ASHE MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ASHE MEMORIAL HOSPITAL INC (EIN 56-0603900)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-14
- IRS object ID
- 201412269349302471
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-14T15:12:47-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 N TRYON STREET SUITE 1000 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560603900 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ASHE | NameControl |
| Phone | 3368467101 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOY MCCLURE | Name |
| Title | CFO | Title |
| Phone | 3368467101 | Phone |
| Date Signed | 2014-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN NORMAN | Name |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | 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 | LAURA LAMBETH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 28877067 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.ASHEMEMORIAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1939 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | GACUTE HOSPITAL CARE SERVICES PROVIDED TO THE RESIDENTS OF ASHE COUNTY, NC AND SURROUNDING AREAS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 394 | TotalNbrEmployees |
| Total Nbr Volunteers | 65 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 728508 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 915229 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28925590 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 26424307 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 175658 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1156777 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 438907 | OtherRevenuePriorYear |
| Other Revenue Current Year | 380754 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 30268663 | TotalRevenuePriorYear |
| Total Revenue Current Year | 28877067 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 16093 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 14588 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 16921317 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 16012422 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 309057 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 13924067 | OtherExpensePriorYear |
| Other Expenses Current Year | 13032292 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 30861477 | TotalExpensesPriorYear |
| Total Expenses Current Year | 29059302 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -592814 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -182235 | RevenuesLessExpensesCY |
| Total Assets BOY | 17668240 | TotalAssetsBOY |
| Total Assets EOY | 17339906 | TotalAssetsEOY |
| Total Liabilities BOY | 10185242 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10380465 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7482998 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6959441 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE HOSPITAL'S MISSION STATEMENT IS ICARE, WHICH STANDS FOR INVESTMENT IN THE DEVELOPMENT OF PEOPLE, COMMITMENT TO CONTINUOUS IMPROVEMENT, ACCOUNTABILITY TO THOSE WE SERVE, RESPONSIVENESS TO THE HEALTH CARE NEEDS OF THE COMMUNITY, AND EXCELLENCE IN PRIMARY HEALTHCARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 27350302 | Expense |
| Grants | 14588 | Grants |
| Revenue | 26575225 | Revenue |
| Description | ASHE MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF ASHE COUNTY AND THE SURROUNDING AREAS. RECENT PROJECTS COMPLETED THAT IMPROVED THE FACILITY AND THE SERVICES OFFERED TO THE COMMUNITY INCLUDED: (1) A NEW BUILDING COMPLETED ON THE CAMPUS OF ASHE MEMORIAL HOSPITAL, INC TO HOUSE MOUNTAIN FAMILY CARE CENTER, OUR HOSPITAL-BASED RURAL HEALTH CLINIC, (2)ENHANCEMENTS AND ADDITIONS OF SOFTWARE TO ACHIEVE "MEANINGFUL USE" IN THE ELECTRONIC HEALTH RECORD PROJECT, (3) RENOVATION OF OFFICE SPACE THAT IS OCCUPIED BY MOUNT JEFFERSON FAMILY MEDICINE IN THE HOSPITAL-OWNED PHYSICIAN BUILDING, (4) NEW HOSPITAL-OWNED OB/GYN PRACTICE OPENED IN AN AREA WITHIN 3 MILES OF THE HOSPITAL, (5) NEW MEDICAL EQUIPMENT IN THE OPERATING ROOM AND FITNESS EQUIPMENT AT MOUNTAIN HEARTS, (6) NEW FURNITURE IN THE OUTPATIENT/EMERGENCY DEPARTMENT AREA, (7) ENHANCEMENT OF THE PHONE AND COMMUNICATIONS SYSTEM, AND (8) A FACELIFT TO THE CHAPEL LOCATED WITHIN THE HOSPITAL. THE HOSPITAL PROVIDED A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT AND OUTREACH TO THE COUNTY AND SURROUNDING AREAS. BENEFIT AND OUTREACH PROGRAMS ARE PROVIDED IN CONJUNCTION WITH THE ASHE COUNTY HEALTH COUNCIL AND INDEPENDENTLY THROUGH VARIOUS DEPARTMENTS AND SERVICES. OUR SIXTH COMMUNITY HEALTH FAIR WAS HELD DURING THE SUMMER. THIS PROJECT CONTINUES TO RECEIVE THE HIGHEST EVALUATION SCORES OF ANY SECTION OF THE BLUE RIDGE ELECTRIC ANNUAL MEETING. | Description |
| Total Program Service Expense | 27350302 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| 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 | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 57 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 394 | 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 | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOY R MCCLURE CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3368467101 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAMES G GAMBILL JR | |||||||
| PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| TOM EFFORD | |||||||
| VICE PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| DICK MILLER | |||||||
| VICE PRESIDENT | 1.00 | X | X | 0 | 0 | 0 | |
| JAN CADDELL | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| JANE LONON | |||||||
| SECERTARY | 1.00 | X | X | 0 | 0 | 0 | |
| HOBART DAVIS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DR CHARLES JONES | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRADLEY MCNEILL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BRETT T SUMMEY DDS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| EDWARD J MILLER MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| STEPHEN SHOEMAKER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL MINCEY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SUE HAMPTON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| NANCY KAUTZ | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| WALTER E DAVIS MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DENNES E HOUCK | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| GREG BOWERS RPH | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOE THORE | |||||||
| CHIEF OPERATING OFFICER | 40.00 | X | 0 | 0 | 0 | ||
| JAMES MICHAEL A TAN | |||||||
| ER PHYSICIAN | 42.40 | 262821 | 0 | 25904 | X | ||
| JOSEPH J LOZANO | |||||||
| ER PHYSICIAN | 38.10 | 258312 | 0 | 19654 | X | ||
| LEE HAMILTON | |||||||
| HOSPITALIST-PHYSICIAN | 44.90 | 253235 | 0 | 5586 | X | ||
| TERRY L WILLIAMS | |||||||
| OB/GYN PHYSICIAN | 40.00 | 252186 | 0 | 19854 | X | ||
| CB JONES JR | |||||||
| PHYSICIAN ASSISTANT-ER | 44.60 | 197939 | 0 | 18780 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1224493 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 89778 | TotalOtherCompensation |
| Number Individuals GT100 K | 10 | 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 |
|---|---|---|---|---|---|
| RESTORE RESPIRATORY CARE INC | |||||
| 200 GALLERIA PARKWAY SUITE 1800 | ATLANTA | GA | 30339 | RESPIRATORY THERAPY | 670613 |
| QUORUM HEALTH RESOURCES LLC | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370271018 | MANAGEMENT FEES/CEO | 330046 |
| HERMITAGE ANESTHESIA | |||||
| PO BOX 1153 | JEFFERSON | NC | 28640 | ANESTHESIA | 225996 |
| DEBORAH L KINCAID SIDERS | |||||
| 257 NEW BEGINNINGS | WEST JEFFERSON | NC | 28694 | ANESTHESIA | 216000 |
| CRNA PLUS PA | |||||
| 411 HWY 16 SOUTH | JEFFERSON | NC | 28640 | ANESTHESIA | 216000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| All Other Contributions | 915229 | AllOtherContributions |
| Total Contributions | 915229 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 623000 | 25516354 | 25516354 |
| OTHER OPERATING REVENUE | 623000 | 496630 | 496630 |
| PHARMACY | 446110 | 313295 | 313295 |
| FITNESS CENTER | 713940 | 98028 | 98028 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 26424307 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 188479 | TotalRevenueColumn |
| Exclusion | $188,479 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 150918 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 150918 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 150918 | TotalRevenueColumn |
| Exclusion | $150,918 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 968298 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 968298 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 968298 | TotalRevenueColumn |
| Exclusion | $968,298 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA & VENDING | 722210 | 192579 | $192,579 |
| INSURANCE REFUNDS/SETTLEMENTS | 900099 | 35865 | $35,865 |
| PURCHASE DISCOUNTS | 900099 | 1392 | $1,392 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 229836 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28877067 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26424307 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,537,531 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14588 | Total |
| Program Services | 14588 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13121838 | Total |
| Program Services | 13121838 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2026133 | Total |
| Program Services | 1857489 | ProgramServices |
| Management And General | 153290 | ManagementAndGeneral |
| Fundraising | 15354 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 864451 | Total |
| Program Services | 792500 | ProgramServices |
| Management And General | 65401 | ManagementAndGeneral |
| Fundraising | 6550 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120225 | Total |
| Management And General | 120225 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54077 | Total |
| Management And General | 54077 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51631 | Total |
| Management And General | 51631 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1208096 | Total |
| Program Services | 1117703 | ProgramServices |
| Management And General | 90393 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27917 | Total |
| Program Services | 5554 | ProgramServices |
| Management And General | 22084 | ManagementAndGeneral |
| Fundraising | 279 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4554850 | Total |
| Program Services | 4259840 | ProgramServices |
| Management And General | 275281 | ManagementAndGeneral |
| Fundraising | 19729 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 341952 | Total |
| Program Services | 39194 | ProgramServices |
| Management And General | 302758 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 985886 | Total |
| Program Services | 985886 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57310 | Total |
| Program Services | 47025 | ProgramServices |
| Management And General | 10285 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 202357 | Total |
| Program Services | 202357 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1642586 | Total |
| Program Services | 1642586 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 324699 | Total |
| Program Services | 324699 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT EXPENSE | 2472766 | 2472766 | ||
| MISCELLANEOUS | 950195 | 466277 | 216773 | 267145 |
| RECRUITMENT | 37745 | 37745 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29059302 | Total |
| Program Services | 27350302 | ProgramServices |
| Management And General | 1399943 | ManagementAndGeneral |
| Fundraising | 309057 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1254600 | BOY |
| EOY | 2009633 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 518467 | BOY |
| EOY | 722874 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2144079 | BOY |
| EOY | 3138035 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21269 | BOY |
| EOY | 19269 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 608861 | BOY |
| EOY | 570135 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 120079 | BOY |
| EOY | 120984 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 31032900 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 20673959 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11628987 | BOY |
| EOY | 10358941 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1006578 | BOY |
| EOY | 33745 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 365320 | BOY |
| EOY | 366290 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17668240 | BOY |
| EOY | 17339906 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4717438 | BOY |
| EOY | 4983548 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 377669 | BOY |
| EOY | 351059 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4680617 | BOY |
| EOY | 4098926 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 409518 | BOY |
| EOY | 946932 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10185242 | BOY |
| EOY | 10380465 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7335573 | BOY |
| EOY | 6752920 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 147425 | BOY |
| EOY | 206521 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7482998 | BOY |
| EOY | 6959441 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17668240 | BOY |
| EOY | 17339906 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -182235 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -80722 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -260600 | 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) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $7,612 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 7612 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE ORGANIZATION IS A MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING EXPENDITURES ON BEHALF OF ITS MEMBERSHIP BODY. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 277913 | OtherCostOrOtherBasis |
| Book Value | 277913 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15588171 | OtherCostOrOtherBasis |
| Depreciation | 8972672 | Depreciation |
| Book Value | 6615499 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 109022 | OtherCostOrOtherBasis |
| Depreciation | 14536 | Depreciation |
| Book Value | 94486 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13934178 | OtherCostOrOtherBasis |
| Depreciation | 10900654 | Depreciation |
| Book Value | 3033524 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1123616 | OtherCostOrOtherBasis |
| Depreciation | 786097 | Depreciation |
| Book Value | 337519 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10358941 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICARE/MEDICAID DUE | Description |
| Amount | $946,932 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 946932 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | THE 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. ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013 AND 2012. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2010, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 633827 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 633827 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02180 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3792128 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3782552 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9576 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 117237 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 117237 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00400 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4543192 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3782552 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 760640 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02610 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4768 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4768 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4768 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4768 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4547960 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3782552 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 765408 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02630 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,359,420 | BadDebtExpenseAmount |
| Amount Attributable To | 543768 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7961253 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8042733 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -81480 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | CRITICAL ACCESS HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 15000.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 25000.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lien On Residence | X | LienOnResidence |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| MOUNTAIN FAMILY CARE CENTER | ||||
| 200 HOSPITAL AVENUE | JEFFERSON | NC | 28640 | RURAL HEALTH CLINIC |
| AMH ASHE WOMEN'S CENTER | ||||
| 420 E 2ND STREET | WEST JEFFERSON | NC | 28694 | PHYSICIANS OFFICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (5 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 6A: NCHA | |
| PART I, L7 COL(F): THE ORGANIZATION RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYOR COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE ORGANIZATION RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). ON THE BASIS OFHISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE ORGANIZATIONS UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. | |
| PART III, LINE 9B: THE POLICY DOES NOT SPECIFICALLY ADDRESS THIS ISSUE BUT WE NORMALLY PROVIDE THE CHARITY CARE DISCOUNT PRIOR TO SENDING TO BAD DEBT IF THE PATIENT QUALIFIES FOR CHARITY IN PART BUT FAILS TO PAY THEIR PORTION DUE. | |
| PART V, SECTION B, LINE 3: THE HOSPITAL CONDUCTED TWO SURVEYS TO SOLICIT FEEDBACK FROM PERSONS WHO REPRESENT THE COMMUNITY. FIRST, THE HOSPITAL CONDUCTED A YOUTH RISK BEHAVIOR SURVEY BY SURVEYING MIDDLE SCHOOL STUDENTS IN THE AREA ABOUT BEHAVIORS THAT AFFECT THEIR HEALTH. SECOND, THE HOSPITAL CONDUCTED THE COMMUNITY OPINION SURVEY IN EACH APPALACHIAN DISTRICT COUNTY (ALLEGHANY, ASHE AND WATAUGA) THROUGH THE COLLECTION OF PAPER SURVEYS AND DISTRIBUTION OF A LINK ON AREA WEBSITES THROUGH SURVEY MONKEY. ADDITIONALLY, LOCAL MEDIA OUTLETS SUPPORTED THE PROMOTION OF THE SURVEY THROUGH ON-AIR INTERVIEWS, PRESS RELEASE STORIES, AND PAID ADVERTISING ON THE RADIO. | ASHE MEMORIAL HOSPITAL INC. |
| PART V, SECTION B, LINE 4: ALLEGHANY MEMORIAL HOSPITALAPPALACHIAN REGIONAL HEALTHCARE SYSTEMS | ASHE MEMORIAL HOSPITAL INC. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 0 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 0 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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 | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES MICHAEL A TAN | ||||||||||||||
| ER PHYSICIAN | 262821 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25904 | 0 | 288725 | 0 | 0 | 0 |
| JOSEPH J LOZANO | ||||||||||||||
| ER PHYSICIAN | 258312 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 19654 | 0 | 277966 | 0 | 0 | 0 |
| LEE HAMILTON | ||||||||||||||
| HOSPITALIST-PHYSICIAN | 253235 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 5586 | 0 | 258821 | 0 | 0 | 0 |
| TERRY L WILLIAMS | ||||||||||||||
| OB/GYN PHYSICIAN | 252186 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 19854 | 0 | 272040 | 0 | 0 | 0 |
| CB JONES JR | ||||||||||||||
| PHYSICIAN ASSISTANT-ER | 197939 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18780 | 0 | 216719 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | THE HOSPITAL PAYS FOR MEMBERSHIP DUES TO THE JEFFERSON ROTARY CLUB FOR CERTAIN KEY OFFICERS. THE PURPOSE OF THE ROTARY CLUB IS TO BRING TOGETHER BUSINESS AND PROFESSIONAL LEADERS TO PROVIDE HUMANITARIAN SERVICE, ENCOURAGE HIGH ETHICAL STANDARDS IN ALL VOCATIONS, AND HELP BUILD GOODWILL AND PEACE IN THE WORLD. AMOUNTS ARE BILLED DIRECTLY TO THE ORGANIZATION. THE HOSPITAL ALSO PAYS DUES TO JEFFERSON LANDING GOLF CLUB FOR CERTAIN KEY OFFICERS. ALL INVOICES ARE PAID DIRECTLY BY THE ORGANIZATION. | |
| PART I, LINE 3 | COMPENSATION FROM AN UNRELATED ORGANIZATION (SEE FORM 990, PART VII, LINE 5). RAYMOND D WILLIAMS IS COMPENSATED THROUGH QUORUM HEALTH RESOURCES, LLC, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO OF THE HOSPITAL. PLEASE SEE THE RESPONSE TO FORM 990, PART VI, LINE 15A FOR MORE DETAILS. | |
| PART III | ASHE MEMORIAL HOSPITAL DOES NOT COMPENSATE MEMBERS FOR THEIR SERVICE AS DIRECTORS OF THE BOARD. ALL COMPENSATION LISTED ON PART VII, LINE 1, COLUMN (D) FOR BOARD MEMBERS WAS PAID FOR VARIOUS MEDICAL SERVICES RENDERED TO THE ORGANIZATION. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Loan Table LoanTable
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SARA HOUSER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Purpose Of Loan | TUITION LOAN FROM AMH TO MRS. HOUSER | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Balance Due | 19269 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 0 | ApprovedByBoard |
| Written Agreement | 0 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 19269 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| DRAGO PROPERTIES LLC | |||
| OWNED BY OFFICER JOE THORE | 35033 | RENTAL PAYMENTS FOR STORAGE SPACE | 0 |
| CHARLES W JONES MD | |||
| BOARD MEMBER | 168375 | DR. JONES WAS PAID BY AMH FOR SURGERY CALL FOR THE AMOUNT OF $97,500. ALSO, DR. JONES PAID RENT OF $63,951 FOR SPACE, LABOR AND SUPPLIES FOR THE PURPOSE OF PERFORMING ENDOSCOPY. ALSO, DR. JONES PAID RENT OF $6,924 FOR OFFICE SPACE IN THE PROFESSIONAL BUILDING FROM AMH. | 0 |
| TAMMY L THORE MD | |||
| WIFE OF JOE THORE, COO AND AMH FOUNDATION DIRECTOR | 72800 | DR. THORE WAS PAID BY AMH FOR SURGERY CALL IN THE AMOUNT OF $72,800, WHICH INCLUDES SOME INDIVIDUAL TRANSACTIONS EXCEEDING $10,000. | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE CEO OF THE HOSPITAL IS CONTRACTED FOR HIS SERVICE THROUGH QUORUM HEALTH RESOURCES, LLC (QHR) AND NOVANT HEALTH SHARED SERVICES (NHSS)BY THE BOARD OF TRUSTEES. SEE THE RESPONSE TO PART VI, LINE 15A FOR FURTHER DETAILS. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE HOSPITAL IS ORGANIZED AS A STOCK CORPORATION, AND SHARES OF STOCK ARE SOLD TO MEMBERS OF THE COMMUNITY AND ARE FREELY TRANSFERABLE, BUT HAVE NO CAPITAL VALUE. SHAREHOLDERS DO NOT RECEIVE DIVIDENDS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | TRUSTEES SHALL BE ELECTED BY THE SHAREHOLDERS OF THE CORPORATION AT THE ANNUAL MEETING OF THE MEMBERSHIP. EACH SELECTED TRUSTEE SHALL HOLD OFFICE FOR A TERM OF THREE YEARS AND UNTIL HIS SUCCESSOR IS ELECTED AND QUALIFIED. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ORGANIZATION CANNOT SELL REAL PROPERTY WITHOUT APPROVAL BY THE SHAREHOLDERS. PLEASE SEE THE RESPONSE TO LINE 6 ABOVE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. PRIOR TO SUBMISSION TO THE IRS, THE FINANCE COMMITTEE WAS INFORMED BY THE CEO AND CFO THAT THE RETURNS WOULD BE FILED TIMELY. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL VOTING MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST SURVEY AND RETURN TO THE BOARD CHAIRMAN. THE SURVEY INCLUDES A DISCLOSURE STATEMENT AND A REVIEW OF THE POLICY. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE HOSPITAL HAS BEEN MANAGED BY HCA AND/OR QUORUM HEALTH RESOURCES, LLC (QHR) SINCE 1982. THE CONTRACT EXPIRED IN AUGUST 2013 AND WAS NOT RENEWED BY THE BOARD OF TRUSTEES. SUBSEQUENTLY, THE BOARD OF TRUSTEES OF THE HOSPITAL CONTRACTED WITH NOVANT HEALTH SHARED SERVICES WITH THE EFFECTIVE DATE OF AUGUST 2013. NOVANT WAS TO ALSO EMPLOY THE CEO WITH A VERY SIMILAR CONTRACT AS HAD BEEN ADMINISTERED THROUGH THE YEARS BY QHR. SINCE A NON-COMPETE CLAUSE WAS IN THE QHR CONTRACT FOR THE PERSONNEL, THE QHR CEO WAS HIRED AT ANOTHER QHR FACILITY AND LEFT ASHE MEMORIAL HOSPITAL, INC. IN MAY 2013. THE PRESENT COO ACTED AS THE CEO UNTIL THE NOVANT CEO WAS HIRED AND PUT IN PLACE IN JULY 2013. EVEN THOUGH THE ACTUAL CONTRACT WITH NOVANT DID NOT BEGIN UNTIL AUGUST, THE BOARD OF TRUSTEES AGREED FOR THE CEO TO BEGIN THE ORIENTATION PERIOD EARLIER. | |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, THE HOSPITAL WIDELY DISTRIBUTES AN ANNUAL REPORT TO THE COMMUNITY. PLEASE CONTACT THE ADMINISTRATIVE OFFICE FOR FURTHER DETAILS. SEE FORM 990, PART VI, LINE 20. | |
| FORM 990, PART XI, LINE 9: | RELASE FROM RESTRICTIONS FOR OPERATIONS -260,600. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | NO CHANGE FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMH ASHE WOMEN'S CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 451482188 | EIN |
| Primary Activities | PHYSICIANS PRACTICE | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582078244 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11A | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 0 | ControlledOrg |
| 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 | 1 | 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 | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 469176 | AmountInvolved |
| Method Of Amt Determination | AUDITED FINANCIAL STATEMENTS | MethodOfAmtDetermination |