THE OUTER BANK HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- THE OUTER BANK HOSPITAL INC (EIN 56-2112733)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-05-14
- IRS object ID
- 201331349349300233
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-14T07:52:44-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 N TRYON STREET SUITE 1000 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 562112733 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE OUTER BANKS HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | OUTE | NameControl |
| Phone | 2528475129 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2100 STANTONSBURG ROAD | AddressLine1 |
| City | GREENVILLE | City |
| State | NC | State |
| ZIP Code | 27835 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID HUGHES | Name |
| Title | SECRETARY/TREASURER | Title |
| Phone | 2524494500 | Phone |
| Date Signed | 2013-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN NORMAN | Name |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 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 | RONALD SLOAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2100 STANTONSBURG ROAD | AddressLine1 |
| City | GREENVILLE | City |
| State | NC | State |
| ZIP Code | 27835 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 50024707 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.VIDANTHEALTH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE A WIDE RANGE OF QUALITY SERVICES TO THE RESIDENTS AND VISITORS OF THE OUTER BANKS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 367 | TotalNbrEmployees |
| Total Nbr Volunteers | 41 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 48733785 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 49887752 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 52862 | InvestmentIncomePriorYear |
| Investment Income Current Year | 62754 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 69274 | OtherRevenuePriorYear |
| Other Revenue Current Year | 74201 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 48855921 | TotalRevenuePriorYear |
| Total Revenue Current Year | 50024707 | 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 | 19226039 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 19682933 | 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 | 19726938 | OtherExpensePriorYear |
| Other Expenses Current Year | 20946321 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 38952977 | TotalExpensesPriorYear |
| Total Expenses Current Year | 40629254 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 9902944 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 9395453 | RevenuesLessExpensesCY |
| Total Assets BOY | 59742470 | TotalAssetsBOY |
| Total Assets EOY | 60754128 | TotalAssetsEOY |
| Total Liabilities BOY | 5157270 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6273475 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 54585200 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 54480653 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO ENHANCE THE QUALITY OF LIFE FOR THE RESIDENTS & VISITORS OF DARE COUNTY & THE SURROUNDING REGION BY PROMOTING WELLNESS & PROVIDING THE HIGHEST QUALITY HEALTHCARE SERVICE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 26647393 | Expense |
| Revenue | 37884481 | Revenue |
| Description | OUTPATIENT AND EMERGENCY SERVICES:PROVIDED EMERGENCY SERVICES TO 23,871 PATIENTS 24 HOURS A DAY FOR 365 DAYS. PROVIDED OUTPATIENT DIAGNOSTIC AND THERAPEUTIC SERVICES TO 19,268 PATIENTS. PERFORMED 1,759 OUTPATIENT SURGICAL PROCEDURES. PROVIDED A PHYSICIAN CLINIC STAFFED WITH 6 PHYSICIANS THAT CARED FOR 19,268 PATIENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 7998336 | Expense |
| Revenue | 11371200 | Revenue |
| Description | INPATIENT SERVICES:PROVIDED INPATIENT CARE 24 HOURS A DAY FOR 365 DAYS TO 1,390 PATIENTS. DELIVERED 404 BABIES. PERFORMED 486 INPATIENT SURGICAL PROCEDURES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 34645729 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | 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 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 367 | 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | 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 |
| Own Website | X | OwnWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TODD WARLITNER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2528475129 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2100 STANTONSBURG ROAD | AddressLine1 |
| City | GREENVILLE | City |
| State | NC | State |
| ZIP Code | 27835 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| ROBERT OWENS | ||||||||
| CHAIRMAN | 4.00 | X | 0 | 0 | 0 | |||
| LINDA PALOMBO | ||||||||
| VICE CHAIRMAN | 4.00 | X | 0 | 0 | 0 | |||
| BEULAH CHARITY ASHBY | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| DR JEFF C HAMMER | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| ROGER ROBERTSON | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| TERRY WHEELER | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| WYNN DIXON | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| ERNEST LARKIN | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| JODY MIDGETTE | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| ARTHUR KENEY | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| STEVE RODRIGUEZ | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| BOB GUANCI | ||||||||
| BOARD DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| RONALD SLOAN | ||||||||
| PRESIDENT | 40.00 | 122104 | 0 | 24239 | X | |||
| TODD WARLITNER | ||||||||
| VP, BUSINESS OPERATIONS | 40.00 | 152736 | 0 | 41654 | X | |||
| GARY HUNTER | ||||||||
| PHYSICIAN | 40.00 | 390932 | 0 | 7977 | X | |||
| JENNIFER HALLORAN | ||||||||
| PHYSICIAN | 40.00 | 188258 | 0 | 13698 | X | |||
| DAVID THOMPSON | ||||||||
| PHYSICIAN | 40.00 | 219340 | 0 | 18884 | X | |||
| VERN METCALF | ||||||||
| PHYSICIAN | 40.00 | 276943 | 0 | 16058 | X | |||
| DAVID LUSTIG | ||||||||
| PHYSICIAN | 40.00 | 352300 | 0 | 1525 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1702613 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 124035 | TotalOtherCompensation |
| Number Individuals GT100 K | 15 | 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 |
|---|---|---|---|---|---|
| GE MEDICAL SYSTEMS | |||||
| PO BOX 402076 | ATLANTA | GA | 303842076 | SERVICE CONTRACT | 385448 |
| AVIATION ANESTHESIA ASSOC INC | |||||
| 158 BATTLEFIELD COURT | MANTEO | NC | 27954 | PROVIDE CNAS | 325385 |
| OUTER BANKS ANESTHESIA PC | |||||
| 128 WEIR POINT DR | MANTEO | NC | 27954 | PROVIDE CNAS | 283380 |
| AUREUS RADIOLOGY LLC | |||||
| PO BOX 3037 | OMAHA | NE | 68103 | PROFESSIONAL SERVICES | 275529 |
| SHARED HOSPITAL SERVICES | |||||
| 3530 ELMHURST LANE | PORTSMOUTH | VA | 23701 | CONTRACT EMPLOYEES | 168011 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 49255681 | TotalRevenueColumn |
| Related Or Exempt Function Income | 49255681 | RelatedOrExemptFunctionIncome |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 632071 | TotalRevenueColumn |
| Related Or Exempt Function Income | 632071 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 49887752 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 62754 | TotalRevenueColumn |
| Exclusion | $62,754 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAFETERIA MEALS | Description |
| Business Code | 722210 | BusinessCode |
| Total Revenue Column | 74201 | TotalRevenueColumn |
| Exclusion | $74,201 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 74201 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 50024707 | TotalRevenueColumn |
| Related Or Exempt Function Income | 49887752 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $136,955 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16056772 | Total |
| Program Services | 15345782 | ProgramServices |
| Management And General | 710990 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 539949 | Total |
| Program Services | 531417 | ProgramServices |
| Management And General | 8532 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1995611 | Total |
| Program Services | 1925223 | ProgramServices |
| Management And General | 70388 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1090601 | Total |
| Program Services | 1035144 | ProgramServices |
| Management And General | 55457 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3814615 | Total |
| Management And General | 3814615 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22772 | Total |
| Management And General | 22772 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18268 | Total |
| Management And General | 18268 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4139809 | Total |
| Program Services | 3138884 | ProgramServices |
| Management And General | 1000925 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 136118 | Total |
| Management And General | 136118 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3076001 | Total |
| Program Services | 3076001 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11377 | Total |
| Program Services | 11377 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 880768 | Total |
| Program Services | 880768 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 223184 | Total |
| Program Services | 223184 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 564987 | Total |
| Program Services | 564987 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2420507 | Total |
| Program Services | 2420507 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 517899 | Total |
| Program Services | 517899 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| CHARGEABLE SUPPLIES | 4935803 | 4935803 | |
| RECRUITMENT | 155987 | 38753 | 117234 |
| NON OPERATING | 28226 | 28226 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40629254 | Total |
| Program Services | 34645729 | ProgramServices |
| Management And General | 5983525 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4564646 | BOY |
| EOY | 5001596 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8493586 | BOY |
| EOY | 8203952 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 949673 | BOY |
| EOY | 1028991 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 266669 | BOY |
| EOY | 175039 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 40741805 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 22339274 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19934489 | BOY |
| EOY | 18402531 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23173997 | BOY |
| EOY | 25789275 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2359410 | BOY |
| EOY | 2152744 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59742470 | BOY |
| EOY | 60754128 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4027978 | BOY |
| EOY | 4561626 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1129292 | BOY |
| EOY | 1711849 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5157270 | BOY |
| EOY | 6273475 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54585200 | BOY |
| EOY | 54480653 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54585200 | BOY |
| EOY | 54480653 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59742470 | BOY |
| EOY | 60754128 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 9395453 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -9500000 | 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 Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1694182 | OtherCostOrOtherBasis |
| Book Value | 1694182 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 28038964 | OtherCostOrOtherBasis |
| Depreciation | 14273816 | Depreciation |
| Book Value | 13765148 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11000091 | OtherCostOrOtherBasis |
| Depreciation | 8065458 | Depreciation |
| Book Value | 2934633 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8568 | OtherCostOrOtherBasis |
| Book Value | 8568 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 18402531 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENTS | Description |
| Book Value | 25789275 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 25789275 | TotalOfBookValueProgramRelated |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD PARTY PAYORS | $1,420,849 |
| RESERVE FOR PROFESSIONAL LIABILITY LOSSES | $291,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1711849 | TotalOfAmounts |
| Total Revenue | 50024707 | TotalRevenue |
| Total Expenses | 40629254 | TotalExpenses |
| Excess Or Deficit For Year | 9395453 | ExcessOrDeficitForYear |
| Other | -$9,500,000 | OtherAmount |
| Total Adjustments | -9500000 | TotalAdjustments |
| Excess Or Deficit Per FS | -104547 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 50024707 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 50024707 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 50024707 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 40629254 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 40629254 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 40629254 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE OUTER BANKS HOSPITAL, INC. IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: CAPITAL CONTRIBUTIONS AND TRANSFERS WITH AFFILIATES NET -9,500,000 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| 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 | 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 | 1962083 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1962083 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04830 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4851033 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4851033 | DirectOffsettingRevenue |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6813116 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4851033 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1962083 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04830 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 16 | NumberOfActivitiesOrPrograms |
| Persons Served | 4105 | PersonsServed |
| Total Community Benefit Expense | 546100 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12260 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 533840 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01310 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 59 | PersonsServed |
| Total Community Benefit Expense | 53738 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 53738 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 7528 | PersonsServed |
| Total Community Benefit Expense | 179216 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 179216 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00440 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 27 | NumberOfActivitiesOrPrograms |
| Persons Served | 11692 | PersonsServed |
| Total Community Benefit Expense | 779054 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12260 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 766794 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01880 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 27 | NumberOfActivitiesOrPrograms |
| Persons Served | 11692 | PersonsServed |
| Total Community Benefit Expense | 7592170 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4863293 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2728877 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06710 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 1440 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1440 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 12777 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 12777 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 20 | PersonsServed |
| Total Community Building Expense | 22604 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 22604 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 318 | PersonsServed |
| Total Community Building Expense | 5947 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5947 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Total Community Building Expense | 2260 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2260 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 5 | NumberOfActivitiesOrPrograms |
| Persons Served | 338 | PersonsServed |
| Total Community Building Expense | 45028 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 45028 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,544,272 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 13825376 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11862495 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1962881 | 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 |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership |
|---|---|
| 1 THE OUTER BANKS HOSPITAL MEDICAL OFFICE BUILDING LLC | |
| HEALTHCARE | 1.00000 |
| 2 OUTER BANKS PROFESSIONAL SERVICES LLC | |
| HEALTHCARE | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | THE OUTER BANKS HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4800 SOUTH CROATAN HIGHWAY | AddressLine1 |
| City | NAGS HEAD | City |
| State | NC | State |
| ZIP Code | 27959 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE OUTER BANKS HOSPITAL INC | 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 | 200.000000000000 | 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 |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (22 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: CHARITY CARE IS DETERMINED BASED UPON MEETING 200% OF FEDERAL POVERTY GUIDELINES AND HAVING LIMITED ASSETS OTHER THAN A HOME. DISCOUNTS ARE ALSO PROVIDED FOR ANY PATIENTS WITHOUT INSURANCE, REGARDLESS OF INCOME LEVELS. | ||
| PART I, LINE 6A: IN ADDITION TO THE COMMUNITY BENEFIT REPORT FOR THE OUTER BANKS HOSPITAL, INFORMATION REGARDING THIS ENTITY IS FOUND IN THE ANNUAL REPORT FOR UNIVERSITY HEALTH SYSTEMS OF EASTERN CAROLINA. | ||
| PART II: SEE SCHEDULE O. | ||
| PART III, LINE 4: LINE 2 COSTS WERE CALCULATED USING THE ESTIMATED COST TO CHARGE RATIO FROM THE MEDICARE COST REPORT. | ||
| PART III, LINE 8: ANY SHORTFALL OF MEDICARE REVENUE TO MEDICARE ALLOWABLE COSTS OF CARE COULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE IN THE AREA SERVED BY THE ORGANIZATION OTHER PROVIDERS WOULD NOT BE AVAILABLE TO PROVIDE THE SERVICES REQUIRED. THEREFORE, THE CARE WOULD BECOME A GOVERNMENT OBLIGATION. | ||
| PART III, LINE 9B: RECOMMENDED PATIENT ACCOUNTS WILL CONTINUE TO GO THROUGH THE ACCOUNTS RECEIVABLE BILLING CYCLE AS NORMAL. WHEN THE ACCOUNT REACHES THE CUSTOMER SERVICE/COLLECTIONS MANAGER, SUPERVISOR FINANCIAL COUNSELING OR PATIENT ACCOUNTS SUPERVISOR, BASED ON THE INFORMATION GIVEN, A DECISION WILL BE MADE WHETHER TO PROCEED WITH COLLECTION OR REFER THE ACCOUNT FOR APPROVAL OF CHARITY CARE. THE PROCESS WILL OCCUR AS FOLLOWS: I. FINANCIAL COUNSELORS WILL TRY TO LOCATE THIRD PARTY PAYORS. IF NOT ELIGIBLE FOR ANY THIRD PARTY COVERAGE (INCLUDING CHARITIES), THEY MAY, BASED UPON THE FINANCIAL INFORMATION RECEIVED, RECOMMEND THE PATIENT FOR CHARITY CARE.II. PATIENT COUNSELORS WILL REVIEW FOR ANY THIRD PARTY PAYORS AND VERIFY EMPLOYMENT AND ASSETS. A CHARITY CARE APPLICATION WILL NEED TO BE COMPLETED ALONG WITH TAX RETURN, PAY STUBS, SOCIAL SECURITY AWARD LETTER AND OTHER FINANCIAL INFORMATION AS MAY BE REQUIRED. III. THE PATIENT ACCOUNTS SUPERVISOR, SUPERVISOR FINANCIAL COUNSELING OR CUSTOMER SERVICE/COLLECTIONS MANAGER, BASED UPON ACCOUNT BALANCE AND THE INFORMATION GIVEN, WILL MAKE A DECISION WHETHER TO PROCEED WITH COLLECTION OR REFER THE PATIENT ACCOUNT FOR APPROVAL FOR CHARITY CARE.PRESUMPTIVE ELIGIBILITY FOR CHARITY CARE THERE ARE OCCASIONS IN WHICH A PATIENT MAY APPEAR ELIGIBLE FOR A CHARITY CARE DISCOUNT, BUT THERE IS NO FINANCIAL ASSISTANCE INFORMATION AVAILABLE TO SUPPORT FINANCIAL AID.A. SOME PATIENTS ARE PRESUMED TO BE ELIGIBLE FOR CHARITY CARE DISCOUNTS ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES (E.G., HOMELESSNESS, PATIENTS WITH NO INCOME, BANKRUPTCY, DECEASED PATIENTS WITH NO ESTATE OR SPOUSE, ETC).B. THROUGH THE ASSISTANCE OF A THIRD PARTY VENDOR AND CERTAIN ALGORITHMS, IN CONJUNCTION WITH OUR CHARITY POLICY GUIDELINES, ALL ACCOUNTS PRIOR TO OUTSIDE COLLECTION AGENCY REFERRAL WILL BE TESTED FOR PRESUMPTIVE CHARITY. C. THE ACCOUNTS DEEMED CHARITY WILL BE ADJUSTED OFF AND THE REMAINING ACCOUNTS WILL BE REFERRED TO AN OUTSIDE COLLECTION AGENCY. D. ONCE THE AGENCY HAS HAD THE ACCOUNTS FOR SIX MONTHS AND HAS DEEMED THEM UNCOLLECTIBLE, THE ACCOUNTS WITH BALANCES $1,200.00 AND LESS WILL BE RETURNED TO THE HOSPITAL AND REMOVED FROM THE PATIENTS CREDIT FILE. ACCOUNTS WITH BALANCES ABOVE $1,200.00 WILL REMAIN WITH THE AGENCY AND KEPT ON THE PATIENTS CREDIT FILE. E. THE ACCOUNTS RETURNED TO THE HOSPITAL WILL BE PLACED IN A UNIQUE FINANCIAL CLASS AND WILL NOT BE PURSUED FOR COLLECTIONS. | ||
| PART V, SECTION B, LINE 11H: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 13G: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 15E: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 16E: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 17E: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 18C: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 18D: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 19D: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 20: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART V, SECTION B, LINE 21: N/A | THE OUTER BANKS HOSPITAL, INC. | |
| PART VI, LINE 2: THE ORGANIZATION ASSESSES COMMUNITY NEED IN CONJUNCTION WITH THE STATE AFFILIATED COUNTY HEALTH DEPARTMENTS AND OTHER LOCAL HEALTH CARE ORGANIZATIONS. SEE ALSO SCHEDULE O. | ||
| PART VI, LINE 3: INFORMATION IS AVAILABLE ON THE ORGANIZATION'S WEBSITE AND AT REGISTRATION FOR PATIENTS. IN ADDITION, FACE TO FACE FINANCIAL COUNSELING IS AVAILABLE TO PATIENTS AND THEIR FAMILIES IN THE CENTRAL BUSINESS OFFICE. | ||
| PART VI, LINE 4: SEE SCHEDULE O. | ||
| PART VI, LINE 5: SEE SCHEDULE O. | ||
| PART VI, LINE 6: SEE SCHEDULE O. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TODD WARLITNER | |||||||||||||
| 139424 | 0 | 13312 | 0 | 0 | 0 | 30274 | 0 | 11380 | 0 | 194390 | 0 | 0 | 0 |
| GARY HUNTER | |||||||||||||
| 390932 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 7977 | 0 | 398909 | 0 | 0 | 0 |
| JENNIFER HALLORAN | |||||||||||||
| 188258 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 13698 | 0 | 201956 | 0 | 0 | 0 |
| DAVID THOMPSON | |||||||||||||
| 219340 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 18884 | 0 | 238224 | 0 | 0 | 0 |
| VERN METCALF | |||||||||||||
| 276943 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16058 | 0 | 293001 | 0 | 0 | 0 |
| DAVID LUSTIG | |||||||||||||
| 352300 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1525 | 0 | 353825 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | RONALD SLOAN WAS COMPENSATED BY UNIVERSITY HEALTH SYSTEMS OF EAST CAROLINA, INC. (D/B/A VIDANT HEALTH) FOR SERVICES RENDERED IN HIS CAPACITY AS PRESIDENT OF THE OUTER BANKS HOSPITAL, INC. VIDANT HEALTH IS AN UNRELATED ORGANIZATION TO THE OUTER BANKS HOSPITAL. RONALD SLOAN'S COMPENSATION IS BROKEN OUT AS FOLLOWS: BASE COMPENSATION $101,800 BONUS & INCENTIVE $ 13,000 OTHER REPORTABLE COMPENSATION $ 7,304 DEFERRED COMPENSATION $ 23,480 NON-TAXABLE BENEFITS $ 759 TOTAL COMPENSATION $146,343 | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ACCORDING TO THE ORGANIZATION'S AMENDED AND RESTATED BYLAWS, ARTICLE II, THE ORGANIZATION HAS TWO MEMBERS, EAST CAROLINA HEALTH AND CHESAPEAKE HOSPITAL AUTHORITY. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS ELECT THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING ACTIONS SHALL NOT BE TAKEN WITHOUT UNANIMOUS CONSENT OF THE MEMBERS: POSSESS PROPERTY, INVEST FUNDS, ADDITIONAL CAPITAL CONTRIBUTIONS, ADMIT MEMBERS, MERGER OR DISSOLUTION, AMENDMENT, CON LITIGATION, SALE OF ASSETS, BUSINESS OF CORPORATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT FORM 990 WILL BE REVIEWED BY THE PRESIDENT AND THE VP OF BUSINESS OPERATIONS BEFORE IT IS FILED WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICTS OF INTEREST ARE REQUIRED TO BE SUBMITTED ANNUALLY. THESE SUBMISSIONS ARE REVIEWED BY LEGAL COUNSEL AGAINST CORPORATE COMPLIANCE POLICIES. WHEN A CONFLICT ARISES, THE MEMBER OF THE GOVERNING BODY IS RECUSED FROM VOTING. | |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION IS DETERMINED BY THE BOARD IN CONSULTATION WITH THE MEMBERS, CONSIDERING THE PERFORMANCE AND PREVAILING MARKET RATES. THIS PROCESS WAS LAST PERFORMED IN 2010. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VII, SECTION B, LINE 1: | COMBINED FORMS 1099 WERE ISSUED BY THE VIDANT HEALTH SYSTEM TO THE INDEPENDENT CONTRACTORS. THE REPORTED COMPENSATION ON PART VII INCLUDES ONLY THOSE AMOUNTS PAID DIRECTLY BY THE OUTER BANKS HOSPITAL. | |
| FORM 990, PART XI, LINE 5: | CAPITAL CONTRIBUTIONS AND TRANSFERS WITH AFFILIATES NET -9,500,000. TOTAL TO FORM 990, PART XI, LINE 5: -9,500,000. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | NO CHANGE IN METHOD FROM PRIOR YEAR |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| OUTER BANKS PROFESSIONAL SVC LLC | |||||||||
| 604 AMANDA ST | MANTEO | NC | 27954 | 270484506 | FAMILY PRACTICE | NC | 425672 | 4314511 | N/A |
| OUTER BANKS MEDICAL OFFICE BUILDING LLC | |||||||||
| 4810 S CROATAN HWY | NAGS HEAD | NC | 27959 | 161740979 | MED OFFICE BLDG | NC | 757875 | 847779 | N/A |
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| EAST CAROLINA HEALTH INC | ||||||||||
| 2100 STANTONSBURG ROAD | GREENVILLE | NC | 27835 | 911997979 | HEALTHCARE | NC | 501(C)(3) | 509(A)(3) | N/A | 0 |
| EAST CAROLINA HEALTH INC | ||||||||||
| 2100 STANTONSBURG ROAD | GREENVILLE | NC | 27835 | 562003393 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | N/A | 0 |
| CHESAPEAKE HOSPITAL AUTHORITY | ||||||||||
| 736 N BATTLEFIELD BLVD | CHESAPEAKE | VA | 23320 | 237133975 | HEALTHCARE | VA | 501(C)(3) | N/A | N/A | 0 |
| 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 | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | 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 | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| EAST CAROLINA HEALTH INC | ||
| Q | 5700000 | ACTUAL CASH PAYMENT |
| CHESAPEAKE HOSPITAL AUTHORITY | ||
| Q | 3800000 | ACTUAL CASH PAYMENT |