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ASHE MEMORIAL HOSPITAL FOUNDATION: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
ASHE MEMORIAL HOSPITAL FOUNDATION (EIN 58-2078244)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-08-13
IRS object ID
201542259349302109
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)
Return2015-08-13T11:11:13-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1227 WEST TRADE STREET SUITE 800AddressLine1
CityCHARLOTTECity
StateNCState
ZIP Code28202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN582078244EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ASHE MEMORIAL HOSPITAL FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlASHEBusinessNameControlTxt
Phone3368467101PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL AVENUEAddressLine1
CityJEFFERSONCity
StateNCState
ZIP Code28640ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOY MCCLUREPersonNm
Person TitleCFOPersonTitleTxt
Phone3368467101PhoneNum
Signature2015-08-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOHN NORMANPreparerPersonNm
PTINP01506766PTIN
Phone7049985200PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOE THOREPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL AVENUEAddressLine1
CityJEFFERSONCity
StateNCState
ZIP Code28640ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$182,816GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1993FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionPROMOTION OF ASHE MEMORIAL HOSPITAL ACTIVITIES.ActivityOrMissionDesc
Voting Members Governing Body22VotingMembersGoverningBodyCnt
Voting Members Independent22VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers22TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$354,016PYContributionsGrantsAmt
CY Contributions Grants$159,392CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$15,159PYInvestmentIncomeAmt
CY Investment Income$23,424CYInvestmentIncomeAmt
PY Other Revenue-$43,279PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$325,896PYTotalRevenueAmt
CY Total Revenue$182,816CYTotalRevenueAmt
PY Grants And Similar Paid$469,176PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$132,516CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$57,308PYOtherExpensesAmt
CY Other Expenses$0CYOtherExpensesAmt
PY Total Expenses$526,484PYTotalExpensesAmt
CY Total Expenses$132,516CYTotalExpensesAmt
PY Revenues Less Expenses-$200,588PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$50,300CYRevenuesLessExpensesAmt
Total Assets BOY$1,396,582TotalAssetsBOYAmt
Total Assets EOY$1,447,429TotalAssetsEOYAmt
Total Liabilities BOY$662,096TotalLiabilitiesBOYAmt
Total Liabilities EOY$586,593TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$734,486NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$860,836NetAssetsOrFundBalancesEOYAmt
MissionPROMOTION OF ASHE MEMORIAL HOSPITAL ACTIVITIES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$132,516ExpenseAmt
Grant$132,516GrantAmt
DescTHE FOUNDATION SUPPORTS ASHE MEMORIAL HOSPITAL AND ITS ACTIVITIES.Desc
Total Program Service Expenses$132,516TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
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 Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
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 Ent0BusinessRlnWithOfficerEntInd
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
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
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 Members22GoverningBodyVotingMembersCnt
Independent Voting Member22IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
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 Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHARLES WRIGHTBusinessNameLine1
FieldValueIRS element (for citing)
Phone3368460798PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL AVENUEAddressLine1
CityJEFFERSONCity
StateNCState
ZIP Code28640ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JANE LONON
PRESIDENT1.00Yes (X)Yes (X)$0$0$0
MARTIN LITTLE
VICE PRESIDENT1.00Yes (X)Yes (X)$0$0$0
DONNIE JOHNSON
TREASURER1.00Yes (X)Yes (X)$0$0$0
KATRINA MILLER
SECRETARY1.00Yes (X)Yes (X)$0$0$0
VITA BLEVINS
FOUNDATION MEMBER1.00Yes (X)$0$0$0
PAT COOPER
FOUNDATION MEMBER1.00Yes (X)$0$0$0
JOHN JOHNSTON
FOUNDATION MEMBER1.00Yes (X)$0$0$0
KEVIN KURTZ MD
FOUNDATION MEMBER1.00Yes (X)$0$0$0
PHIL MCMILLAN
FOUNDATION MEMBER1.00Yes (X)$0$0$0
POLLY OSOWITT RN
FOUNDATION MEMBER1.00Yes (X)$0$0$0
KAREN POWELL
FOUNDATION MEMBER1.00Yes (X)$0$0$0
TIMOTHY RECTOR DDS
FOUNDATION MEMBER1.00Yes (X)$0$0$0
KAY SEXTON
FOUNDATION MEMBER1.00Yes (X)$0$0$0
JOHN SHEPHERD
FOUNDATION MEMBER1.00Yes (X)$0$0$0
GREG WARMUTH
FOUNDATION MEMBER1.00Yes (X)$0$0$0
MAX YATES
FOUNDATION MEMBER1.00Yes (X)$0$0$0
JOE THORE
FOUNDATION DIRECTOR1.00Yes (X)$0$0$0
JEFF DOLLAR
FOUNDATION MEMBER1.00Yes (X)$0$0$0
DON PHILLIPS
FOUNDATION MEMBER1.00Yes (X)$0$0$0
GREG SEXTON
FOUNDATION MEMBER1.00Yes (X)$0$91,797$24,221
MICHAEL VANNOY
FOUNDATION MEMBER1.00Yes (X)$0$0$0
SHANE VANNOY
FOUNDATION MEMBER1.00Yes (X)$0$0$0
PAT PHILLIPS
FOUNDATION MEMBER1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$91,797TotReportableCompRltdOrgAmt
Total Other Compensation$24,221TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$159,392AllOtherContributionsAmt
Total Contributions$159,392TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$23,424TotalRevenueColumnAmt
Exclusion$23,424ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$182,816TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$23,424ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$132,516TotalAmt
Program Services$132,516ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$132,516TotalAmt
Program Services$132,516ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$632,662BOYAmt
EOY$631,238EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$30,463BOYAmt
EOY$16,839EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$733,457BOYAmt
EOY$799,352EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,396,582BOYAmt
EOY$1,447,429EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$662,096BOYAmt
EOY$586,593EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$662,096BOYAmt
EOY$586,593EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$704,023BOYAmt
EOY$860,836EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$30,463BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$734,486BOYAmt
EOY$860,836EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,396,582BOYAmt
EOY$1,447,429EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$50,300ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$38,020NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$38,030OtherChangesInNetAssetsAmt
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)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ASHE MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
EIN560603900EIN
Organization Type3OrganizationTypeDesc
Governing Document ListedYes (1)GoverningDocumentListedInd
Supported Org NotifiedYes (1)SupportedOrgNotifiedInd
US OrganizedYes (1)USOrganizedInd
Support$132,516SupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$132,516SupportSumAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO ASHE MEMORIAL HOSPITALDesc
Amt$586,593Amt
FieldValueIRS element (for citing)
Total Liability$586,593TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. THE ORGANIZATION ADOPTED THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATIONS FINANCIAL STATEMENTS AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX POSITIONS AS OF SEPTEMBER 30, 2014.ExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1ASHE MEMORIAL HOSPITAL INCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL AVENUEAddressLine1
CityJEFFERSONCity
StateNCState
ZIP Code28640ZIPCode
FieldValueIRS element (for citing)
Recipient EIN560603900RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$132,516CashGrantAmt
Purpose Of GrantGENERAL OPERATIONAL SUPPORTPurposeOfGrantTxt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationASHE MEMORIAL HOSPITAL FOUNDATION IS A SUPPORTING ORGANIZATION FOR ASHE MEMORIAL HOSPITAL. ALL ASSISTANCE IS GIVEN FOR GENERAL OPERATIONAL SUPPORT OF THE HOSPITAL ACTIVITIES.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WAS REVIEWED BY TOP MANAGEMENT OF THE FOUNDATION AND ASHE MEMORIAL HOSPITAL (THE SUPPORTED ORGANIZATION).
FORM 990, PART VI, SECTION B, LINE 12CEACH BOARD MEMBER ANNUALLY RECEIVES A COPY OF THE CONFLICT OF INTEREST POLICY AND SIGNS A STATEMENT THAT THE POLICY HAS BEEN REVIEWED, AND DISCLOSES ANY CONFLICTS OF INTEREST. AT THAT TIME EACH BOARD MEMBER IS RESPONSIBLE FOR RECUSING THEMSELVES FROM A PARTICULAR VOTE IF A CONFLICT ARISES.
FORM 990, PART VI, SECTION C, LINE 18PHOTOCOPIES OF THE ORGANIZATION'S FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST. THE FORM 990 CAN ALSO BE ACCESSED THROUGH GUIDESTAR.ORG, A NON-PROFIT WEBSITE.
FORM 990, PART VI, SECTION C, LINE 19PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATIONS 30,463. MISCELLANEOUS ADJUSTMENT TO NET ASSETS 7,567.
FORM 990, PART XII, LINE 2CNO CHANGE IN PROCESS FROM PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1ASHE MEMORIAL HOSPITAL INCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 HOSPITAL AVENUEAddressLine1
CityJEFFERSONCity
StateNCState
ZIP Code28640ZIPCode
FieldValueIRS element (for citing)
EIN560603900EIN
Primary ActivitiesPROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICESPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
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 Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ASHE MEMORIALBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeBTransactionTypeTxt
Involved$132,516InvolvedAmt
Method Of Amount DeterminationCONTRIBUTIONSMethodOfAmountDeterminationTxt