ASHE MEMORIAL HOSPITAL INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ASHE MEMORIAL HOSPITAL INC (EIN 56-0603900)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-13
- IRS object ID
- 201222269349302212
- Schema version
- 2010v3.4
- 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 | 2012-08-13T14:30:34-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560603900 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITALINC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ASHE | NameControl |
| Phone | 3368467101 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RAYMOND D WILLIAMS | Name |
| Title | CEO | Title |
| Phone | 3368467101 | Phone |
| Date Signed | 2012-08-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RAYMOND D WILLIAMS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 32488759 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.ASHEMEMORIAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1939 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | ACUTE HOSPITAL CARE SERVICES PROVIDED TO THE RESIDENTS OF ASHE COUNTY, NC AND SURROUNDING AREA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 18 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 356 | TotalNbrEmployees |
| Total Nbr Volunteers | 61 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1262909 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 976258 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 30099449 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 31277161 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 31284 | InvestmentIncomePriorYear |
| Investment Income Current Year | 19446 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 579397 | OtherRevenuePriorYear |
| Other Revenue Current Year | 212723 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 31973039 | TotalRevenuePriorYear |
| Total Revenue Current Year | 32485588 | 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 | 16267441 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 16889710 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 213874 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 14756722 | OtherExpensePriorYear |
| Other Expenses Current Year | 16232833 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 31024163 | TotalExpensesPriorYear |
| Total Expenses Current Year | 33122543 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 948876 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -636955 | RevenuesLessExpensesCY |
| Total Assets BOY | 15301324 | TotalAssetsBOY |
| Total Assets EOY | 18588566 | TotalAssetsEOY |
| Total Liabilities BOY | 7191263 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10342629 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8110061 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8245937 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | ASHE MEMORIAL HOSPITAL'S MISSION STATEMENT IS ICARE, WHICH STANDS FOR INVESTMENT IN THE DEVELOPMENT OF PEOPLE, COMMITMENT TO CONTINUOUS IMPROVEMENT, ACCOUNTABILITY TO THOSE WE SERVE, RESPONSIVENESS TO THE HEALTH CARE NEEDS OF THE COMMUNITY, AND EXCELLENCE IN PRIMARY HEALTH CARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 30266491 | Expense |
| Revenue | 31277161 | Revenue |
| Description | ASHE MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF ASHE COUNTY AND THE SURROUNDING AREAS.RECENT PROJECTS COMPLETED THAT IMPROVED THE FACILITY AND THE SERVICES OFFERED TO THE COMMUNITY INCLUDED: (1) A NEW BUILDING COMPLETED ON THE CAMPUS OF ASHE MEMORIAL HOSPITAL, INC. TO HOUSE MOUNTAIN FAMILY CARE CENTER, OUR HOSPITAL-BASED RURAL HEALTH CLINIC, (2) ENHANCEMENTS AND ADDITIONS OF SOFTWARE TO ACHIEVE "MEANINGFUL USE" IN THE ELECTRONIC HEALTH RECORD PROJECT, (3) RENOVATION OF OFFICE SPACE THAT IS OCCUPIED BY MOUNT JEFFERSON FAMILY MEDICINE IN THE HOSPITAL-OWNED PHYSICIAN BUILDING, (4) NEW HOSPITAL-OWNED OB/GYN PRACTICE OPENED IN AN AREA WITHIN 3 MILES OF THE HOSPITAL, (5) NEW MEDICAL EQUIPMENT IN THE OPERATING ROOM AND FITNESS EQUIPMENT AT MOUNTAIN HEARTS, (6) NEW FURNITURE IN THE OUTPATIENT/EMERGENCY DEPARTMENT AREA, (7) ENHANCEMENT OF THE PHONE AND COMMUNICATIONS SYSTEM, AND (8) A FACELIFT TO THE CHAPEL LOCATED WITHIN THE HOSPITAL.THE HOSPITAL PROVIDED A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT AND OUTREACH TO THE COUNTY AND SURROUNDING AREAS. BENEFIT AND OUTREACH PROGRAMS ARE PROVIDED IN CONJUNCTION WITH THE ASHE COUNTY HEALTH COUNCIL AND INDEPENDENTLY THROUGH VARIOUS DEPARTMENTS AND SERVICES. OUR SIXTH COMMUNITY HEALTH FAIR WAS HELD DURING THE SUMMER. THIS PROJECT CONTINUES TO RECEIVE THE HIGHEST EVALUATION SCORES OF ANY SECTION OF THE BLUE RIDGE ELECTRIC ANNUAL MEETING. | Description |
| Total Program Service Expense | 30266491 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| 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 | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 49 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 356 | 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 | 18 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 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 | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOY R MCCLURE CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3368467101 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (30 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAMES G GAMBILL JR | |||||||
| PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| GALE HURLEY | |||||||
| VICE PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| DICK MILLER | |||||||
| VICE PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| TOM EFFORD | |||||||
| VICE PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| JAN CADDELL | |||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | |
| MARY ANN MOORE | |||||||
| SECERTARY | 2.00 | X | X | 0 | 0 | 0 | |
| DR CHARLES JONES | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| TIM VANNOY | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| BRADLEY MCNEILL | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| BRETT T SUMMEY DDS | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| EDWARD J MILLER MD | |||||||
| BOARD MEMBER | 2.00 | X | 18403 | 0 | 0 | ||
| HOBART DAVIS | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| TOMMY HOWELL | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| STEPHEN SHOEMAKER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JANE LONON | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| MICHAEL MINCEY | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| SUE HAMPTON | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| NANCY KAUTZ | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| WALTER E DAVIS MD | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JOE THORE | |||||||
| CHIEF OPERATING OFFICER | 40.00 | X | X | 92138 | 0 | 11971 | |
| SHERRY COX | |||||||
| CHIEF HUMAN RESOURCES OFFICER | 40.00 | X | 66764 | 0 | 13266 | ||
| JOY MCCLURE | |||||||
| CHIEF FINANCIAL OFFICER | 40.00 | X | 85480 | 0 | 14566 | ||
| JUDY DAVIS | |||||||
| COMPLIANCE OFFICER | 40.00 | X | 78661 | 0 | 10148 | ||
| SARA HOUSER | |||||||
| CHIEF NURSING OFFICER | 40.00 | X | 106052 | 0 | 13472 | ||
| RD WILLIAMS | |||||||
| CHIEF EXECUTIVE OFFICER | 40.00 | X | 168674 | 0 | 18600 | ||
| JAMES MICHAEL TAN | |||||||
| EMERGENCY DEPT PHYSICIAN | 45.00 | 275225 | 0 | 27799 | X | ||
| WILLIAM BLACKERBY | |||||||
| EMERGENCY DEPT PHYSICIAN | 39.00 | 246133 | 0 | 13204 | X | ||
| CB JONES JR | |||||||
| EMERGENCY DEPT PHYSICIAN ASSISTANT | 47.00 | 209013 | 0 | 22397 | X | ||
| MARK SCOTT | |||||||
| EMERGENCY DEPT PHYSICIAN ASSISTANT | 46.00 | 203924 | 0 | 19452 | X | ||
| STACI CHAMBERLAIN | |||||||
| HOSPITALIST PHYSICIAN | 40.00 | 188550 | 0 | 16218 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1739017 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 181093 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | 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 |
|---|---|---|---|---|---|
| RESTORE RESPIRATORY CARE INC | |||||
| 200 GALLERIA PARKWAY SUITE 1800 | ATLANTA | GA | 30339 | RESPIRATORY THERAPY SERVICES | 732202 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| PO BOX 96485 | CHICAGO | IL | 606936485 | MOBILE MRI SERVICES | 379395 |
| QUORUM HEALTH RESOURCES LLC | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 370271018 | HEALTHCARE MANAGEMENT SERVICES | 325267 |
| HERMITAGE ANESTHESIA | |||||
| PO BOX 1153 | JEFFERSON | NC | 28640 | ANESTHESIA SERVICES | 225996 |
| DEBORAH L SIDERS CRNA | |||||
| 200 HOSPITAL AVENUE | JEFFERSON | NC | 28640 | ANESTHESIA SERVICES | 216100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
| Related Organizations | 130697 | RelatedOrganizations |
| Government Grants | 240067 | GovernmentGrants |
| All Other Contributions | 605494 | AllOtherContributions |
| Total Contributions | 976258 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621400 | 30633603 | 30633603 |
| PHARMACY | 446110 | 356350 | 356350 |
| LIFELINE RENTALS | 900099 | 107070 | 107070 |
| FITNESS CENTER | 713940 | 102542 | 102542 |
| OTHER REVENUES | 900099 | 77596 | 77596 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 31277161 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22617 | TotalRevenueColumn |
| Exclusion | $22,617 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 109913 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 109913 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 109913 | TotalRevenueColumn |
| Exclusion | $109,913 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 3171 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -3171 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3171 | TotalRevenueColumn |
| Exclusion | -$3,171 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA & VENDING | 722210 | 173397 | $173,397 |
| INSURANCE REFUNDS/SETT | 900099 | 16681 | $16,681 |
| PURCHASE DISCOUNTS | 900099 | 2672 | $2,672 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -89940 | TotalRevenueColumn |
| Exclusion | -$89,940 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 102810 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32485588 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31277161 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $124,105 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1491966 | Total |
| Program Services | 596786 | ProgramServices |
| Management And General | 790742 | ManagementAndGeneral |
| Fundraising | 104438 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12290297 | Total |
| Program Services | 12038325 | ProgramServices |
| Management And General | 251972 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 372807 | Total |
| Program Services | 341777 | ProgramServices |
| Management And General | 28205 | ManagementAndGeneral |
| Fundraising | 2825 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1794589 | Total |
| Program Services | 1645218 | ProgramServices |
| Management And General | 135772 | ManagementAndGeneral |
| Fundraising | 13599 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 940051 | Total |
| Program Services | 861807 | ProgramServices |
| Management And General | 71121 | ManagementAndGeneral |
| Fundraising | 7123 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 114146 | Total |
| Management And General | 114146 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68584 | Total |
| Management And General | 68584 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49050 | Total |
| Management And General | 49050 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3025001 | Total |
| Program Services | 2798660 | ProgramServices |
| Management And General | 226341 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50775 | Total |
| Program Services | 10102 | ProgramServices |
| Management And General | 40165 | ManagementAndGeneral |
| Fundraising | 508 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5751548 | Total |
| Program Services | 5379030 | ProgramServices |
| Management And General | 347606 | ManagementAndGeneral |
| Fundraising | 24912 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 325927 | Total |
| Program Services | 37357 | ProgramServices |
| Management And General | 288570 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1011435 | Total |
| Program Services | 1011435 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86695 | Total |
| Program Services | 71136 | ProgramServices |
| Management And General | 15559 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 166869 | Total |
| Program Services | 166869 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1364328 | Total |
| Program Services | 1364328 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 310106 | Total |
| Program Services | 310106 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBTS | 3528016 | 3528016 | ||
| MISCELLANEOUS EXPENSES | 215075 | 105539 | 49067 | 60469 |
| RECRUITMENT | 165278 | 165278 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33122543 | Total |
| Program Services | 30266491 | ProgramServices |
| Management And General | 2642178 | ManagementAndGeneral |
| Fundraising | 213874 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1775020 | BOY |
| EOY | 1475185 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 407051 | BOY |
| EOY | 318633 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2180453 | BOY |
| EOY | 2806350 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 645162 | BOY |
| EOY | 609786 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 197225 | BOY |
| EOY | 126083 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 29969830 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 19276806 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8553105 | BOY |
| EOY | 10693024 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 515315 | BOY |
| EOY | 520187 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300072 | BOY |
| EOY | 1290365 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 727921 | BOY |
| EOY | 748953 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15301324 | BOY |
| EOY | 18588566 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4261323 | BOY |
| EOY | 6070650 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 326641 | BOY |
| EOY | 385335 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1915044 | BOY |
| EOY | 3833259 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 688255 | BOY |
| EOY | 53385 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7191263 | BOY |
| EOY | 10342629 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7973451 | BOY |
| EOY | 8001227 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136610 | BOY |
| EOY | 244710 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8110061 | BOY |
| EOY | 8245937 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15301324 | BOY |
| EOY | 18588566 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -636955 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 772831 | ReconcilationOtherChanges |
| 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 | $3,969 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 3969 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF OTHER LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1I: | ReturnReference |
| Explanation | THE ORGANIZATION IS A MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING EXPENDITURES ON BEHALF OF ITS MEMBERSHIP BODY. THE AMOUNT OF DUES ALLOCATED TO LOBBYING EXPENDITURES WAS $3,969. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 277913 | OtherCostOrOtherBasis |
| Book Value | 277913 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14979278 | OtherCostOrOtherBasis |
| Depreciation | 7757125 | Depreciation |
| Book Value | 7222153 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1099553 | OtherCostOrOtherBasis |
| Depreciation | 694941 | Depreciation |
| Book Value | 404612 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13580688 | OtherCostOrOtherBasis |
| Depreciation | 10824740 | Depreciation |
| Book Value | 2755948 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 32398 | OtherCostOrOtherBasis |
| Book Value | 32398 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10693024 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN HOME HEALTH PROJECT | 1145486 | C |
| DUE FROM FOUNDATION | 144879 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 1290365 | TotalOfBookValueProgramRelated |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | Description |
| Amount | $53,385 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 53385 | TotalOfAmounts |
| Total Revenue | 32485588 | TotalRevenue |
| Total Expenses | 33122543 | TotalExpenses |
| Excess Or Deficit For Year | -636955 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -403 | NetUnrealizedGLOnInvestments |
| Prior Period Adjustments | 1209210 | PriorPeriodAdjustments |
| Other | -$435,976 | OtherAmount |
| Total Adjustments | 772831 | TotalAdjustments |
| Excess Or Deficit Per FS | 135876 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 32488356 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -403 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -403 | RevenueNotRptdF990 |
| Revenue Subtotal | 32488759 | RevenueSubtotal |
| Other Revenues Not Included | -3171 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -3171 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 32485588 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 33561690 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 439147 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 439147 | ExpensesNotRptdF990 |
| Expenses Subtotal | 33122543 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 33122543 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2011 AND 2010. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2008, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | NET ASSETS RELEASED FROM RESTRICTION -435,976. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | LOSS ON SALE OF EQUIPMENT -3,171. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | LOSS ON SALE OF EQUIPMENT 3,171. NET ASSETS RELEASED FROM RESTRICTION 435,976. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| 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 | 615140 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 615140 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02080 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5105855 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4970961 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 134894 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00460 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 31291 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 31291 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5752286 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4970961 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 781325 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02650 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 42829 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 42829 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3681 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3681 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 46510 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 46510 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5798796 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4970961 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 827835 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02800 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 13739 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 13739 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 13739 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 13739 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,717,085 | BadDebtExpenseAmount |
| Amount Attributable To | 686830 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11693171 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12250503 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -557332 | 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 | ASHE MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | CRITICAL ACCESS HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA IN 2010 PER IRS ANNOUNCEMENT 2011-37 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| AMH SEGRAVES CARE CENTER | ||||
| 200 HOSPITAL AVENUE | JEFFERSON | NC | 28640 | SKILLED NURSING |
| MOUNTAIN FAMILY CARE CENTER | ||||
| 200 HOSPITAL AVENUE | JEFFERSON | NC | 28640 | RURAL HEALTH CLINIC |
| AMH ASHE WOMEN'S CENTER | ||||
| 200 HOSPITAL AVENUE | JEFFERSON | NC | 28640 | PHYSICIANS OFFICES |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT WAS PREPARED ON THE ORGANIZATION'S BEHALF WITH ASSISTANCE FROM THE NORTH CAROLINA HOSPITAL ASSOCIATION, AND THE FINAL REPORT WAS MADE AVAILABLE TO THE PUBLIC ON THE NCHA'S WEBSITE. | ||
| PART I, LINE 7: THE ORGANIZATION USED AN INTERNALLY-DERIVED RATIO OF COSTS TO CHARGES OF 48.67% TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID TREATMENTS AT COST. | ||
| PART I, L7 COL(F): THE AMOUNT ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $ 3,528,016 THAT HAS BEEN OMITTED FOR PURPOSES OF CALCULATING THE AMOUNT ON PART I, LINE 7, COL (F). | ||
| PART III, LINE 4: THE ORGANIZATION DID NOT HAVE A FOOTNOTE IN THE CURRENT AUDITED FINANCIALS THAT DESCRIBES BAD DEBT EXPENSE.THE ORGANIZATION USED AN INTERNALLY-DERIVED RATIO OF COSTS TO CHARGES OF 48.67% TO CALCULATE BAD DEBT AT COST.THE ORGANIZATION ESTIMATES THAT APPROXIMATELY 40% OF BAD DEBTS AT COST COULD BE ATTRIBUTABLE TO PATIENTS THAT COULD BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THIS ESTIMATE IS BASED ON EXPERIENCE AND HISTORICAL DATA. IN THE COMMUNITY WE SERVE, A NUMBER OF OLDER PATIENTS THAT FAIL TO QUALIFY FOR MEDICAID OR MEDICARE BENEFITS DECLINE TO PROVIDE THE FINANCIAL INFORMATION REQUIRED TO QUALIFY A PATIENT FOR OUR ASSISTANCE POLICY, IN ADDITION, THERE IS A GROWING DIFFICULTY IN OBTAINING THE INFORMATION FROM YOUNGER PATIENTS, DESPITE THE HOSPITAL'S BEST ATTEMPTS AT OBTAINING THIS INFORMATION. AS A RESULT, MANY UNPAID MEDICAL CHARGES ULTIMATELY END UP BEING CHARGED TO BAD DEBT DUE TO UNAVAILABLE INFORMATION IN THE CURRENT YEAR. | ||
| PART III, LINE 8: AMOUNTS REPORTED ON PART III, LINES 5 AND 6 ARE DERIVED FROM THE ORGANIZATION'S MEDICARE COST REPORT. | ||
| PART III, LINE 9B: WHEN A PATIENT HAS QUALIFIED FOR FINANCIAL ASSISTANCE BASED ON FINANCIAL STATUS, AND THERE IS A CO-PAY AMOUNT DUE AND PAYABLE BY THE PATIENT, THE AMOUNT DUE FROM THE PATIENT IS THE ONLY AMOUNT THAT MAY BE SENT OUT FOR COLLECTION. THE HOSPITAL UTILIZES A THIRD-PARTY SERVICE FOR THE MAJORITY OF ITS COLLECTIONS. THE REMAINDER OF THE BILL IS WRITTEN OFF TO CHARITY CARE. | ||
| THE HOSPITAL SUPPORTS THE ASHE HEALTHY CAROLINIANS TASK FORCE WHICH HAS BEEN INSTRUMENTAL IN THE ASSESSMENT AND PLANNING TO MEET COMMUNITY NEEDS FOR THE LAST 17 YEARS. SOME OF THE PROJECTS HAVE INCLUDED THE IMPLEMENTATION OF A SCHOOL BASED HEALTH CENTER IN OUR ONLY MIDDLE SCHOOL IN THE COUNTY, PROVIDING ACCESS TO CARE BY SUPPORT OF THE ASHE COUNTY FREE MEDICAL CLINIC, AND THE PRESENT DEVELOPMENT OF NETWORK TO ASSURE ACCESS TO CARE FOR THE UNINSURED AND UNDERINSURED IN THE COUNTY. | ||
| PART VI, LINE 2: THE HOSPITAL WORKS WITH THE APPALACHIAN DISTRICT HEALTH DEPARTMENT TO ASSESS COMMUNITY NEEDS, USING PRIMARY AND SECONDARY DATA EVERY THREE YEARS. IN ADDITION, THE ASHE HEALTHY CAROLINIANS ASSESSES COMMUNITY NEEDS INFORMALLY ON AN ONGOING BASIS USING OPINION SURVEYS AND SECONDARY DATA. IT PRESENTS THIS DATA ON A REGULAR BASIS TO THE COMMUNITY FOR PLANNING OF SERVICES BY LOCAL GOVERNMENT AND NON-PROFITS. | ||
| PART VI, LINE 3: THE HOSPITAL PRINTS INFORMATIONAL PACKETS AND SUPPORTS THE COMMUNITY OUTREACH DEPARTMENT TO EDUCATE THE PUBLIC ABOUT ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS AND THE HOSPITAL'S FINANCIAL ASSITANCE POLICY. THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS POSTED ON A PUBLIC WEB SITE MAINTAINED BY THE NORTH CAROLINA HOSPTIAL ASSOCIATION. ASHE MEMORIAL PROVIDES FISCAL AND SUPERVISORY MANAGEMENT FOR SEVERAL FEDERAL AND STATE PROGRAMS, INCLUDING THE ASHE/ALLEGHANY FARMWORKERS HEALTH PROGRAM, AND THE ASHE MEDICATION ASSISTANCE PROGRAM. IN ADDITION, IT PROVIDES OVERSIGHT AND FISCAL MANAGEMENT FOR AN ENDOWMENT FUND TO PROVIDE ASSISTANCE TO THOSE AFFECTED BY CANCER IN THE COMMUNITY.UNINSURED PATIENTS ARE INFORMED OF FINANCIAL ASSISTANCE AT REGISTRATION, DURING THE VISIT, AND UPON DISCHARGE. BOTH UNINSURED AND UNDER-INSURED PATIENTS RECEIVE INFORMATION ON THE BACK OF BILLING STATEMENTS OF FINANCIAL ASSISTANCE ROUTES THAT PATIENTS MAY TAKE IF THEY CANNOT PAY PART OR ALL OF THEIR BILL. STATEMENTS ARE SENT OUT BETWEEN 4 DAYS AFTER DISCHARGE AND/OR WITHIN A WEEK AFTER INSURANCE HAS ADJUDICATED THE CLAIM. THERE ARE ALSO SIGNS AND PLACARDS IN THE REGISTRATION AREA INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE. | ||
| PART VI, LINE 4: THE HOSPITAL SERVES ASHE COUNTY NORTH CAROLINA, AN ISOLATED, ECONOMICALLY DEPRESSED, RURAL COUNTY IN THE NORTHWEST MOUNTAINS OF NORTH CAROLINA. HAVING A POPULATION OF APPROXIMATELY 26,450 AND AN UNEMPLOYMENT RATE OF 12.3% IN 2010, IT CONTINUES TO EXPAND THE NUMBER OF PERSONS BELOW THE POVERTY RATE, WHICH IN 2010 WAS 20% OF THE POPULATION OF ASHE COUNTY, COMPARED TO THE STATE AVERAGE OF 17.4%. THE PER CAPITA PERSONAL INCOME IS $31,965, WELL BELOW THE STATE AVERAGE OF $43,417. ASHE MEMORIAL IS THE ONLY HOSPITAL IN ASHE COUNTY. | ||
| PART VI, LINE 6: THE ORGANIZATION EXTENDS PRIVILEDGES TO LOCAL PHYSICIANS AND MEDICAL STAFF IN MOST DEPARTMENTS OF THE HOSPITAL. THE ORGANIZATION'S GOVERNING BODY CONSISTS PRIMARILY OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE HOSPITAL. ASHE MEMORIAL HOSPITAL IS ORGANIZED AS A 501(C)(3) ORGANIZATION. THE INCOME GENERATED BY THE PROVISION OF SERVICES IS USED TO SUPPORT THE ONGOING OPERATIONS OF THE ORGANIZATION. ANY SURPLUS FUNDS GENERATED FROM OPERATIONS ARE UTILIZED TO FUND IMPROVEMENTS TO THE PHYSICAL PLANT AND TO SUPPORT THE PROVISION OF SERVICES TO INDIVIDUAL PATIENTS WHO ARE UNABLE TO PAY FOR THIER CARE.ASHE MEMORIAL HOSPITAL PROVIDES A MONTHLY OPPORTUNITY FOR THE PUBLIC TO HAVE THEIR BLOOD SUGAR AND CHOLESTEROL LEVELS CHECKED WITH A FASTING BLOOD DRAW. THE HOSPITAL CHARGES $20 FOR THIS SERVICE. THE SERVICE REQUIRES THE FOLLOWING FROM HOSPITAL STAFF: (1) MOUNTAIN HEARTS RECEPTIONIST - SETS APPOINTMENTS (2) LAB PHLEBOTOMIST - BLOOD DRAW (3) REGISTRATION CLERK - REGISTERS PATIENT IN THE HOSPITAL PATIENT SYSTEM (4) LAB TECH - RUNS THE TESTS (5) LAB TECH - PRINTS RESULTS AND MAILS TO PATIENT. THE RESULTING COST TO THE HOSPITAL IS $20.00 PER SCREENING. THE PROGRAM WAS DESIGNED TO BREAK EVEN IN ORDER TO PROVIDE THIS VALUABLE SERVICE AT AN AFFORDABLE COST.ASHE MEMORIAL HOSPITAL, IN CONJUNCTION WITH OUR JEFFERSONS ROTARY CLUB, PROVIDES AN ANNUAL OPPORTUNITY FOR THE MEN OF OUR COUNTY TO HAVE THEIR PSA TEST AND PROSTATE EXAM FREE OF CHARGE. THE SERVICE REQUIRES THE FOLLOWING FROM HOSPITAL STAFF: (1) COMMUNITY OUTREACH AND PUBLIC RELATIONS - ADVERTISING AND EDUCATION TO PUBLIC, (2) SCHEDULING DEPARTMENT - SETS APPOINTMENTS FOR BLOOD DRAW, (3) MOUNTAIN HEARTS RECEPTIONIST - SETS APPOINTMENT FOR EXAM, (4) LAB PHLEBOTOMIST - BLOOD DRAW, (5) REGISTRATION CLERK - REGISTERS PATIENT IN THE HOSPITAL PATIENT SYSTEM, (6) LAB TECH - RUNS THE TESTS, (7) COMMUNITY OUTREACH COORDINATOR - ENTERS DEMOGRAPHICS INTO TRACKING SYSTEM, (8) CEO AND CFO - MANAGE PATIENT AND CHART FLOW, (9) COMMUNITY OUTREACH COORDINATOR - ENTERS RESULTS INTO TRACKING SYSTEM, GENERATES AND MAILS RESULT LETTERS TO PATIENTS.DR. JAMES HAMBY DONATES HIS TIME TO CONSULT AND CONDUCT EXAMS.THE HOSPITAL SUPPORTS THE ASHE HEALTHY CAROLINIANS TASK FORCE WHICH HAS BEEN INSTRUMENTAL IN THE ASSESSMENT AND PLANNING TO MEET COMMUNITY NEEDS FOR THE LAST 18 YEARS. SOME OF THE PROJECTS HAVE INCLUDED THE IMPLEMENTATION OF A SCHOOL BASED HEALTH CENTER IN OUR ONLY MIDDLE SCHOOL IN THE COUNTY, PROVIDING ACCESS TO CARE BY SUPPORT OF THE ASHE COUNTY FREE MEDICAL CLINIC, AND THE PRESENT DEVELOPMENT OF NETWORK TO ASSURE ACCESS TO CARE FOR THE UNINSURED AND UNDERINSURED IN THE COUNTY. | ||
| PART VI, LINE 7: THE ORGANIZATION 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 | 0 | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RD WILLIAMS | |||||||||||||
| 161414 | 0 | 0 | 0 | 7260 | 0 | 5109 | 0 | 13491 | 0 | 187274 | 0 | 0 | 0 |
| JAMES MICHAEL TAN | |||||||||||||
| 275225 | 0 | 0 | 0 | 0 | 0 | 12315 | 0 | 15484 | 0 | 303024 | 0 | 0 | 0 |
| WILLIAM BLACKERBY | |||||||||||||
| 246133 | 0 | 0 | 0 | 0 | 0 | 4224 | 0 | 8980 | 0 | 259337 | 0 | 0 | 0 |
| CB JONES JR | |||||||||||||
| 209013 | 0 | 0 | 0 | 0 | 0 | 15522 | 0 | 6875 | 0 | 231410 | 0 | 0 | 0 |
| MARK SCOTT | |||||||||||||
| 203924 | 0 | 0 | 0 | 0 | 0 | 15141 | 0 | 4311 | 0 | 223376 | 0 | 0 | 0 |
| STACI CHAMBERLAIN | |||||||||||||
| 188550 | 0 | 0 | 0 | 0 | 0 | 9427 | 0 | 6791 | 0 | 204768 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | THE HOSPITAL PAYS FOR MEMBERSHIP DUES TO THE JEFFERSON ROTARY CLUB FOR CERTAIN KEY OFFICERS. THE PURPOSE OF THE ROTARY CLUB IS TO BRING TOGETHER BUSINESS AND PROFESSIONAL LEADERS TO PROVIDE HUMANITARIAN SERVICE, ENCOURAGE HIGH ETHICAL STANDARDS IN ALL VOCATIONS, AND HELP BUILD GOODWILL AND PEACE IN THE WORLD. AMOUNTS ARE BILLED DIRECTLY TO THE ORGANIZATION. THE HOSPITAL ALSO PAYS DUES TO JEFFERSON LANDING GOLF CLUB FOR CERTAIN KEY OFFICERS. ALL INVOICES ARE PAID DIRECTLY BY THE ORGANIZAITON. | |
| PART III | COMPENSATION FROM AN UNRELATED ORGANIZATION (SEE FORM 990, PART VII, LINE 5): RAYMOND D. WILLIAMS IS COMPENSATED THROUGH QUORUM HEALTH RESOURCES, LLC, AN UNRELATED ORGANIZATION, FOR HIS SERVICES AS CEO OF THE HOSPITAL. PLEASE SEE THE RESPONSE TO FORM 990, PART VI, LINE 15A FOR MORE DETAILS. | SUPPLEMENTAL INFORMATION |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SARA HOUSER | NamePerson |
| Purpose Of Loan | ACCUMULATED STUDENT LOAN, TO BE PAID BACK THROUGH EMPLOYMENT | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $8,017 | OriginalPrincipalAmount |
| Balance Due | 23269 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 23269 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| DRAGO PROPERTIES LLC | |||
| OWNED BY OFFICER JOE THORE | 23700 | RENTAL PAYMENTS FOR STORAGE SPACE | 0 |
| JMG ENERGY SOLUTIONS INC | |||
| OWNED AND OPERATED BY FAMILY MEMBER OF BOARD MEMBER JAMES GAMBILL | 196530 | PURCHASE OF FUEL, OIL, AND ENERGY SERVICES | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | BOARD MEMBERS RICHARD MILLER AND JOE THORE HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE CEO OF THE HOSPITAL IS CONTRACTED FOR HIS SERVICE THROUGH QUORUM HEALTH RESOURCES, LLC (QHR) BY THE BOARD OF TRUSTEES. SEE THE RESPONSE TO PART VI, LINE 15A FOR FURTHER DETAILS. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE HOSPITAL IS ORGANIZED AS A STOCK CORPORATION, AND SHARES OF STOCK ARE SOLD TO MEMBERS OF THE COMMUNITY AND ARE FREELY TRANSFERABLE, BUT HAVE NO CAPITAL VALUE. SHAREHOLDERS DO NOT RECEIVE DIVIDENDS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | TRUSTEES SHALL BE ELECTED BY THE SHAREHOLDERS OF THE CORPORATION AT THE ANNUAL MEETING OF THE MEMBERSHIP. EACH SELECTED TRUSTEE SHALL HOLD OFFICE FOR A TERM OF THREE YEARS AND UNTIL HIS SUCCESSOR IS SELECTED AND QUALIFIED. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ORGANIZATION CANNOT SELL REAL PROPERTY WITHOUT APPROVAL BY THE SHAREHOLDERS. PLEASE SEE THE RESPONSE TO LINE 6 ABOVE. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. PRIOR TO SUBMISSION TO THE IRS, THE BOARD PLANNING AND FINANCE COMMITTEE REVIEWED THE RETURN AND MADE RECOMMENDATIONS FOR APPROVAL TO THE FULL BOARD. THE FULL BOARD OF TRUSTEES AUTHORIZED THE RETURN FOR SUBMISSION TO THE IRS. | |
| ALL VOTING BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST SURVEY AND RETURN TO THE BOARD CHAIRMAN. THE SURVEY INCLUDES A DISCLOSURE STATEMENT AND A REVIEW OF THE POLICY. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE HOSPITAL CEO IS AN EMPLOYEE THROUGH CONTRACT MANAGEMENT SERVICE QUORUM HEALTH RESOURCES, LLC (QHR), AN UNRELATED CORPORATION. QHR PROVIDES COMPARATIVE SALARY RANGES FROM UP TO THREE SOURCES OF HOSPITALS OF SIMILAR NET REVENUES AND RECOMMENDS TO THE BOARD OF TRUSTEES ANY SALARY ADJUSTMENT FOR THE CEO. APPROVAL BY THE BOARD IS REQUIRED. FOR OTHER KEY EMPLOYEES, THERE IS A REVIEW PROCESS ANNUALLY BY THE CHIEF HUMAN RESOURCES OFFICER USING THE NORTH CAROLINA HEALTHCARE HUMAN RESOURCES ASSOCIATION COMPENSATION AND BENEFITS SURVEY. BASE RATES ARE COMPARED TO THE SURVEY RESULTS, INCORPORATED INTO THE BUDGET BY THE CEO, CFO, AND CHRO, AND SUBMITTED FOR BOARD APPROVAL. | FORM 990, PART VI, SECTION B, LINE 15 | |
| 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 ONLINE AT GUIDESTAR.ORG, A NON-PROFIT WEBSITE. | FORM 990, PART VI, SECTION C, LINE 18 | |
| PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, THE HOSPITAL WIDELY DISTRIBUTES AN ANNUAL REPORT TO THE COMMUNITY. PLEASE CONTACT THE ADMINISTRATIVE OFFICE FOR FURTHER DETAILS. SEE FORM 990, PART VI, LINE 20. | FORM 990, PART VI, SECTION C, LINE 19 | |
| AVERAGE HOURS WORKED FOR RELATED ORGANIZATIONS: | BOARD MEMBER AND OFFICER JOE THORE WORKED AN AVERAGE OF 5 HOURS PER WEEK FOR ASHE MEMORIAL FOUNDATION, A RELATED ORGANIZATION. | FORM 990, PART VII, LINE 1: |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED LOSSES ON INVESTMENTS: -403. PRIOR PERIOD ADJUSTMENTS: 1,209,210. NET ASSETS RELEASED FROM RESTRICTION -435,976. TOTAL TO FORM 990, PART XI, LINE 5: 772,831. | FORM 990, PART XI, LINE 5: |
| BOARD MEMBER COMPENSATION: | ASHE MEMORIAL HOSPITAL DOES NOT COMPENSATE MEMBERS FOR THEIR SERVICE AS DIRECTORS OF THE BOARD. ALL COMPENSATION LISTED ON PART VII, LINE 1, COLUMN (D) FOR BOARD MEMBERS WAS PAID FOR VARIOUS MEDICAL SERVICES RENDERED TO THE ORGANIZATION. | FORM 990, PART VII, LINE 1: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMH ASHE WOMEN'S CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVENUE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 451482188 | EIN |
| Primary Activities | PHYSICIANS PRACTICE | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Total Income | 97650 | TotalIncome |
| EOY Assets | 147120 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HOSPITAL AVE | AddressLine1 |
| City | JEFFERSON | City |
| State | NC | State |
| ZIP Code | 28640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582078244 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11A | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 0 | ControlledOrg |
| 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 | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHE MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 130697 | AmountInvolved |