CALDWELL MEMORIAL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CALDWELL MEMORIAL HOSPITAL INC (EIN 56-0554202)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-02-13
- IRS object ID
- 201330449349300158
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-02-13T07:50:09-06:00 | 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 | 560554202 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CALD | NameControl |
| Phone | 8287575100 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DONALD J GARDNER JR | Name |
| Title | CFO & VP OF FINANCE | Title |
| Phone | 8287575100 | Phone |
| Date Signed | 2013-02-13 | 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 | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LAURA J EASTON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 111786727 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CALDWELLMEMORIAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTH CARE SERVICES TO THE PEOPLE OF CALDWELL COUNTY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1032 | TotalNbrEmployees |
| Total Nbr Volunteers | 118 | TotalNbrVolunteers |
| Total Gross UBI | 1044806 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 300922 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 587466 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 92906792 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 108113225 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -38184 | InvestmentIncomePriorYear |
| Investment Income Current Year | 315196 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 829331 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2770840 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 93998861 | TotalRevenuePriorYear |
| Total Revenue Current Year | 111786727 | 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 | 46326781 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 48010542 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 51928832 | OtherExpensePriorYear |
| Other Expenses Current Year | 61584350 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 98255613 | TotalExpensesPriorYear |
| Total Expenses Current Year | 109594892 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -4256752 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2191835 | RevenuesLessExpensesCY |
| Total Assets BOY | 48429934 | TotalAssetsBOY |
| Total Assets EOY | 55838070 | TotalAssetsEOY |
| Total Liabilities BOY | 18493680 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 22891891 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 29936254 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 32946179 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROMOTE SAFE, EFFECTIVE, COMPASSIONATE MEDICAL CARE AND TO PROMOTE HEALTHLY LIFESTYLES FOR OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 94394178 | Expense |
| Revenue | 111786727 | Revenue |
| Description | CALDWELL MEMORIAL HOSPITAL IS PROUD TO PROVIDE THE QUALITY HEALTHCARE YOU TRUST AND THE CARING YOU DESERVE. SINCE OPENING IN 1951, CALDWELL MEMORIAL HOSPITAL HAS CONTINUED TO GROW AND CHANGE IN ORDER TO BETTER MEET THE NEEDS OF OUR COMMUNITY. THE MISSION OF CALDWELL MEMORIAL HOSPITAL IS TO PROVIDE SAFE, EFFECTIVE, COMPASSIONATE CARE AND TO PROMOTE HEALTHY LIFESTYLES TO OUR COMMUNITY. ANCHORED BY A 110-BED ACUTE CARE FACILITY, CALDWELL MEMORIAL HOSPITAL'S SERVICES INCLUDE A VAST ARRAY OF MEDICAL AND SURGICAL SERVICES. AMONG SERVICES OFFERED, BUT BY NO MEANS A COMPLETE LIST, ARE CAROTID ARTERY STENTING; CARDIOVASCULAR AND ENDOVASCULAR CARE; RADIATION ONCOLOGY; COMPUTER-ASSISTED ORTHOPEDIC SURGERY; NEUROLOGY AND MEMORY CARE; PAIN MANAGEMENT; A FULLY STAFFED 24-HOUR EMERGENCY DEPARTMENT; CALDWELL PHYSICIANS CLINICS CONVENIENTLY LOCATED COUNTY-WIDE; DIAGNOSTIC SERVICES; OUTPATIENT SURGERY; PLUS URGENT CARE; AND THE QUEST 4 LIFE WELLNESS CENTER. MULTIPLE EDUCATIONAL AND COUNSELING PROGRAMS ARE AVAILABLE FOR A WIDE ARRAY OF HEALTHCARE NEEDS INCLUDING CANCER, DIABETES, NUTRITION, JOINT CARE, PRE-NATAL CLASSES AND PARENTING SKILLS. CALDWELL PHYSICIANS IS A DIVISION OF CALDWELL MEMORIAL HOSPITAL. WITH PRACTICES IN COMMUNITIES COUNTYWIDE, CALDWELL PHYSICIANS PROVIDES THE PRIMARY AND SPECIALTY HEALTHCARE, DIAGNOSTICS AND TREATMENTS THAT OUR COMMUNITY NEEDS IN CONVENIENT LOCATIONS NEAR THEIR HOMES. CALDWELL PHYSICIANS INCLUDES: CALDWELL ACUTE CARE SPECIALISTS, EMPLOYER GROUP CLINIC, FALLS MEDICAL PRACTICE, FALLS NEUROLOGY AND MEMORY CENTER, FALLS PEDIATRICS, FALLS PLUS URGENT CARE, LAUREL PARK WOMEN'S CLINIC, MAIN STREET MEDICAL PRACTICE, MCBURNEY PRIMARY CARE, MULBERRY PEDIATRICS, OCCUPATIONAL HEALTH, ROBBINS CARDIOLOGY, ROBBINS PIEDMONT VISTA ENT, ROBBINS FAMILY PRACTICE, ROBBINS INTERNAL MEDICINE, ROBBINS PULMONOLOGY, ROBBINS PLUS URGENT CARE, SOUTHFORK MEDICAL PRACTICE AND WESTPOINTE MEDICAL PRACTICE. | Description |
| Total Program Service Expense | 94394178 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 118 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1032 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DON GARDNER & CHRIS WASHBURN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8287575221 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| BOYD WILSON | ||||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | ||
| PARKER WILLIAMSON | ||||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | ||
| BILL JOHNSON | ||||||||
| SECRETARY/TREASURER | 1.00 | X | X | 0 | 0 | 0 | ||
| GARY SHORE | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| ALEX BERNHARDT JR | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| DEBORAH MURRAY | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| PETER PURCELL MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MARK BATTS MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| RICK COFFEY | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MIKE CHAMBERLAIN | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JOHN MCCORMICK MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| LAURA J EASTON | ||||||||
| PRESIDENT/CEO | 40.00 | X | 229534 | 0 | 81211 | |||
| SHARON KIMBALL | ||||||||
| VICE PRESIDENT, CHIEF NURSING OFFICER | 40.00 | X | 135264 | 0 | 12573 | |||
| DAVID HORN | ||||||||
| VICE PRESIDENT, MARKETING AND PHY. RECRUIT. | 40.00 | X | 119096 | 0 | 14642 | |||
| DANNY MORGAN | ||||||||
| VICE PRESIDENT, PHYSICIAN SERVICES | 40.00 | X | 107004 | 0 | 8828 | |||
| REBECCA SMITH | ||||||||
| VP, COO, HR AND QUALITY/RISK MGMT | 40.00 | X | 159198 | 0 | 16941 | |||
| DONALD GARDNER JR | ||||||||
| VP, FINANCE | 40.00 | X | 168495 | 0 | 16360 | |||
| JOHN POWELL MC | ||||||||
| CPN CHAIR, EX-OFFICIO DIRECTOR | 40.00 | 182861 | 0 | 14837 | X | |||
| DAVID A LOWRY | ||||||||
| PHYSICIAN | 40.00 | 397725 | 0 | 13826 | X | |||
| DONALD E SCHMECHEL | ||||||||
| PHYSICIAN | 40.00 | 328760 | 0 | 9261 | X | |||
| RONALD H DUBOW | ||||||||
| PHYSICIAN | 40.00 | 293023 | 0 | 16745 | X | |||
| PAUL D WARRICK | ||||||||
| PHYSICIAN | 40.00 | 287781 | 0 | 8828 | X | |||
| RAMESH L KRISHNARAJ | ||||||||
| PHYSICIAN | 40.00 | 268457 | 0 | 14167 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2677198 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 228219 | TotalOtherCompensation |
| Number Individuals GT100 K | 49 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| CALDWELL FAMILY PHYSICIANS PA | |||||
| CONNELLY SPRINGS ROAD | LENOIR | NC | 28645 | PROFESSIONAL MEDICAL SERVICES | 1097650 |
| TIM BLINSON CONSTRUCTION | |||||
| 2377 MILLS COVE PLACE | LENOIR | NC | 28645 | MINOR CONTRUCTION PROJECTS | 444989 |
| DLP CARDIAC PARTNERS LLC (MEDCATH) | |||||
| 3700 ARCO CORPORATE OFFICE SUITE 4 | CHARLOTTE | NC | 28273 | CATH LAB PARTNER | 352423 |
| SIMPLER NORTH AMERICA LP | |||||
| PO BOX 643979 | PITTSBURGH | PA | 152643979 | LEAN-STRATEGIC ADVISORY WORK | 222386 |
| KAUFMAN HALL | |||||
| 5202 OLD ORCHARD ROAD SUITE N700 | SKOKIE | IL | 60077 | STRATEGIC PLANNING & FORECASTING | 192394 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 575973 | RelatedOrganizations |
| All Other Contributions | 11493 | AllOtherContributions |
| Total Contributions | 587466 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES | 621500 | 103082756 | 103082756 | |
| OTHER PATIENT REVENUE | 900099 | 2832168 | 2832168 | |
| WELLNESS CENTER | 713990 | 843653 | 843653 | |
| LAB SERVICES | 621400 | 698570 | 636350 | 62220 |
| JOINT VENTURE INCOME | 541900 | 350090 | 211157 | 138933 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 305988 | TotalRevenueColumn |
| Exclusion | $305,988 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 108113225 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 232550 | TotalRevenueColumn |
| Exclusion | $232,550 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 213045 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 213045 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 213045 | TotalRevenueColumn |
| Exclusion | $213,045 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 82646 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 82646 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 82646 | TotalRevenueColumn |
| Exclusion | $82,646 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MEANINGFUL USE INCENTI | 900099 | 1695179 | $1,695,179 |
| OTHER INCOME | 900099 | 862616 | $862,616 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2557795 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 111786727 | TotalRevenueColumn |
| Related Or Exempt Function Income | 106762431 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1044806 | UnrelatedBusinessRevenue |
| Exclusion | $3,392,024 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1206844 | Total |
| Program Services | 946214 | ProgramServices |
| Management And General | 260630 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37583377 | Total |
| Program Services | 32308624 | ProgramServices |
| Management And General | 5274753 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 655331 | Total |
| Program Services | 561815 | ProgramServices |
| Management And General | 93516 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6182279 | Total |
| Program Services | 5300065 | ProgramServices |
| Management And General | 882214 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2382711 | Total |
| Program Services | 2042697 | ProgramServices |
| Management And General | 340014 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88991 | Total |
| Management And General | 88991 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36505 | Total |
| Management And General | 36505 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11740506 | Total |
| Program Services | 7472443 | ProgramServices |
| Management And General | 4268063 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 288962 | Total |
| Management And General | 288962 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5062204 | Total |
| Program Services | 4101819 | ProgramServices |
| Management And General | 960385 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2337119 | Total |
| Program Services | 2337119 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 148119 | Total |
| Program Services | 92031 | ProgramServices |
| Management And General | 56088 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 450306 | Total |
| Program Services | 450306 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4281848 | Total |
| Program Services | 4281848 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1187236 | Total |
| Program Services | 1187236 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 17117700 | 16610575 | 507125 |
| BAD DEBT EXPENSE | 11817810 | 11817810 | |
| EQUIPMENT RENTAL & MAIN | 6343567 | 4415480 | 1928087 |
| MISCELLANEOUS | 515368 | 468096 | 47272 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 168109 | Total |
| Management And General | 168109 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109594892 | Total |
| Program Services | 94394178 | ProgramServices |
| Management And General | 15200714 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6715 | BOY |
| EOY | 8582 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4544071 | BOY |
| EOY | 7054007 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10628701 | BOY |
| EOY | 12483899 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 279450 | BOY |
| EOY | 114361 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2582996 | BOY |
| EOY | 2833180 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1307785 | BOY |
| EOY | 836240 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 83859186 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 60565166 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20303163 | BOY |
| EOY | 23294020 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5319593 | BOY |
| EOY | 6534166 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2039644 | BOY |
| EOY | 1289872 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 215310 | BOY |
| EOY | 109225 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1202506 | BOY |
| EOY | 1280518 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48429934 | BOY |
| EOY | 55838070 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7732680 | BOY |
| EOY | 10296354 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 254528 | BOY |
| EOY | 88537 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9377698 | BOY |
| EOY | 11245184 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1128774 | BOY |
| EOY | 1261816 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18493680 | BOY |
| EOY | 22891891 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29936254 | BOY |
| EOY | 32946179 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29936254 | BOY |
| EOY | 32946179 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48429934 | BOY |
| EOY | 55838070 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2191835 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 818090 | 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 B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $12,244 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 12244 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $12,244 WAS ESTIMATED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1137587 | OtherCostOrOtherBasis |
| Book Value | 1137587 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30207515 | OtherCostOrOtherBasis |
| Depreciation | 26822722 | Depreciation |
| Book Value | 3384793 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9117489 | OtherCostOrOtherBasis |
| Depreciation | 1266975 | Depreciation |
| Book Value | 7850514 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 42762905 | OtherCostOrOtherBasis |
| Depreciation | 32475469 | Depreciation |
| Book Value | 10287436 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 633690 | OtherCostOrOtherBasis |
| Book Value | 633690 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 23294020 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| REFUNDS PAYABLE AND PATIENT DEPOSITS | $536,155 |
| ESTIMATED THIRD PARTY SETTLEMENTS | $550,244 |
| PHYSICIAN RECRUITMENT OBLIGATIONS | $175,417 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1261816 | TotalOfAmounts |
| Total Revenue | 111786727 | TotalRevenue |
| Total Expenses | 109594892 | TotalExpenses |
| Excess Or Deficit For Year | 2191835 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 818090 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 818090 | TotalAdjustments |
| Excess Or Deficit Per FS | 3009925 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 112642817 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 818090 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 38000 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 856090 | RevenueNotRptdF990 |
| Revenue Subtotal | 111786727 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 111786727 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 109632892 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 38000 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 38000 | ExpensesNotRptdF990 |
| Expenses Subtotal | 109594892 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 109594892 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT, PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL'S LAB SERVICES TO NON-PATIENTS AND SALES FROM THE QUEST 4 LIFE WELLNESS CENTER CONSTITUTE UNRELATED BUSINESS INCOME UNDER THE INTERNAL REVENUE CODE. THE HOSPITAL AND FOUNDATION HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2012 AND 2011. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 225.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1235617 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1235617 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01260 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11794625 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7143706 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4650919 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04760 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1233488 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 384986 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 848502 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00870 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14263730 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7528692 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6735038 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06890 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 561722 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 561722 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 561722 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 561722 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14825452 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7528692 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7296760 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07460 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,569,728 | BadDebtExpenseAmount |
| Amount Attributable To | 1158995 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 24852869 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 25230067 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -377198 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 MULBERRY STREET SW PO BOX 1890 | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | DISPROPORTIONATE SHARE HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA FOR 2011 | 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 | 225.000000000000 | 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 |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 20 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (20 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| GEORGE M HANCOCK SURGERY CENTER | ||||
| 1031 MORGANTON BLVD | LENIOR | NC | 28645 | OUTPATIENT SURGERY CENTER |
| FALLS MEDICAL PARK | ||||
| 4355 HICKORY BLVD | GRANITE FALLS | NC | 28630 | FALLS MEDICAL PRACTICE, FALLS NEURO & MEMORY, FALLS PEDIATRIC PRACTICE |
| MAIN STREET MEDICAL PARK | ||||
| 589 MAIN STREET | HUDSON | NC | 28638 | MAIN STREET MEDICAL PRACTICE |
| MULBERRY PEDIATRICS | ||||
| 401 MULBERRY STREET | LENIOR | NC | 28645 | MULBERRY PEDIATRIC PRACTICE |
| ROBBINS MEDICAL PARK | ||||
| 322 MULBERRY STREET | LENOIR | NC | 28645 | ROBBINS ENT PRACTICE, FAMILY CARE, INTERNAL MEDICINE, AND URGENT CARE |
| SOUTHFOLK MEDICAL PARK | ||||
| 1731 CONNELLY SPRINGS ROAD | LENIOR | NC | 28645 | SOUTHFOLK MEDICAL PRACTICE |
| WESTPOINTE MEDICAL PRACTICE | ||||
| 2651 MORGANTON BLVD | LENIOR | NC | 28645 | WESTPOINTE MEDICAL PRACTICE |
| THE CENTER FOR WOUND TREATMENT | ||||
| 401 MULBERRY STREET | LENIOR | NC | 28645 | WOUND CARE CENTER |
| AMERICAN HOMEPATIENT OF UNIFOUR LLC | ||||
| 1929 TATE BLVD | HICKORY | NC | 28602 | DURABLE MEDICAL EQUIPMENT LTD. PARTNERSHIP JOINT VENTURE |
| GUARDIAN HEALTH SERVICES LLC | ||||
| 1771 TATE BLVD SUITE 101 | HICKORY | NC | 28602 | HOME HEALTH AGENCY JOINT VENTURE |
| HALLMARK FAMILY PHYSICIANS INC | ||||
| 321 MULBERRY STREET SE | LENIOR | NC | 28645 | FAMILY PHYSICIANS |
| CALDWELL MEMORIAL SLEEP CENTER | ||||
| 270 PINE MOUNTAIN ROAD SUITE 1 | HUDSON | NC | 28638 | SLEEP CENTER |
| CENTER FOR BREAST HEALTH | ||||
| 1031 MORGANTON BLVD SUITE B | LENIOR | NC | 28645 | BREAST HEALTH |
| MCCREARY CANCER CENTER | ||||
| 212 MULBERRY STREET SW | LENIOR | NC | 28645 | RADIATION AND MEDICAL ONCOLOGY |
| PAIN MANAGEMENT CENTER | ||||
| 1031 MORGANTON BLVD | LENIOR | NC | 28645 | PAIN MANAGEMENT |
| FALLS PEDIATRICS | ||||
| 4355 HICKORY BLVD LOWER SUITE | GRANITE FALLS | NC | 28630 | PEDIATRIC CARE |
| LAUREL PARK WOMEN'S HEALTH | ||||
| 222 MORGANTON BLVD SW | LENIOR | NC | 28645 | OBSTETRIC AND GYNECOLOGICAL CARE |
| ROBBINS PULMONOLOGY | ||||
| 322 MULBERRY STREET SW | LENIOR | NC | 28645 | OUTPATIENT PULMONARY CLINIC |
| QUEST4LIFE WELLNESS CENTER | ||||
| 1031 MORGANTON BLVD SW SUITE A | LENIOR | NC | 28645 | COMMUNITY WELLNESS FACILITY |
| CENTER FOR DIABETES HEALTH | ||||
| 1031 MORGANTON BLVD SUITE A | LENIOR | NC | 28645 | DIABETES EDUCATION AND SUPPORT SERVICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: THE ORGANIZATION USED WORKSHEET 2 OF THE 2011 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. | ||
| THE HOSPITAL HAS, SINCE 1996, PARTICIPATED IN THE NORTH CAROLINA MEDICAID REIMBURSEMENT INITIATIVE (THE "MRI PLAN"). IN CONNECTION THEREWITH, THE HOSPITAL RECEIVED APPROXIMATELY $804,000 AND $1,076,000, RESPECTIVELY, FROM THE MRI PLAN DURING THE YEARS ENDED SEPTEMBER 30, 2012 AND 2011, AND RECOGNIZED AS NET REVENUE $1,073,000 AND $807,000, RESPECTIVELY. IN 2011, THE HOSPITAL RECOGNIZED AN ADDITIONAL $300,000 FROM THE ELIMINATION OF RESERVES FOR MRI PLAN YEARS 2009 THROUGH 2010, WHICH MANAGEMENT DETERMINED WERE NO LONGER NECESSARY BASED ON SEVERAL FACTS, PRIMARILY WRITTEN CONFIRMATION FROM THE STATE IN JULY 2010 THAT IT WOULD NOT RETROSPECTIVELY SETTLE ANY OF THESE PLAN YEARS. FURTHERMORE, THE NORTH CAROLINA DIVISION OF MEDICAL ASSISTANCE COMPLETED DISPROPORTIONATE SHARE HOSPITAL ("DSH") AUDITS THROUGH 2008. THOSE AUDITS SHOW NO OVERPAYMENTS IN AGGREGATE BASED ON THE CENTER FOR MEDICARE AND MEDICAID SERVICES ("CMS") FINAL REGULATIONS PUBLISHED IN THE DECEMBER 19, 2008 FEDERAL REGISTER.IN APRIL 2012, CMS APPROVED A NORTH CAROLINA MEDICAID ASSESSMENT PLAN TO REDUCE THE GAP BETWEEN MEDICAID AND UNINSURED COSTS AND PAYMENTS (THE "GAP PLAN") RETROACTIVE TO JANUARY 1, 2011. UNDER THE GAP PLAN, PROVIDERS PERIODICALLY PAY AN ASSESSMENT TO THE STATE OF NORTH CAROLINA AND PERIODICALLY RECEIVE MEDICAID PAYMENTS FROM THE STATE OF NORTH CAROLINA. IN 2012, THE STATE COLLECTED ASSESSMENTS AND MADE PAYMENTS FOR THE THREE QUARTERS ENDING SEPTEMBER 30, 2011 AND THE FOUR QUARTERS ENDING SEPTEMBER 30, 2012. DURING 2012, THE HOSPITAL PAID ASSESSMENTS OF APPROXIMATELY $3,474,000, WHICH WERE RECORDED AS OTHER EXPENSE IN THE CONSOLIDATED STATEMENT OF OPERATIONS, AND RECEIVED PAYMENTS OF APPROXIMATELY $6,829,000, OF WHICH $6,429,000 WAS RECORDED AS NET PATIENT REVENUE. | ||
| PART I, L7 COL(F): FOR PURPOSES OF CALCULATING PERCENT OF TOTAL EXPENSE FOR LINE 7, COLUMN (F), TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25 HAS BEEN ADJUSTED TO REMOVE $11,817,810 BAD DEBT EXPENSE. | ||
| PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE:THE HOSPITAL HAS PROVIDED SERVICES TO PERSONS WHO HAVE NOT PAID FOR SUCH SERVICES EITHER BECAUSE THEY HAVE BEEN UNWILLING OR UNABLE TO PAY. EFFORTS ARE MADE BY THE HOSPITAL TO DETERMINE IF A PATIENT MEETS CHARITY POLICY GUIDELINES THAT ARE ESTABLISHED BY THE HOSPITAL. IF THESE GUIDELINES ARE MET AND CAN BE VERIFIED, THEN SUCH AMOUNTS ARE INCLUDED IN CHARITY CARE. UNTIL SUCH TIME, SUCH AMOUNTS ARE COMBINED IN BAD DEBTS BECAUSE THEY HAVE NOT BEEN VERIFIED OR DOCUMENTED AS CHARITY CARE DUE TO LACK OF SUPPORTING FINANCIAL INFORMATION. IN SOME CASES, PATIENTS WHO WOULD (OR COULD) QUALIFY FOR CHARITY CARE ARE UNWILLING OR UNABLE TO PRODUCE THE NECESSARY INFORMATION TO SUBSTANTIATE THEIR QUALIFICATION. THUS, BAD DEBTS INCLUDE AMOUNTS THAT WOULD OTHERWISE QUALIFY FOR CHARITY CARE UNDER THE HOSPITAL'S GUIDELINES. THE ESTIMATED COST OF UNREIMBURSED SERVICES ATTRIBUTABLE TO BAD DEBTS - EFFECTIVELY "FREE" SERVICES PROVIDED TO PATIENTS - HAS BEEN DETERMINED BY APPLYING A COST TO CHARGE RATIO TO THE AMOUNT OF BAD DEBTS. SUCH ESTIMATED COSTS WERE APPROXIMATELY $4,636,000 AND $4,682,000 IN THE YEARS ENDED SEPTEMBER 30, 2012 AND 2011, RESPECTIVELY.COSTING METHODOLOGY:THE AMOUNTS DISCLOSED ON LINES 2 AND 3 OF PART III, SECTION A ARE REPORTED ON THE ORGANIZATION'S MOST RECENTLY FILED MEDICARE COST REPORT (FY 2011). THE ORGANIZATION HAS ESTIMATED THE AMOUNT OF UNREIMBURSED COSTS OF TREATING MEDICARE PATIENTS FOR FY 2011 TO BE $6,832,000. | ||
| PART III, LINE 8: WITH COUNTYWIDE DOUBLE-DIGIT UNEMPLOYMENT AND A POPULATION ALREADY HEAVILY DEPENDENT UPON MEDICARE AND MEDICAID, THE ENTIRETY OF THE MEDICARE SHORTFALL (REPORTED IN LINE 7) IS COMMUNITY BENEFIT, EQUATING DIRECTLY TO "FREE" CARE PROVIDED BY CALDWELL MEMORIAL. | ||
| PART V, SECTION B, LINE 3: ANALYSIS OF INFORMATION REGARDING HEALTH STATUS, RISK FACTORS, ACCESS TO CARE AND COMMUNITY ASSETS/RESOURCES WAS COMPLETED. PRIMARY DATA WAS COLLECTED USING A TWO-STAGE CLUSTER SAMPLING SYSTEM TO IDENTIFY SEVEN INTERVIEW SITES. TWO-PERSON TEAMS THEN CONDUCTED SITE SURVEYS/INTERVIEWS IN THE SEVEN LOCATIONS INCLUDING DEMOGRAPHICS (RACE, EDUCATION, INCOME, EMPLOYMENT LEVEL) QUALITY OF LIFE, COMMUNITY IMPROVEMENT, HEALTH INFORMATION, PERSONAL HEALTH, ACCESS TO CARE AND EMERGENCY PREPAREDNESS. OVER 200 SURVEYS WERE COLLECTED. OTHER DATA USED IN ANALYZING THE COMMUNITY NEEDS INCLUDED NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, U.S. CENSUS BUREAU, U.S. ENVIRONMENTAL PROTECTION AGENCY, NORTH CAROLINA DEPARTMENT OF LABOR, AND NORTH CAROLINA PUBLIC HEALTH. INFORMATION FROM VARIOUS LOCAL EDUCATION, LAW ENFORCEMENT, AND SOCIAL SERVICE AGENCIES WAS ALSO INCLUDED IN ANALYSIS. | N/A FOR 2011 | |
| PART V, SECTION B, LINE 5C: IN ADDITION TO BEING MADE AVAILABLE UPON REQUEST FROM THE HOSPITAL FACILITY, THE NEEDS ASSESSMENT WAS PRESENTED AT THE COUNTY BOARD OF HEALTH MEETING. | N/A FOR 2011 | |
| PART VI, LINE 2: IN COLLABORATION WITH THE CALDWELL COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY AGENCIES (SCHOOL SYSTEM, SOCIAL SERVICES, TOWNSHIPS/MUNICIPALITIES AND UNINSURED CLINIC) CALDWELL MEMORIAL HOSPITAL COMPLETED A FORMAL 2011-2014 COMMUNITY HEALTH ASSESSMENT (CHA). IT HAD BEEN OVER FIVE YEARS SINCE A COMMUNITY HEALTH ASSESSMENT HAD BEEN COMPLETED, THOUGH MANY EFFORTS FOCUSED ON THE HEALTH OF COMMUNITY HAD BEEN ONGOING. COMMUNITY SURVEYS (FACE-TO-FACE SURVEYS WITH RESIDENTS) WERE CONDUCTED IN AREAS OF THE COUNTY IDENTIFIED USING A TWO CLUSTER SAMPLING METHOD. OTHER DATA USED IN ANALYZING THE COMMUNITY NEEDS INCLUDED NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS, U.S. CENSUS BUREAU, U.S. ENVIRONMENTAL PROTECTION AGENCY, NORTH CAROLINA DEPARTMENT OF LABOR, AND NORTH CAROLINA PUBLIC HEALTH. INFORMATION FROM VARIOUS LOCAL EDUCATION, LAW ENFORCEMENT AND SOCIAL SERVICE AGENCIES WAS ALSO INCLUDED IN ANALYSIS. THE NORTH CAROLINA HEALTHY PEOPLE 20/20 OBJECTIVES WERE ALSO PART OF THE ANALYSIS. ONGOING FEEDBACK FROM THE COMMUNITY AND OTHER HEALTH CARE AGENCIES (MENTAL HEALTH SERVICES, SCHOOL SYSTEM, SOCIAL SERVICE AGENCIES, HEALTH CARE CLINICS AND ECONONIC DEVELOPMENT GROUPS) WAS ALSO CONSIDERED IN THE DEVELOPMENT OF COMMUNITY PLANS. A COMMUNITY ADVISORY GROUP (COMPRISED OF AGENCIES NOTED ABOVE AND COMMUNITY MEMBERS) REVIEWED DATA AND IDENTIFED THREE HEALTH OBJECTIVES FOR THE COUNTY BOARD OF HEALTH: SUBSTANCE ABUSE, TEEN PREGNANCY, AND HIGH SCHOOL DROPOUT RATE. IT WAS FELT THAT EACH OF THESE DIRECTLY CONTRIBUTES TO THE HEALTH OF OUR RESIDENTS. IN ADDITION TO THE THREE NOTED OBJECTIVES, CMH HAS ADOPTED OTHER AREAS OF FOCUS FOR THE HEALTH OF OUR COMMUNITY. THESE INCLUDE HEALTHY LIVING (EXERCISE AND NUTRITION), OCCUPATIONAL HEALTH, MENTAL HEALTH AND HEALTH SCREEINGS BASED ON THE DATA COLLECTED IN THE COMMUNITY HEALTH ASSESSMENT. | ||
| PART VI, LINE 3: CALDWELL MEMORIAL HOSPITAL (CMH) PROVIDES NEEDED HEALTHCARE SERVICES TO ANYONE REGARDLESS OF THAT PERSON'S ABILITY TO PAY. CMH'S CHARITY CARE POLICY IS DESIGNED TO ASSIST PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR HEALTHCARE SERVICES. THE POLICY CAN BE FOUND ON THE CMH PUBLIC WEBSITE. CMH DISPLAYS INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND CHARITY CARE IN ITS EMERGENCY ROOM, REGISTRATION AREAS IN THE HOSPITAL AND CLINICS, AND FINANCIAL COUNSELOR OFFICES. A LINK IS ALSO PROVIDED ON THE HOSPITAL'S WEBSITE TO THE AVAILABILITY OF FINANCIAL ASSISTANCE AND ITS CHARITY CARE POLICY, ALONG WITH AN ON-LINE APPLICATION. INPATIENT CASE MANAGERS ALSO PROVIDE INFORMATION TO THE PATIENTS REGARDING AVAILABLE PROGRAMS AND THE ORGANIZAITONS FINANCIAL POLICY. CONSULTATION WITH FINANCIAL COUNSELORS IS ALSO AVAILABLE TO ALL PATIENTS AS NEEDED. | ||
| PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR CALDWELL MEMORIAL HOPSITAL IS CALDWELL COUNTY WITH A LIMITED NUMBER OF PATIENTS FROM THE SURROUNDING COUNTIES OF BURKE, WATAUGA AND CATAWBA. CALDWELL COUNTY IS IN THE NORTHWEST SECTION OF NORTH CAROLINA IN THE FOOTHILLS OF THE BLUE RIDGE MOUNTAINS AND IS BOUNDED ON THE NORTHWEST BY WATAUGA COUNTY, ON THE NORTHEAST BY WILKES COUNTY, ON THE EAST BY ALEXANDER COUNTY, ON THE SOUTH BY CATAWBA AND BURKE COUNTIES, AND ON THE WEST BY BURKE AND AVERY COUNTIES. TODAY, THERE ARE NINE INCORPORATED MUNICIPALITIES IN THE COUNTY: LENOIR, HUDSON, GRANITE FALLS, CEDAR ROCK, CAJAHS MOUNTAIN, GAMEWELL, SAWMILLS AND PARTS OF BLOWING ROCK AND RHODHISS. POPULATION IS JUST OVER 80,000. MEDIAN INCOME IS $36,936. POPULATION MAKEUP IS 92.2% WHITE, 5.2% BLACK, 4.7% HISPANIC AND 2.6% OTHER. MEDIAN AGE IS 37.5 YEARS. 49.4% ARE MALES AND 50.6% FEMALES. UNEMPLOYMENT IN 2012 WAS 10.2%. | ||
| PART VI, LINE 5: CALDWELL MEMORIAL HOSPITAL PROVIDES FINANCIAL SUPPORT TO TWO COMMUNITY AGENCIES: THE HELPING HANDS CLINIC (PROVIDING CARE TO THE UNINSURED) AND THE SATIE AND J. E. BROYHILL CALDWELL SENIOR CENTER (FOCUS ON THE LIVES AND ADVOCACY FOR SENIORS). OTHER COMMUNITY INVOLVEMENT INCLUDES BUT IS NOT LIMITED TO:1. ANNUAL PROSTATE SCREENING FOR CALDWELL COUNTY RESIDENTS (AVERAGING 100+ MEN SCREENED ANNUALLY). 2. HEALTH FAIRS THROUGHOUT THE YEAR FOCUSING ON WELLNESS, HEALTH EATING, GETTING FIT, SCREENINGS FOR CHOLESTEROL, HYPERTENSION, DIABETES, ETC. 3. SUPPORT AND INVOLVEMENT IN THE CALDWELL COMMUNITY GARDENS WHICH HELPS FOSTER COMMUNITY GARDENING IN CALDWELL COUNTY, NC AS A STRATEGY TO HELP OUR COMMUNITY EAT SMART BY INCREASING AFFORDABLE ACCESS TO HEALTHY FOODS AND SUSTAINABILITY. 4. REPRESENTATION BY ORGANIZATION REPRESENTATIVES ON LOCAL HEALTH CARE RELATED BOARDS (CC BOARD OF HEALTH, CC HOSPICE AND PALLIATIVE CARE, CC CHILD PROTECTION TEAM). 5. ESTABLISHMENT OF CALDWELL COUNTY MENTAL HEALTH WORK GROUP. MEMBERSHIP INCLUDES CMH, LOCAL LME, MOBILE CRISIS AND LAW ENFORCEMENT AGENCIES WORKING TOWARDS IMPROVING MENTAL HEALTH CARE IN CALDWELL COUNTY. 6. ESTABLISHMENT OF CALDWELL MEMORIAL HEALTHWORKS WHICH IS OCCUPATIONAL, INDUSTRIAL, AND WORKER'S COMPENSATION MEDICINE DESIGNED TO ASSIST EMPLOYERS TOWARD THESE TRIPLE AIM GOALS OF IMPROVING THE QUALITY OF HEALTHCARE, ACCESS TO HEALTHCARE AND PATIENT SATISFACTION. 7. THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INTERESTED PERSONS. 8. THE HOSPITAL EXTENDS STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. | ||
| PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LAURA J EASTON | |||||||||||||
| 220084 | 0 | 9450 | 0 | 0 | 0 | 72383 | 0 | 8828 | 0 | 310745 | 0 | 0 | 0 |
| REBECCA SMITH | |||||||||||||
| 139573 | 0 | 3125 | 0 | 16500 | 0 | 8113 | 0 | 8828 | 0 | 176139 | 0 | 0 | 0 |
| DONALD GARDNER JR | |||||||||||||
| 163304 | 0 | 5191 | 0 | 0 | 0 | 7532 | 0 | 8828 | 0 | 184855 | 0 | 0 | 0 |
| JOHN POWELL MC | |||||||||||||
| 182861 | 0 | 0 | 0 | 0 | 0 | 6009 | 0 | 8828 | 0 | 197698 | 0 | 0 | 0 |
| DAVID A LOWRY | |||||||||||||
| 397725 | 0 | 0 | 0 | 0 | 0 | 4998 | 0 | 8828 | 0 | 411551 | 0 | 0 | 0 |
| DONALD E SCHMECHEL | |||||||||||||
| 328760 | 0 | 0 | 0 | 0 | 0 | 433 | 0 | 8828 | 0 | 338021 | 0 | 0 | 0 |
| RONALD H DUBOW | |||||||||||||
| 277523 | 0 | 0 | 0 | 15500 | 0 | 7917 | 0 | 8828 | 0 | 309768 | 0 | 0 | 0 |
| PAUL D WARRICK | |||||||||||||
| 287781 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8828 | 0 | 296609 | 0 | 0 | 0 |
| RAMESH L KRISHNARAJ | |||||||||||||
| 259007 | 0 | 0 | 0 | 9450 | 0 | 5339 | 0 | 8828 | 0 | 282624 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | MEMBERSHIPS AT THE ORGANIZATION'S ON-SITE QUEST 4 LIFE FITNESS CENTER ARE PROVIDED TO CERTAIN OFFICERS AND KEY EMPLOYEES. THE FITNESS CENTER IS OPERATED DIRECTLY BY THE ORGANIZATION. |
| PART I, LINE 4B | LAURA EASTON (CEO) HAS A SECURED BENEFIT PLAN WHICH IS INCLUDED IN THE STUDY COMPLETED BY THE INDEPENDENT COMPENSATION CONSULTANT. THE LOAN UNDER THIS ARRANGEMENT IS RECORDED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND FULLY SECURED BY A LIFE INSURANCE POLICY ON THE LIFE OF THE CEO. |
| PART I, LINE 6 | SENIOR MANAGEMENT HAS AN INCENTIVE PROGRAM WHICH IS PARTIALLY EARNED BASED ON PROFIT MARGIN AND DAYS CASH ON HAND. THE EARNED INCENTIVE IS REVIEWED BY THE HR COMMITTEE OF THE BOARD AND APPROVED ANNUALLY. EMPLOYED PHYSICIANS ARE PAID ON A PRODUCTIVITY BASIS BASED ON RVU'S GENERATED IN THEIR PRACTICE OPERATIONS. THESE ARE TIED TO MGMA BENCHMARKS. |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | PAUL WARRICK | NamePerson |
| Purpose Of Loan | START UP LOAN | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $324,600 | OriginalPrincipalAmount |
| Balance Due | 114361 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 114361 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE/FINANCE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 2 | GARY SHORE AND BILL JOHNSON HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. IT WAS REVIEWED IN DETAIL BY THE AUDIT AND COMPLIANCE COMMITTEE AND PRESENTED TO THE FULL BOARD DURING THE AUDIT AND COMPLIANCE REPORT. THE FULL BOARD RECEIVED A COPY OF THE FORM 990 FOR THEIR REVIEW AND FOR ANY QUESTIONS. THE FULL BOARD VOTED FOR A FINAL APPROVAL OF THE FORM 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD ANNUALLY REVIEWS THE CONFLICT OF INTEREST STATEMENTS. MINUTES OF BOARD MEETINGS REFLECT ANY DECLARED CONFLICT OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION COMPLETES THE REBUTTABLE PRESUMPTION OF REASONABLENESS AS DESCRIBED IN TREASURY REGULATION 4958(6)(C) FOR EACH OFFICER AND KEY EMPLOYEE. THIS PROCESS IS PERFORMED BY AN OUTSIDE INDEPENDENT COMPENSATION SPECIALIST. THE CONSULTANT'S FINDINGS ARE PRESENTED TO THE HR COMMITTEE OF THE BOARD AND ARE ULTIMATELY APPROVED BY THE FULL BOARD. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ON GUIDESTAR.ORG. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. PLEASE USE THE ORGANIZATION'S "CONTACT US" LINK ON ITS WEBSITE FOR REQUESTS. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 818,090. | 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
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1890 | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581935514 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 7 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALDWELL MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GUARDIAN HEALTH SERVICE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 343 SECOND STREET | AddressLine1 |
| City | HICKORY | City |
| State | NC | State |
| ZIP Code | 28601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752950776 | EIN |
| Primary Activity | HOME HEALTHCARE | PrimaryActivity |
| Legal Domicile State | NC | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | -12673 | ShareOfTotalIncome |
| Share Of EOY Assets | 1895777 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALLMARK FAMILY PHYSICIANS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1766 CONNELLY SPRINGS ROAD | AddressLine1 |
| City | LENOIR | City |
| State | NC | State |
| ZIP Code | 28645 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202088324 | EIN |
| Primary Activity | PHYSICIAN PRACTICE | PrimaryActivity |
| Legal Domicile State | NC | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| CALDWELL MEMORIAL HOSPITAL FOUNDATION | ||
| C | 575973 | CASH |
| CALDWELL MEMORIAL HOSPITAL FOUNDATION | ||
| O | 186911 | ACTUAL COSTS |