GASTON MEMORIAL HOSPITAL INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- GASTON MEMORIAL HOSPITAL INC (EIN 56-0619359)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-04-06
- IRS object ID
- 201110969349300551
- Schema version
- 2009v1.7
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-04-06T08:44:03-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES PLLC | 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 | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560619359 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GASTON MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GAST | NameControl |
| Phone | 7048342000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 280531747 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID O'CONNOR | Name |
| Title | CFO | Title |
| Phone | 7048342000 | Phone |
| Date Signed | 2011-03-30 | 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 | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID O'CONNOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 280531747 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 383769132 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.CAROMONT.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | To provide exceptional health care to the communities we serve. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3091 | TotalNbrEmployees |
| Total Nbr Volunteers | 192 | TotalNbrVolunteers |
| Total Gross UBI | 925418 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 140661 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 455641 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 373678 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 363285894 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 378127914 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 104775 | InvestmentIncomePriorYear |
| Investment Income Current Year | 112375 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 4408753 | OtherRevenuePriorYear |
| Other Revenue Current Year | 5155165 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 368255063 | TotalRevenuePriorYear |
| Total Revenue Current Year | 383769132 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 42500 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 88799 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 158413435 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 157119443 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 189145978 | OtherExpensePriorYear |
| Other Expenses Current Year | 200992995 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 347601913 | TotalExpensesPriorYear |
| Total Expenses Current Year | 358201237 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 20653150 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 25567895 | RevenuesLessExpensesCY |
| Total Assets BOY | 296184905 | TotalAssetsBOY |
| Total Assets EOY | 324420647 | TotalAssetsEOY |
| Total Liabilities BOY | 314205955 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 314318521 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -18021050 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10102126 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide exceptional healthcare to the communities we serve. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 337036111 | Expense |
| Grants | 88799 | Grants |
| Revenue | 378216050 | Revenue |
| Description | CAROMONT HEALTH PROVIDES INPATIENT, OUTPATIENT, EMERGENCY, AND SURGICAL SERVICES TO THE RESIDENTS OF GASTON COUNTY AND SURROUNDING AREAS AT ITS 435-LICENSED BED HOSPITAL, GASTON MEMORIAL HOSPITAL. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS. | Description |
| Total Program Service Expense | 337036111 | 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 |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | 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 | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 288 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 3091 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| 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 | DAVID O'CONNOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7048342000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 28054 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (31 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 |
|---|---|---|---|---|---|---|---|---|
| James R Beam | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| H Spurgeon Mackie Jr | ||||||||
| Chairman | 1.00 | X | 0 | 0 | 0 | |||
| Dr Robert D Crouch | ||||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | |||
| Richard K Craig | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Mary Frances Forrester | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Kelvin C Harris MD | ||||||||
| Director | 1.00 | X | 0 | 225445 | 18524 | |||
| William K Gary Sr | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| James H Howard Jr | ||||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | |||
| Sheila S Reilly PhD | ||||||||
| Vice Chairman | 1.00 | X | 0 | 0 | 0 | |||
| Barry M Pomeroy | ||||||||
| Past Treasurer | 1.00 | X | 0 | 0 | 0 | |||
| Mickey Price | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Dr Kathy Drum | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| David Allen Smith | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Dr H Clayton Thomason III | ||||||||
| Chief-of-Staff | 1.00 | X | 27900 | 0 | 0 | |||
| Johnathan D Williams MD | ||||||||
| Past Chief-of-Staff | 1.00 | X | 30000 | 0 | 0 | |||
| Vincent Quinn | ||||||||
| Director | 1.00 | X | 0 | 0 | 0 | |||
| Robert H Blalock Jr | ||||||||
| Past Chairman | 1.00 | X | 0 | 0 | 0 | |||
| Wayne F Shovelin | ||||||||
| CEO THROUGH SEPT. | 40.00 | 1972052 | 0 | 712653 | X | |||
| David O'Connor | ||||||||
| CFO/Asst. Treasurer | 40.00 | 579283 | 0 | 174861 | X | |||
| Maria Long | ||||||||
| VP General Counsel/Asst. S | 40.00 | 355765 | 0 | 121679 | X | |||
| Valinda L Rutledge | ||||||||
| CEO AS OF OCT. | 40.00 | 257892 | 0 | 43500 | X | |||
| Terry L Jones | ||||||||
| EVP/CAO | 40.00 | 632609 | 0 | 206916 | X | |||
| JAMES D Huber | ||||||||
| VP MEDICAL SERVICES | 40.00 | 540103 | 0 | 158668 | X | |||
| STEVEN A RUBIN | ||||||||
| VP PRACTICE MANAGEMENT | 40.00 | 372256 | 0 | 129844 | X | |||
| W K HARWELL | ||||||||
| VP PATIENT CARE SERVICES | 40.00 | 375060 | 0 | 166459 | X | |||
| ANDREA K SERRA | ||||||||
| VP Wellness | 40.00 | 319224 | 0 | 117066 | X | |||
| MICHAEL R JOHNSON | ||||||||
| AVP, CIO | 40.00 | 225386 | 0 | 32995 | X | |||
| SHARILYN J REESE | ||||||||
| Corporate Controller | 40.00 | 215723 | 0 | 23375 | X | |||
| DAVID S MCSWAIN | ||||||||
| Clinical Pharmacist | 40.00 | 207913 | 0 | 23504 | X | |||
| LAURA W SWANSON | ||||||||
| Clinical Pharmacist | 40.00 | 179839 | 0 | 13646 | X | |||
| RICHARD C BLACKBURN | ||||||||
| AVP Support Services | 40.00 | 183050 | 0 | 29258 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 6474055 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 225445 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1972948 | TotalOtherCompensation |
| Number Individuals GT100 K | 104 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SHARED (SIEMENS) MEDICAL SOLUTIONS | |||||
| 51 VALLEY STREAM PARKWAY | MALVERN | PA | 19355 | INFORMATION SYSTEMS | 4568728 |
| MORRISON MANAGEMENT SPECIALISTS INC | |||||
| 3 WACHOVIA CENTER STE 3000 401 S | CHARLOTTE | NC | 28202 | FOOD SERVICES MANAGEMENT | 4100943 |
| ARAMARK CTS | |||||
| 12483 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | BIOMED SERVICES | 2306054 |
| GASTON ANESTHESIA ASSOCIATES | |||||
| PO BOX 601713 | CHARLOTTE | NC | 28260 | CRNA SERVICES | 1867323 |
| REHABCARE GROUP | |||||
| 7733 FORSYTH BLVD STE 1700 | ST LOUIS | MO | 63105 | OP REHAB SERVICES | 1376032 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 51 | NumberOfContractorsGT100K |
| Government Grants | 172894 | GovernmentGrants |
| All Other Contributions | 200784 | AllOtherContributions |
| Total Contributions | 373678 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES REVEN | 621500 | 376617160 | 376180414 | 436746 |
| PARTNERSHIP INCOME | 541900 | 800617 | 764619 | 35998 |
| IMAGING REVENUE | 621500 | 428637 | 428637 | |
| LINEN/LAUNDRY | 541900 | 97200 | 73163 | 24037 |
| NURSING OUTREACH | 621500 | 87504 | 87504 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 96796 | TotalRevenueColumn |
| Related Or Exempt Function Income | 96796 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 378127914 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 111538 | TotalRevenueColumn |
| Exclusion | $111,538 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 837 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 837 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 837 | TotalRevenueColumn |
| Exclusion | $837 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA & VENDING IN | 722210 | 2255812 | $2,255,812 | |
| PHARMACY REVENUE | 621500 | 2076656 | $2,076,656 | |
| DISCOUNTS & REBATES | 621500 | 481068 | 481068 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 341629 | TotalRevenueColumn |
| Related Or Exempt Function Income | 35703 | RelatedOrExemptFunctionIncome |
| Exclusion | $305,926 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 5155165 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 383769132 | TotalRevenueColumn |
| Related Or Exempt Function Income | 377719267 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 925418 | UnrelatedBusinessRevenue |
| Exclusion | $4,750,769 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88799 | Total |
| Program Services | 88799 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10239710 | Total |
| Program Services | 2864392 | ProgramServices |
| Management And General | 7375318 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127597 | Total |
| Program Services | 127597 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119305641 | Total |
| Program Services | 114890068 | ProgramServices |
| Management And General | 4415573 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18036801 | Total |
| Program Services | 16470656 | ProgramServices |
| Management And General | 1566145 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9409694 | Total |
| Program Services | 8558798 | ProgramServices |
| Management And General | 850896 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5251589 | Total |
| Program Services | 5251589 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2192896 | Total |
| Program Services | 31133 | ProgramServices |
| Management And General | 2161763 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158855 | Total |
| Management And General | 158855 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23922 | Total |
| Management And General | 23922 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27705287 | Total |
| Program Services | 25126483 | ProgramServices |
| Management And General | 2578804 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 881379 | Total |
| Program Services | 133438 | ProgramServices |
| Management And General | 747941 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2442474 | Total |
| Program Services | 1789358 | ProgramServices |
| Management And General | 653116 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 247094 | Total |
| Program Services | 247094 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8718047 | Total |
| Program Services | 8715894 | ProgramServices |
| Management And General | 2153 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102367 | Total |
| Program Services | 57999 | ProgramServices |
| Management And General | 44368 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 533641 | Total |
| Program Services | 268905 | ProgramServices |
| Management And General | 264736 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9285762 | Total |
| Program Services | 9285762 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26706067 | Total |
| Program Services | 26706067 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2627482 | Total |
| Program Services | 2627482 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| UBI TAX | -5415 | -5415 | |
| MEDICAL SUPPLIES | 66616455 | 86995 | 66529460 |
| BAD DEBT | 40397974 | 40397974 | |
| EQUIPMENT | 5201236 | 37368 | 5163868 |
| RECRUITING | 968469 | 118222 | 850247 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 937414 | Total |
| Program Services | 853048 | ProgramServices |
| Management And General | 84366 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 358201237 | Total |
| Program Services | 337036111 | ProgramServices |
| Management And General | 21165126 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -14801 | BOY |
| EOY | -3285 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35522404 | BOY |
| EOY | 33966858 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4975910 | BOY |
| EOY | 5676105 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7006967 | BOY |
| EOY | 7706644 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 477025151 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 269748931 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 208555162 | BOY |
| EOY | 207276220 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3110334 | BOY |
| EOY | 17892 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 306912 | BOY |
| EOY | 349220 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2311646 | BOY |
| EOY | 2311646 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34410371 | BOY |
| EOY | 67119347 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 296184905 | BOY |
| EOY | 324420647 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45447702 | BOY |
| EOY | 34757005 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 225406834 | BOY |
| EOY | 219898498 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43351419 | BOY |
| EOY | 59663018 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 314205955 | BOY |
| EOY | 314318521 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -18021050 | BOY |
| EOY | 10102126 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -18021050 | BOY |
| EOY | 10102126 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 296184905 | BOY |
| EOY | 324420647 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $23,922 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 23922 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | Annual dues were paid to the North Carolina Hospital Association and the American Hospital Association, of which $23,922 was determined to be expenditures used in lobbying activities by these organizations. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1654070 | OtherCostOrOtherBasis |
| Book Value | 1654070 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 260481793 | OtherCostOrOtherBasis |
| Depreciation | 107501851 | Depreciation |
| Book Value | 152979942 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 203290825 | OtherCostOrOtherBasis |
| Depreciation | 157712158 | Depreciation |
| Book Value | 45578667 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11598463 | OtherCostOrOtherBasis |
| Depreciation | 4534922 | Depreciation |
| Book Value | 7063541 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 207276220 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| PREPAID PENSION OBLIGATION | 26368035 |
| DEFERRED FINANCING COSTS | 5941413 |
| OTHER RECEIVABLES | 3754574 |
| 457B PLAN ASSETS | 3169112 |
| DEFERRED CHARGE - INTEREST RATE SWAP | 27886213 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 67119347 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| 457B PLAN LIABILITY | $3,169,112 |
| ESTIMATED 3RD PARTY SETTLEMENTS | $28,584,396 |
| CAPITAL LEASE OBLIGATION | $23,294 |
| INTEREST RATE SWAP LIABILITY | $27,886,216 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 59663018 | TotalOfAmounts |
| Total Revenue | 383769132 | TotalRevenue |
| Total Expenses | 358201237 | TotalExpenses |
| Excess Or Deficit For Year | 25567895 | ExcessOrDeficitForYear |
| Other | $2,555,281 | OtherAmount |
| Total Adjustments | 2555281 | TotalAdjustments |
| Excess Or Deficit Per FS | 28123176 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 381751209 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -2017923 | OtherRevenues |
| Revenue Not Rptd F990 | -2017923 | RevenueNotRptdF990 |
| Revenue Subtotal | 383769132 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 383769132 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 358201237 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 358201237 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 358201237 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Part XI, Line 8 - Other Adjustments: | EQUITY TRANSFER: -16869616. RESTATEMENT OF INTEREST SWAP: 19424897. |
| Part XII, Line 2d - Other Adjustments: | FOUNDATION TRANSFER: -2017923. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13481041 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 13481041 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04240 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 59098761 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 45226075 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13872686 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04370 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 830248 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 754731 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 75517 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 73410050 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 45980806 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 27429244 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08630 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 891846 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2390 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 889456 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00280 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 922681 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 917681 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00290 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3922430 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3422139 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 500291 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 261074 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 261074 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5998031 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3429529 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2568502 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00810 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 79408081 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 49410335 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 29997746 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09440 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 623913 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 623913 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 623913 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 623913 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $13,775,512 | BadDebtExpenseAmount |
| Amount Attributable To | 874183 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 118789448 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 100267511 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 18521937 | 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 V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GASTON MEMORIAL HOSPITAL INCORPORATED | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 28054 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | 6 OUTPATIENT CLINICS; 3 DIAGNOSTIC CENTERS | Other |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: Regardless of income, assets are also used to determine if a patient qualifies for Charity. The primary residence on up to (1) acre of land, one automobile for each working aged adult, and other assets, including but not limited to, retirement funds, investments and other financial assets, cash value of life insurance policies, and equity in property or real assets, totaling up to $25,000 are exempt from consideration as assets in determining Charity Care eligibility. Annual income from property of real assets will be deducted from the amount of equity in the asset when calculating the exemption. | IncomeBasedCriteria |
| Costing Method Used | Part I, Line 7: The costing methodology used is a cost accounting system. All patient segments are accounted for. All costs are from the system, no cost to charge ratios were used in the calculations. | CostingMethodUsed |
| Subsidized Health Services Expln | Part I, Line 7g: These costs do not include any amounts associated with a physician's clinic. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | Part I, Line 7f: $40,397,973 Bad Debt Expense removed from total expenses prior to calculating Percent of Total Expense. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: Allowances for uncollectible accounts are computed based on statistical information from current and prior years' experience. The System grants credit to patients without collateral, substantially all of whom are from the surrounding area.The system described in part 1 line 7 was used for Part III line 2. Total charges and the charges written off to bad debt were tabulated at the patient level. The detailed cost of the patient was multiplied by the ratio of charges written off/total charges per patient to assign the cost to the patient. Because of this cost based method, discounts and payments would be the difference between the total charges and the charges written off to bad debt.Rationale for Part III, Lines 2 and 3 - Charges written off to charity/bad debt in the Emergency Room are subject to means testing. If the patient qualifies Schedule H Part VI Page 2 under the charity care policy the account is written off. The reminder of the hospital is subject to application for charity and if no application is filed, the unpaid amount becomes bad debt. The uninsured qualifying patient % in the ER was applied to the remainder of the hospital to determine the amount of bad debt that could have been charity. The amount was at the charge level, and the cost to charge ratio for the internally costed bad debt was used to determine the cost associated with those charges. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: The Medicare Cost report standard costing methodology is followed when filing the cost report. This is a step down methodology that applies the average patient cost to Medicare patients, thus understating the true cost. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: The policy does contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. Below is verbiage from the policy: Charity - Gaston Memorial Hospital offers medical services free or at a reduced rate through the Charity Care Program. Determination of full or partial Charity Care will be based on the patient's income, family size, and assets. Potential eligibility exists only after reimbursement efforts from all other third party resources, federal, state, and local assistance programs have been exhausted.Expired Patients - Patients, including out of county residents, who have died, have no estate, and have no responsible spouse are deemed to have no income for the purpose of determining Charity Care eligibility. | DebtCollectionPolicy |
| General Explanation | Part I, Line 6a: The organization community benefit report made available to the public contains community benefits for all related organizations to the hospital. | GeneralExplanation |
| Needs Assessment | Part VI, Line 2: At CaroMont Health, we are in love with life. That love of life is a dynamic force that is making its way from each employee and volunteer in our organization out into our community-touching the lives of every person we serve. Community priorities are established through a number of mechanisms: a. Leadership opinions are sought to help identify needed services in the community. Telephone surveys are conducted on a periodic basis to gather opinions from residents in the service area. The most recent study was completed in the spring of 2009. b. Patient satisfaction data is analyzed to determine where and/or how services need to be improved. c. Service area data (vital statistics, demographics and utilization) are analyzed for trends. This information is coordinated with public health data to determine voids and service area health problems. d. Findings from community surveys/reports published by other organizations (United Way, Chamber of Commerce, Partnership for Children, Gaston County, etc.) are gathered and reviewed for pertinence to community health problems. e. Gaston Memorial Hospital through the Gaston County Healthcare Commission in conjunction with the Gaston County Health Department conducts a Community Assessment every four years. The most recent study was Fall, 2008). This assessment gathers opinions and is combined with public health data to determine the top four community-wide health issues. Service area strengths, weaknesses and opportunities are used as a basis for establishing community priorities. All this information is used to establish organizational priorities, identify agencies and organizations to be involved in resolving community issues, and implement programs to resolve identified issues. Goals, objectives and strategies are established and the progress is evaluated on an annual basis. f. Board members, senior management and department directors are involved in numerous organizations. Through this network of relationships, further information about the community and the needs of area residents and organizations are used in the development of programs and services available though CaroMont Health. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: The organization notifies patients by distributing brochures and/or verbal communication with staff that include, Registrars, Financial Counselors, and Benefit Eligibility Specialists.The organization has developed a program to assist uninsured and underinsured community members with enrollment in public programs. Seven employees assist individuals with enrollment in Medicaid, NC Health Choice, Medicare, Crime Victims program, food stamps, vocational rehab, public housing, Wal-Mart prescription program, meals on wheels and adult services at DSS. In FY2010, the cost of this program was $403,387. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: The organization's primary service area is Gaston County, North Carolina. Its secondary service area includes the counties of Cleveland and Lincoln in North Carolina and York in South Carolina. The primary service area is urban with an estimated population of 208,958 in 2009. There are no other acute care hospitals in Gaston County. For the fiscal year ended June 30, 2010, Medicaid patients comprised 17.2% of the hospital's gross charges and Uninsured patients comprised 7.8% of the hospital's gross charges. According to the U.S Census Bureau, 15.1% of the persons in Gaston County were below poverty level in 2008. According to the U.S. Department of Health and Human Services, there are two medically underserved service areas in Gaston County. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: Gaston Memorial Hospital Foundation:The Gaston Memorial Hospital Foundation (a subsidiary of CaroMont Health) was established in 1985. The primary purpose of the Foundation is to provide funding for health care projects and services within the Health Care System and in the community. The Foundation also solicits and receives donations and administers two scholarship funds for students pursuing health related careers. In addition to the Foundation utilizing its investment earnings for donations, CaroMont Health donates up to 10% of its operating income to the GMH Foundation each year. Gaston Memorial Hospital Foundation actively supports Gaston Family Health Services (GFHS), a federally qualified healthcare clinic providing medical and dental services to the uninsured and underinsured population of Gaston County. This clinic is important to assuring that the uninsured and underinsured have access to health care in Gaston County. During fiscal year 2010, the Foundation donated $480,778 to GFHS. CaroMont Health is committed to assisting GFHS in providing for these patients who might otherwise go without primary care services. Gaston Community Healthcare Commission:In 1992 the Gaston Community Healthcare Commission (GCHC) was established with Gaston Memorial Hospital as a sponsoring organization. The GCHC has been a certified Healthy Carolinian Task Force since 1994. The purpose of this organization is to develop a workable community-wide agenda through a problem solving network of organizations and individuals to improve health status of Gaston County. As a designated Healthy Carolinian Task Force, initiatives have to be coordinated by a Board that is representative of the community, and document the impact that its initiatives have on health status. Since 1998, the following organizations have had a permanent position on the GCHC: Gaston Memorial Hospital, Gaston County Health Department, Gaston/Lincoln/Cleveland Mental Health Authority, Gaston Family Health Services, Gaston County Department of Social Services, Gaston County School System, Gaston College and Gaston Emergency Medical Services. The 25 member GCHC Board directed the activities of seven initiatives that were undertaken to improve health status. These efforts focused on improving the health of children, assisting residents of all ages to make better life styles choices, and improving access and decreasing the cost of medical services. During 2003 the GCHC was transferred to Gaston Together. Gaston Together allows the GCHC to have broader exposure in the community, and greater ability to seek grants to assist with the implementation of the numerous initiatives, while taking a broader advocacy position for addressing local health issues. The GCHC has been identified as the point organization for addressing health issues as a part of Gaston County's Vision 2012. Vision 2012 is a collaborative effort between Gaston County and the Gaston County Chamber of Commerce to implement initiatives for addressing economic development, infrastructure development, housing, safety, social/arts, and health issues. All of these actions have resulted in a stronger Board and community involvement for GCHC in order to continue to address health related issues. Workforce Development:CaroMont Health identifies and fills the health care provider needs of the community. The physician recruitment department is led by a Director of Physician Recruiter who oversees the Department of Physician Services, recruits physicians and physician extenders as needed and maintains open communication with all those involved in recruitment process.Enviromental Improvements:CaroMont Health has made great strides to become more eco-friendly. Some of these improvements include: a. Recycling 300,000 lbs of cardboard b. Recycling 990,205 lbs of office paper c. Recycling 190,000 lbs of metal d. Recycling fluorescent Lamps e. Began Plastic bottle recycling 2009 - estimated volume 5000lbs f. Established internal office paper collection system g. Began rechargeable battery recycling program h. Donated 100's of pc's and monitors to local schools and churches (reduced need to destroy) | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: EVENTSHealthcare Career Day:CaroMont Health holds this an annual event for middle and high school students who are interested in a career in healthcare. During this fair, students have the opportunity to interact with CaroMont Health professionals and learn about their particular careers. Departments who are take part include Respiratory Care, Surgical Services, Rehab Services, Imaging Services, and Pharmacy, Food and Nutrition Services, and others. Over 100 students typically attend this event from all over Gaston County.CaroMont Health Heart Walk:This is an annual charity event sponsored by CaroMont Health is held to raise money for the Heart Society of Gaston County. The purpose of the Heart Walk charity event is to:(1) Increase awareness of cardiovascular disease and promote a heart healthy lifestyle by encouraging exercise. (2) Collect monetary donations to support the programs of the Heart Society of Gaston County which include medication assistance for persons with heart disease, cholesterol and blood pressure screenings for the public and cardiovascular health education programs for school children and the public.More than 400 walkers turned out for the May 2010 event where more than $14,000 was raised for the cause.Commissioner's School of Excellence:Each summer, the Gaston County Board of Commissioner funds a two-week residential experience for rising 10th graders at Belmont Abbey College. The Commissioners' School of Excellence (CSE) offers a variety of hands-on activities and seminars designed to help participants better understand Gaston County, and their own roles as future leaders. During this two-week session, some of these students who have expressed an interest in health care visit the hospital for a tour of the facility and to learn more about prospective careers. They get to interact with health care professionals in the Laboratory, Food and Nutrition Services and Imaging Services. Camp Summer Breeze is a week-long day camp for children with asthma. It combines traditional camp activities with asthma education in a medically supervised environment. The camp is held at Camp Rotary in western Gastonia. The July 2009 camp had 20 campers and junior volunteers. Children who cannot afford the tuition are given scholarships, and no campers have ever been turned away. Campers are given daily instruction on managing their disease, including hands-on training in how to properly measure their peak flows, proper inhaler use, and helpful breathing techniques.The CaroMont Candlelight 8K was held in October 2009 to raise money to provide prescription medications to patients via HealthNet Gaston. It was a "fall festival" event, which included an eight kilometer road race and a two mile fun run. Both began and ended on CaroMont's campus. This event received the endorsement of the Gastonia City Council, as well as cooperation and in-kind support from the NC Department of Transportation and the Gastonia Police Department. With more than 50 CaroMont employee volunteers and 700 runners, the event raised nearly $21,000 for HealthNet Gaston.The CaroMont Cancer Center held several programs and events for Breast Cancer Survivors including a Pink Ribbon Luncheon with a panel of experts to answer questions about Breast Health; Pink Ribbon Club which is a support group for survivors; Pink Ribbon Dinner and Expo that offers an educational session and expo of "pink ribbon" merchandise. The Annual Prostate Screening is held at Gaston Memorial Hospital every year. Men who fall within the screening guidelines as indicated by the American Cancer Society are eligible for a free screening that includes a digital rectal exam and Prostate Screening Assessment. The men are also provided with prostate education and prevention. HealthNet Gaston:HealthNet Gaston (HNG) is a program designed to provide comprehensive health care services to low-income, uninsured residents of Gaston County. Its services include: a medical home/primary care physician services, specialty physician services, medication assistance, case management/health coaching activities, and hospital services. HNG operates through the leadership and collaboration of its four founding strategic partners, including: Gaston Memorial Hospital, Gaston Family Health Services, Community Health Partners, Gaston Community Health Care Commission. Other strategic partners involved with this initiative include community physicians, Gaston County Department of Social Services, Gaston County Health Department, and other local leaders. Flu Prepardeness:CaroMont Health provided significant community leadership and service during the H1N1 flu pandemic of 2009-2010. Numerous CaroMont Health staff members were recruited to provide vaccinations for Gaston County school children, and to staff community vaccination clinics. CaroMont employees - including nurses, medical assistants and security personnel - contributed nearly 500 hours for these vaccination clinics. In addition, CaroMont provided in-kind support for planning and coordinating with our community partners. In February 2010, Gaston County Commissioners presented commendations to CaroMont Health, Gaston County Health Department, Gaston College, Gaston County Schools, and Gaston Emergency Management Services for "outstanding contributions protecting the health of the people of Gaston County during the 2009 H1N1 flu response."HEALTH PROFESSIONS EDUCATIONStudents from more than twenty-five colleges and universities ranging from two-year programs to traditional four-year programs to Masters level programs receive all or part of their clinical training at various Health Care System facilities. Disciplines include: nursing, counseling, occupational therapy, clinical pastoral education, respiratory therapy, paramedic - basic and emergency medical technicians, laboratory technology, medical office administration, physical therapist assistant, phlebotomy, radiographic technology, recreational therapy, therapeutic recreation, health services and information management, nurse midwifery, family nurse practitioner, neonatal nursing, communication sciences and disorders, cardiovascular interventional technology, radiation therapy, social work, pharmacy, and physical therapy. In 2002, the Hospital established a partnership with the University of North Carolina - Charlotte ("UNCC") School of Nursing entitled CaroMont Health and the University of North Carolina at Charlotte Student Partnership. This partnership provides funding for a clinical facilitator and class supplies and has allowed UNCC to increase its class enrollment by ten nursing school students in their junior and senior years. The students have a classroom at the Hospital and clinical rotations take place throughout CaroMont Health.CASH AND IN-KIND CONTRIBUTIONSThe organization makes contributions to many community agencies. In FY2010, cash donations were made to over 30 community groups and/or events. In addition, the organization allows classroom space to be used by community groups and donates medical supplies and office supplies to various local and international organizations. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: CaroMont Health's vision is to be a nationally recognized leader and valued partern in promoting individual health and vibrant communities. CaroMont Health in Gastonia, North Carolina is a regional, independent, not-for-profit health care system. It encompasses Gaston Memorial Hospital with 435-beds; Courtland Terrace, a 96-bed skilled nursing facility; Gaston Hospice which includes the 12-bed Robin Johnson House inpatient facility and palliative care facility, CaroMont Medical Group, a network of primary and specialty physician offices in five counties and two states, and CaroMont Specialty Surgery, a freestanding ambulatory surgery center. | AffiliatedHealthCareSystem |
| Reports Filed With States | NC | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Method Of ValuationMethodOfValuation | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|
| GASTONIA GRIZZLIES | ||||||||
| PO BOX 177 | GASTONIA | NC | 28053 | 421554288 | N/A | 5500 | FMV | COMMUNITY ASSISTANCE |
| COMMUNITY FOUNDATION OF GASTON COUNTY | ||||||||
| 991 W HUDSON BLVD | GASTONIA | NC | 28052 | 581340834 | 501(C)(3) | 15000 | FMV | COMMUNITY ASSISTANCE |
| GASTONIA DOWNTOWN DEVELOPMENT CORP | ||||||||
| PO BOX 2396 | GASTONIA | NC | 28053 | 560840699 | 501(C)(3) | 5500 | FMV | COMMUNITY ASSISTANCE |
| GASTON COUNTY FAMILY YMCA | ||||||||
| 615 WEST FRANKLIN BLVD | GASTONIA | NC | 28052 | 560655420 | 501(C)(3) | 7500 | FMV | COMMUNITY ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (15 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kelvin C Harris MD | |||||||||||||
| 0 | 161539 | 0 | 61856 | 0 | 2050 | 0 | 0 | 0 | 18524 | 0 | 243969 | 0 | 0 |
| Wayne F Shovelin | |||||||||||||
| 642828 | 0 | 394994 | 0 | 934230 | 0 | 577417 | 0 | 135236 | 0 | 2684705 | 0 | 922287 | 0 |
| David O'Connor | |||||||||||||
| 311111 | 0 | 121980 | 0 | 146192 | 0 | 135558 | 0 | 39303 | 0 | 754144 | 0 | 132010 | 0 |
| Maria Long | |||||||||||||
| 204730 | 0 | 71010 | 0 | 80025 | 0 | 91791 | 0 | 29888 | 0 | 477444 | 0 | 78135 | 0 |
| Valinda L Rutledge | |||||||||||||
| 145002 | 0 | 112500 | 0 | 390 | 0 | 31876 | 0 | 11624 | 0 | 301392 | 0 | 0 | 0 |
| Terry L Jones | |||||||||||||
| 317938 | 0 | 102793 | 0 | 211878 | 0 | 145175 | 0 | 61741 | 0 | 839525 | 0 | 194604 | 0 |
| JAMES D Huber | |||||||||||||
| 282610 | 0 | 105745 | 0 | 151748 | 0 | 126760 | 0 | 31908 | 0 | 698771 | 0 | 148138 | 0 |
| STEVEN A RUBIN | |||||||||||||
| 220154 | 0 | 87145 | 0 | 64957 | 0 | 81654 | 0 | 48190 | 0 | 502100 | 0 | 53423 | 0 |
| W K HARWELL | |||||||||||||
| 209766 | 0 | 79742 | 0 | 85552 | 0 | 85931 | 0 | 80528 | 0 | 541519 | 0 | 77812 | 0 |
| ANDREA K SERRA | |||||||||||||
| 183620 | 0 | 73870 | 0 | 61734 | 0 | 77183 | 0 | 39883 | 0 | 436290 | 0 | 59535 | 0 |
| MICHAEL R JOHNSON | |||||||||||||
| 195465 | 0 | 27397 | 0 | 2524 | 0 | 32995 | 0 | 0 | 0 | 258381 | 0 | 0 | 0 |
| SHARILYN J REESE | |||||||||||||
| 187419 | 0 | 27146 | 0 | 1158 | 0 | 23375 | 0 | 0 | 0 | 239098 | 0 | 0 | 0 |
| DAVID S MCSWAIN | |||||||||||||
| 177095 | 0 | 0 | 0 | 30818 | 0 | 23504 | 0 | 0 | 0 | 231417 | 0 | 0 | 0 |
| LAURA W SWANSON | |||||||||||||
| 176807 | 0 | 0 | 0 | 3032 | 0 | 13646 | 0 | 0 | 0 | 193485 | 0 | 0 | 0 |
| RICHARD C BLACKBURN | |||||||||||||
| 146401 | 0 | 20050 | 0 | 16599 | 0 | 29258 | 0 | 0 | 0 | 212308 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 1a | Travel for Companions - If a spouse or companion is expected to attend an event, it must be approved in advance and the expenses of the spouse or companion will be treated as taxable compensation and added to the employee's W2 or a 1099 will be issued at the end of the calendar year. During FY 2010 this benefit was provided to the CEO and some board members. Tax indemnification and gross-up payments - Reimbursement for certain taxable benefit costs (i.e. cell phones) will be grossed up for any tax obligations. Health or social club dues or initiation fees - A percentage of personal use of dues payments for membership in a health or fitness club or a social or recreational club will be added to the employee's W-2 at the end of the calendar year. During FY 2010 this benefit was provided to the CEO and CFO. |
| Part I, Line 4a | Wayne F. Shovelin, CEO participates in a Supplemental Salary Continuation Retirement Plan. Gross payments for 2010 were $5,914,998. Please refer to the Schedule O disclosure for Part VI, Section B, Line 15 for more detail. |
| Part I, Line 6 | Certain CaroMont Medical Group Inc. Physician's Compensation packages are based on the individual physician's net results from operations as calculated based soley on his/her net charges less his/her allocable share of clinic overhead costs. Executive Incentive Compensation Plan for all key employees based on the achievement of annual Business Objectives and Financial Performance of the consolidated system. Manager Incentive Plan based on consolidated corporate and individual performance goals. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||
| 521309402 | 65820HVF7 | 2003-01-23 | 120000000 | NEW CONSTRUCTION, PURCHASE CAPITAL EQUIPMENT, PARTIAL ADVANCE REFUNDING | 0 | 0 |
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||
| 521309402 | 65820HA94 | 2008-01-01 | 118400000 | RENOVATION OF HOSPITAL, PURCHASE OF CAPITAL EQUIPMENT, CURRENT REFUNDING | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|
| 120405450 | 21 | 4642069 | 96734224 | 2007 | 0 | 1 | 1 | 1 |
| 118628201 | 17871 | 2471189 | 29562598 | 2009 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 1 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 1 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Business Name Line2NameOfHedgeProvider/BusinessNameLine2 | Term Of HedgeTermOfHedge | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|---|---|
| MERRILL LYNCH | |||||||
| 0 | 1 | 1 | CAPITAL SERVICES | 31.600000000000 | 0 | 0 | 0 |
| MERRILL LYNCH | |||||||
| 0 | 1 | 1 | DERIVATIVE PRODUCTS | 21.000000000000 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| LUCINDA DAVIS | |||
| FAMILY MEMBER OF DIRECTOR, JAMES BEAM | 54150 | COMPENSATION AS EMPLOYEE | 0 |
| BARBARA WILLIAMS | |||
| FAMILY MEMBER OF DIRECTOR, JOHNATHAN WILLIAMS | 35963 | COMPENSATION AS EMPLOYEE | 0 |
| GENA POMEROY | |||
| FAMILY MEMBER OF DIRECTOR, BARRY POMEROY | 37484 | COMPENSATION AS EMPLOYEE | 0 |
| CAROLINA ORTHAPAEDIC & SPORT MEDICINE CENTER PA | |||
| ENTITY MORE THAN 5% OWNERSHIP BY CLAYTON THOMAS, III | 242296 | AGREEMENT FOR PROVISION OF IMAGING SERVICES TO THE ORGANIZATION | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | The organization's Form 990 is reviewed by the Audit Finance Investment Committee of the Board of Directors prior to presentation to the full Board before the Form is filed with the IRS. | |
| Form 990, Part VI, Section B, line 12c | Each applicable employee and director shall fully and truthfully complete a questionnaire concerning potential and actual conflicts of interest annually. Such questionnaire shall identify the employee's obligation to immediately make the President aware in writing of any potential or actual conflicts on interest as they may arise and contain said employee's agreement to abide by all terms and conditions of this policy as a condition of retaining their position. Such questionnaires shall be reviewed annually by the Vice President/General Counsel and the Corporate Compliance Officer. The President shall make the Board of Directors aware of any actual conflicts of interest. | |
| Form 990, Part VI, Section B, line 15 | The CEO, CFO/Assistant Treasurer and General Counsel/Assistant Secretary are compensated for their services by CaroMont Health, Inc. The compensation of all CaroMont executives for each year is established by the Compensation Committee of the CaroMont Health Board of Directors, based on guidance and opinions provided by an independent, third-party compensation consultant. Board members who serve on the Compensation Committee are independent and free of any conflict of interest. Any Compensation Committee member who develops a conflict of interest during his/her term with respect to the discussion of any executive's compensation leaves the meeting and does not participate in the discussion or decision-making by the remaining independent members of the Compensation Committee. The Compensation Committee retains jurisdiction over the total compensation package for executives and reviews executive benefits and perquisites as well as total cash compensation. Compensation for the CEO is established through a process of dialogue with the CEO, comparison with comparable market data and determination by the Compensation Committee of acceptable salary range and percentile ranking. All compensation decisions for the CEO are recommended by the Compensation Committee and approved by the Board of Directors. Compensation for all other executives is established through a process of dialogue between the CEO and the executive, comparison with comparable market data and determination by the CEO of acceptable salary range and percentile ranking. All compensation decisions for executives are recommended by the CEO and approved by the Compensation Committee. Full collected compensation information and any compensation opinions provided during these processes will be kept with the Compensation Committee or Board minutes, as applicable. In 2009, the Board of Directors, by and through the Compensation Committee, conducted two detailed reviews of the retirement benefit to be paid to its retiring CEO. In conducting these reviews, the Compensation Committee worked through an evaluation of the retiring CEO's performance during his 33-year tenure with the organization. The Compensation Committee concluded that in the areas of finance and quality measures, the retiring CEO's performance consistently exceeded expectations and has positioned CaroMont Health as a leader in the region. His performance in the area of patient satisfaction has, in the mission-critical area of emergency services, exceeded the Board of Director's expectations. Overall, and over the arc of his career at CaroMont, the retiring CEO's leadership has led CaroMont Health from a mere community hospital into a regional healthcare powerhouse. The Committee concluded that his leadership had outperformed the region and fulfilled the community's desire to keep its healthcare system under local control, thereby justifying his retirement payment as fair and reasonable compensation for outstanding performance. | |
| Form 990, Part VI, Section C, line 19 | At this time, the organization's governing documents and conflict of interest policy are not made available to the public. The organization's financial statements are made available upon request. | |
| Schedule K Supplental Information | THREE 501(C)(3) ORGANIZATIONS WITHIN THE PARENT-SUBSIDIARY CONTROLLED GROUP BENEFIT FROM THE BONDS AS FOLLOWS: GASTON MEMORIAL HOSPITAL, INC. (56-0619359); CAROMONT HEALTH, INC. (58-1636959); CAROMONT HEALTH SERVICES, INC. (56-1455630). GASTON MEMORIAL HOSPITAL, INC. HOLDS THE LIABILITY FOR THE BONDS, PER AUDITED FINANCIAL STATEMENTS. | |
| SCHEDULE K, PART II, LINE 5: BOND (A) CREDIT ENHANCEMENT INSURANCE: $ 3,386,000 OTHER ISSUANCE COSTS: 1,256,069 BOND (B) CREDIT ENHANCEMENT INSURANCE: $ 1,553,717 OTHER ISSUANCE COSTS: 917,472 | ||
| FORM 990, PART III, LINE 4A | The vision of CaroMont Health is to be a nationally recognized leader and valued partner in promoting individual health and vibrant communities. STRATEGY AND OBJECTIVES: CaroMont Health undertakes a comprehensive assessment of its services every three to five years to determine strategic changes required to address the changing healthcare environment, and thus the overall program directions that need to be pursued. On an annual basis, goals and objectives are established that will allow progress towards the desired direction. Many of CaroMont Health's Fiscal Year 2010 objectives related to activities to improve the health of the community, including: 1. Develop an aggressive growth strategy to include - Leverage existing vertical and horizontal integration - Identify and establish partnerships to create compelling value proposition 2. The Focus of CaroMont Health's Growth Strategy - Enhance brand presence in key secondary market locations - Expand access points for care: - Portals for new referrals - Emphasize urgent and primary care (right care, right place, right time) - Design to provide coordinated and accountable care - Link cross-referrals, interventions, health management and wellness - Utilize e-technology, 24/7 connectivity and relationship-building - Create a 'personally remarkable' individualized care experience In addition, several of CaroMont Health's business objectives focused on improving the quality of care provided to our patients. Examples are: - Support continued development of a "safety net" program to provide "medical home" and medical services to qualified uninsured residents of Gaston County. - Complete requirements for JCAHO Certification for Disease- Specific Care Certification Program for Joint, Stroke, Heart Failure, Inpatient Diabetes, and Hip and Knee Replacement. - Participating in, and/or sponsoring/cosponsoring 10 or more healthcare related community events or programs that contribute to improving the health and wellness status of the communities we serve. - Participating in at least 48 speaking engagements or promotions regarding various CaroMont Health services and programs. - Conduct or participate in wellness health screenings within the community and/or places of employment. - Assess the benefit of establishing a Level III Trauma Program based on community need and physician input. - Enhance/expand the scope of our cardiovascular service - Develop a multi-disciplinary representation of physician councils to facilitate physician leadership development, provide a forum for evaluating and aligning new services, enhance care coordination, sharpen our focus and streamline the health care operating system. HEALTHNET GASTON: HealthNet Gaston (HNG) is a program designed to provide comprehensive health care services to low-income, uninsured residents of Gaston County. Its services include: a medical home/primary care physician services, specialty physician services, medication assistance, case management/health coaching activities, and hospital services. HNG operates through the leadership and collaboration of its four founding strategic partners, including: Gaston Memorial Hospital, Gaston Family Health Services, Community Health Partners, Gaston Community Health Care Commission. Other strategic partners involved with this initiative include community several physicians, Gaston County Department of Social Services, Gaston County Health Department, and other local leaders. During fiscal year 2010, the hospital provided $8,761,805 and the employed physicians provided $680,715 of uncompensated care to the HNG patients. UNITED WAY: CaroMont Health is a pace setter organization for United Way and in fiscal year 2010, employees pledged $157,877 to United Way. Since 1990, CaroMont Health has donated a 10% match of the United Way employee pledges to the employee hardship fund on an annual basis. Funds are distributed to CaroMont Health employees who experience an unforeseen catastrophic event (for example; fire, serious accident, etc.) during the year. GASTON COMMUNITY HEALTHCARE COMMISSION: In 1992 the Gaston Community Healthcare Commission (GCHC) was established with Gaston Memorial Hospital as a sponsoring organization. The GCHC has been a certified Healthy Carolinian Partnership since 1994. The purpose of this organization is to develop a workable community-wide agenda through a problem solving network of organizations and individuals to improve health status of Gaston County residents. As a certified Healthy Carolinian Partnership, initiatives are based on the most recent Community Health Assessment, coordinated by Board that is representative of the community, and document the impact that these initiatives have on health status. Since 1998, the following organizations have had a permanent position on the GCHC: Gaston Memorial Hospital, Gaston County Health Department, Pathways, Gaston Family Health Services, Gaston County Department of Social Services, Gaston County School System, Gaston College, United Way, Gaston Regional Chamber, Medical Society, and Gaston Emergency Medical Services. The 25 member GCHC Board directed the activities of seven initiatives that are undertaken to improve health status. These efforts focus on improving the health of children, assisting residents of all ages to make healthier life styles choices, improving access to medical care, and decreasing the cost of medical services. During 2003 the administration of the GCHC was transferred to Gaston Together. Gaston Together allows the GCHC to have broader exposure in the community, build greater volunteer participation, and greater ability to seek grants to assist with the implementation of their numerous initiatives, while taking a broader advocacy position for addressing local health issues. The GCHC has been identified as the point organization for addressing health issues as a part of Gaston County's Vision 2020. Facilitated by Gaston Together, Vision 2020 is a collaborative community effort to implement initiatives addressing economic development, infrastructure development, housing, safety, social/arts, and health issues to position Gaston County for the future. All of these actions have resulted in a stronger Board and community involvement for GCHC in order to continue to improve the health status of the residents of Gaston County. CaroMont Health has significantly impacted its community in providing many different health improvement projects, groups, events, education programs, etc. | STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: |
| HEALTH INSURANCE ENROLLMENT PROGRAMS: Gaston Memorial Hospital has developed a program to assist uninsured and underinsured community members with enrollment in public programs. Seven employees assist individuals with enrollment in Medicaid, NC Health Choice, Medicare, Crime Victims program, food stamps, vocational rehab, public housing, Wal-Mart prescription program, meals on wheels and adult services at DSS at an annual cost of $403,387. The primary service area of CaroMont Health is Gaston County in North Carolina. However, because of the regional nature of multiple services and/or programs that are provided through the organization, we provide a substantial amount of health care services to residents outside Gaston County. These out of county residents primarily come from Cleveland and Lincoln Counties in North Carolina, as well as York and Cherokee Counties in South Carolina. In fiscal year 2010, Gaston Memorial Hospital provided over $72 million of uncompensated care services to patients who had no insurance representing 7.8% of total services provided. In addition, the hospital provided over $159 million in services to Medicaid patients, representing 17.2% of the total services provided. No funding is received by CaroMont Health from Gaston County to provide this uncompensated care. Services are provided to all Gaston County residents, regardless of their ability to pay. All programs are funded from excess working capital. On occasion grants are received from The Duke Endowment, local foundations, federal or state agencies for specific programs, such as assistance with the start-up of parish nurse ministries, assistance with bioterrorism readiness, and the Breast Health Navigator position. Community priorities are established through a number of mechanisms: - Leadership opinions are sought to help identify needed services in the community. - Telephone surveys are conducted on a periodic basis to gather opinions from residents in the service area. - Patient satisfaction data is analyzed to determine where and/or how services need to be improved. - Service area data (vital statistics, demographics and utilization) are analyzed for trends. This information is coordinated with public health data to determine voids and service area health problems. - Findings from community surveys/reports published by other organizations (United Way, Chamber of Commerce, Partnership for Children, Gaston County, etc.) are gathered and reviewed for pertinence to community health problems. - Gaston Memorial Hospital through the GCHC in conjunction with the Gaston County Health Department conducts a Community Assessment every four years. This assessment gathers opinions and is combined with public health data to determine the top four community-wide health issues. - Service area strengths, weaknesses and opportunities are used as a basis for establishing community priorities. All this information is used to establish organizational priorities, identify agencies and organizations to be involved in resolving community issues, and implement programs to resolve identified issues. Goals, objectives and strategies are established and the progress is evaluated on an annual basis. - Board members, senior management and department directors are involved in numerous organizations. Through this network of relationships, further information about the community and the needs of area residents and organizations are used in the development of programs and services available though CaroMont Health. Health Professionals Education: CaroMont Health provides over $925,113 for the following educational activities: Precepting - UNCC, GWU, Queens AD, CPCC, Kaplan, CUSP (Admin.Support) CUSP (Administrative Support) Pharmacy Practice Residency (Pharmacy) Preceptor - GC Dietary (Administrative Support) Preceptor - California College of Health Sciences (Admin Support) Preceptor - ASU (Administrative Support) Preceptor MOC - UNCC (Administrative Support) Precepting/Mentor (Pharmacy) Precepting - Pharmacy -Wingate College Student (Pharmacy) Preceptor - Gardner Webb University (Administrative Support) Coordinated Nursing Assistant Instructor Orientation (Education Svcs) Precepting - Wingate College Student (Pharmacy - March - April 2010) Pharmacy Student #2 Mentoring - Wingate (Pharmacy) Pharmacy Student Mentoring-UNC Student #2 (Pharmacy) Pharmacy Student Mentoring-UNC Student #1 (Pharmacy) New Graduate Welcome Receptions (Administrative Support) Preceptor - Queens (Administrative Support) Pharmacy Student #1 Mentoring - Wingate (Pharmacy) Preceptor - Certified Clinical Medical Asst (Administrative Support) Lincoln-Cleveland Nurses Celebration (Executive Offices) Coordinated Gaston City Schools Allied Science Education Program (Education Services) Gaston Co Education Foundation BOD (Executive Offices) IC Training (Administrative Support) Financial contributions and in-kind contributions totaling $742,201 cover a wide array of community events and activities such as: Gaston Regional Chamber Economic Development Dept Dues (Exec. Offices) Daniel Stowe Botanical Gardens Holiday Lights (Executive Offices) Gaston County Family YMCA (Marketing) Gaston Regional Chamber Annual Dues (Executive Offices) Community Foundation Sponsorship for Simms Award (Exec. Offices) Boys Scouts of America (Marketing) NC Chamber Annual Membership (Executive Offices) Mt. Holly Springfest (Marketing) Gaston Regional Chamber (Marketing) Gaston Literacy Council Inc. (Marketing Gaston Chamber Salute to Manufacturing (Marketing) First Friday Focus-Gaston Regional Chamber (Marketing) March of Dimes Ambassador Avenue Sponsor (Marketing) Heart Society's 2010 Heart Ball Patron Level Donation (Marketing) Bessemer City Chamber Annual membership (Execuitve Offices) Heart Society 2010 Golden Heart Award Sponsor (Marketing) Gaston Chamber 2009 Economic Forecast Luncheon ( Marketing) Gaston Regional Chamber 2010 Planning Retreat (Marketing) Gastonia Jaycees (Marketing) Advanced Home Care Infusion Services (Patient Care) Gastonia Civitan Club Dues (Executive Offices) Advanced Home Care Annual Charity Golf (GMH) Belmont Abbey Corporate Annual membership (Executive Offices) Montcross Area Chamber of Commerce (Marketing) Catawba River Womens Group (Marketing - FY2010) United Way Women's Luncheon Table Sponsor (Marketing) South Point High School Baseball Tournament Sponsor Gastonia Grizzlies Annual Baseball Camp Sponsorship Gastonia Grizzlies HMI Sponsored Grizzly Baseball Camp Classroom space for Community Groups (Education Services) Samaritan's Purse - donation of medical supplies (Housekeeping) Framed Artwork to Junior League of Gaston County (Housekeeping) Giveaways for Cleveland County Fair (Marketing) Hand sanitizers to Taste of Gaston Event (Marketing) Refreshments for Cancer Center holiday concert (Marketing) Ink pens to Living Well after Lung Cancer program (Marketing) Personal Computer to Gaston County YMCA (Information Systems) Community Building Activities - Staff provide time and expertise to Workforce Development - Physician Recruitment. | ||
| FORM 990, PART V AND PART VII | THE FILING ORGANIZATION USES A RELATED ORGANIZATION FOR ITS PAYROLL FUNCTION. ALL W-2S ARE FILED BY THE COMMON PAYMASTER. HOWEVER, AMOUNTS PAID BY THE COMMON PAYMASTER ARE TREATED AS IF PAID DIRECTLY BY THE ORGANIZATION FOR WHICH SERVICES ARE PERFORMED. | COMMON PAYMASTER |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 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 |
|---|---|---|---|---|---|---|---|---|---|
| CaroMont Health | |||||||||
| 2525 Court Drive | Gastonia | NC | 28054 | 581636959 | MEDICAL SERVICES | NC | 501(c)(3) | Line 11b, II | N/A |
| CaroMont Health Services | |||||||||
| 2526 Court Drive | Gastonia | NC | 28054 | 561455630 | OUTPATIENT SERVICES | NC | 501(c)(3) | Line 3 | N/A |
| Gaston Memorial Hospital Foundation Inc | |||||||||
| 2527 Court Drive | Gastonia | NC | 28054 | 561479699 | FOUNDATION | NC | 501(c)(3) | Line 9 | N/A |
| CaroMont Medical Group Inc | |||||||||
| 2528 Court Drive | Gastonia | NC | 28054 | 561479712 | MEDICAL GROUP | NC | 501(c)(3) | Line 9 | N/A |
| Hospice of Gaston County Inc | |||||||||
| 2529 Court Drive | Gastonia | NC | 28054 | 581341530 | Hospice Care | NC | 501(c)(3) | Line 7 | N/A |
| Gaston Emergency Physicians Inc | |||||||||
| 2531 Court Drive | Gastonia | NC | 28054 | 562209423 | Supporting Organization | NC | 501(c)(3) | Line 11a, I | N/A |
| 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 | 1 | 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 | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |