUNTY AND GASTON COUNTY WORKS WITH THE ADOLOSCENT PREGNANCY PREVENTION CAMPAIGN OF NC. THESE NEEDS ARE BEING ADDRESSED BY THOSE GROUPS.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 14G: BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBALLY OR IN WRITING TO SCHEDULED PATIENTS PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER.
CAROMONT REGIONAL MEDICAL CENTERPART V, SECTION B, LINE 16E: COLLECTION ACTIONS ARE TAKEN AFTER REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE PATIENT'S ELIGIBILITY FOR ASSISTANCE.

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 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):43,014,968 BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES PRIOR TO CALCULATING PERCENT OF TOTAL EXPENSE.
PART I, 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 7H:RESEARCH ACTIVITIES: CAROMONT HEALTH IS INVOLVED IN APPROXIMATELY 75 RESEARCH STUDIES, APPROXIMATELY FORTY PERCENT 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 NURSING AND PHARMACY RESEARCH STUDIES.
PART II, COMMUNITY BUILDING ACTIVITIES:WORKFORCE DEVELOPMENT - CAROMONT HEALTH'S RECRUITMENT OF PHYSICIANS INTO THE FIVE COUNTIES THE SYSTEM SERVES IS DRIVEN BY THE CHANGING LANDSCAPE OF HEALTHCARE 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 HEALTHCARE NEEDS OF THE COMMUNITY ARE MET IN A QUALITY DRIVEN AND CONVENIENT MANNER.
PART III, LINE 4:LINE 2: TOTAL CHARGES AND THE 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. 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.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 ALSO 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 ACTUAL MEDICARE SHORTFALL OF $13.4 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:- LEADERSHIP OPINIONS ARE SOUGHT TO HELP IDENTIFY NEEDED SERVICES IN THE COMMUNITY VIA PARTNERSHIPS WITH THE GASTON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, LOCAL NON-PROFIT ORGANIZATIONS FOCUSED ON HEALTH IMPROVEMENT IN OUR COMMUNITIES AND OTHER HEALTH-FOCUSED ENTITIES. CAROMONT HEALTH ALSO WORKS WITH COMMUNITY AGENCIES TO CONDUCT COMMUNITY NEEDS ASSESSMENTS AND QUALITY OF LIFE SURVEYS EVERY TWO TO THREE YEARS. - PATIENT SATISFACTION DATA IS ANALYZED TO DETERMINE WHERE AND/OR HOW SERVICES NEED TO BE IMPROVED.- SERVICE AREA DATA (VITAL STATISTICS, DEMOGRAPHICS AND UTILIZATION) ARE ANALYZED FOR TRENDS. THIS INFORMATION IS COORDINATED WITH PUBLIC HEALTH DATA TO DETERMINE VOIDS AND SERVICE AREA HEALTH PROBLEMS.- FINDINGS FROM COMMUNITY SURVEYS/REPORTS PUBLISHED BY OTHER ORGANIZATIONS (UNITED WAY, CHAMBER OF COMMERCE, PARTNERSHIP FOR CHILDREN, GASTON COUNTY, ETC.) ARE GATHERED AND REVIEWED FOR PERTINENCE TO COMMUNITY HEALTH PROBLEMS.- CAROMONT REGIONAL MEDICAL CENTER THROUGH THE GASTON COMMUNITY HEALTHCARE COMMISSION IN CONJUNCTION WITH THE GASTON COUNTY HEALTH DEPARTMENT CONDUCTS A COMMUNITY ASSESSMENT EVERY THREE YEARS. THE MOST RECENT STUDY CONCLUDED IN THE FALL OF 2012 AND WAS PUBLISHED IN JANUARY 2013. THIS ASSESSMENT GATHERS OPINIONS AND IS COMBINED WITH PUBLIC HEALTH DATA TO DETERMINE THE TOP FOUR COMMUNITY-WIDE HEALTH ISSUES. SERVICE AREA STRENGTHS, WEAKNESSES AND OPPORTUNITIES ARE USED AS A BASIS FOR ESTABLISHING COMMUNITY PRIORITIES. ALL THIS INFORMATION IS USED TO ESTABLISH ORGANIZATIONAL PRIORITIES, IDENTIFY AGENCIES AND ORGANIZATIONS TO BE INVOLVED IN RESOLVING COMMUNITY ISSUES, AND IMPLEMENT PROGRAMS TO RESOLVE IDENTIFIED ISSUES. GOALS, OBJECTIVES AND STRATEGIES ARE ESTABLISHED AND THE PROGRESS IS EVALUATED ON AN ANNUAL BASIS.- BOARD MEMBERS, SENIOR MANAGEMENT AND DEPARTMENT DIRECTORS ARE INVOLVED IN NUMEROUS ORGANIZATIONS. THROUGH THIS NETWORK OF RELATIONSHIPS, FURTHER INFORMATION ABOUT THE COMMUNITY AND THE NEEDS OF AREA RESIDENTS AND ORGANIZATIONS ARE USED IN THE DEVELOPMENT OF PROGRAMS AND SERVICES AVAILABLE THOUGH CAROMONT HEALTH.
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, 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 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, IS THE HOSPITAL'S SECONDARY MARKET. THERE ARE NO OTHER ACUTE CARE HOSPITALS IN THE PRIMARY SERVICE AREA. ACCORDING TO THE U.S. CENSUS BUREAU, GASTON COUNTY HAD AN ESTIMATED POPULATION OF 209,420 (2013), A MEDIAN HOUSEHOLD INCOME OF $43,220 (2008-2012), AND 17% PERSONS BELOW POVERTY LEVEL (2008-2012). THE ETHIC/RACIAL DEMOGRAPHICS STATE THAT 80.5% OF THE POPULATION IDENTIFY THEMSELVES AS WHITE, 15.8% AS BLACK OR AFRICAN AMERICAN, 6.2% AS HISPANIC AND 1.4% AS ASIAN. DURING THE YEAR, 7.5% OF THE HOSPITAL'S GROSS CHARGES WERE FROM UNINSURED PATIENTS AND 15.2% FROM MEDICAID PATIENTS.
PART VI, LINE 5:ACCOUNTABLE CARE ORGANIZATIONTHE INSTITUTE FOR HEALTHCARE IMPROVEMENT HAS ESTABLISHED A TRIO OF OBJECTIVES CALLED THE TRIPLE AIM, WHICH CAROMONT HEALTH HAS ADOPTED:1 IMPROVE THE HEALTH OF THE POPULATION2 ENHANCE THE PATIENT EXPERIENCE (QUALITY, ACCESS, RELIABILITY)3 CONTROL COSTSTHESE THREE OBJECTIVES ARE ALL CRITICAL COMPONENTS IN BEING WHAT IS KNOWN IN THE INDUSTRY AS AN ACCOUNTABLE CARE ORGANIZATION (ACO). IN OUR STEPS TOWARD BECOMING AN ACO, CAROMONT HEALTH HAS EXECUTED CHANGES THAT HAVE LEAD, AND WILL CONTINUE TO LEAD, TO BETTER COORDINATED CARE WITH BETTER OUTCOMES AT LOWER COSTS FOR PATIENTS. WE ALSO EMBRACE THE "MEDICAL HOME" CONCEPT, WHICH IS A NATIONAL INITIATIVE DESIGNED TO IMPROVE HEALTH CARE QUALITY. MEDICAL HOMES ARE PATIENT CENTERED, TEAM-BASED APPROACHES TO CARE THAT HAVE BEEN SHOWN TO REDUCE HOSPITAL ADMISSIONS AND DECREASE COSTS.COMMUNITY HEALTHOUR 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, AS WELL AS WORKING TO MANAGE THIS ILLNESS WITH THE OUR OWN WORKFORCE. 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. PATIENT CENTERED MEDICAL HOMETHE PATIENT-CENTERED MEDICAL HOME IS A HEALTH CARE SETTING THAT FACILITATES PARTNERSHIPS BETWEEN PATIENTS AND THEIR PERSONAL PHYSICIANS. THE PROGRAM PROVIDES MEDICAL PRACTICES WITH INFORMATION ABOUT ORGANIZING PATIENT-CENTERED CARE, WORKING IN TEAMS, AND COORDINATING AND TRACKING DURING THE CONTINUUM OF CARE. CURRENTLY, ALL PRIMARY CARE PRACTICES IN OUR SYSTEM ARE RECOGNIZED AS LEVEL 3 PATIENT-CENTERED MEDICAL HOMES BY THE NATIONAL COMMITTEE OF QUALITY ASSURANCE (NCQA) - THE HIGHEST RECOGNITION A CLINIC CAN OBTAIN.HEALTHNET GASTONHEALTHNET GASTON (HNG) IS A PROGRAM DESIGNED TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO LOW-INCOME, UNINSURED RESIDENTS OF GASTON COUNTY. ITS SERVICES INCLUDE: A MEDICAL HOME/PRIMARY CARE PHYSICIAN SERVICES, SPECIALTY PHYSICIAN SERVICES, MEDICATION ASSISTANCE, CASE MANAGEMENT/HEALTH COACHING ACTIVITIES, AND HOSPITAL SERVICES. HNG OPERATES THROUGH THE LEADERSHIP AND COLLABORATION OF ITS FOUR FOUNDING STRATEGIC PARTNERS, INCLUDING: CAROMONT REGIONAL MEDICAL CENTER, GASTON FAMILY HEALTH SERVICES, COMMUNITY HEALTH PARTNERS, GASTON COMMUNITY HEALTH COMMISSION. OTHER STRATEGIC PARTNERS INVOLVED WITH THIS INITIATIVE INCLUDE COMMUNITY PHYSICIANS, GASTON COUNTY DEPARTMENT OF SOCIAL SERVICES, GASTON COUNTY HEALTH DEPARTMENT, AND OTHER LOCAL LEADERS. COMMUNITY HEALTH IMPROVEMENT ADVOCACYCAROMONT HEALTH HAS SIGNIFICANTLY IMPACTED ITS COMMUNITY IN PROVIDING MANY DIFFERENT HEALTH IMPROVEMENT PROJECTS, GROUPS, EVENTS, EDUCATION PROGRAMS AND SPONSORSHIPS. IN FISCAL YEAR 2014, CAROMONT HEALTH INVESTED OVER $8 MILLION IN THE COMMUNITY THROUGH HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, COMMUNITY BENEFIT OPERATIONS, DONATIONS, AND IN-KIND DONATIONS OF GOOD AND SERVICES. OTHER EFFORTS TO PROMOTE HEALTH IN THE COMMUNITY ARE FACILIATED BY HAVING A MAJORITY OF THE ORAGANIZATION'S GOVERNING BOARD COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR MOST OR ALL DEPARTMENTS. THE ORGANIZATION APPLIES ITS SURPLUS OF FUNDS TO FURTHER ITS MISSION OF "PROVIDING EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE". THIS IS ACCOMPLISHED BY INVESTING IN NEW SERVICES, CAPITAL EQUIPMENT, INFORMATION TECHNOLOGY, RENOVATION OF THE PHYSICAL PLANT, PHYSICIAN ACQUISITIONS, ETC.
PART VI, LINE 6:CAROMONT HEALTH IN GASTONIA, NORTH CAROLINA IS A REGIONAL, INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE SYSTEM. IT ENCOMPASSES GASTON MEMORIAL HOSPITAL (D.B.A. CAROMONT REGIONAL MEDICAL CENTER "CRMC") WITH 435-BEDS; 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 45 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, AND 1 OCCUPATIONAL MEDICINE CLINIC.
PART VI, LINE 7, REPORTS FILED WITH STATESNC

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (24 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
GASTON FAMILY HEALTH SERVICES
991 WEST HUDSON BOULEVARDGASTONIANC28052581958398501(C)(3)$300,000FEDERALLY QUALIFIED HEALTHCARE CENTER OFFERING MEDICAL CARE TO LOW INCOME RESIDENTS
MOUNT HOLLY COMMUNITY DEVELOPMENT FOUNDATION
1068 SOUTH MAIN STREETMOUNT HOLLYNC28120200738339501(C)(3)$100,000COMMUNITY ASSISTANCE
GASTON REGIONAL CHAMBER
601 W FRANKLIN BLVDGASTONIANC28053560232990501(C)(6)$97,950COMMUNITY ASSISTANCE
GASTON TOGETHER
PO BOX 817GASTONIANC28053562048064501(C)(3)$75,000COMMUNITY ASSISTANCE
GASTON COUNTY SCHOOLS
1351 BRADFORD HEIGHTSGASTONIANC28053566001032N/A$62,241COMMUNITY ASSISTANCE
TOWN OF CRAMERTON
155 N MAIN STCRAMERTONNC28032560891982N/A$55,000COMMUNITY ASSISTANCE
GASTON COLLEGE FOUNDATION
201 HIGHWAY 321 SOUTHDALLASNC28034237079454501(C)(3)$50,000COMMUNITY ASSISTANCE
COMMUNITY FOUNDATION
1201 E GARRISON BLVDGASTONIANC28052581340834501(C)(3)$30,000COMMUNITY ASSISTANCE
MONTCROSS AREA CHAMBER OF COMMERCE
PO BOX 368BELMONTNC28012560710166501(C)(6)$20,900COMMUNITY ASSISTANCE
GASTONIA GRIZZLIES
PO BOX 177GASTONIANC28053421554288N/A$20,750COMMUNITY ASSISTANCE
HEART SOCIETY OF GASTON COUNTY
1201 EAST GARRISON BLVDGASTONIANC28052561330921501(C)(3)$19,800COMMUNITY ASSISTANCE
HOLY ANGELS FOUNDATION
660 WILKINSON BLVDBELMONTNC28012561762654501(C)(3)$15,000COMMUNITY ASSISTANCE
MCADENVILLE FOUNDATION
PO BOX 1939MCADENVILLENC28101560623961501(C)(3)$15,000COMMUNITY ASSISTANCE
NORTH CAROLINA MEDICAL SOCIETY ALLIANCE
3131 CHANNEL VIEW LANDINGBELMONTNC28012561493811501(C)(3)$13,566COMMUNITY ASSISTANCE
AS ONE MINISTRIES
805 WEST AIRLINE AVENUEGASTONIANC28054562180931501(C)(3)$10,000COMMUNITY ASSISTANCE
AUTEN-STOWE POST NO 144 AMERICAN LEGION
202 PARK DRIVEBELMONTNC28012566088269501(C)(19)$10,000COMMUNITY ASSISTANCE
BOYS & GIRLS CLUBS OF GREATER GASTON
PO BOX 23GASTONIANC28053561419498501(C)(3)$6,000COMMUNITY ASSISTANCE
DALLAS HISTORIC COURTHOUSE FOUNDATION
306 W MAIN STREETDALLASNC28034455094816501(C)(3)$6,000COMMUNITY ASSISTANCE
TWENTY SEVEN FOREVER FOUNDATION
2030 LINDA STREETGASTONIANC28054461843123N/A$5,000COMMUNITY ASSISTANCE
BELMONT ABBEY COLLEGE PARTNERSHIP
100 BELMONT-MT HOLLY ROADBELMONTNC28012560547498501(C)(3)$5,000COMMUNITY ASSISTANCE
CANCER SERVICES OF GASTON COUNTY
306 SOUTH COLUMBIA STGASTONIANC28054561164253501(C)(3)$5,000COMMUNITY ASSISTANCE
CHARLOTTE REGIONAL PARTNERSHIP
550 S CALDWELL STREET SUITE 760CHARLOTTENC28202581457132501(C)(3)$5,000COMMUNITY ASSISTANCE
GASTON COUNTY MEDICAL SOCIETY ALLIANCE
3729 EAGLEBROOK DRIVEGASTONIANC28056561493811501(C)(3)$5,000COMMUNITY ASSISTANCE
THE GREAT 100 NC
PO BOX 4875GREENSBORONC27404561705456501(C)(3)$5,000COMMUNITY ASSISTANCE
FieldValueIRS element (for citing)
Total501c3 Org9Total501c3OrgCnt
Total Other Org15TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
GERTRUDE CLINTON HEALTH CAREERS SCHOLARSHIPS27$40,000
ONCOLOGY PHARMACY ASSISTANCE10$553

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 IIITHE 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

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR GE WARD ADCOCK III
CHIEF-OF-STAFF$0$191,263$20,000$74,027$0$6,890$0$11,491$0$15,312$20,000$298,983$0$0
DOUG LUCKETT
CEO/PRESIDENT$590,205$0$121,154$0$780$0$113,546$0$16,372$0$842,057$0$0$0
DAVID O'CONNOR
EVP/CFO/ASST. TREASURER$362,570$0$111,268$0$1,164$0$82,348$0$16,162$0$573,512$0$0$0
MARIA LONG
EVP CHIEF LEGAL OFFICER/ASST. SECRET$294,902$0$85,720$0$894$0$70,934$0$1,998$0$454,448$0$0$0
KATHLEEN K BESSON
EVP/COO$258,881$0$69,784$0$671$0$59,308$0$15,566$0$404,210$0$0$0
TODD DAVIS MD
VP MEDICAL AFFAIRS$290,216$0$89,341$0$540$0$55,236$0$15,796$0$451,129$0$0$0
MICHAEL R JOHNSON
VP CIO$250,804$0$78,198$0$1,898$0$56,242$0$14,984$0$402,126$0$0$0
W K HARWELL
VP PATIENT CARE$172,745$0$74,892$0$57,602$0$29,307$0$4,797$0$339,343$0$53,114$0
ELIZABETH MCCRAW
VP HUMAN RESOURCES$202,734$0$62,876$0$337$0$45,045$0$15,370$0$326,362$0$0$0
ANDREA K SERRA
VP WELLNESS DEVELOPMENT$203,407$0$59,737$0$904$0$43,793$0$7,992$0$315,833$0$0$0
RANDALL L KELLEY
FORMER OFFICER$347,736$0$0$0$342,327$0$43,999$0$4,063$0$738,125$0$0$0
JERRY LEVINE
FORMER KEY EMPLOYEE$243,881$0$83,569$0$269,766$0$29,274$0$6,339$0$632,829$0$0$0
PENNY P COWDEN
FORMER HIGHLY COMPENSATED$95,316$0$0$0$127,191$0$8,791$0$4,423$0$235,721$0$0$0
CRAIG A DUNKER
FORMER HIGHLY COMPENSATED$56,106$0$0$0$131,939$0$1,122$0$1,246$0$190,413$0$0$0
STEVEN A RUBIN
FORMER HIGHLY COMPENSATED$0$0$0$0$109,009$0$0$0$175$0$109,184$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3THE CEO, CFO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY GASTON MEMORIAL HOSPITAL, 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 LEAVES THE MEETING AND 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-BDURING THE YEAR THE ORGANIZATION PAID SEVERANCE PAYMENTS TO THE FORMER OFFICER AND KEY EMPLOYEES IDENTIFIED BELOW: RANDALL L. KELLEY, FORMER OFFICER $331,138 STEVEN A. RUBIN, FORMER KEY EMPLOYEE $109,009 CRAIG A. DUNKER, FORMER KEY EMPLOYEE $131,456 PENNY P. COWDEN, FORMER KEY EMPLOYEE $127,003 JERRY LEVINE, FORMER KEY EMPLOYEE $257,519 THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM THE FILING ORGANIZATION FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 69,504 MARIA LONG - 55,601 DOUG LUCKETT - 107,551 JERRY LEVINE - 20,569 RANDALL L. KELLEY - 37,456 W.K. HARWELL - 19,277 ANDREA K. SERRA - 29,459 KATHLEEN K. BESSON - 43,360 ELIZABETH MCCRAW - 31,007 TODD DAVIS, MD - 44,061 MICHAEL R. JOHNSON - 38,563 PENNY P. COWDEN - 7,313 THE FOLLOWING HIGHLY COMPENSATED EMPLOYEE RECEIVED A PAYOUT FROM A DEFERRED COMPENSATION PLAN BY THE FILING ORGANIZATION THAT IS TAXABLE IN THE CURRENT PERIOD: W.K. HARWELL - $53,114 THE PAYOUT LISTED ABOVE IS COMPRISED OF DEFERRED COMPENSATION REPORTED ON A PRIOR FORM 990.
PART I, LINE 6EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES AND FINANCIAL PERFORMANCE OF THE CONSOLIDATED SYSTEM. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
NORTH CAROLINA MEDICAL CARE COMMISSION
A52130940265820HVF72003-01-23$120,000,000SEE PART VI000
NORTH CAROLINA MEDICAL CARE COMMISSION
B52130940265820HG642008-01-31$118,400,000SEE PART VI000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtCapitalized InterestCapitalizedInterestAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$1,000,000$123,594,002$5,150,936$1,256,069$3,386,000$91,583,288$22,217,70920050Yes (1)Yes (1)Yes (1)
B$37,420,000$118,649,818$610,174$917,471$1,553,718$28,952,424$86,616,0312009Yes (1)0Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndEngage Bond Counsel ContractsEngageBondCounselContractsIndAny Research AgreementsAnyResearchAgreementsIndEngage Bond Counsel ResearchEngageBondCounselResearchIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndChange In Use Bond Financed PropChangeInUseBondFinancedPropPctRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00Yes (1)Yes (1)Yes (1)Yes (1)0.001700.000000.001700Yes (1)0.001100Yes (1)
B00Yes (1)Yes (1)Yes (1)Yes (1)0.000000.000100.000100Yes (1)0.000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndBusiness Name Line2HedgeProviderName/BusinessNameLine2Term Of HedgeTermOfHedgePctSuperintegrated HedgeSuperintegratedHedgeIndHedge TerminatedHedgeTerminatedIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
MERRILL LYNCH
A000Yes (1)Yes (1)Yes (1)CAPITAL SERVICES31.600000000000Yes (1)000Yes (1)
MERRILL LYNCH
B00Yes (1)Yes (1)0Yes (1)DERIVATIVE PRODUCTS21.000000000000Yes (1)000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
DATE REBATE COMPUTATION PERFORMEDISSUER 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 INFORMATIONTHREE 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) GASTON MEMORIAL HOSPITAL, INC. 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 $ 249,818.
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

Name Of Interested NameOfInterested

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GASTON REGIONAL CHAMBER OF COMMERCEBusinessNameLine1
FieldValueIRS element (for citing)
Relationship DescriptionA KEY EMPLOYEE OF THE ORGANIZATION IS A BOARD MEMBER OF THE CHAMBERRelationshipDescriptionTxt
Transaction$112,890TransactionAmt
TransactionVARIOUS PAYMENTS FOR MEMBERSHIP DUES, SPONSORSHIPS, AND EVENTSTransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 4ASTATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: CAROMONT HEALTH IS A NOT-FOR-PROFIT HEALTH SYSTEM HEADQUARTERED IN GASTONIA, NC THAT PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES WITHIN FIVE COUNTIES AND TWO STATES. CAROMONT HEALTH EMPLOYS NEARLY 4,000 HEALTHCARE PROFESSIONALS WITH A MEDICAL STAFF MEMBERSHIP OF MORE THAN 450. CAROMONT REGIONAL MEDICAL CENTER, A MAGNET DESIGNATED 435-BED ACUTE CARE HOSPITAL, IS THE ANCHOR OF CAROMONT HEALTH AND FEATURES A STATE-OF-THE-ART CANCER CENTER, BIRTHPLACE AND NEONATAL INTENSIVE CARE UNIT, AS WELL AS A LEVEL III TRAUMA CENTER AND A COMPREHENSIVE SYSTEM OF CARE. AS AN INNOVATIVE LEADER IN HEALTH CARE, CAROMONT HEALTH HAS BEEN AWARDED MANY TOP HONORS IN 2014. SOME KEY ACHIEVEMENTS IN 2014 INCLUDE BEING NAMED A 100 TOP HOSPITAL BY BECKER'S HOSPITAL REVIEW AND A BEST REGIONAL HOSPITAL BY THE U. S. NEWS & WORLD REPORT. ADDITIONALLY, CAROMONT HEALTH WAS RECOGNIZED BY PREVENTION PARTNERS FOR OUR COMMITMENT TO PROVIDING COMPREHENSIVE WELLNESS PROGRAMS TO OUR EMPLOYEES, EARNING US THE HEALTHCARE IN EXCELLENCE AWARD. CAROMONT HEALTH'S MISSION IS TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE, AND WE STRIVE TO FULFILL THAT MISSION EVERY DAY. THIS REPORT IS INTENDED TO SHARE SOME OF THE MANY WAYS THAT CAROMONT HEALTH GIVES BACK TO OUR COMMUNITY. INTERNAL PROGRAMS AND COMMUNITY CARE CAROMONT HEALTH HAS PROVIDED HEALTH CARE TO RESIDENTS OF GASTONIA, GASTON COUNTY AND SURROUNDING COUNTIES FOR MORE THAN 70 YEARS. WHETHER IT IS THE LATEST TECHNOLOGY, CARE MODEL OR WELLNESS INITIATIVE, CAROMONT HEALTH IS CONSTANTLY LOOKING FOR WAYS TO IMPROVE AND PROVIDE OUR COMMUNITY THE BEST CARE POSSIBLE TO KEEP THEM HEALTHY FOR GENERATIONS TO COME. RESEARCH PROGRAMS CAROMONT HEALTH PARTICIPATED IN A NUMBER OF NATIONAL RESEARCH TRIALS AND PROGRAMS IN 2014. CAROMONT INVESTED $1.5 MILLION, $809,000 OF WHICH WAS UNREIMBURSED, IN THESE PROGRAMS FOR TREATMENTS, PROCEDURES, MEDICATIONS AND STAFF TIME. RESEARCH PROGRAMS ARE THE KEY TO INNOVATION AND ADVANCEMENT IN HEALTH CARE AND CAROMONT HEALTH IS DEDICATED TO SUPPORTING OUR MEDICAL PROFESSIONALS IN THE PURSUIT OF NEW TREATMENTS. PHYSICIAN RECRUITMENT & RETENTION CAROMONT BOASTS A ROBUST AND TALENTED MEDICAL STAFF OF MORE THAN 450 PHYSICIANS. MANY CAROMONT HEALTH PHYSICIANS, FROM A NUMBER OF DISCIPLINES, ARE RECOGNIZED REGIONALLY AND NATIONALLY FOR THEIR WORK AND ACHIEVEMENTS. CAROMONT HEALTH CONSISTENTLY SEEKS TO RECRUIT LEADERS IN THE FIELD OF MEDICINE AND INVESTS IN THE MEDICAL STAFF IN A NUMBER OF WAYS, INCLUDING ATTENDANCE AT INDUSTRY CONFERENCES AND OFFERING CONTINUING EDUCATION OPPORTUNITIES. IN 2014, CAROMONT INVESTED $804,374 TO RECRUIT, TRAIN AND RETAIN HIGHLY-SKILLED PHYSICIANS TO PROVIDE NATIONALLY-RECOGNIZED, HIGH-QUALITY CARE. UNREIMBURSED COSTS OF CARE IN 2014, CAROMONT HEALTH HAD $67.8 MILLION IN UNREIMBURSED HEALTH CARE COSTS. THIS AMOUNT COVERS ALL FORMS OF UNREIMBURSED CARE, INCLUDING MORE THAN $11.7 MILLION IN CHARITY CARE, $37.6 MILLION IN MEDICARE AND MEDICAID LOSSES, AND $18.5 IN BAD DEBT. CAROMONT PROVIDES CARE TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. THE CHARITY CARE AND BAD DEBT TOTALS REFLECT THE AMOUNT THAT IS NOT REIMBURSED, EITHER BY THE INABILITY OR CHOICE NOT TO PAY. THE MEDICARE AND MEDICAID LOSSES REFLECT THE COST OF CARE PROVIDED THAT WAS NOT PAID FOR BY EITHER THE APPLICABLE GOVERNMENT PROGRAM OR THE PATIENT. COMMUNITY HEALTH IMPROVEMENT INITIATIVES & INVESTMENTS CAROMONT HEALTH IS ACTIVE IN OUR COMMUNITY IN A NUMBER OF WAYS INCLUDING DONATIONS, INVESTMENTS AND VOLUNTEERISM. IN THE LAST FISCAL YEAR, CAROMONT INVESTED MORE THAN $3 MILLION IN OUR COMMUNITY THROUGH HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, DONATIONS, AND IN-KIND CONTRIBUTIONS OF GOODS AND SERVICES. IN FISCAL YEAR 2014, CAROMONT PROVIDED $300,000 TO GASTON FAMILY HEALTH SERVICES, A LOCAL FEDERALLY QUALIFIED HEALTHCARE CLINIC THAT PROVIDES HEALTHCARE, HEALTH EDUCATION, AND PREVENTIVE CARE SERVICES TO PATIENTS WITHOUT REGARDS TO THEIR ABILITY TO PAY. STUDENT EDUCATION CAROMONT HEALTH ALSO INVESTS HEAVILY IN THE FUTURE OF HEALTH CARE BY INVESTING IN THE EDUCATION OF LOCAL HEALTH CARE STUDENTS. IN 2014, CAROMONT INVESTED $3.8 MILLION TO COVER THE COSTS OF STUDENT ROTATIONS AND EDUCATION. THIS INCLUDES THE USE OF EQUIPMENT, STAFF AND INSTRUCTOR TIME, AND PROGRAM DEVELOPMENT FOR HIGH SCHOOL AND COLLEGE CURRICULA. SPONSORSHIPS & PARTNERSHIPS CAROMONT HEALTH IS ALWAYS SEEKING ACTIVE PARTNERS IN OUR JOURNEY TOWARD ACHIEVING BETTER COMMUNITY HEALTH. ONE OF THE WAYS WE IDENTIFY THESE PARTNERS IS THROUGH THE SPONSORSHIP PROGRAM. IN 2014 WE WERE PROUD TO PARTNER WITH SEVERAL ORGANIZATIONS, INCLUDING: BOYS & GIRLS CLUB OF GREATER GASTON, COMMUNITY FOUNDATION OF GASTON COUNTY, HEART SOCIETY OF GASTON COUNTY, HOLY ANGELS AND OTHERS. IN ADDITION TO THESE SPONSORED EVENTS, OUR WELLNESS DEPARTMENT IS ACTIVE WITH SEVERAL COMMUNITY ORGANIZATIONS TO IMPROVE THE HEALTH OF THE COUNTY. THESE ACTIVITIES TAKE THE FORM OF HEALTH FAIRS, LUNCH AND LEARNS, FAITH AND HEALTH MINISTRY, PHYSICIAN PRESENTATIONS AND COMMUNITY WELLNESS CHALLENGES. PATIENT ADVOCACY - ENROLLMENT ASSISTANCE CAROMONT REGIONAL MEDICAL CENTER HAS DEVELOPED A PROGRAM TO ASSIST UNINSURED AND UNDER-INSURED COMMUNITY MEMBERS WITH ENROLLMENT IN PUBLIC PROGRAMS. SEVERAL EMPLOYEES ASSIST INDIVIDUALS WITH ENROLLMENT IN MEDICAID, MEDICARE, NC HEALTH CHOICE, CRIME VICTIMS PROGRAMS, FOOD STAMPS, VOCATIONAL REHAB, PUBLIC HOUSING, PRESCRIPTION PROGRAMS, MEALS ON WHEELS AND ADULT SERVICES THROUGH DSS. THE TOTAL COST TO CAROMONT HEALTH FOR THIS PROGRAM IS $381,120. EMPLOYEE INVOLVEMENT & SUPPORT CAROMONT HEALTH EMPLOYEES ARE ALSO AMBASSADORS FOR OUR MESSAGE OF WELLNESS AND GOODWILL. IN 2014, OUR EMPLOYEES WERE A DRIVING FORCE IN RAISING FUNDS AND DONATIONS FOR SEVERAL CAUSES, INCLUDING: 2014 CAROMONT HEART WALK ON MAY 1, MORE THAN FOUR HUNDRED WALKERS GATHERED ON THE FRONT LAWN OF CAROMONT REGIONAL MEDICAL CENTER FOR THE 11TH ANNUAL HEART WALK. THE ONE-MILE WALK RAISED MORE THAN $17,500 FOR THE HEART SOCIETY OF GASTON COUNTY. UNITED WAY PACESETTER CAMPAIGN THE PACESETTER CAMPAIGN OFFERS OUR EMPLOYEES THE OPPORTUNITY TO SUPPORT MORE THAN 23 LOCAL ORGANIZATIONS WITH THE EASE OF A SINGLE DONATION. LAST FISCAL YEAR, CAROMONT HEALTH EMPLOYEES CONTRIBUTED NEARLY $160,000 TO THE UNITED WAY. COMMUNITY GROUPS AND INITIATIVES CAROMONT HEALTH EMPLOYEES ALSO CONTRIBUTE TIME TO SUPPORT LOCAL ORGANIZATIONS, THROUGH BOARD APPOINTMENTS AND VOLUNTEER OPPORTUNITIES. SEVERAL MEMBERS OF OUR LEADERSHIP TEAM SERVE ON LOCAL BOARDS AND WORK CLOSELY WITH PARTNER GROUPS, SUCH AS GASTON TOGETHER AND HEALTHNET GASTON, TO BETTER THE HEALTH OF GASTON COUNTY. THESE TIES TO THE COMMUNITY HELP US PAINT A CLEARER PICTURE OF THE RESIDENTS NEEDS, ALLOWING US TO TAILOR OUR PROGRAMS AND SERVICES TO BEST MEET THOSE NEEDS.
FORM 990, PART VI, SECTION A, LINE 1B:BOARD MEMBER INDEPENDENCE: IN CALENDAR YEAR 2014, THE BOARD OF DIRECTORS OF CAROMONT HEALTH CONDUCTED A COMPREHENSIVE REVIEW OF BEST PRACTICES REGARDING INDEPENDENCE OF BOARD MEMBERS. THIS REVIEW RESULTED IN THE DEVELOPMENT OF A BOARD POLICY ON INDEPENDENCE OF BOARD MEMBERS. USING IRS REGULATIONS AND GUIDANCE, INDUSTRY BEST PRACTICES, GUIDANCE AND COMMENTARY APPLICABLE TO NON-PROFIT HEALTHCARE INSTITUTIONS, AND ADVICE OF COUNSEL, THE BOARD OF DIRECTORS DEVELOPED AND IMPLEMENTED A ROBUST POLICY THAT DEFINES INDEPENDENT AND NON-INDEPENDENT DIRECTORS AND CLASSIFIES DIRECTORS ON AN ANNUAL BASIS AS INDEPENDENT AND NON-INDEPENDENT. USING THE IRS REPORTING REQUIREMENTS AS A MINIMUM SET OF CRITERIA FOR DETERMINING THE INDEPENDENT STATUS OF BOARD MEMBERS, THE BOARD'S POLICY GOES BEYOND THE MINIMUM CRITERIA AND DEFINES ADDITIONAL CRITERIA THAT RENDER A BOARD MEMBER NON-INDEPENDENT. ONCE DETERMINED TO HAVE A DISQUALIFYING CONDITION THAT RENDERS THE MEMBER NON-INDEPENDENT, A BOARD MEMBER WHOSE DISQUALIFYING CONDITION HAS BEEN REMEDIED MAY ONLY BE RESTORED TO INDEPENDENT STATUS FOLLOWING A SPECIFIED TIME LIMIT DEFINED IN THE POLICY. IN REPORTING THE NUMBER OF INDEPENDENT DIRECTORS IN PART I, LINE 4 AND PART VI, SECTION A, LINE 1B, THE BOARD OF DIRECTORS HAS DETERMINED THAT IT WILL REPORT THE NUMBER DETERMINED BY ITS POLICY, RECOGNIZING THAT THIS MAY BE A STRICTER INTERPRETATION THAN THE IRS REQUIRES. IN SEATING BOARD COMMITTEES, SUCH AS THE EXECUTIVE COMPENSATION COMMITTEE AND THE AUDIT FINANCE AND INVESTMENT COMMITTEE, THE BOARD DETERMINES A DIRECTOR'S ELIGIBILITY TO SERVE ON THOSE COMMITTEES BASED ON APPLICATION OF THE BOARD'S DEFINITION OF INDEPENDENCE.
FORM 990, PART VI, SECTION A, LINE 2BOARD MEMBERS DR. CHARLES MEAKIN, III AND MR. JAMES R. BEAM HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THE CORPORATION SHALL BE CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE 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 7BTHE 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 11THE 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 12CEACH 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 RESPONSIBILITY OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID INDIVIDUAL'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. QUESTIONNAIRES SUBMITTED BY DIRECTORS ARE REVIEWED ANNUALLY BY THE NOMINATING COMMITTEE OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15THE CEO, CFO, 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 LEAVES THE MEETING AND 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 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 18THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19AT 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 TO AFFILIATE -27,784,946. CHANGE IN VALUE OF INTEREST RATE SWAP -1,674,321.
PART XII, LINE 2CTHE PROCESS HAS NOT CHANGED FROM LAST YEAR.
FORM 990, PART V AND PART VIICOMMON 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 (6 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CAROMONT HEALTH INC
2525 COURT DRIVEGASTONIANC28054581636959MEDICAL SERVICESNC501(C)(3)LINE 11B, IIN/A0
CAROMONT HEALTH SERVICES INC
2526 COURT DRIVEGASTONIANC28054561455630OUTPATIENT SERVICESNC501(C)(3)LINE 30CAROMONT HEALTH INC
GASTON MEMORIAL HOSPITAL FOUNDATION INC
2527 COURT DRIVEGASTONIANC28054561479699FOUNDATIONNC501(C)(3)LINE 90CAROMONT HEALTH INC
CAROMONT MEDICAL GROUP INC
2528 COURT DRIVEGASTONIANC28054561479712MEDICAL GROUPNC501(C)(3)LINE 90CAROMONT HEALTH INC
HOSPICE OF GASTON COUNTY INC
2529 COURT DRIVEGASTONIANC28054581341530HOSPICE CARENC501(C)(3)LINE 70CAROMONT HEALTH INC
GASTON EMERGENCY PHYSICIANS INC
2531 COURT DRIVEGASTONIANC28054562209423SUPPORTING ORGANIZATIONNC501(C)(3)LINE 11A, I0CAROMONT HEALTH INC
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd