CALDWELL MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CALDWELL MEMORIAL HOSPITAL INC (EIN 56-0554202)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-13
- IRS object ID
- 201442259349302954
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-13T15:02:03-05:00 | 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 | 560554202 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CALD | NameControl |
| Phone | 8287575100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEPHEN RINALDI | Name |
| Title | CFO & VP OF FINANCE | Title |
| Phone | 8287575100 | Phone |
| Date Signed | 2014-08-13 | 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 J EASTON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 120451103 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CALDWELLMEMORIAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROMOTE SAFE, EFFECTIVE, COMPASSIONATE MEDICAL CARE AND TO PROMOTE HEALTHY LIFESTYLES FOR OUR COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 964 | TotalNbrEmployees |
| Total Nbr Volunteers | 120 | TotalNbrVolunteers |
| Total Gross UBI | 1085240 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 587466 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 8575609 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 108113225 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 110959625 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 315196 | InvestmentIncomePriorYear |
| Investment Income Current Year | 172828 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2770840 | OtherRevenuePriorYear |
| Other Revenue Current Year | 743041 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 111786727 | TotalRevenuePriorYear |
| Total Revenue Current Year | 120451103 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 48010542 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 52740572 | 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 | 61584350 | OtherExpensePriorYear |
| Other Expenses Current Year | 63856297 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 109594892 | TotalExpensesPriorYear |
| Total Expenses Current Year | 116596869 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2191835 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3854234 | RevenuesLessExpensesCY |
| Total Assets BOY | 55838070 | TotalAssetsBOY |
| Total Assets EOY | 60534899 | TotalAssetsEOY |
| Total Liabilities BOY | 22891891 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 24914453 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 32946179 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 35620446 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROMOTE SAFE, EFFECTIVE, COMPASSIONATE MEDICAL CARE AND TO PROMOTE HEALTHY LIFESTYLES FOR OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 97461798 | Expense |
| Revenue | 108329125 | Revenue |
| Description | SINCE OPENING IN 1951, CALDWELL MEMORIAL HOSPITAL HAS CONTINUED TO GROW AND CHANGE IN ORDER TO BETTER MEET THE NEEDS OF OUR COMMUNITY. THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROVIDE SAFE, EFFECTIVE, COMPASSIONATE CARE AND TO PROMOTE HEALTHY LIFESTYLES TO OUR COMMUNITY. ANCHORED BY A 110-BED ACUTE CARE FACILITY, CALDWELL MEMORIAL HOSPITAL'S SERVICES INCLUDE A VAST ARRAY OF MEDICAL AND SURGICAL SERVICES. AMONG SERVICES OFFERED, BUT BY NO MEANS A COMPLETE LIST, ARE CAROTID ARTERY STENTING; CARDIOVASCULAR AND ENDOVASCULAR CARE; RADIATION ONCOLOGY; COMPUTER-ASSISTED ORTHOPEDIC SURGERY; NEUROLOGY AND MEMORY CARE; PAIN MANAGEMENT; A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT; CALDWELL PHYSICIANS CLINICS CONVENIENTLY LOCATED COUNTY-WIDE; DIAGNOSTIC SERVICES; OUTPATIENT SURGERY; PLUS URGENT CARE; AND THE QUEST 4 LIFE WELLNESS CENTER. MULTIPLE EDUCATIONAL AND COUNSELING PROGRAMS ARE AVAILABLE FOR A WIDE ARRAY OF HEALTHCARE NEEDS INCLUDING CANCER, DIABETES, NUTRITION, JOINT CARE, PRE-NATAL CLASSES AND PARENTING SKILLS. CALDWELL PHYSICIANS IS A DIVISION OF CALDWELL MEMORIAL HOSPITAL. WITH PRACTICES IN COMMUNITIES COUNTYWIDE, CALDWELL PHYSICIANS PROVIDES THE PRIMARY AND SPECIALTY HEALTHCARE, DIAGNOSTICS AND TREATMENTS THAT OUR COMMUNITY NEEDS IN CONVENIENT LOCATIONS NEAR THEIR HOMES. CALDWELL PHYSICIANS INCLUDES: CALDWELL ACUTE CARE SPECIALISTS, EMPLOYER GROUP CLINIC, FALLS MEDICAL PRACTICE, FALLS PEDIATRICS, FALLS PLUS URGENT CARE, HALLMARK FAMILY PRACTICE, LAUREL PARK WOMEN'S CLINIC, MAIN STREET MEDICAL PRACTICE, MCBURNEY PRIMARY CARE, MULBERRY PEDIATRICS, OCCUPATIONAL HEALTH, ROBBINS CARDIOLOGY, ROBBINS PIEDMONT VISTA ENT, ROBBINS FAMILY PRACTICE, ROBBINS INTERNAL MEDICINE, ROBBINS PULMONOLOGY, ROBBINS PLUS URGENT CARE, ROBBINS SURGICAL, SOUTHFORK MEDICAL PRACTICE AND WESTPOINTE MEDICAL PRACTICE. | Description |
| Total Program Service Expense | 97461798 | 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 | 0 | 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 | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 129 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 964 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHEN RINALDI & CHRIS WASHBURN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8287575100 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| MARK BURREL BATTS MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| GEORGE ALEX BERNHARDT JR | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MICHAEL MARK CHAMBERLAIN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD EUGENE COFFEY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LAURA JEAN EASTON | |||||||
| BOARD MEMBER | 40.00 | X | 280825 | 0 | 22140 | X | |
| WILLIAM RUSSELL JOHNSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JAMES LEE LAYTON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DEBORAH LYN MURRAY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RICHARD EDWARD PEARCE MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN DAVID POWELL MD | |||||||
| EMPLOYED MD | 40.00 | X | 220570 | 0 | 18445 | ||
| PETER NELSON PURCELL MD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| GARY EDWIN SHORE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| PARKER TREVILIAN WILLIAMSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| BOYD CECIL WILSON JR | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DANIEL D MORGAN | |||||||
| VICE PRESIDENT | 40.00 | X | 140209 | 0 | 12186 | X | |
| DONALD FRANK GARDNER JR | |||||||
| VP / CFO | 40.00 | X | 207417 | 0 | 17254 | X | |
| DAVID RAYMOND HORN | |||||||
| VICE PRESIDENT | 40.00 | X | 152940 | 0 | 14778 | X | |
| REBECCA THOMPSON SMITH | |||||||
| VP / COO | 40.00 | X | 198464 | 0 | 17660 | X | |
| SHARON MARIE KIMBALL | |||||||
| VP / CNO | 40.00 | X | 166395 | 0 | 12862 | X | |
| JOHN HOWARD EDMUNDS | |||||||
| EMPLOYED MD | 40.00 | 455724 | 0 | 8828 | X | ||
| DAVID A LOWRY | |||||||
| EMPLOYED MD | 40.00 | 383533 | 0 | 14361 | X | ||
| PAUL D WARRICK | |||||||
| EMPLOYED MD | 40.00 | 359953 | 0 | 16872 | X | ||
| MARK R BRADY | |||||||
| EMPLOYED MD | 40.00 | 320331 | 0 | 11299 | X | ||
| RONALD H DUBOW | |||||||
| EMPLOYED MD | 40.00 | 295753 | 0 | 16839 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3182114 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 183524 | TotalOtherCompensation |
| Number Individuals GT100 K | 60 | 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 |
|---|---|---|---|---|---|
| CALDWELL FAMILY PHYSICIANS | |||||
| CONNELLY SPRINGS ROAD | LENOIR | NC | 28645 | PROFESSIONAL MEDICAL SERVICES | 1097650 |
| DLP CARDIAC PARTNERS LLC | |||||
| 3700 ARCO CORPORATE OFFICE SUITE 45 | CHARLOTTE | NC | 28273 | CATH LAB PARTNER | 757339 |
| KAUFMAN HALL | |||||
| 5202 OLD ORCHARD ROAD SUITE N700 | SKOKIE | IL | 60077 | FORECASTING CONSULTANT | 457873 |
| TIM BLINSON CONSTRUCTION CO | |||||
| 2377 MILLS COVE PLACE | LENOIR | NC | 28645 | MINOR CONSTRUCTION CONTRACTOR | 235486 |
| PANDERA SYSTEMS | |||||
| 5325 PRIMROSE LAKE CIRCLE SUITE A | TAMPA | FL | 33647 | BUSINESS INTELLIGENCE CONSULTANT | 158400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 1075609 | RelatedOrganizations |
| All Other Contributions | 7500000 | AllOtherContributions |
| Total Contributions | 8575609 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES | 621500 | 103755893 | 103755893 | |
| PHARMACY REVENUE | 900099 | 3348616 | 3348616 | |
| QUEST4LIFE WELLNESS CENTER REVENU | 713990 | 821685 | 821685 | |
| LAB SERVICES | 621400 | 754866 | 679379 | 75487 |
| JOINT VENTURE INCOME | 541900 | 552929 | 364861 | 188068 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1725636 | TotalRevenueColumn |
| Exclusion | $1,725,636 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 110959625 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 172828 | TotalRevenueColumn |
| Exclusion | $172,828 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 213480 | 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 | 213480 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 213480 | TotalRevenueColumn |
| Related Or Exempt Function Income | 213480 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MEANINGFUL USE INCENTIVE | 900099 | 522352 | $522,352 |
| OTHER INCOME | 900099 | 7209 | $7,209 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 529561 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 120451103 | TotalRevenueColumn |
| Related Or Exempt Function Income | 108362229 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1085240 | UnrelatedBusinessRevenue |
| Exclusion | $2,428,025 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42731358 | Total |
| Program Services | 36321654 | ProgramServices |
| Management And General | 6409704 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10009214 | Total |
| Program Services | 8507832 | ProgramServices |
| Management And General | 1501382 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13722926 | Total |
| Program Services | 8919902 | ProgramServices |
| Management And General | 4803024 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 362260 | Total |
| Management And General | 362260 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2352012 | Total |
| Management And General | 2352012 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1688065 | Total |
| Program Services | 1688065 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 168123 | Total |
| Program Services | 100874 | ProgramServices |
| Management And General | 67249 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 548215 | Total |
| Program Services | 548215 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4447023 | Total |
| Program Services | 4447023 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 759050 | Total |
| Program Services | 759050 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 17956472 | 17956472 | |
| BAD DEBT EXPENSE | 12128667 | 12128667 | |
| EQUIPMENT RENTALS AND M | 7948558 | 5563991 | 2384567 |
| STATE INCOME TAXES | 1197089 | 1197089 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 577837 | Total |
| Program Services | 520053 | ProgramServices |
| Management And General | 57784 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116596869 | Total |
| Program Services | 97461798 | ProgramServices |
| Management And General | 19135071 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8582 | BOY |
| EOY | 5274917 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7054007 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12483899 | BOY |
| EOY | 16227879 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 114361 | BOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2833180 | BOY |
| EOY | 2994070 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 836240 | BOY |
| EOY | 818219 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 91008703 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 65114528 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23294020 | BOY |
| EOY | 25894175 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6534166 | BOY |
| EOY | 6846624 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 1417966 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1289872 | BOY |
| EOY | 1061049 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109225 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1280518 | BOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55838070 | BOY |
| EOY | 60534899 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10296354 | BOY |
| EOY | 11435151 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88537 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11245184 | BOY |
| EOY | 12423455 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1261816 | BOY |
| EOY | 1055847 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22891891 | BOY |
| EOY | 24914453 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32946179 | BOY |
| EOY | 35620446 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32946179 | BOY |
| EOY | 35620446 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55838070 | BOY |
| EOY | 60534899 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3854234 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 276846 | ReconciliationUnrealizedInvest |
| Reconcilation Prior Adjustment | -1456811 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | -2 | 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 | $14,193 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 14193 | 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 | ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $14,193 WAS ESTIMATED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1232587 | OtherCostOrOtherBasis |
| Book Value | 1232587 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 32537715 | OtherCostOrOtherBasis |
| Depreciation | 28185124 | Depreciation |
| Book Value | 4352591 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10419816 | OtherCostOrOtherBasis |
| Depreciation | 1328132 | Depreciation |
| Book Value | 9091684 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 45798284 | OtherCostOrOtherBasis |
| Depreciation | 35601272 | Depreciation |
| Book Value | 10197012 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1020301 | OtherCostOrOtherBasis |
| Book Value | 1020301 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 25894175 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED THIRD PARTY SETTLEMENTS | $364,697 |
| DEFERRED FEE PLAN LIABILITY | $691,150 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1055847 | 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 IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT, PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON OR 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 |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 225.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15420285 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6178364 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9241921 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08900 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1379020 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 533302 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 845718 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00810 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16799305 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6711666 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10087639 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09710 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 122378 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 122378 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 552221 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 552221 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00530 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 674599 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 674599 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00650 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17473904 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6711666 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10762238 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10360 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,938,708 | BadDebtExpenseAmount |
| Amount Attributable To | 2874000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 25883015 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 28643963 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2760948 | 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 | 1 | 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 | CALDWELL MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW PO BOX 1890 | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | DISPROPORTIONATE SHARE HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL | 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 |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | 0 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 225.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| 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 |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, L7 COL(F): UNCOLLECTIBLE ACCOUNTS - THE HOSPITAL HAS PROVIDED SERVICES TO PERSONS WHO HAVE NOT PAID FOR SUCH SERVICES EITHER BECAUSE THEY HAVE BEEN UNWILLING OR UNABLE TO PAY. EFFORTS ARE MADE BY THE HOSPITAL TO DETERMINE IF A PATIENT MEETS CHARITY POLICY GUIDELINES THAT ARE ESTABLISHED BY THE HOSPITAL. IF THESE GUIDELINES ARE MET AND CAN BE VERIFIED, THEN SUCH AMOUNTS ARE INCLUDED IN CHARITY CARE. UNTIL SUCH TIME, SUCH AMOUNTS ARE COMBINED IN THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS BECAUSE THEY HAVE NOT BEEN VERIFIED OR DOCUMENTED AS CHARITY CARE DUE TO LACK OF SUPPORTING FINANCIAL INFORMATION. IN SOME CASES, PATIENTS WHO WOULD (OR COULD) QUALIFY FOR CHARITY CARE ARE UNWILLING OR UNABLE TO PRODUCE THE NECESSARY INFORMATION TO SUBSTANTIATE THEIR QUALIFICATION. THUS, THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS INCLUDE AMOUNTS THAT WOULD OTHEWISE QUALIFY FOR CHARITY CARE UNDER THE HOSPITAL'S GUIDELINES.THE ESTIMATED COST OF UNREIMBURSED SERVICES ATTRIBUTABLE TO THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS - EFFECTIVELY "FREE" SERVICES PROVIDED TO PATIENTS - HAS BEEN DETERMINED BY APPLYING A COST TO CHARGE RATIO TO THE AMOUNT OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS. | ||
| PART III, LINE 9B: THE HOSPITAL DOES NOT SUBJECT ANY PATIENTS TO A COLLECTION AGENCY WHO HAS QUALIFIED FOR FINANCIAL ASSISTANCE GUIDELINES. | ||
| PART V, SECTION B, LINE 3: ANALYSIS OF INFORMATION REGARDING HEALTH STATUS, RISK FACTORS, ACCESS TO CARE AND COMMUNITY ASSETS/RESOURCES WAS COMPLETED. PRIMARY DATA WAS COLLECTED USING A TWO-STAGE CLUSTER SAMPLING SYSTEM TO IDENTIFY SEVEN (7) INTERVIEW SITES. TWO (2) PERSON TEAMS THEN CONDUCTED SITE SURVEYS/INTERVIEWS IN THE SEVEN LOCATIONS INCLUDING DEMOGRAPHICS (RACE, EDUCATION, INCOME, EMPLOYMENT LEVEL) QUALITY OF LIFE, COMMUNITY IMPROVEMENT, HEALTH INFORMATION, PERSONAL HEALTH, ACCESS TO CARE AND EMERGENCY PREPAREDNESS. OVER 200 SURVEYS WERE COLLECTED. OTHER DATA USED IN ANALYZING THE COMMUNITY NEEDS INCLUDED NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, U.S. CENSUS BUREAU, U. S. ENVIRONMENTAL PROTECTION AGENCY, NORTH CAROLINA DEPARTMENT OF LABOR AND NORTH CAROLINA PUBLIC HEALTH. INFORMATION FROM VARIOUS LOCAL EDUCATION, LAW ENFORCEMENT AND SOCIAL SERVICE AGENCIES WAS ALSO INCLUDED IN ANALYSIS. | CALDWELL MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 5C: PRESENTED AT THE COUNTY BOARD OF HEALTH MEETING, PUBLIC FORUM | CALDWELL MEMORIAL HOSPITAL | |
| PART VI, LINE 2: IN COLLABORATION WITH THE CALDWELL COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY AGENCIES (SCHOOL SYSTEM, SOCIAL SERVICES, TOWNSHIPS/MUNICIPALITIES AND UNINSURED CLINIC) CALDWELL MEMORIAL HOSPITAL COMPLETED A FORMAL 2011-2014 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). IT HAD BEEN OVER FIVE YEARS SINCE A COMMUNITY HEALTH ASSESSMENT HAD BEEN COMPLETED, THOUGH MANY EFFORTS FOCUSED ON THE HEALTH OF COMMUNITY HAD BEEN ONGOING. COMMUNITY SURVEYS (FACE TO FACE SURVEYS WITH RESIDENTS) WERE CONDUCTED IN AREAS OF THE COUNTY IDENTIFIED USING A TWO CLUSTER SAMPLING METHOD. OTHER DATA USED IN ANALYZING THE COMMUNITY NEEDS INCLUDED NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, U.S. CENSUS BUREAU, U. S. ENVIRONMENTAL PROTECTION AGENCY, NORTH CAROLINA DEPARTMENT OF LABOR AND NORTH CAROLINA PUBLIC HEALTH. INFORMATION FROM VARIOUS LOCAL EDUCATION, LAW ENFORCEMENT AND SOCIAL SERVICE AGENCIES WAS ALSO INCLUDED IN ANALYSIS. THE NORTH CAROLINA HEALTHY PEOPLE 20/20 OBJECTIVES WERE ALSO PART OF THE ANALYSIS. ONGOING FEEDBACK FROM THE COMMUNITY AND OTHER HEALTH CARE AGENCIES (MENTAL HEALTH SERVICES, SCHOOL SYSTEM, SOCIAL SERVICE AGENCIES, HEALTH CARE CLINICS AND ECONONIC DEVELOPMENT GROUPS WAS ALSO CONSIDERED IN THE DEVELOPMENT OF COMMUNITY PLANS. A COMMUNITY ADVISORY GROUP (COMPRISED OF AGENCIES NOTED ABOVE AND COMMUNITY MEMBERS) REVIEWED DATA AND IDENTIFED THREE HEALTH OBJECTIVES FOR THE COUNTY BOARD OF HEALTH; SUBSTANCE ABUSE, TEEN PREGNANCY, AND HIGH SCHOOL DROP OUT RATE. IT WAS FELT THAT EACH OF THESE DIRECTLY CONTRIBUTE TO THE HEALTH OF OUR RESIDENTS.IN ADDITION TO THE NOTED THREE OBJECTIVES CMH HAS ADOPTED OTHER AREAS OF FOCUS FOR THE HEALTH OF OUR COMMUNITY. THESE INCLUDE HEALTHY LIVING (EXERCISE AND NUTRITION), OCCUPATIONAL HEALTH, MENTAL HEALTH AND HEALTH SCREEINGS BASED ON THE DATA COLLECTED IN THE COMMUNITY HEALTH ASSESSMENT. | ||
| PART VI, LINE 3: CALDWELL MEMORIAL HOSPITAL (CMH) PROVIDES NEEDED HEALTHCARE SERVICES TO ANYONE REGARDLESS OF THAT PERSON'S ABILITY TO PAY. CMH'S CHARITY CARE POLICY IS DESIGNED TO ASSIST PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR HEALTHCARE SERVICES. THE POLICY CAN BE FOUND ON THE CMH PUBLIC WEBSITE. CMH DISPLAYS INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE IN ITS EMERGENCY ROOM, REGISTRATION AREAS IN THE HOSPITAL AND CLINICS, FINANCIAL COUNSELOR OFFICES. A LINK IS ALSO PROVIDED ON THE HOSPITAL'S WEBSITE TO THE AVAILABILITY OF FINANCIAL ASSISTANCE AND ITS CHARITY CARE POLICY, ALONG WITH AN ON-LINE APPLICATION. INPATIENT CASE MANAGERS ALSO PROVIDE INFORMATION TO THE PATIENTS REGARDING AVAILABLE PROGRAMS AND THE ORGANIZAITONS FINANCIAL POLICY. CONSULTATION WITH FINANCIAL COUNSELORS IS ALSO AVAILABLE TO ALL PATIENTS AS NEEDED. | ||
| PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR CALDWELL MEMORIAL HOPSITAL IS CALDWELL COUNTY WITH A LIMITED NUMBER OF PATIENTS FROM THE SURROUNDING COUNTIES OF BURKE, WATAUGA AND CATAWBA. CALDWELL COUNTY IS IN THE NORTHWEST SECTION OF NORTH CAROLINA IN THE FOOTHILLS OF THE BLUE RIDGE MOUNTAINS AND IS BOUNDED ON THE NORTHWEST BY WATAUGA COUNTY, ON THE NORTHEAST BY WILKES COUNTY, ON THE EAST BY ALEXANDER COUNTY, ON THE SOUTH BY CATAWBA AND BURKE COUNTIES AND ON THE WEST BY BURKE AND AVERY COUNTIES.T. TODAY, THERE ARE NINE INCORPORATED MUNICIPALITIES IN THE COUNTY: LENOIR, HUDSON, GRANITE FALLS, CEDAR ROCK, CAJAHS MOUNTAIN, GAMEWELL, SAWMILLS AND PARTS OF BLOWING ROCK AND RHODHISS. POPULATION IS JUST OVER 80, 000. MEDIAN INCOME IS $36, 936. POPULATION MAKEUP IS 92.2% WHITE, 5.2% BLACK, 4.7% HISPANIC AND 2.6% OTHER. MEDIAN AGE IS 37.5 YEARS. 49.4% ARE MALES AND 50.6% FEMALES. UNEMPLOYEMENT IN 10.2012 WAS 10.2%. | ||
| PART VI, LINE 5: CALDWELL MEMORIAL HOSPITAL PROVIDES FINANCIAL SUPPORT TO TWO COMMUNITY AGENCIES. THE HELPING HANDS CLINIC (PROVIDING CARE TO THE UNINSURED) AND THE SATIE AND J. E. BROYHILL CALDWELL SENIOR CENTER (FOCUS ON THE LIVES AND ADVOCACY FOR SENIORS). OTHER COMMUNITY INVOLVEMENT INCLUDES BUT IS NOT LIMITED TO: 1. ANNUAL PROSTATE SCREENING FOR CALDWELL COUNTY RESIDENTS (AVERAGING 100+ MEN SCREENED ANNUALLY)2. HEALTH FAIRS THROUGHOUT THE YEAR FOCUSING ON WELLNESS, HEALTH EATING, GETTING FIT, SCREENINGS FOR CHOLESTEROL, HYPERTENSION, DIABETES, ETC. 3. SUPPORT AND INVOLVEMENT IN THE CALDWELL COMMUNITY GARDENS WHICH HELPS FOSTER COMMUNITY GARDENING IN CALDWELL COUNTY, NC AS A STRATEGY TO HELP OUR COMMUNITY EAT SMART BY INCREASING AFFORDABLE ACCESS TO HEALTHY FOODS AND SUSTAINABILITY 4. REPRESENTATION BY ORGANIZATION REPRESENTATIVES ON LOCAL HEALTH CARE RELATED BOARDS (CC BOARD OF HEALTH, CC HOSPICE AND PALLIATIVE CARE, CC CHILD PROTECTION TEAM)5. ESTABLISHMENT OF CALDWELL COUNTY MENTAL HEALTH WORK GROUP. MEMBERSHIP INCLUDES CMH, LOCAL LME, MOBILE CRISIS AND LAW ENFORCEMENT AGENCIES WORKING TOWARDS IMPROVING MENTAL HEALTH CARE IN CALDWELL COUNTY 6. ESTABLISHMENT OF CALDWELL MEMORIAL HEALTHWORKS WHICH IS OCCUPATIONAL, INDUSTRIAL, AND WORKER'S COMPENSATION MEDICINE DESIGNED TO ASSIST EMPLOYERS TOWARD THESE TRIPLE AIM GOALS OF IMPROVING THE QUALITY OF HEALTHCARE, ACCESS TO HEALTHCARE AND PATIENT SATISFACTION. | ||
| PART VI, LINE 6: CALDWELL MEMORIAL HOSPITAL, INC. IS A PRIVATE, NOT-FOR-PROFIT HEALTH CARE ORGANIZATION LOCATED IN LENOIR, NORTH CAROLINA. CALDWELL BECAME A MEMBER OF THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM ON MAY 1, 2013. PRIOR TO MAY 1, 2013, CALDWELL WAS AN INDEPENDENT, PRIVATE, NOT-FOR-PROFIT AND UNAFFILIATED HEALTH ORGANIZATION. CALDWELL HAS A 62 YEAR HISTORY OF PROVIDING EXCELLENT HEALTH SERVICES TO THE RESIDENTS AND VISITORS OF CALDWELL AND SURROUNDING COUNTIES. CALDWELL PROVIDES COMPREHENSIVE CARE AND SERVICES AT A NUMBER OF DIFFERENT LOCATIONS IN CALDWELL COUNTY. THESE INCLUDE:1. THE MAIN CAMPUS WHICH INCLUDES A 110 BED ACUTE CARE HOSPITAL, OUTPATIENT DIAGNOSTIC SERVICES, EMERGENCY ROOM AND INPATIENT AND OUTPATIENT SURGICAL SERVICES. 2. THE HANCOCK SURGERY CENTER INCORPORATING OUTPATIENT SURGERY AND PAIN MANAGEMENT. ADJACENT IS THE CENTER FOR BREAST HEALTH AND THE AMBULATORY INFUSION CENTER.3. THE QUEST4LIFE WELLNESS CENTER IS A STATE OF THE ART FITNESS CENTER OPEN TO THE PUBLIC ON A MEMBERSHIP BASIS. IN ADDITION, OUTPATIENT THERAPY SERVICES ARE HOUSED ADJACENT TO THE QUEST4LIFE, AS IS THE CENTER FOR DIABETES HEALTH.4. THE MCCREARY CANCER CENTER HOUSING MEDICAL AND RADIATION ONCOLOGIC SERVICES AND CT SCAN. 5. A MULTI-SPECIALTY GROUP PRACTICE (CALDWELL PHYSICIAN NETWORK CPN) CONSISTING OF APPROXIMATELY 55 PROVIDERS (PHYSICIANS AND MID-LEVEL PROVIDERS) LOCATED IN EIGHT LOCATIONS THROUGHOUT CALDWELL COUNTY. SERVICES INCLUDE GENERAL AND FAMILY PRACTICE, INTERNAL MEDICINE, PEDIATRICS, OBSTETRICS AND GYNECOLOGY, CARDIOLOGY, PULMONOLOGY, GASTROENTEROLOGY, GENERAL SURGERY, URGENT CARE AND DIAGNOSTIC SERVICES. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| 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 | 1 | 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 (12 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAURA JEAN EASTON | ||||||||||||||
| BOARD MEMBER | 224353 | 0 | 56472 | 0 | 0 | 0 | 13312 | 0 | 8828 | 0 | 302965 | 0 | 0 | 0 |
| JOHN DAVID POWELL MD | ||||||||||||||
| EMPLOYED MD | 220570 | 0 | 0 | 0 | 0 | 0 | 9617 | 0 | 8828 | 0 | 239015 | 0 | 0 | 0 |
| DANIEL D MORGAN | ||||||||||||||
| VICE PRESIDENT | 116487 | 0 | 23722 | 0 | 0 | 0 | 3358 | 0 | 8828 | 0 | 152395 | 0 | 0 | 0 |
| DONALD FRANK GARDNER JR | ||||||||||||||
| VP / CFO | 164798 | 0 | 42619 | 0 | 0 | 0 | 8426 | 0 | 8828 | 0 | 224671 | 0 | 0 | 0 |
| DAVID RAYMOND HORN | ||||||||||||||
| VICE PRESIDENT | 123760 | 0 | 29180 | 0 | 0 | 0 | 5950 | 0 | 8828 | 0 | 167718 | 0 | 0 | 0 |
| REBECCA THOMPSON SMITH | ||||||||||||||
| VP / COO | 160750 | 0 | 37714 | 0 | 0 | 0 | 8832 | 0 | 8828 | 0 | 216124 | 0 | 0 | 0 |
| SHARON MARIE KIMBALL | ||||||||||||||
| VP / CNO | 134290 | 0 | 32105 | 0 | 0 | 0 | 4034 | 0 | 8828 | 0 | 179257 | 0 | 0 | 0 |
| JOHN HOWARD EDMUNDS | ||||||||||||||
| EMPLOYED MD | 455724 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8828 | 0 | 464552 | 0 | 0 | 0 |
| DAVID A LOWRY | ||||||||||||||
| EMPLOYED MD | 383533 | 0 | 0 | 0 | 0 | 0 | 5533 | 0 | 8828 | 0 | 397894 | 0 | 0 | 0 |
| PAUL D WARRICK | ||||||||||||||
| EMPLOYED MD | 359953 | 0 | 0 | 0 | 0 | 0 | 8044 | 0 | 8828 | 0 | 376825 | 0 | 0 | 0 |
| MARK R BRADY | ||||||||||||||
| EMPLOYED MD | 320331 | 0 | 0 | 0 | 0 | 0 | 2471 | 0 | 8828 | 0 | 331630 | 0 | 0 | 0 |
| RONALD H DUBOW | ||||||||||||||
| EMPLOYED MD | 295753 | 0 | 0 | 0 | 0 | 0 | 8011 | 0 | 8828 | 0 | 312592 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | LAURA EASTON (CEO) HAS A SECURED BENEFIT PLAN WHICH IS INCLUDED IN THE STUDY COMPLETED BY THE INDEPENDENT COMPENSATION CONSULTANT; THE LOAN UNDER THIS ARRANGEMENT IS RECORDED ON THE FINANCIAL STATEMENTS AND FULLY SECURED BY LIFE INSURANCE ON THE LIFE OF THE CEO. | |
| PART I, LINE 5 | SENIOR MANAGEMENT HAS AN INCENTIVE PROGRAM WHICH IS PARTIALLY EARNED BASED ON PROFIT MARGIN AND DAYS CASH ON HAND. THE EARNED INCENTIVE IS REVIEWED BY THE HR COMMITTEE OF THE BOARD AND APPROVED ANNUALLY; EMPLOYED PHYSICIANS ARE PAID ON A PRODUCTIVITY BASIS BASED ON RVU'S GENERATED IN THEIR PRACTICE OPERATIONS. THESE ARE TIED TO MGMA BENCHMARKS. | |
| PART III | SCHEDULE J, LINE 2: AN EXPENSE REPORT TO INCLUDE RECIEPTS MUST BE SUBMITTED AND AUTHORIZED USING THE AUTHORIZATION MATRIX. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE/FINANCE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. THE FULL BOARD RECEIVED A COPY OF THE FORM 990 FOR THEIR REVIEW AND FOR ANY QUESTIONS. THE FULL BOARD VOTED FOR A FINAL APPROVAL OF THE FORM 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD ANNUALLY REVIEWS THE CONFLICT OF INTEREST STATEMENTS. MINUTES OF BOARD MEETINGS REFLECT ANY DECLARED CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION COMPLETES THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DESCRIBED IN TREASURY REGULATION 4958(6)(C) FOR EACH OFFICER AND KEY EMPLOYEE. THIS PROCESS IS PERFORMED BY AN OUTSIDE INDEPENDENT COMPENSATION SPECIALIST. THE CONSULTANT'S FINDINGS ARE PRESENTED TO THE HR COMMITTEE OF THE BOARD AND ARE ULTIMATELY APPROVED BY THE FULL BOARD. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ON GUIDESTAR.ORG. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. PLEASE USE THE ORGANIZATION'S "CONTACT US" LINK ON ITS WEBSITE FOR REQUESTS. | |
| FORM 990, PART XI, LINE 9: | EXPENDED FOR RESTRICTED PURPOSES -1,026,956. NET ASSETS RELEASED FROM RESTRICTION 1,019,724. NET ASSETS RELEASED FOR OPERATIONS 7,230. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | |
| ATTACHMENT TO SCHEDULE H | AS A RESULT OF AN AFFILIATION WITH THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM ON MAY 1, 2013, CALDWELL MEMORIAL HOSPITAL CONDUCTED A FIVE MONTH AUDIT OF ITS FINANCIAL STATEMENTS ENDING SEPTEMBER 30, 2013. CALDWELL MEMORIAL HOSPITAL DID NOT CONDUCT A TWELVE MONTH AUDIT OF ITS BOOKS THAT WOULD COINCIDE WITH THIS TAX RETURN. AS A RESULT, THE AUDITED FINANCIAL STATEMENTS ATTACHED TO THIS RETURN REFLECT THE FIVE MONTHS ENDING SEPTEMBER 30, 2013. | AUDITED FINANCIAL STATEMENTS FOR YEAR ENDED SEPTEMBER 30, 2013 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1890 | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581935514 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 7 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUARDIAN HEALTH SERVICE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 343 SECOND STREET | AddressLine1 |
| City | HICKORY | City |
| State | NC | State |
| ZIP Code | 28601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752950776 | EIN |
| Primary Activity | HOME HEALTHCARE | PrimaryActivity |
| Legal Domicile State | NC | LegalDomicileState |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | -3982 | ShareOfTotalIncome |
| Share Of EOY Assets | 991122 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
| 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 | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | 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 | CALDWELL MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 1075609 | AmountInvolved |