HUGH CHATHAM MEMORIAL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- HUGH CHATHAM MEMORIAL HOSPITAL INC (EIN 56-0642846)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-01
- IRS object ID
- 201312139349300431
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-01T12:05:50-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560642846 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HUGH | NameControl |
| Phone | 3365277000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DR | AddressLine1 |
| City | ELKIN | City |
| State | NC | State |
| ZIP Code | 28621 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DONALD E TRIPPEL | Name |
| Title | CFO | Title |
| Phone | 3365277000 | Phone |
| Date Signed | 2013-07-29 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DONALD E TRIPPEL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DR | AddressLine1 |
| City | ELKIN | City |
| State | NC | State |
| ZIP Code | 28621 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 111646338 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HUGHCHATHAM.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1930 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE BIRTHING AND ACUTE CARE SERVICES IN ADDITION TO SKILLED NURSING, RETIREMENT COMMUNITY, HOME HEALTH, AND HOSPICE SERVICES PRIMARILY TO THE RESIDENTS OF AND SURROUNDING COUNTIES TO SURRY COUNTY, NORTH CAROLINA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 940 | TotalNbrEmployees |
| Total Nbr Volunteers | 77 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 87503 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 269138 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 95978184 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 100519936 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 4908309 | InvestmentIncomePriorYear |
| Investment Income Current Year | 7800662 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3008615 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2751835 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 103982611 | TotalRevenuePriorYear |
| Total Revenue Current Year | 111341571 | 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 | 41959439 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 40669502 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 60427 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 57865308 | OtherExpensePriorYear |
| Other Expenses Current Year | 62414883 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 99824747 | TotalExpensesPriorYear |
| Total Expenses Current Year | 103084385 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 4157864 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 8257186 | RevenuesLessExpensesCY |
| Total Assets BOY | 188383176 | TotalAssetsBOY |
| Total Assets EOY | 200822149 | TotalAssetsEOY |
| Total Liabilities BOY | 99702548 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 99710683 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 88680628 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 101111466 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO CONSISTENLY DELIVER EXCEPTIONAL QUALITY AND SERVICE BY DEMONSTRATING THE VALUES OF SERVICE, TEAMWORK, ACCOUNTABILITY, RESPECT, AND SAFE CARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 96883004 | Expense |
| Revenue | 100519936 | Revenue |
| Description | NESTLED IN THE WESTERN PIEDMONT WINE COUNTRY OF NORTH CAROLINA, HUGH CHATHAM MEMORIAL HOSPITAL HAS PROVIDED HIGH QUALITY MEDICAL CARE FOR RESIDENTS OVER A DISTINGUISHED 80-YEAR HISTORY. A PRIVATE, NOT-FOR-PROFIT, 501(C)(3) HOSPITAL, HCMH EMPLOYS MORE THAN 840, AND IS SERVED BY MORE THAN 70 PHYSICIANS REPRESENTING 26 SPECIALTIES OR SUBSPECIALTIES. IN A RECENT NATIONAL PATIENT SATISFACTION SURVEY, THE HOSPITAL'S PATIENTS GAVE THE OUTPATIENT DEPARTMENT A 99% EXCELLENT RATING; THE EMERGENCY DEPARTMENT 94% AND THE OB/GYN SERVICES 98%. IN ADDITION, FOLLOWING A 2009 QUALITY EVALUATION, THE NATIONAL PRESS GANEY FIRM AWARDED THE HOSPITAL'S OUTPATIENT SURGERY DEPARTMENT A PRESTIGIOUS SUMMIT AWARD, RESERVED FOR CLIENTS WHO ACHIEVE AND MAINTAIN EXTRAORDINARY RESULTS. OVER THE YEARS, HCHM PATIENTS HAVE MADE THE HOSPITAL OUR REGIONS'S CHOICE FOR TECHNOLOGIES AND CARE. RECENT NATIONAL RANKINGS OF SEVERAL IMPORTANT MEASURES REINFORCE THIS CHOICE. THE JOINT COMMISSION AWARDED FULL ACCREDITATION TO THE HOSPITAL'S LABORATORY, AND THE NORTH CAROLINA NURSES ASSOCIATION (NCNA) GAVE HUGH CHATHAM MEMORIAL HOSPITAL THE COVETED HALLMARKS RECOGNITION. THIS AWARD AFFIRMS WHAT GENERATIONS OF PATIENTS HAVE KNOWN: THE NURSES AT HCMH ARE EXCELLENT, WORK WELL TOGETHER, AND ARE DEDICATED TO CARING FOR THEIR PATIENTS. HUGH CHATHAM MEMORIAL HOSPITAL HAS ONCE AGAIN BEEN RECOGNIZED BY ALLIANT MANAGEMENT SERVICES (AMS) FOR ACHIEVING OUTSTANDING LEVELS OF PATIENT AND PHYSICIAN SATISFACTION. HUGH CHATHAM EARNED THE SAME AWARD IN 2009 AND RECEIVED THE HONOR AT ALLIANT MANAGEMENT SERVICES' ANNUAL RECOGNITION CEREMONY LAST FALL IN LOUISVILLE, KENTUCKY. AS A RECIPIENT OF THE PATIENT SATISFACTION AWARD, HUGH CHATHAM MEMORIAL HOSPITAL EARNED TOP SCORES ON SURVEYS COMPLETED BY INPATIENTS, OUTPATIENTS AND PHYSICIANS. INPATIENT = 95TH PERCENTILE EMERGENCY DEPARTMENT = 95TH PERCENTILE OUTPATIENT DEPARTMENT = 99TH PERCENTILE - VISION STATEMENT -TO BE THE BEST COMMUNITY HOSPITAL IN THE NATION, WITH SERVICE AS OUR GUIDING PRINCIPLE - GEOGRAPHIC SERVICE AREA AND TARGET POPULATIONS FOR COMMUNITY INITIATIVES - THE HOSPITAL'S PRIMARY SERVICE AREA INCLUDES NINE ZIP CODES COMPRISING ROUGHLY A FIFTEEN-MILE DIAMETER AROUND ELKIN, NORTH CAROLINA. THE SECONDARY SERVICE AREA INCLUDES AN ADDITIONAL FIVE ZIP CODES WIDENING THE DIAMETER TO THIRTY MILES AROUND ELKIN. BOTH OF THE ABOVE MARKETS INCLUDE PART, BUT NOT ALL, OF THE NORTH CAROLINA COUNTIES OF WILKES, ALLEGHANY, YADKIN AND SURRY AND THE ENTIRE POPULATION OF EACH COMMUNITY IS TARGETED FOR ALL SERVICES AND INITIATIVES. ADDITIONAL TARGET MARKETS INCLUDE PORTIONS OF THE SOUTH WESTERN VIRGINIA COUNTIES OF CARROLL, GRAYSON, AND PATRICK. - FUNDING OF INITIATIVE PROGRAMS -THE RESOURCES OF HUGH CHATHAM MEMORIAL HOSPITAL FUND THE PROGRAMS. - DETERMINING COMMUNITY PRIORITIES AND COLLABORATION -THROUGH A GRANT FROM THE DUKE ENDOWMENT, A COMMUNITY NEEDS ASSESSMENT SURVEY WAS CONDUCTED IN A RECENT YEAR. USING INFORMATION FROM THIS SURVEY, ADMISSIONS DATA AND VOLUME DATA FROM THE HOSPITAL, AND PARTNERSHIPS WITH YADKIN AND SURRY SENIOR CENTERS, SURRY COMMUNITY COLLEGE, AND OTHER AGENCIES, NEEDS ARE IDENTIFIED, PRIORITIES ESTABLISHED, AND LEADERSHIP ROLES ASSIGNED FROM WITHIN THE COLLABORATIVE GROUP. THE HOSPITAL'S BOARD OF TRUSTEES, PHYSICIANS, AND ADMINISTRATION MEET EACH YEAR TO DETERMINE STRATEGIC NEEDS OF THE COMMUNITY AT THEIR ANNUAL PLANNING RETREAT. - COMMUNITY SERVICE PROGRAMS SPONSORED BY HUGH CHATHAM MEMORIAL HOSPITAL --PATIENT EDUCATION PROGRAMS- LAMAZE AND CHILDBIRTH INFANT AND CHILD CPR BREASTFEEDING CARDIAC REHABILITATION WOMEN'S HEALTH EDUCATIONAL SEMINARS-COMMUNITY HEALTH SCREENINGS AND IMMUNIZATIONS- CANCER SCREENINGS (PROSTATE, BREAST, SKIN, COLON) CHOLESTEROL/GLUCOSE BLOOD PRESSURE/HEART RATE/OXYGEN SATURATION WEIGHT/BODY MASS INDEX FALLS ASSESSMENT BONE DENSITY TETANUS/FLU-HEALTH PROMOTION, OUTREACH, AND SUPPORT GROUPS- CANCER HEART AND SOUL LOOK GOOD FEEL BETTER CANCER SUPPORT HOSPICE GRIEF CAMP FOR CHILDREN BEREAVEMENT AND THE GRIEF PROCESS STROKE SUPPORT AMPUTEE SUPPORT ALZHEIMER'S SUPPORT CPR FOR INDUSTRY, DAY CARE WORKERS, AND LIFEGUARDS SENIOR FITNESS CLASSES CARDIAC REHABILITATIONDURING 2011, HUGH CHATHAM MEMORIAL HOSPITAL ACQUIRED NEW PHYSICIAN PRACTICES - A FAMILY PRACTICE, SURGICAL PRACTICE, AND ORTHOPEDIC PRACTICE. THE ORTHOPEDIC GROUP IS LOCATED CLOSE TO THE HOSPITAL AND SERVES INDIVIDUALS SPREAD ACROSS TWO COMMUNITIES. THE ORTHOPEDIC GROUP ALSO TRAVELS TO OTHER CRITICAL ACCESS FACILITIES TO OFFER THEIR SERVICES. THE FAMILY PRACTICE IS AN EXTENSION OF THE PRACTICE LOCATED IN JONESVILLE THAT OFFERS EXTENDED HOURS TO BETTER SERVE THE WORKING COMMUNITY.THE HOSPITAL ROLLED OUT THE PATIENT EDUCATION (HCTV) TO INCREASE PATIENT AWARENESS OF HEALTH CARE TOPICS. IT HAS SIX STREAMING CHANNELS WITH A VARIETY OF PATIENT EDUCATION TOPICS AS WELL AS THE VIDEO ON DEMAND OPTION SO PATIENTS CAN DIAL A NUMBER ON THE PHONE AND SELECT A VIDEO FROM A LIST OF TOPICS.THE HOSPITAL INCREASED THEIR COMMUNITY RELATIONSHIP WITH LOCAL SCHOOLS BY PROVIDING HIGH SCHOOL STUDENT INTERNSHIPS AS PART OF THE CLASS CURRICULUM. STUDENTS CAME TO TEH HOSPITAL FOR A CLASS PERIOD DURING THE SCHOOL SEMESTER AND RECEIVED A GRADE FOR HIGH SCHOOL CREDIT.WILKES COMMUNITY COLLEGE ADDED THE HOSPITAL AS ONE OF THEIR CLINICAL SITES FOR NURSING STUDENTS.THE HOSPITAL TRAVELED TO TWO LOCAL INDUSTRIAL ORGANIZATIONS TO PROVIDE STROKE EDUCATION AND OTHER HEALTHCARE EDUCATION TO THE COMMUNITY. | Description |
| Total Program Service Expense | 96883004 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | 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 | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 77 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 940 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | 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 | 0 | InvestmentInJointVenture |
| 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 | CHERYL PARDUE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3365277595 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DRIVE | AddressLine1 |
| City | ELKIN | City |
| State | NC | State |
| ZIP Code | 28621 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| MIKE STANLEY | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| BOB MIDKIFF | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| DAVID CLINE | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| CAROL JERNIGAN | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| DONNA THOMPSON | |||||||
| ASSISTANT SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| MARK HEINER MD | |||||||
| CHIEF OF STAFF | 1.00 | X | X | 24000 | 0 | 0 | |
| BOB BALL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ERCEL CARTER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| TERRY DARNELL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| FRED EIDSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JAMES FREEMAN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JL LOWE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RAYMOND PARKER | |||||||
| BOARD MEMBER | 1.00 | X | 12000 | 0 | 0 | ||
| GEORGE SAPPENFIELD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVID LOVING | |||||||
| CEO | 40.00 | X | 349070 | 0 | 0 | ||
| DONALD TRIPPEL | |||||||
| CFO | 40.00 | X | 160365 | 0 | 29103 | ||
| DOMINICK CARBONE MD | |||||||
| PHYSICIAN | 40.00 | 729773 | 0 | 16658 | X | ||
| RIZWAN AHMEND MD | |||||||
| PHYSICIAN | 40.00 | 462958 | 0 | 16903 | X | ||
| CHRISTOPHER SPONGBERG MD | |||||||
| PHYSICIAN | 40.00 | 316242 | 0 | 23603 | X | ||
| LAWRENCE NABORS MD | |||||||
| PHYSICIAN | 40.00 | 296609 | 0 | 16903 | X | ||
| ANDREW LEE MD | |||||||
| PHYSICIAN | 40.00 | 314351 | 0 | 7352 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2665368 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 110522 | TotalOtherCompensation |
| Number Individuals GT100 K | 27 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SODEXO INC | |||||
| PO BOX 536922 | ATLANTA | GA | 30353 | DIETARY & HOUSEKEEPING SERVICES | 3157698 |
| CARDINAL HEALTH | |||||
| PO BOX 905867 | CHARLOTTE | NC | 28290 | PATIENT & HOSPITAL SUPPLIES | 1725213 |
| CARDINAL DISTRIBUTION PHARMACY | |||||
| 25025 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY SUPPLIES & MEDICATIONS | 1466479 |
| HORIZON CSA LLC | |||||
| 265 PITT ROAD | MOORESVILLE | NC | 28115 | EQUIPMENT MAINTENANCE | 1290169 |
| SMITH & NEPHEW | |||||
| PO BOX 933782 | ATLANTA | GA | 311933782 | ORTHOPEDICS | 1236017 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 82 | NumberOfContractorsGT100K |
| All Other Contributions | 269138 | AllOtherContributions |
| Total Contributions | 269138 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT CARE SERVICES | 621400 | 99645855 | 99645855 |
| NET HOSPICE INVESTMENT | 623000 | 874081 | 874081 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 100519936 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5029561 | TotalRevenueColumn |
| Exclusion | $5,029,561 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1447200 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 304767 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1142433 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1142433 | TotalRevenueColumn |
| Exclusion | $1,142,433 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2755722 | Securities |
| Other | 15379 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2755722 | Securities |
| Other | 15379 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2771101 | TotalRevenueColumn |
| Exclusion | $2,771,101 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS REVENUE | 900099 | 1343776 | $1,343,776 |
| CAFETERIA & VENDING | 722210 | 265626 | $265,626 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1609402 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 111341571 | TotalRevenueColumn |
| Related Or Exempt Function Income | 100519936 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $10,552,497 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 972594 | Total |
| Program Services | 243149 | ProgramServices |
| Management And General | 680815 | ManagementAndGeneral |
| Fundraising | 48630 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31757423 | Total |
| Program Services | 30423497 | ProgramServices |
| Management And General | 1333926 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 458920 | Total |
| Program Services | 429989 | ProgramServices |
| Management And General | 28249 | ManagementAndGeneral |
| Fundraising | 682 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5238057 | Total |
| Program Services | 4907838 | ProgramServices |
| Management And General | 322436 | ManagementAndGeneral |
| Fundraising | 7783 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2242508 | Total |
| Program Services | 2101135 | ProgramServices |
| Management And General | 138041 | ManagementAndGeneral |
| Fundraising | 3332 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 221018 | Total |
| Management And General | 221018 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34525 | Total |
| Management And General | 34525 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200776 | Total |
| Management And General | 200776 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 342602 | Total |
| Management And General | 342602 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11745107 | Total |
| Program Services | 10584597 | ProgramServices |
| Management And General | 1160510 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 644056 | Total |
| Program Services | 10998 | ProgramServices |
| Management And General | 633058 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9395770 | Total |
| Program Services | 9034773 | ProgramServices |
| Management And General | 360997 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1285811 | Total |
| Program Services | 1285811 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 244839 | Total |
| Program Services | 198098 | ProgramServices |
| Management And General | 46741 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3476139 | Total |
| Program Services | 3476139 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7826307 | Total |
| Program Services | 7826307 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 208180 | Total |
| Program Services | 208180 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 18732965 | 18732965 | |
| MEDICAL SUPPLIES | 4110171 | 4110171 | |
| PROVIDER TAX | 2673990 | 2673990 | |
| MISCELLANEOUS EXPENSES | 1272627 | 635367 | 637260 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103084385 | Total |
| Program Services | 96883004 | ProgramServices |
| Management And General | 6140954 | ManagementAndGeneral |
| Fundraising | 60427 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12340946 | BOY |
| EOY | 13666198 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 569803 | BOY |
| EOY | 303824 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8488207 | BOY |
| EOY | 8936839 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1501315 | BOY |
| EOY | 1362916 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3390699 | BOY |
| EOY | 3760849 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 151439829 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 67358333 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89509492 | BOY |
| EOY | 84081496 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 66319058 | BOY |
| EOY | 79077370 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4039055 | BOY |
| EOY | 4911602 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2224601 | BOY |
| EOY | 4721055 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 188383176 | BOY |
| EOY | 200822149 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8680779 | BOY |
| EOY | 8671659 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79565000 | BOY |
| EOY | 78090000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11456769 | BOY |
| EOY | 12949024 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 99702548 | BOY |
| EOY | 99710683 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89245373 | BOY |
| EOY | 101695377 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -564745 | BOY |
| EOY | -583911 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88680628 | BOY |
| EOY | 101111466 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 188383176 | BOY |
| EOY | 200822149 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 8257186 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 4173652 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 1 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $7,118 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 7118 | 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 | PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS TO LEGISLATIVE BODIES ON BEHALF OF THEIR MEMBERSHIP BASES. EACH YEAR, A PORTION OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING ENDEAVORS. FOR THE CURRENT YEAR, THE PORTION OF DUES PAID ALLOCATED TO LOBBYING IS APPROXIMATELY $7,118. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2530463 | OtherCostOrOtherBasis |
| Book Value | 2530463 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 93114473 | OtherCostOrOtherBasis |
| Depreciation | 25814272 | Depreciation |
| Book Value | 67300201 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9038259 | OtherCostOrOtherBasis |
| Depreciation | 5177475 | Depreciation |
| Book Value | 3860784 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 46560216 | OtherCostOrOtherBasis |
| Depreciation | 36366586 | Depreciation |
| Book Value | 10193630 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 196418 | OtherCostOrOtherBasis |
| Book Value | 196418 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 84081496 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| INTEREST PAYABLE | $1,146,887 |
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $4,594,704 |
| PHYSICIAN GUARANTEE | $316,348 |
| INTEREST RATE SWAP | $6,789,826 |
| RESIDENT TRUST FUNDS | $101,259 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 12949024 | TotalOfAmounts |
| Total Revenue | 111341571 | TotalRevenue |
| Total Expenses | 103084385 | TotalExpenses |
| Excess Or Deficit For Year | 8257186 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 5688780 | NetUnrealizedGLOnInvestments |
| Other | -$1,515,128 | OtherAmount |
| Total Adjustments | 4173652 | TotalAdjustments |
| Excess Or Deficit Per FS | 12430838 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 96744423 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 5688780 | NetUnrealizedGainsInvestments |
| Other Revenues | -20590695 | OtherRevenues |
| Revenue Not Rptd F990 | -14901915 | RevenueNotRptdF990 |
| Revenue Subtotal | 111646338 | RevenueSubtotal |
| Other Revenues Not Included | -304767 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -304767 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 111341571 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 84313585 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 304767 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 304767 | ExpensesNotRptdF990 |
| Expenses Subtotal | 84008818 | ExpensesSubtotal |
| Other Expenses Not Included | 19075567 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 19075567 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 103084385 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL, FOUNDATION, AND AUXILIARY ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE HOSPITAL HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN VALUE OF SWAP AGREEMENT -810,010. TRANSFER OF EQUITY TO FOUNDATION, NET -70,706. RECOGNIZED LOSSES ON IMPAIRMENTS -307,170. FOUNDATION'S UNREALIZED GAINS -327,242. TOTAL TO SCHEDULE D, PART XI, LINE 8: -1,515,128. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE NET WITH REVENUES -18,732,965. TRANSFER OF EQUITY TO FOUNDATION -70,706. CHANGE IN VALUE OF SWAP AGREEMENT -810,010. RECOGNIZED LOSSES ON IMPAIRMENTS -307,170. FOUNDATION UNREALIZED GAINS -327,242. INVESTMENT MANAGEMENT FEE -342,602. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | DIRECT RENTAL EXPENSES -304,767. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENTAL EXPENSES 304,767. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE NET WITH REVENUES 18,732,965. INVESTMENT MANAGEMENT FEE 342,602. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1876504 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1876504 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02220 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14320809 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13073582 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1247227 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01480 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16197313 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13073582 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3123731 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03700 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 40460 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 40460 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 183791 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 183791 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 591255 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 591255 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00700 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 815506 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 815506 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00970 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17012819 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13073582 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3939237 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04670 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3000 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $5,890,457 | BadDebtExpenseAmount |
| Amount Attributable To | 2061660 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 75168909 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 74981533 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 187376 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 0 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HUGH CHATHAM MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 180 PARKWOOD DRIVE | AddressLine1 |
| City | ELKIN | City |
| State | NC | State |
| ZIP Code | 28621 | 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 | HUGH CHATHAM MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 12 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (12 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| HUGH CHATHAM NURSING CENTER | ||||
| 700 JOHNSON RIDGE ROAD | ELKIN | NC | 28621 | NURSING FACILITY |
| YADKIN VALLEY HOME HEALTH | ||||
| 213 WINSTON ROAD | JONESVILLE | NC | 28642 | HOME HEALTH |
| YADKIN VALLEY ADULT MEDICINE | ||||
| 500 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
| CLINGMAN MEDICAL CENTER | ||||
| 3369 CLINGMAN ROAD | RONDA | NC | 28670 | PHYSICIANS OFFICES |
| YADKIN VALLEY UROLOGY | ||||
| 200 JOHNSON RIDGE MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
| HUGH CHATHAM FAMILY MEDICINE JONESVILLE | ||||
| 112 N SWAIM STREET | JONESVILLE | NC | 28642 | PHYSICIANS OFFICES |
| YADKIN VALLEY GASTROENTEROLOGY | ||||
| 201 WEST MAIN STREET | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
| G I CLINIC | ||||
| 201 WEST MAIN STREET | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
| YADKIN VALLEY DERMATOLOGY | ||||
| 690 PARKWOOD MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
| FOOTHILLS FAMILY MEDICINE | ||||
| 600 CHATHAM MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
| HUGH CHATHAM FAMILY MEDICINE ELKIN | ||||
| 101 CLAREMONT MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
| HUGH CHATHAM SURGICAL | ||||
| 201 B CLAREMONT MEDICAL PARK | ELKIN | NC | 28621 | PHYSICIANS OFFICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 7: THE ORGANIZATION'S INTERNAL COST ACCOUNTING SYSTEM WAS USED TO COMPUTE A COST-TO-CHARGES RATIO THAT WAS USED TO CALCULATE COSTS USED IN PART I, LINE 7. | ||
| PART I, L7 COL(F): THE TOTAL EXPENSE AMOUNT LISTED ON FORM 990, PART IX, LINE 26 CONTAINS BAD DEBT EXPENSE OF $18,732,965 THAT WAS REMOVED FOR THE PURPOSE OF CALCULATING TOTAL CHARITY CARE PERCENTAGE ON LINE 7, COLUMN (F). | ||
| THE HOSPITAL'S COMMUNITY BENEFIT REPORT IS FILED THROUGH THE MEDICAL CARE COMMISSION OF NORTH CAROLINA. | PART I, LINE 6A: | |
| PART II: HUGH CHATHAM MEMORIAL HOSPITAL PROVIDES ALL LOCAL SCHOOLS WITH FREE HAND SANITIZERS WITH FLU PREVENTION BROCHURES EVERY FALL AND SUNCREEN WITH MELANOMA AWARENESS BROCHURES EVERY SPRING. | ||
| PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE GROSS BAD DEBT EXPENSE PER AUDITED FINANCIAL STATEMENTS REDUCED TO COST USING AN INTERNALLY COMPUTED COST-TO-CHARGES RATIO FROM THE ORGANIZATION'S COST ACCOUNTING SYSTEMS.DUE TO THE FACT THAT APPROXIMATELY 30% OF THE SURROUNDING COMMUNITY'S RESIDENTS ARE CONSIDERED TO BE LIVING BELOW THE POVERTY LINE, IN COMBINATION WITH THE FACT THAT THE UNEMPLOYMENT PERCENTAGE FOR THE AREA IS APPROXIMATELY 12.7%, THE ORGANIZATION FEELS THAT APPROXIMATELY 35% OF BAD DEBT IS AN APPROPRIATE ESTIMATION OF THE AMOUNT OF BAD DEBT THAT MAY CONSTITUTE A COMMUNITY BENEFIT. | ||
| PART III, LINE 8: AN INTERNAL COST-TO-CHARGE RATIO WAS USED TO COMPUTE MEDICARE ALLOWABLE COSTS OF CARE ON PART III, LINE 6. | ||
| PART III, LINE 9B: HCMH MAKES EVERY EFFORT TO EVALUATE PATIENTS PRIOR TO PLACEMENT WITH A COLLECTIONS AGENCY TO SEE IF THEY ARE QUALIFIED FOR MEDICAID OR HOSPITAL CHARITY CARE. WE HAVE AN IN-HOUSE EMPLOYEE DESIGNATED TO ASSISTING PATIENTS ELIGIBLE FOR MEDICAID AND/OR FINANCIAL ASSISTANCE. AT THE POINT OF THE PATIENT NOT BEING ELIGIBLE AND FAILURE TO RESPOND FOR OUR PAYMENT PLAN OPTIONS, THE ACCOUNT IS PLACED WITH A COLLECTION AGENCY AND THE AGENCY MAKES AN EFFORT FOR 30 DAYS PRIOR TO PLACING ON THE CREDIT SCORE, TO OBTAIN PAYMENT. | ||
| PART VI, LINE 2: THE ORGANIZATION TRACKS THE RESULTS OF HEALTH SCREENINGS PROVIDED THROUGH ITS QUARTERLY HEALTH FAIRS AND LOOKS FOR TRENDS. THESE SCREENINGS PROVIDE INSIGHT INTO FURTHER MEDICAL NEEDS OF THE COMMUNITY MEMBERS. THE FAIRS ARE HELD QUARTERLY AND ARE ATTENDED BY HUNDREDS OF PEOPLE WHO ARE OFFERED THIRTEEN DIFFERENT TYPES OF SCREENS. ADDITIONALLY, THE ORGANIZATION SUBSCRIBES TO NATIONAL AFFILIATED ORGANIZATIONS THAT PROVIDE DATA ON REGIONAL HEALTH NEEDS. LAST YEAR, THIS DATA SHOWED A RISE IN STROKE RELATED DEATHS. SUBSEQUENTLY, HCMH FOCUSED ON STROKE EDUCATION AND PREVENTION AT ALL LOCAL EVENTS, FAIRS, FESTIVALS, ETC (EXAMPLES INCLUDE KIDSFEST, HEARTFEST, AND SCREENINGS SPECIFICALLY HELD FOR OUR EMPLOYEES). | ||
| PART VI, LINE 3: FINANCIAL ASSISTANCE EDUCATION IS MADE AVAILABLE AT ADMISSION AND ON THE WEBSITE. AT REGISTRATION THERE ARE BROCHURES WITH FINANCIAL ASSISTANCE INFORMATION MADE AVAILABLE. SIGNAGE IS LOCATED THROUGHOUT THE FACILITY TO INFORM AND EDUCATE THE PUBLIC OF THEIR FINANCIAL RIGHTS. HUGH CHATHAM MEMORIAL HOSPITAL OFFERS A LANGUAGE LINE FOR THE NON-ENGLISH SPEAKING COMMUNITY AND PHONETREE ASSISTANCE WHERE NEEDED. | ||
| PART VI, LINE 4: THE PRIMARY SERVICE AREA OF THE HOSPITAL INCLUDES NINE ZIP CODES--ROUGHLY A FIFTEEN MILE DIAMETER AROUND ELKIN, NC. THE SECONDARY SERVICE AREA INCLUDES AN ADDITIONAL FIVE ZIP CODES WIDENING THE DIAMETER TO THIRTY MILES AROUND ELKIN. BOTH OF THESE MARKETS INCLUDE PART, BUT NOT ALL, OF THE NORTH CAROLINA COUNTIES OF WILKES, ALLEGHANY, YADKIN, AND SURRY. SOUTHERN VIRGINIA COUNTIES OF GRAYSON, PATRICK, AND CARROLL ARE ALSO INCLUDED. THESE AREAS HAVE BEEN SEVERELY AFFECTED BY THE ECONOMIC CLIMATE OF THE PAST YEAR. THE AREA CURRENTLY HAS AN UNEMPLOYMENT PERCENTAGE OF 12.7%. DOBSON, NC, WHICH IS IN THE CENTER OF SURRY COUNTY, IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. HUGH CHATHAM IS THE ONLY HOSPITAL IN THE PRIMARY SERVICE AREA. | ||
| PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OF ITS DEPARTMENTS.HCMH OFFERS A WIDE VARIEY OF SERVICES TO OUR COMMUNITY, SUCH AS WOMEN'S HEALTH EDUCATION SEMINARS,INFANT AND CHILD CPR CLASSES, LAMAZE AND CHILDBIRTH CLASSES, CARDIAC REHABILITATION, AND VARIOUS PATIENT EDUCATIONAL PROGRAMS. THE HOSPITAL PARTICIPATES IN AND HOSTS MANY COMMUNITY HEALTH SCREENINGS AND IMMUNIZATIONS, CANCER SCREENINGS (PROSTRATE, BREAST, SKIN, AND COLON), AS WELL AS SCREENINGS IN THE FOLLOWING AREAS: CHOLESTEROL/GLUCOSE, BLOOD PRESSURE, HEART RATE,OXYGEN SATURATION, WEIGHT AND BODY MASS INDEX ASSESSMENT, FALLS ASSESSMENT, BONE DENSITY TESTING, TETANUS AND FLU CLINICS. THE EMPLOYEES AT HCMH ARE COMMITTED TO THE AREA'S NEEDS. COMMITTMENT IS DEMONSTRATED THROUGH PARTICIPATION IN THE FOLLOWING: THE STOP HUNGER FOOD DRIVE, MARCH OF DIMES, UNITED WAY, TRI C MINISTRIES, SUSAN G. KOMEN WALKATHONS, SPECIAL OLYMPICS, THE AMERICAN CANCER SOCIETY, THE NATIONAL MS SOCIETY, AND A LOCAL ORGANIZATION TRIAD FIRST IN FAMILIES THAT HELPS CHILDREN IN NEED.HCMH IS COMMITTED TO THE PROMOTION OF HEALTH, OUTREACH, AND SUPPORT GROUPS. THE HOSPITAL SPONSORS THE FOLLOWING:CANCER HEART AND SOUL, LOOK GOOD FEEL BETTER CANCER SUPPORT, HOSPICE GRIEF CAMP FOR CHILDREN, BEREAVEMENT AND THE GRIEF PROCESS, STROKE SUPPORT, AMPUTEE SUPPORT, ALZHEIMER'S SUPPORT, CPR FOR INDUSTRY, DAY CARE WORKERS, AND LIFEGUARDS, SENIOR FITNESS CLASSES, AND CARDIAC REHABILITATION CLASSES. HCMH ALSO HOLDS "LUNCH AND LEARNS" WHICH ARE OFFERED TO THE COMMUNITY PROMOTING DIFFERENT TOPICS OF HEALTH RELATED INTEREST.THE HOSPITAL ALSO SPONSORS THE GRACE CLINIC WHICH IS A LOCAL FREE CLINIC WHICH OPERATES ON DONATED SERVICES AND SUPPLIES. | ||
| PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| NC | PART VI, LINE 7 | REPORTS FILED WITH STATES |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | 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 (7 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID LOVING | |||||||||||||
| 344270 | 0 | 0 | 0 | 4800 | 0 | 0 | 0 | 0 | 0 | 349070 | 0 | 0 | 0 |
| DONALD TRIPPEL | |||||||||||||
| 144007 | 0 | 15000 | 0 | 1358 | 0 | 22000 | 0 | 7103 | 0 | 189468 | 0 | 0 | 0 |
| DOMINICK CARBONE MD | |||||||||||||
| 380511 | 0 | 348902 | 0 | 360 | 0 | 9800 | 0 | 6858 | 0 | 746431 | 0 | 0 | 0 |
| RIZWAN AHMEND MD | |||||||||||||
| 420037 | 0 | 42729 | 0 | 192 | 0 | 9800 | 0 | 7103 | 0 | 479861 | 0 | 0 | 0 |
| CHRISTOPHER SPONGBERG MD | |||||||||||||
| 280749 | 0 | 35133 | 0 | 360 | 0 | 16500 | 0 | 7103 | 0 | 339845 | 0 | 0 | 0 |
| LAWRENCE NABORS MD | |||||||||||||
| 205773 | 0 | 89252 | 0 | 1584 | 0 | 9800 | 0 | 7103 | 0 | 313512 | 0 | 0 | 0 |
| ANDREW LEE MD | |||||||||||||
| 314111 | 0 | 0 | 0 | 240 | 0 | 249 | 0 | 7103 | 0 | 321703 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 6 | MEMBERS OF THE ADMINISTRATIVE DEPARTMENT ARE ELIGIBLE FOR AN ADMINISTRATIVE BONUS BASED ON THE FINANCIAL PERFORMANCE OF THE PRIOR YEAR. AMOUNTS PAID OUT TO INDIVIDUALS LISTED ON PART VII OF THE FORM 990 FOR 2011 WERE: DONALD TRIPPEL: $15,000 THE PHYSICIANS IN CHARGE OF THE UROLOGY PRACTICE, GASTROENTEROLOGY PRACTICE, AND CLINGMAN CLINIC ARE ELIGIBLE TO RECEIVE A PORTION OF THE NET PROFIT FROM THEIR PRACTICE UP TO 20% OF THEIR BASE SALARY. ANOTHER PHYSICIAN IN CHARGE OF THE HOSPITALIST GROUP IS ELIGIBLE TO RECEIVE UP TO 20% OF THEIR BASE SALARY DEPENDING ON PERFORMANCE MEASURES OF THE HOSPITALIST GROUP. AMOUNTS PAID OUT TO INDIVIDUALS LISTED ON PART VII OF THE FORM 990 FOR 2011 WERE: DOMINICK CARBONE, MD $348,902 RIZWAN AHMEND, MD 42,729 CHRISTOPHER SPONGBERG, MD 35,133 LAWRENCE NABORS, MD 89,252 | |
| PART III | COMPENSATION FROM AN UNRELTED ORGANIZATION: CEO DAVID LOVING IS COMPENSATED BY AN OUTSIDE MANAGEMENT COMPANY, ALLIANT MANAGEMENT GROUP. | SUPPLEMENTAL INFORMATION |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| NORTH CAROLINA MEDICAL CARE COMMISSION | |||||||
| 521309402 | 657902F31 | 2003-04-23 | 39673032 | REFUNDING, NEW STRUCTURES, EQUIPMENT | 0 | 0 | 0 |
| NORTH CAROLINA MEDICAL CARE COMMISSION | |||||||
| 521309402 | 65821DAF8 | 2008-09-24 | 45455000 | NEW STRUCTURES, EQUIPMENT | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Capitalized InterestCapitalizedInterest |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 6150000 | 40932286 | 4414510 | 529906 | 1878294 | 21551473 | 11100000 | 2005 | 1 | 0 | 1 | 1 | |
| 1215000 | 46276755 | 435743 | 513249 | 42448072 | 2010 | 0 | 0 | 1 | 1 | 3493414 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate | Term Of HedgeTermOfHedge | Superintegrated HedgeSuperintegratedHedge | Hedge TerminatedHedgeTerminated |
|---|---|---|---|---|---|---|---|---|
| (no name) | ||||||||
| 0 | 0 | 0 | 0 | 0 | 0 | |||
| WELLS FARGO | ||||||||
| 0 | 1 | 1 | 0 | 0 | 0 | 30.000000000000 | 1 | 0 |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCH K, PART II, LINE 11, COLUMN A | Identifier |
| Explanation | THE OTHER SPENT PROCEEDS OF $11,100,000 WERE USED TO CURRENTLY REFUND PRIOR BONDS ISSUED ON 05-08-1996. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BOARD MEMBER RAYMOND PARKER IS AN ATTORNEY AND HAS BUSINESS RELATIONSHIPS WITH OTHER BOARD MEMBERS AND KEY EMPLOYEES. | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL ENTERED INTO A MANAGEMENT AGREEMENT IN JUNE 2006 WITH ALLIANT, AN UNRELATED CORPORATION WHEREBY THE MANAGEMENT COMPANY WILL PERFORM MANAGEMENT AND ADMINISTRATION SERVICES ON A DAY-TO-DAY BASIS AND PROVIDE A CHIEF EXECUTIVE OFFICER. THE AGREEMENT CALLS FOR A BASE MANAGEMENT FEE OF APPROXIMATELY $220,000 IN THE FIRST YEAR WITH ANNUAL INCREASES TO APPROXIMATE THE INCREASE IN CONSUMER PRICE INDEX. IN ADDITION TO THE ANNUAL FEE, THE HOSPITAL IS REQUIRED TO PAY THE SALARIES, BONUSES AGREED UPON BY THE BOARD, AND ALL FRINGE BENEFITS OF THE MANAGEMENT COMPANY'S KEY PERSONNEL WHO PERFORM THE ADMINISTRATIVE DUTIES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH SUPERVISION AND ASSISTANCE BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DELIVERED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL. THE RETURN WAS THEN PRESENTED AT A SCHEDULED MEETING OF THE BOARD OF DIRECTORS BY A REPRESENTATIVE OF THE ACCOUNTING FIRM, AND EACH VOTING MEMBER OF THE BOARD WAS PROVIDED A COPY FOR DISCUSSION AND QUESTIONS. FOLLOWING THE MEETING AND A PERIOD OF TIME FOR COMMENT, THE RETURN WAS FILED WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, ALL VOTING BOARD MEMBERS ARE PRESENTED WITH THE GOVERNANCE POLICIES CONCERNING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. UPON REVIEW AND DISCUSSION CONCERNING RELATIONSHIPS WITH THE ORGANIZATION, ITS AFFILIATES, OR AMONGST EACH OTHER, THE BOARD MEMBERS ARE REQUIRED TO COMPLETE AND RETURN THE POLICY STATEMENT TO THE ADMINISTRATION. THESE STATEMENTS ARE REVIEWED BY THE BOARD CHAIR AND ARE PRESENTED TO THE AUDITORS DURING THE ANNUAL AUDIT. | |
| FORM 990, PART VI, SECTION B, LINE 15 | A REPRESENTATIVE FROM ALLIANT, THE OUTSIDE MANAGEMENT COMPANY, MEETS WITH THE BOARD TO REVIEW AND APPROVE SALARIES FOR THE CEO AND OTHER OFFICERS. THE SALARIES OF THE TOP EXECUTIVE AND OTHER MEMBERS OF THE ADMINISTRATIVE DEPARTMENT ARE DETERMINED IN THE CONTRACT NEGOTIATIONS. A REVIEW OF ALL SALARIES, TOP TO BOTTOM, WAS DONE THROUGH THE ADMINISTRATIVE TEAM. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 5,688,780. CHANGE IN VALUE OF SWAP AGREEMENT -810,010. TRANSFER OF EQUITY TO FOUNDATION, NET -70,706. RECOGNIZED LOSSES ON IMPAIRMENTS -307,170. FOUNDATION'S UNREALIZED GAINS -327,242. TOTAL TO FORM 990, PART XI, LINE 5: 4,173,652. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | 562049537 | FUNDRAISING | NC | 501(C)(3) | LINE 11A, I | HUGH CHATHAM MEMORIAL HOSPITAL | 1 |
| HUGH CHATHAM MEMORIAL HOSPITAL AUXILIARY | ||||||||||
| 180 PARKWOOD DRIVE | ELKIN | NC | 28621 | 561199949 | THRIFT/GIFT SHOP | NC | 501(C)(3) | LINE 11A, I | HUGH CHATHAM MEMORIAL HOSPITAL | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC | ||
| Q | 143606 | CASH |
| HUGH CHATHAM MEMORIAL HOSPITAL FOUNDATION INC | ||
| R | 72900 | CASH |