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CUMBERLAND COUNTY HOSPITAL SYSTEM INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CUMBERLAND COUNTY HOSPITAL SYSTEM INC (EIN 56-0845796)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-15
IRS object ID
201302279349303095
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-15T14:36:06-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1420 North 20th St Suite 2400AddressLine1
CityBirminghamCity
StateALState
ZIP Code35203ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN560845796EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Cumberland County Hospital System IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCUMBNameControl
Phone9106154829Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 2000AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code283022000ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSANDRA WILLIAMS CFOName
TitleChief Financial OfficerTitle
Phone9106154829Phone
Date Signed2013-08-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCharles B Freeman IIName
PTINP00430353PTIN
Phone2053216000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSandra WilliamsNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 2000AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code283022000ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1023560960GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.capefearvalley.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionCumberland County Hospital System, Inc. exists to meet the health care needs of the residents of Cumberland and Bladen counties, and the surrounding area in North Carolina.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members20NbrIndependentVotingMembers
Total Nbr Employees6592TotalNbrEmployees
Total Nbr Volunteers460TotalNbrVolunteers
Total Gross UBI-18838TotalGrossUBI
Net Unrelated Business Txbl Income-18838NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year750077ContributionsGrantsPriorYear
Contributions Grants Current Year473794ContributionsGrantsCurrentYear
Program Service Revenue Prior Year747761734ProgramServiceRevenuePriorYear
Program Service Revenue CY802320052ProgramServiceRevenueCY
Investment Income Prior Year16528780InvestmentIncomePriorYear
Investment Income Current Year10908415InvestmentIncomeCurrentYear
Other Revenue Prior Year7789242OtherRevenuePriorYear
Other Revenue Current Year11056199OtherRevenueCurrentYear
Total Revenue Prior Year772829833TotalRevenuePriorYear
Total Revenue Current Year824758460TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year183391GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY254315GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year355490906SalariesEtcPriorYear
Salaries Etc Current Year379001606SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year386053651OtherExpensePriorYear
Other Expenses Current Year422299786OtherExpensesCurrentYear
Total Expenses Prior Year741727948TotalExpensesPriorYear
Total Expenses Current Year801555707TotalExpensesCurrentYear
Revenues Less Expenses Prior Year31101885RevenuesLessExpensesPriorYear
Revenues Less Expenses CY23202753RevenuesLessExpensesCY
Total Assets BOY865155354TotalAssetsBOY
Total Assets EOY929405691TotalAssetsEOY
Total Liabilities BOY520277668TotalLiabilitiesBOY
Total Liabilities EOY524539582TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY344877686NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY404866109NetAssetsOrFundBalancesEOY
Mission DescriptionCumberland County Hospital System, Inc. exists to meet the health care needs of the residents of Cumberland and Bladen counties, and the surrounding area in North Carolina.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense762679170Expense
Grants254315Grants
Revenue802320052Revenue
DescriptionAs part of meeting the health care needs of the service area, CCHS, Inc. admitted 35,095 patients, provided 218,379 patient days of care, had 148,576 emergency room visits and had over 463,400 outpatient visits for other services.Description
Total Program Service Expense762679170TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096515NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees6592NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed1Form8899Filed
Form1098 C Filed1Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members20NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNCStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1James DupeBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9106154829TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 2000AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code283022000ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Jeannette Council
Trustee2.00X000
Jerry Dean
Trustee2.00X000
Mary Dickey
Trustee2.00X000
Kenneth Edge
Trustee2.00X000
Marshall Faircloth
Trustee2.00X000
Bradley Broussard
Trustee2.00X000
Jimmy Keefe
Trustee2.00X000
Ed Melvin
Trustee2.00X000
Marion Gillis Olion
Trustee2.00X000
Divyang Patel
Trustee2.00X000
Rueben Rivers
Trustee2.00X000
Bryant Murphy
Trustee2.00X000
Sanjeev Slehria
Trustee2.00X000
Charles Evans
Trustee2.00X000
Jennifer Twaddell
Trustee2.00X000
Denise Mahone Wyatt
Trustee2.00X000
James Martin
Trustee2.00X000
Lucy Jones
Trustee2.00X000
Donald L Porter
Vice Chair2.00X000X
Earnest Curry
Chairperson2.00X000X
John Henley
Board Chairperson2.00X000X
Billy King
Secretary/Treasurer2.00X000X
Michael Nagowski
CEO55.00711907086332X
Sandra Williams
CFO55.00468184019977X
William Pryor
CHRO55.00286208022080X
Richard Osenbach
Medical Director55.00752498020945X
John Whitley
Staff Physician55.00750968010301X
John Spitalieri
Staff Physician55.00721030018498X
Stuart Shelton
Medical Director55.00598400026469X
Alden Reine
Medical Director55.00516306018572X
Joyce Korzen
Former COO0.0027000000X
Michael Harrington
Former COO0.00432304025977X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5507805TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation249151TotalOtherCompensation
Number Individuals GT100 K387NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Simpli Fi Managed Services
1834 Sally Hill Farms BlvdFlorenceSC29501Professional Services4821844
Aramark Clinical Technology Services
12483 Collection Ctr DriveChicagoIL60693Professional Services4556019
Allied Barton Security Services
PO Box 534265AtlantaGA303534265Security Services3158754
AMN Healthcare Inc
2735 Collection Ctr DriveChicagoIL60693Professional Services2715639
Fayetteville Kidney Center
PO Box 101518AtlantaGA30392Professional Services2367652
FieldValueIRS element (for citing)
Number Of Contractors GT100 K85NumberOfContractorsGT100K
Government Grants134332GovernmentGrants
All Other Contributions339462AllOtherContributions
Total Contributions473794TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Rev.900099789307358789307358
Ancillary Medical Ser.9000991286616012866160
Education/Outreach611710146534146534
FieldValueIRS element (for citing)
Total Program Service Revenue802320052TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8989473TotalRevenueColumn
Exclusion$8,989,473ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real50582Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real13135Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real37447Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column37447TotalRevenueColumn
Unrelated Business Revenue13807UnrelatedBusinessRevenue
Exclusion$23,640ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities200604519Securities
Other103788Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities198771665Securities
Other17700Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1832854Securities
Other86088Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1918942TotalRevenueColumn
Exclusion$1,918,942ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Purchase Rebates, Dis.8129006328267$6,328,267
Cafeteria and Parking9000993582650$3,582,650
Employee Daycare Rev.6211101140480$1,140,480

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column-32645TotalRevenueColumn
Unrelated Business Revenue-32645UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue11018752TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column824758460TotalRevenueColumn
Related Or Exempt Function Income802320052RelatedOrExemptFunctionIncome
Unrelated Business Revenue-18838UnrelatedBusinessRevenue
Exclusion$21,983,452ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total254315Total
Program Services254315ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1595000Total
Program Services1435500ProgramServices
Management And General159500ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total299661753Total
Program Services299661753ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total13870781Total
Program Services12483703ProgramServices
Management And General1387078ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total43872269Total
Program Services39485042ProgramServices
Management And General4387227ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total20001803Total
Program Services18001623ProgramServices
Management And General2000180ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total6545940Total
Program Services5891346ProgramServices
Management And General654594ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1521638Total
Program Services1369474ProgramServices
Management And General152164ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total438146Total
Program Services394331ProgramServices
Management And General43815ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total95000Total
Program Services95000ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total1202501Total
Program Services1082251ProgramServices
Management And General120250ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3999299Total
Program Services3599369ProgramServices
Management And General399930ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total10607603Total
Program Services9546843ProgramServices
Management And General1060760ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total12046330Total
Program Services10841697ProgramServices
Management And General1204633ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total183493Total
Program Services165144ProgramServices
Management And General18349ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total785754Total
Program Services707179ProgramServices
Management And General78575ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total13436654Total
Program Services12092989ProgramServices
Management And General1343665ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total33053695Total
Program Services29748326ProgramServices
Management And General3305369ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total16942152Total
Program Services15247937ProgramServices
Management And General1694215ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical supplies11445150710300635611445151
Bad Debt112779248112779248
Purchased services19586933176282401958693
Contract labor18714537168430831871454

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total55909356Total
Program Services50318421ProgramServices
Management And General5590935ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total801555707Total
Program Services762679170ProgramServices
Management And General38876537ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2089182BOY
EOY25364839EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY58317021BOY
EOY53332889EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY101542779BOY
EOY93594183EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY9101968BOY
EOY8609183EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY6038843BOY
EOY4936431EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis685019767LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec381838811LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY297534152BOY
EOY303180956EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY235082670BOY
EOY266819448EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY155448739BOY
EOY173567762EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY865155354BOY
EOY929405691EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY65444177BOY
EOY85488984EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY131933BOY
EOY180715EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY298476441BOY
EOY292262366EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY156225117BOY
EOY146607517EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY520277668BOY
EOY524539582EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY333749175BOY
EOY393737598EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY344877686BOY
EOY404866109EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY865155354BOY
EOY929405691EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses23202753ReconcilationRevenueExpenses
Reconcilation Other Changes36785670ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$95,000DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB95000TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Beginning Balance0BeginningBalance
Ending Balance0EndingBalance

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis21109573OtherCostOrOtherBasis
Book Value21109573BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis395245393OtherCostOrOtherBasis
Depreciation177477018Depreciation
Book Value217768375BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1495897OtherCostOrOtherBasis
Depreciation589518Depreciation
Book Value906379BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis256645850OtherCostOrOtherBasis
Depreciation194709108Depreciation
Book Value61936742BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10523054OtherCostOrOtherBasis
Depreciation9063167Depreciation
Book Value1459887BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings303180956TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables13662396
Self Insurance Trusts42361525
Trusts - Bond Funds21303836
Other Assets8077190
Construction in Progress40075761
Derivative Instrument48087054
FieldValueIRS element (for citing)
Total Book Value Other Assets173567762TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Estimated Prof Liability & Worker Comp Costs$52,056,129
Due to Payor Agencies$46,464,334
Derivative Instrument$48,087,054
FieldValueIRS element (for citing)
Total Of Amounts146607517TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage500.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care0AmountsBudgetedForCharityCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense19819000TotalCommunityBenefitExpense
Direct Offsetting Revenue1538000DirectOffsettingRevenue
Net Community Benefit Expense18281000NetCommunityBenefitExpense
Percent Of Total Expense0.02650PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense56912000TotalCommunityBenefitExpense
Direct Offsetting Revenue37093500DirectOffsettingRevenue
Net Community Benefit Expense19818500NetCommunityBenefitExpense
Percent Of Total Expense0.02880PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense76731000TotalCommunityBenefitExpense
Direct Offsetting Revenue38631500DirectOffsettingRevenue
Net Community Benefit Expense38099500NetCommunityBenefitExpense
Percent Of Total Expense0.05530PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense75000TotalCommunityBenefitExpense
Net Community Benefit Expense75000NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense3550000TotalCommunityBenefitExpense
Direct Offsetting Revenue3442000DirectOffsettingRevenue
Net Community Benefit Expense108000NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense31663000TotalCommunityBenefitExpense
Direct Offsetting Revenue16098000DirectOffsettingRevenue
Net Community Benefit Expense15565000NetCommunityBenefitExpense
Percent Of Total Expense0.02260PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense20000TotalCommunityBenefitExpense
Net Community Benefit Expense20000NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense35308000TotalCommunityBenefitExpense
Direct Offsetting Revenue19540000DirectOffsettingRevenue
Net Community Benefit Expense15768000NetCommunityBenefitExpense
Percent Of Total Expense0.02290PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense112039000TotalCommunityBenefitExpense
Direct Offsetting Revenue58171500DirectOffsettingRevenue
Net Community Benefit Expense53867500NetCommunityBenefitExpense
Percent Of Total Expense0.07820PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense170000TotalCommunityBuildingExpense
Net Community Building Expense170000NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense55000TotalCommunityBuildingExpense
Net Community Building Expense55000NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense225000TotalCommunityBuildingExpense
Net Community Building Expense225000NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$31,450,000BadDebtExpenseAmount
Amount Reimbursed By Medicare192801617AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare226635055CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-33833438MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities3NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (3 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24HoursOtherOtherGeneral Medical And SurgicalGeneralMedicalAndSurgical
Bladen County Hospital
1501 South Poplar StreetElizabethtownNC28337XXX
Highsmith Rainey Hospital
2150 Robeson StreetFayettevilleNC28301XLong Term Acute Care Hospital
Cape Fear Valley Health System
31638 Owen DriveFayettevilleNC28304XXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (3 entries)

Hospital Facility NumberHospitalFacilityNumberEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeFPG Free PercentFPGFreePercentUses FPG DiscountedUsesFPGDiscountedFPG Discount PercentFPGDiscountPercentExplains BasisExplainsBasisIncome LevelIncomeLevelMedical IndigencyMedicalIndigencyUninsured DiscountUninsuredDiscountExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresAttached To InvoicesAttachedToInvoicesAvailable On RequestAvailableOnRequestOther PublicityOtherPublicityActions On NonpaymentActionsOnNonpaymentCollection ActivitiesCollectionActivitiesReport To Credit AgencyReportToCreditAgencyNotified All PatientsNotifiedAllPatientsNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyUsed Other MethodUsedOtherMethodAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
Bladen County Hospital
111200.0000000000001500.0000000000001XXX11XXX11XX1X00
Highsmith Rainey Hospital
211200.0000000000001500.0000000000001XXX11XXX11XX1X00
Cape Fear Valley Health System
311200.0000000000001500.0000000000001XXX11XXX11XX1X00

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities41NumberOfOtherFacilities

Other Facilities OtherFacilities (41 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
CFV-Rehabilitation Center
1638 Owen DriveFayettevilleNC28304Rehabilitation Center
Cumberland Cty EMS of CFV
610 Gillespie StreetFayettevilleNC28306Emergency Medical Services
CFV Behavior Health Center
3425 Melrose RoadFayettevilleNC28304Behavior Health Center
CFV Detox Center
1724 Roxie AvenueFayettevilleNC28304Detoxication Center
Healthplex Wellness Center
1930 Skibo RoadFayettevilleNC28304Rehabilitation Center
Health Pavilion North
6387 Ramsey StreetFayettevilleNC28311Outpatient services
Valley Medial Assoc - Cape Fear Valley
1638 Owen DriveFayettevilleNC28304Family Practice
Highsmith-Rainey Express Care
150 Robeson StreetFayettevilleNC28311Express Care
Cape Fear Valley Express Care
1638 Owen DriveFayettevilleNC28304Express Care
Cape Fear Valley OBGYN
1341 Walther Reed RoadFayettevilleNC28304OB/Gyn services
Health Pavilion North Express Care
6287 Ramsey StreetFayettevilleNC28301Express Care
Cape Fear Valley Sleep Medicine
1213 Walter Reed RoadFayettevilleNC28304Sleep Center
Health Pavilion North Family Care
6387 Ramsey StreetFayettevilleNC28311Family Practice
Hope Mills Family Care
4092 Professional DriveHope MillsNC28348Family Practice
Cape Fear Valley Neurology
3308 Melrose RoadFayettevilleNC28304Neurology
Cape Fear Valley Perinatology
2109 Valleygate DriveFayettevilleNC28304Perinatology
Behavioral Health Center
3425 Melrose RdFayettevilleNC28304Mental Health Clinic Inpatient
Valley Medial Associates - Highsmith
101 Robeson StreetFayettevilleNC28301Family Practice
Cape Fear Valley Urology
2301 Robeson Street Suite 203FayettevilleNC28305Urology
Hoke Family Medical Center
405 South Main StreetRaefordNC28376Family Practice
Senior Health Services
101 Robeson Street Suite 202FayettevilleNC28310Geriatrics
Bladen Medial Assoc- Elizabethtown
300 A East McKay StreetElizabethtownNC28337Family Practice
Stedman Medical Care
114 Forte RoadStedmanNC28391Family Practice
Cape Fear Valley Neurosurgery
3308 Melrose RoadFayettevilleNC28304Neurosurgery Outpatient
Cape Fear Valley Wound Care Center
101 Robeson St Suite 210FayettevilleNC28301Wound Center
Cape Fear Valley Pediatric Care
1262 Oliver StreetFayettevilleNC28304Pediatric Care
Westside Medical Care
1463 Pamalee DriveFayettevilleNC28303Family Practice
CFV Infectious Disease Care
101 Robeson Street Suite 300FayettevilleNC28301Infectious Disease
Cape Fear Valley Internal Medicine
101 Robeson Street Suite 300FayettevilleNC28301Internal Medicine
Women's Health Specialists
300 East McKay Street Suite FElizabethtownNC28337OB/GYN
CFV Pediatric Endocrinology
101 Robeson Street Suite 410FayettevilleNC28301Diabetes & Endocrinology outpatient
Three Rivers Medical Center
580 West McLean StreetSt PaulsNC28384Family Practice
Bladen Medial Assoc - Bladenboro
106 Fourth StreetBladenboroNC28302Family Practice
Bladen Medial Associates - Dublin
16 3rd StreetDublinNC28332Family Practice
Diabetes & Endocrine Center
101 Robeson Street Suite 405FayettevilleNC28301Diabetes & Endocrinology outpatient
Cape Fear Valley Pediatric Care
6387 Ramsey StreetFayettevilleNC28311Pediatric Care
Behavioral Health Clinic
3425 Melrose RdFayettevilleNC28304Mental Health Outpatient care
Convenient Care for Hoke
104 Southern AvenueRaefordNC28376Family Practice
Walmart Clinic Hoke
4545 Fayetteville RdRaefordNC28376Express Care
Phillips Internal Medicine
507 Doctors DriveElizabethtownNC28337Internal Medicine
Bladen Surgical Specialist
107 East Dunham StreetElizabethtownNC28377Surgical Specialist

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 6a:Cumberland County Hospital System files a community benefit report annually in the state of North Carolina to the North Carolina Hospital Association.
Part II: Cumberland County Hospital System, Inc. ("CCHS") reported coalition building and workforce development details in the Community Building Activities Part II. Coalition building promotes the health of the communities it serves by networking with other community agencies to address the health and safety issues of the community. The employees of CCHS utilize their clinical expertise to collaborate with other community agencies and county and state health departments to provide education and other initiatives that benefit the health of people in the community. Workforce development activities include the recruitment of physicians and other health professionals to medical shortage areas.
Part III, Line 4: A patient's record is reviewed for possible charity care and if the patient does not qualify for charity and the patient does not pay, their charges are written-off as bad debt. Amounts in line 2 are determined by calculating a cost-to-charge ratio. Total expenses (less bad debts and other operating revenue) are divided into total gross patient revenue. Total bad debt charges are multiplied by this percentage.
Part III, Line 8: Cumberland County Hospital Systems, Inc. treats the total shortfall of Medicare reimbursement compared to the amount of computed Medicare allowable costs as a community benefit. The hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publicly insured patients where reimbursement is less than cost of providing the service.
Part III, Line 9b: If patients are determined to qualify for charity, then the account is written-off to charity rather than to bad debt.
Part V, Section B, Line 13g: See the response to Part VI, Line 3Bladen County Hospital
Part V, Section B, Line 13g: See the response to Part VI, Line 3Highsmith Rainey Hospital
Part V, Section B, Line 13g: See the response to Part VI, Line 3Cape Fear Valley Health System
Part V, Section B, Line 19d: Patients are charged at the hospital Usual Customary and Reasonable rates minus 30%.Bladen County Hospital
Part V, Section B, Line 19d: Patients are charged at the hospital Usual Customary and Reasonable rates minus 30%.Highsmith Rainey Hospital
Part V, Section B, Line 19d: Patients are charged at the hospital Usual Customary and Reasonable rates minus 30%.Cape Fear Valley Health System
Part VI, Line 2: The mission of Cape Fear Valley Health System is to strengthen the health and well-being of the greater Cape Fear Valley region through high-quality, compassionate care provided to all who need it. As a community not-for-profit organization, we take seriously our responsibility to invest our resources and energies into understanding and meeting the diverse health care needs of all, and ensure that everyone, regardless of their ability to pay, receive the care they need. The Senior Administrative team serves in various capacities on several local community boards and groups. As members of these various groups, they are able to gain insight to needs of the community. Our community partners are critical to helping us improve the health and well-being of the Cape Fear Valley region. Together, we can combine resources and strengths, positively impacting the greatest number of people. By working closely with the community leaders, we also build a greater sense of community and a shared commitment toward our common goal of improving the community's health. The results help us to determine our short and long term priorities as well as strategies for improving community health. Those community groups and partners CCCC, SRAHEC, CCMAP, Chamber of Commerce, Fayetteville Area PR Alliance, Cumberland County Education Foundation, Communities in Schools of NC, Fort Bragg Regional Alliance, Care Clinic, and the Methodist University Physician Assistant program.
Part VI, Line 3: Uninsured patients are screened at the time of registration for their ability to pay for their health care services. If the patient has no ability to pay and is deemed ineligible for governmental programs (Medicare, Medicaid, etc.) then they are informed of the Hospital Charity program. They are provided with an application and a listing of the appropriate documents necessary to establish eligibility for the Hospital Charity program. All patients receive a copy of our Charity Care Application accompanying the first billing statement.
Part VI, Line 4: Cumberland County Hospital System, Inc. ("CCHS") doing business as Cape Fear Valley Medical Center ("CFVMC") is the flag ship of Cape Fear Valley Health System ("CFVHS"). CFVHS operates a variety of healthcare facilities from its headquarters in Fayetteville, North Carolina including a tertiary acute care hospital, a long-term acute care hospital, a critical access hospital, an inpatient rehabilitation facility, county emergency medical services, an outpatient psychiatric facility, a detoxification facility, a wellness center, 14 primary care clinics, 16 specialty care clinics, 5 walk-in clinics, and Health Pavilion North, an outpatient complex.Cape Fear Valley Health System serves a six-county service area made up of the five counties contiguous to Cumberland County, NC, which is its Primary Service Area. Per information from the 2012 Census Data, Cumberland has a population of over 324,000 residents; this was a growth of 6.9% from the 2000 Census Data. Approximately 53.5% of the 324,000 residents in our primary service area are minorities, compared to 35.3% for the state.
Part VI, Line 5: Chronic diseases like diabetes and obesity are increasing within our community. Our facility has opened a diabetes and endocrine clinic to help those patients diagnosed with diabetes. Our healthplex provides both nutritional and exercise programs to help those in the community address the problem of obesity. The goal is to help all residents learn to manage their conditions and live healthier lives by addressing the challenges associated with these conditions. Example of Program at Cape Fear Valley:Cape Fear Valley Health System's Take Charge of Your Health Program began as an initiative to close the healthcare gap between African-Americans and non-Hispanic Whites in Cumberland County through public service announcements, health fairs, screenings and speaking engagements. It has since broadened its focus to all of Cumberland County. Darvin Jones is the Coordinator of Take Charge of Your Health Program. He serves on the Board of Directors of Community Health Interventions & Sickle Cell Agency, a non-profit that works with individuals with sickle cell disease, hypertension and diabetes. Darvin is also a member of the Cumberland County Council for Healthy Living, a group assembled by the Health Department, and the Cumberland County Schools School Health Advisory Council. Take Charge of Your Health is affiliated with Eat Smart, Move More North Carolina, a statewide initiative.At Cape Fear Valley Health System, it is important to us to give back to our community. In addition to employee United Way donations and volunteer time, our employees participate in a variety of community service initiatives, to include Habitat for Humanity and the Friends of Cancer River Walk. Last year our employees gave over $185,000 in donations to various community organizations.
Part VI, Line 6: Cumberland County Hospital System is a stand-alone health care organization and is not a part of an affiliated health care system.
Part VI, Line 7NCReports Filed With States

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Cape Fear Valley Health FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 87526AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code28304ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient561947017EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant254065AmountOfCashGrant
Purpose Of GrantGeneral SupportPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Cumberland County Hospital System awards grants to patients for purposes of assisting them in paying various bills and other expenses which the patients cannot pay due to their excessive medical expenses required for treating illness. Patients apply and applications are reviewed by hospital social workers. Any funds granted are not paid directly to the organization for which patient owes the bill and/or expense.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Michael Nagowski
47654402065740287890619140244180798239000
Sandra Williams
3319250110695025564099000100770488161000
William Pryor
23238005270201126036890183910308288000
Richard Osenbach
716248016500019750049000160450773443000
John Whitley
72364602500002322000103010761269000
John Spitalieri
720195000835000184980739528000
Stuart Shelton
3838380169157045405099000165690624869000
Alden Reine
4504960650000810000185720534878000
Joyce Korzen
000027000000000270000000
Michael Harrington
356885056682018737099000160770458281000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 4aJoyce Korzen received severance in the amount of $270,000 during the calendar year ending December 31, 2011.
Part I, Line 6A component of the CEO's bonus at year end is dependent on the financial standing of the organization. No specific percentage is tied to net income.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
North Carolina Medical Care Commission
5213094026579022Y72006-05-0437995351Construction and Equipment000
North Carolina Medical Care Commission
52130940265821DAL52008-09-23285335000To refund bonds issued 5/4/2006, and to fund building costs000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindOther Spent ProceedsOtherSpentProceeds
264550003943971554284272974844352680683338123703541648320080011
36450002853350001587540937228381000717820081011260250000

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersTotal Private Business UseTotalPrivateBusinessUse
001101
0011010.003800.00380

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebateTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied
(no name)
000001
Morgan Stanley
0101011.1000000000001

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierSchedule K Supplental InformationIdentifier
ExplanationDifferences between the issue price (Part I) and total proceeds (Part II, line 3) are due to investment earnings. Part II, line 4, column A - The amount shown here consists of debt services fund deposits. Part II, line 4, column B - the amount here consists of $11,360,393 of debt services fund deposits plus $4,515,015 in a reasonably required reserve or replacement fund.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 7aThe Board of Trustees of Cumberland County Hospital System shall be comprised of seven trustees who are the seven members of the Cumberland County Board of Commissioners. The Board of Trustees will also have eight at large trustees who are appointed by the Board of Commissioners. The remaining five at large members are appointed by the Board of Trustees.
Form 990, Part VI, Section B, line 11The process the organization uses to review the Form 990 consists of providing the Form 990 to the Cumberland County Hospital System's Board of Trustees by electronic copy. Board Members will be given time to do a thorough review before the filing date of August 15, 2013.
Form 990, Part VI, Section B, line 12cCumberland County Hospital System, Inc. regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Section B, line 15A human resources consulting firm is retained by Cumberland County Hospital Systems, Inc. to review the competitiveness and reasonableness of the compensation provided to the CEO and other top management personnel.
Form 990, Part VI, Section C, line 19Provided upon request.
Form 990, Part XI, line 5:Net unrealized gains on investments: 22,683,432. Prior period adj. related to Bladen Hospital purchase: 14,102,238. Total to Form 990, Part XI, Line 5: 36,785,670.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (4 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile Foreign CountryLegalDomicileForeignCountryTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeLegal Domicile StateLegalDomicileState
Cape Fear Insurance LTD
PO Box 30600 SMB West Bay Road FGrand CaymanCJ980449284InsuranceCJ1353384633143632100
Bladen County Healthcare LLC
800164702Health Services3862623321391200100PO Box 2000FayettevilleNC28302NC
Cumberland Health Affiliates LLC
562275588Health Services00100PO Box 2000FayettevilleNC28302NC
Valley Health Facilities LLC
204268819Health Services00100PO Box 2000FayettevilleNC28302NC

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
Highsmith-Rainey Medical Arts Center Assoc
PO Box 2000FayettevilleNC28302561747424Rental AssociationNCCumberland County HospitalC2153619957121.00000
Cumberland Health Partners Inc
PO Box 2000FayettevilleNC28302562043978Behavioral Health CareNCCumberland County HospitalC1.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg