CAROMONT MEDICAL GROUP INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CAROMONT MEDICAL GROUP INC (EIN 56-1479712)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-11
- IRS object ID
- 201411319349300611
- Schema version
- 2012v2.1
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-11T17:52:24-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561479712 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CAROMONT MEDICAL GROUP INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CARO | NameControl |
| Phone | 7048342000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 280531747 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID O'CONNOR | Name |
| Title | EVP, CFO | Title |
| Phone | 7048342000 | Phone |
| Date Signed | 2014-05-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID O'CONNOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 280531747 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 112903494 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CAROMONT.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 3 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 829 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 25293 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 88855499 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 87106169 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 4467184 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3323993 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1325719 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2333958 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 94648402 | TotalRevenuePriorYear |
| Total Revenue Current Year | 92789413 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 16000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4800 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 79865266 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 79985121 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 27830854 | OtherExpensePriorYear |
| Other Expenses Current Year | 25464613 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 107712120 | TotalExpensesPriorYear |
| Total Expenses Current Year | 105454534 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -13063718 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -12665121 | RevenuesLessExpensesCY |
| Total Assets BOY | 83328621 | TotalAssetsBOY |
| Total Assets EOY | 72766218 | TotalAssetsEOY |
| Total Liabilities BOY | 9071008 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8224707 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 74257613 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 64541511 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 99181657 | Expense |
| Grants | 4800 | Grants |
| Revenue | 87106169 | Revenue |
| Description | SEE SCHEDULE O.CAROMONT MEDICAL GROUP OWNS AND OPERATES A NETWORK OF OVER 40 PRIMARY CARE AND SPECIALTY PHYSICIAN PRACTICES AND THREE URGENT CARE CENTERS. IT EMPLOYS OVER 110 PHYSICIANS AND 55 PHYSICIAN EXTENDERS IN TWENTY-THREE DIFFERENT SPECIALTIES. CAROMONT MEDICAL GROUP IS COMMITTED TO PROVIDING HIGH QUALITY CARE TO ITS PATIENTS. 100% OF ITS PRIMARY CARE PRACTICES HAVE BEEN CERTIFIED AS A LEVEL 3 PATIENT-CENTERED MEDICAL HOME. THIS HIGHEST LEVEL OF CERTIFICATION AVAILABLE TO PRIMARY CARE PRACTICES BY THE NATIONAL CENTER FOR QUALITY ASSURANCE (NCQA) RECOGNIZES PRACTICES THAT EMPHASIZE CARE COORDINATION AND COMMUNICATION TO IMPROVE QUALITY OUTCOMES FOR THEIR PATIENTS. IN ADDITION, 75% OF SPECIALTY PHYSICIAN PRACTICES HAVE BEEN CERTIFIED AS A LEVEL 3 PHYSICIAN PRACTICE CONNECTIONS. THIS HIGHEST LEVEL OF CERTIFICATION AVAILABLE TO SPECIALTY PRACTICES BY THE NCQA RECOGNIZES PRACTICES THAT USE SYSTEMATIC PROCESSES AND INFORMATION TECHNOLOGY TO IMPROVE THE QUALITY OF PATIENT CARE. CAROMONT MEDICAL GROUP IS ACTIVE IN ITS COMMUNITIES IN A NUMBER OF WAYS. THE PRACTICES MAKE MONETARY AND IN-KIND CONTRIBUTIONS TO COMMUNITY NON-PROFIT ORGANIZATIONS, PHYSICIANS AND STAFF VOLUNTEER AT COMMUNITY EVENTS AND HEALTH FAIRS, AND LEADERS SERVE ON COMMUNITY BOARDS. CAROMONT MEDICAL GROUP ALSO INVESTS IN THE FUTURE OF HEALTH CARE BY OFFERING OPPORTUNITIES TO ADVANCE THE EDUCATION OF LOCAL HEALTH CARE STUDENTS THROUGH PRECEPTORSHIP PROGRAMS FOR COLLEGE STUDENTS, JOB SHADOWING PROGRAMS FOR HIGH SCHOOL STUDENTS, AND MENTORSHIP PROGRAMS. | Description |
| Total Program Service Expense | 99181657 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 193 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 829 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 3 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID O'CONNOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7048342000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 28054 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DR ROBERT CROUCH | ||||||||
| CHAIRMAN 2012 | 1.00 | 1.00 | X | X | 0 | 0 | 0 | |
| SHEILA REILLY PHD | ||||||||
| CHAIRMAN 2013 | 1.00 | 1.00 | X | X | 0 | 0 | 0 | |
| W BARRY SMITH | ||||||||
| DIRECTOR THROUGH DECEMBER 2012 | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| MS SUSIE BROWN | ||||||||
| DIRECTOR AS OF JANUARY 2013 | 1.00 | 1.00 | X | 0 | 0 | 0 | ||
| RANDALL L KELLEY | ||||||||
| CEO THROUGH APRIL 2013 | 1.00 | 49.00 | X | 0 | 832695 | 166291 | ||
| DOUG LUCKETT | ||||||||
| EVP/COO THROUGH APRIL'13/INTERIM CEO | 1.00 | 49.00 | X | 0 | 508051 | 85174 | ||
| DAVID O'CONNOR | ||||||||
| EVP/CFO/ASST. TREASURER | 1.00 | 49.00 | X | 0 | 483333 | 93652 | ||
| MARIA LONG | ||||||||
| EVP/CHIEF LEGAL OFFICER/ASST SEC. | 1.00 | 49.00 | X | 0 | 383962 | 47836 | ||
| DR AJAYPARTAP S BAJWA | ||||||||
| PHYSICIAN | 40.00 | 658459 | 0 | 30271 | X | |||
| DR OMER L SHEDD | ||||||||
| PHYSICIAN | 40.00 | 689787 | 0 | 41387 | X | |||
| DR DUSTIN P LETTS | ||||||||
| PHYSICIAN | 40.00 | 710654 | 0 | 24093 | X | |||
| DR JAMES P GREELISH | ||||||||
| PHYSICIAN | 40.00 | 883217 | 0 | 42670 | X | |||
| DR LOUIS DALESSANDRO | ||||||||
| PHYSICIAN | 40.00 | 905583 | 0 | 27107 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3847700 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2208041 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 558481 | TotalOtherCompensation |
| Number Individuals GT100 K | 163 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ATHENA HEALTH | |||||
| PO BOX 415615 | BOSTON | MA | 02241 | PHYSICIAN MANAGEMENT SYSTEM | 4642038 |
| MEDICUS CONSULTING SERVICES LLC | |||||
| 7 INDUSTRIAL WAY UNIT 5 | SALEM | NH | 03079 | LOCUM TENENS FOR INPATIENT HOSPITAL PROG | 2082362 |
| STAFF CARE INC | |||||
| PO BOX 281923 | ATLANTA | GA | 30384 | LOCUM TENENS FOR INPATIENT HOSPITAL PROG | 428343 |
| NEXTGEN HEALTHCARE | |||||
| PO BOX 809390 | CHICAGO | IL | 60680 | SYSTEM COSTS, SOFTWARE LICENSES, AND MAI | 425884 |
| JAMES ANTEZANNA | |||||
| 13727 GRAND PALISADES PARKWAY | CHARLOTTE | NC | 28260 | TEMPORARY CONTRACTED COVERAGE FOR VASCUL | 271200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| Related Organizations | 25293 | RelatedOrganizations |
| Total Contributions | 25293 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 87106169 | TotalRevenueColumn |
| Related Or Exempt Function Income | 87106169 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 87106169 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1435414 | TotalRevenueColumn |
| Exclusion | $1,435,414 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 22002660 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 19673043 | Securities |
| Other | 441038 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2329617 | Securities |
| Other | -441038 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1888579 | TotalRevenueColumn |
| Exclusion | $1,888,579 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MEANINGFUL USE | 900099 | 1371032 | $1,371,032 |
| MISCELLANEOUS | 621400 | 924069 | $924,069 |
| MANAGEMENT FEE INCOME | 561000 | 38857 | $38,857 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2333958 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 92789413 | TotalRevenueColumn |
| Related Or Exempt Function Income | 87106169 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $5,657,951 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4800 | Total |
| Program Services | 4800 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68944484 | Total |
| Program Services | 65255429 | ProgramServices |
| Management And General | 3689055 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1949178 | Total |
| Program Services | 1831862 | ProgramServices |
| Management And General | 117316 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5610730 | Total |
| Program Services | 5023101 | ProgramServices |
| Management And General | 587629 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3480729 | Total |
| Program Services | 3179830 | ProgramServices |
| Management And General | 300899 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 669 | Total |
| Program Services | 500 | ProgramServices |
| Management And General | 169 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99475 | Total |
| Management And General | 99475 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 550807 | Total |
| Program Services | 73356 | ProgramServices |
| Management And General | 477451 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127640 | Total |
| Program Services | 111823 | ProgramServices |
| Management And General | 15817 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1102240 | Total |
| Program Services | 1000480 | ProgramServices |
| Management And General | 101760 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6419610 | Total |
| Program Services | 6110755 | ProgramServices |
| Management And General | 308855 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86526 | Total |
| Program Services | 56831 | ProgramServices |
| Management And General | 29695 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1750599 | Total |
| Program Services | 1223875 | ProgramServices |
| Management And General | 526724 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1457611 | Total |
| Program Services | 1439728 | ProgramServices |
| Management And General | 17883 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 9929947 | 9929798 | 149 |
| BAD DEBT | 3939489 | 3939489 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105454534 | Total |
| Program Services | 99181657 | ProgramServices |
| Management And General | 6272877 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 367764 | BOY |
| EOY | 197435 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7199853 | BOY |
| EOY | 5265023 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 200000 | BOY |
| EOY | 200000 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 788170 | BOY |
| EOY | 954735 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 316003 | BOY |
| EOY | 136497 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 15029870 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5905558 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6533048 | BOY |
| EOY | 9124312 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63847998 | BOY |
| EOY | 52679518 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3523153 | BOY |
| EOY | 3523153 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 552632 | BOY |
| EOY | 685545 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83328621 | BOY |
| EOY | 72766218 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8825721 | BOY |
| EOY | 8224707 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 116584 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128703 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9071008 | BOY |
| EOY | 8224707 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74257613 | BOY |
| EOY | 64541511 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74257613 | BOY |
| EOY | 64541511 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83328621 | BOY |
| EOY | 72766218 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -12665121 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 2949019 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year | 25293 | CurrentTaxYear |
| Total | 25293 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 67183894 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 75579994 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 74250177 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 88855499 | CurrentTaxYearMinus1Year |
| Current Tax Year | 87106169 | CurrentTaxYear |
| Total | 392975733 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 951649 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1032851 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 655676 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1161305 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2333958 | CurrentTaxYear |
| Total | 6135439 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 68135543 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 76612845 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 74905853 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 90016804 | CurrentTaxYearMinus1Year |
| Current Tax Year | 89465420 | CurrentTaxYear |
| Total | 399136465 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 399136465 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 951649 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1471631 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1701412 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1457535 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1435414 | CurrentTaxYear |
| Total | 7017641 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 951649 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1471631 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1701412 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1457535 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1435414 | CurrentTaxYear |
| Total | 7017641 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 69087192 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 78084476 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 76607265 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 91474339 | CurrentTaxYearMinus1Year |
| Current Tax Year | 90900834 | CurrentTaxYear |
| Total | 406154106 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.98270 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.97470 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.01730 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.02530 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2296965 | OtherCostOrOtherBasis |
| Book Value | 2296965 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4475308 | OtherCostOrOtherBasis |
| Depreciation | 1295918 | Depreciation |
| Book Value | 3179390 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 46641 | OtherCostOrOtherBasis |
| Depreciation | 1262 | Depreciation |
| Book Value | 45379 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8210956 | OtherCostOrOtherBasis |
| Depreciation | 4608378 | Depreciation |
| Book Value | 3602578 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9124312 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 91660611 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 2949019 | NetUnrealizedGainsInvestments |
| Other Revenues | -4038964 | OtherRevenues |
| Revenue Not Rptd F990 | -1089945 | RevenueNotRptdF990 |
| Revenue Subtotal | 92750556 | RevenueSubtotal |
| Other Revenues Not Included | 38857 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 38857 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 92789413 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 101376713 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | -38857 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | -38857 | ExpensesNotRptdF990 |
| Expenses Subtotal | 101415570 | ExpensesSubtotal |
| Other Expenses Not Included | 4038964 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 4038964 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 105454534 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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, 2013 AND 2012, RESPECTIVELY. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT -3,939,489. INVESTMENT MANAGEMENT FEES NETTED WITH REVENUE -99,475. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | MANAGEMENT FEE INCOME NET WITH FEES EXPENSE 38,857. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | MANAGEMENT FEE INCOME NET WITH FEES EXPENSE -38,857. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT 3,939,489. INVESTMENT MANAGEMENT FEES 99,475. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RANDALL L KELLEY | ||||||||||||||
| CEO THROUGH APRIL 2013 | 0 | 577693 | 0 | 232988 | 0 | 22014 | 0 | 156204 | 0 | 10087 | 0 | 998986 | 0 | 0 |
| DOUG LUCKETT | ||||||||||||||
| EVP/COO THROUGH APRIL'13/INTERIM CEO | 0 | 372857 | 0 | 127707 | 0 | 7487 | 0 | 74601 | 0 | 10573 | 0 | 593225 | 0 | 0 |
| DAVID O'CONNOR | ||||||||||||||
| EVP/CFO/ASST. TREASURER | 0 | 351082 | 0 | 124821 | 0 | 7430 | 0 | 79460 | 0 | 14192 | 0 | 576985 | 0 | 0 |
| MARIA LONG | ||||||||||||||
| EVP/CHIEF LEGAL OFFICER/ASST SEC. | 0 | 280995 | 0 | 102230 | 0 | 737 | 0 | 45890 | 0 | 1946 | 0 | 431798 | 0 | 0 |
| DR AJAYPARTAP S BAJWA | ||||||||||||||
| PHYSICIAN | 658459 | 0 | 0 | 0 | 0 | 0 | 27000 | 0 | 3271 | 0 | 688730 | 0 | 0 | 0 |
| DR OMER L SHEDD | ||||||||||||||
| PHYSICIAN | 511193 | 0 | 178594 | 0 | 0 | 0 | 26850 | 0 | 14537 | 0 | 731174 | 0 | 0 | 0 |
| DR DUSTIN P LETTS | ||||||||||||||
| PHYSICIAN | 513157 | 0 | 197497 | 0 | 0 | 0 | 9850 | 0 | 14243 | 0 | 734747 | 0 | 0 | 0 |
| DR JAMES P GREELISH | ||||||||||||||
| PHYSICIAN | 792217 | 0 | 77000 | 0 | 14000 | 0 | 26850 | 0 | 15820 | 0 | 925887 | 0 | 0 | 0 |
| DR LOUIS DALESSANDRO | ||||||||||||||
| PHYSICIAN | 205972 | 0 | 698832 | 0 | 779 | 0 | 19967 | 0 | 7140 | 0 | 932690 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS BY RELATED ORGANIZATION GASTON MEMORIAL HOSPITAL FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 69,460 MARIA LONG - 34,427 DOUG LUCKETT - 72,101 RANDALL L. KELLEY - 152,984 DR. AJAYPARTAP S. BAJWA - 17,000 DR. OMER L. SHEDD - 17,000 DR. JAMES P. GREENLISH - 17,000 |
| PART I, LINE 6 | CERTAIN CAROMONT MEDICAL GROUP INC. PHYSICIAN'S COMPENSATION PACKAGES ARE BASED ON THE INDIVIDUAL PHYSICIAN'S NET RESULTS FROM OPERATIONS AS CALCULATED BASED SOLEY ON HIS/HER NET CHARGES LESS HIS/HER ALLOCABLE SHARE OF CLINIC OVERHEAD COSTS. EXECUTIVE 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 L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES P GREELISH MD | NamePerson |
| Relationship With Organization | PHYSICIAN EMPLOYED BY THE ORGANIZATION | RelationshipWithOrganization |
| Purpose Of Loan | HOUSING LOAN | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $200,000 | OriginalPrincipalAmount |
| Balance Due | 200000 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 200000 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION SHALL BE CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS SHALL CONSIST OF THREE (3) MEMBERS, ALL OF WHOM SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS AND BY THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH APPLICABLE EMPLOYEE AND DIRECTOR SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE EMPLOYEE'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 EMPLOYEE'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES SHALL BE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE 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. | |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VI, SECTION C, LINE 19 | AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. | |
| PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. | RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| CAROMONT SPECIALITY GROUP LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 522451748 | MEDICAL SERVICES | NC | 0 | 0 | CAROMONT MEDICAL GROUP INC |
| CAROMONT SOUTH POINT LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 205453221 | MEDICAL SERVICES | NC | 13400907 | 833353 | CAROMONT MEDICAL GROUP INC |
| CMG - GASTON WOMENS HEALTHCARE LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 205894683 | MEDICAL SERVICES | NC | 4976647 | 318763 | CAROMONT MEDICAL GROUP INC |
| CMG - FAMILY MEDICINE OF CLEVELAND COUNTY LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 205925671 | MEDICAL SERVICES | NC | 0 | 0 | CAROMONT MEDICAL GROUP INC |
| ASHLEY WOMENS CMG LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 264369018 | MEDICAL SERVICES | NC | 11561396 | 977559 | CAROMONT MEDICAL GROUP INC |
| CS CMG LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 272146660 | MEDICAL SERVICES | NC | 0 | 0 | CAROMONT MEDICAL GROUP INC |
| GS CMG LLC | |||||||||
| 2240 REMOUNT RD | GASTONIA | NC | 28054 | 272146801 | MEDICAL SERVICES | NC | 0 | 0 | CAROMONT MEDICAL GROUP INC |
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROMONT HEALTH INC | |||||||||||
| 2525 COURT DRIVE | GASTONIA | NC | 28054 | 581636959 | MEDICAL SERVICES | NC | 501(C)(3) | LINE 11B, II | N/A | 0 | |
| CAROMONT HEALTH SERVICES INC | |||||||||||
| 2526 COURT DRIVE | GASTONIA | NC | 28054 | 561455630 | OUTPATIENT SERVICES | NC | 501(C)(3) | LINE 3 | 0 | CAROMONT HEALTH INC | |
| GASTON MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 2527 COURT DRIVE | GASTONIA | NC | 28054 | 561479699 | FOUNDATION | NC | 501(C)(3) | LINE 9 | 0 | CAROMONT HEALTH INC | |
| HOSPICE OF GASTON COUNTY INC | |||||||||||
| 2529 COURT DRIVE | GASTONIA | NC | 28054 | 581341530 | HOSPICE CARE | NC | 501(C)(3) | LINE 7 | 0 | CAROMONT HEALTH INC | |
| GASTON MEMORIAL HOSPITAL INC | |||||||||||
| 2530 COURT DRIVE | GASTONIA | NC | 28054 | 560619359 | HOSPITAL | NC | 501(C)(3) | LINE 3 | 0 | CAROMONT HEALTH INC | |
| GASTON EMERGENCY PHYSICIANS INC | |||||||||||
| 2531 COURT DRIVE | GASTONIA | NC | 28054 | 562209423 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | 0 | CAROMONT HEALTH INC | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |