GASTON MEMORIAL HOSPITAL FOUNDATION INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- GASTON MEMORIAL HOSPITAL FOUNDATION INC (EIN 56-1479699)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-02
- IRS object ID
- 202241229349300879
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-02T13:39:45-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1Txt |
| City | ASHEVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561479699 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GASTON MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GAST | BusinessNameControlTxt |
| Phone | 7048342000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1Txt |
| City | GASTONIA | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28054 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID O'CONNOR | PersonNm |
| Person Title | EVP, CFO | PersonTitleTxt |
| Phone | 7048342000 | PhoneNum |
| Signature | 2022-05-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DAVID | PersonFirstNm |
| Person Last | OCONNOR | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY BIBBY | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Preparation | 2022-05-02 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID O'CONNOR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1Txt |
| City | GASTONIA | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28054 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,703,972 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CAROMONT.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1985 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO ENGAGE AND INSPIRE OUR COMMUNITY TO SUPPORT CAROMONT HEALTH IN PROVIDING COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE | ActivityOrMissionDesc |
| Voting Members Governing Body | 4 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 3 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,293,604 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,066,885 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $874,141 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,637,087 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $2,167,745 | PYTotalRevenueAmt |
| CY Total Revenue | $2,703,972 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $755,358 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,788,359 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $248,835 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $268,332 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $697,629 | PYOtherExpensesAmt |
| CY Other Expenses | $115,023 | CYOtherExpensesAmt |
| PY Total Expenses | $1,701,822 | PYTotalExpensesAmt |
| CY Total Expenses | $4,171,714 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $465,923 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,467,742 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $27,264,388 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,026,116 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $25,801 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,339 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $27,238,587 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $29,007,777 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO ENGAGE AND INSPIRE OUR COMMUNITY TO SUPPORT CAROMONT HEALTH IN PROVIDING COMPASSIONATE, EXCEPTIONAL AND HIGHLY RELIABLE CARE | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,142,529 | ExpenseAmt |
| Grant | $3,788,359 | GrantAmt |
| Desc | SEE SCHEDULE OTHE CAROMONT HEALTH FOUNDATION RAISES MONEY FOR PROGRAMS, INITIATIVES AND CAPITAL PROJECTS CENTERED ON MEETING THE HEALTH-RELATED NEEDS AND IMPROVING THE QUALITY OF LIFE IN OUR COMMUNITY. IN ADDITION, THE CAROMONT HEALTH FOUNDATION OPERATES A GRANTS PROGRAM BENEFITING BOTH INTERNAL DEPARTMENTS AND LOCAL NON-PROFIT ORGANIZATIONS, AS WELL AS MANAGING SEVEN ACADEMIC SCHOLARSHIP FUNDS. ONE-HUNDRED PERCENT OF CONTRIBUTIONS GO DIRECTLY TO SUPPORT FOUNDATION PROGRAMS, OPERATING COSTS ARE GENEROUSLY COVERED BY CAROMONT HEALTH. | Desc |
| Total Program Service Expenses | $4,142,529 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 3 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 4 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NC | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7048342000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE | AddressLine1Txt |
| City | GASTONIA | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28054 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MS JANIE PARKS PEAK | ||||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MR BOB HOVIS | ||||||||
| DIRECTOR THROUGH 12/31/2020/VICE CHAIR STARTING 1/ | 1.00 | Yes (X) | Yes (X) | $0 | $20,244 | $0 | 2.00 | |
| DR GEORGE E ADCOCK III | ||||||||
| VP/SECRETARY STARTING 1/1/2021 | 1.00 | Yes (X) | Yes (X) | $0 | $502,974 | $88,685 | 40.00 | |
| MR BILL GROSS | ||||||||
| VICE CHAIR THROUGH 12/31/2020/DIRECTOR STARTING 1/ | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MS SHELLEY FRYE COLLINS | ||||||||
| SECRETARY THROUGH 12/31/2020 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MR JAKE GRAY III | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | 1.00 | ||
| MS JENNIFER THOMAS STULTZ | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | 1.00 | ||
| MR REEVES MCGLOHON | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MS MARY BARGER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DR AMI PARKER | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | 1.00 | ||
| DR RAMADA S SMITH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $453,503 | $33,567 | 40.00 | ||
| MS ASHLEY LONG | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $238,644 | $44,367 | 45.00 | ||
| MS JASMINE S STONE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $107,213 | $21,494 | 40.00 | ||
| MR DAVID M O'CONNOR | ||||||||
| EVP/ASST. TREASURER/DIRECTOR | 1.00 | Yes (X) | Yes (X) | $0 | $728,075 | $136,607 | 54.00 | |
| MR K CHRISTOPHER PEEK | ||||||||
| CEO | 1.00 | Yes (X) | $0 | $1,162,438 | $225,233 | 54.00 | ||
| MS LEIGH HICKMAN | ||||||||
| CLO/ASST. SEC. | 1.00 | Yes (X) | $0 | $366,970 | $75,277 | 54.00 | ||
| MS KATHRYN C WAYNE | ||||||||
| DIRECTOR OF DEVELOPMENT | 40.00 | $119,617 | $0 | $28,369 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $119,617 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,580,061 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $653,599 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $394,044 | RelatedOrganizationsAmt |
| All Other Contributions | $672,841 | AllOtherContributionsAmt |
| Total Contributions | $1,066,885 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $451,329 | TotalRevenueColumnAmt |
| Exclusion | $451,329 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,185,758 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,185,758 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,185,758 | TotalRevenueColumnAmt |
| Exclusion | $1,185,758 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,703,972 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,637,087 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,661,011 | TotalAmt |
| Program Services | $3,661,011 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,348 | TotalAmt |
| Program Services | $127,348 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200,835 | TotalAmt |
| Program Services | $200,835 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,435 | TotalAmt |
| Program Services | $9,435 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,065 | TotalAmt |
| Program Services | $45,065 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,997 | TotalAmt |
| Program Services | $12,997 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,185 | TotalAmt |
| Management And General | $29,185 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,393 | TotalAmt |
| Program Services | $39,393 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,445 | TotalAmt |
| Program Services | $46,445 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,171,714 | TotalAmt |
| Program Services | $4,142,529 | ProgramServicesAmt |
| Management And General | $29,185 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $734,154 | BOYAmt |
| EOY | $435,043 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $981,295 | BOYAmt |
| EOY | $72,148 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,232 | BOYAmt |
| EOY | $17,503 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,695,136 | BOYAmt |
| EOY | $22,900,956 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,816,571 | BOYAmt |
| EOY | $5,600,466 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,264,388 | BOYAmt |
| EOY | $29,026,116 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,801 | BOYAmt |
| EOY | $18,339 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,801 | BOYAmt |
| EOY | $18,339 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,485,181 | BOYAmt |
| EOY | $23,407,311 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,753,406 | BOYAmt |
| EOY | $5,600,466 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,238,587 | BOYAmt |
| EOY | $29,007,777 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,264,388 | BOYAmt |
| EOY | $29,026,116 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,467,742 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $3,236,932 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,047,104 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $578,246 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,105,598 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,293,604 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,066,885 | CurrentTaxYearAmt |
| Total | $7,091,437 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,047,104 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $578,246 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,105,598 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,293,604 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,066,885 | CurrentTaxYearAmt |
| Total | $7,091,437 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $728,213 | SubstantialContributorsTotAmt |
| Public Support Total170 | $6,363,224 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $338,222 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $436,381 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $593,590 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $510,942 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $451,329 | CurrentTaxYearAmt |
| Total | $2,330,464 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $791 | CurrentTaxYearMinus2YearsAmt |
| Total | $791 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $9,422,692 | TotalSupportAmt |
| Public Support CY170 | 0.67530 | PublicSupportCY170Pct |
| Public Support PY170 | 0.73970 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $6,753,405 | BeginningYearBalanceAmt |
| Contributions | $629,887 | ContributionsAmt |
| Investment Earnings Or Losses | $1,142,505 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $31,476 | GrantsOrScholarshipsAmt |
| Other Expenditures | $2,893,855 | OtherExpendituresAmt |
| End Year Balance | $5,600,466 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,930,785 | BeginningYearBalanceAmt |
| Contributions | $2,810,378 | ContributionsAmt |
| Investment Earnings Or Losses | $147,349 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $135,107 | GrantsOrScholarshipsAmt |
| End Year Balance | $6,753,405 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,835,087 | BeginningYearBalanceAmt |
| Contributions | $74,346 | ContributionsAmt |
| Investment Earnings Or Losses | $172,984 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $151,632 | GrantsOrScholarshipsAmt |
| End Year Balance | $3,835,087 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,669,926 | BeginningYearBalanceAmt |
| Contributions | $45,458 | ContributionsAmt |
| Investment Earnings Or Losses | $238,927 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $119,224 | GrantsOrScholarshipsAmt |
| End Year Balance | $3,835,087 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,295,330 | BeginningYearBalanceAmt |
| Contributions | $117,530 | ContributionsAmt |
| Investment Earnings Or Losses | $357,695 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $100,629 | GrantsOrScholarshipsAmt |
| End Year Balance | $3,669,926 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (12 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| MACKIE SCHOLARSHIP FUND | $6,083 |
| SHOVELIN SCHOLARSHIP FUND | $3,595,225 |
| HUDSON NURSING SCHOLARSHIP FUND | $360,194 |
| BUCCI SCHOLARSHIP FUND | $6,414 |
| WOMEN OPTIMIZE WELLNESS FUND | $324,855 |
| EMPLOYEE SCHOLARSHIP FUND | $117,554 |
| DAMORE SCHOLARSHIP FUND | $41,768 |
| ONCOLOGY SCHOLARSHIP FUND | $106,199 |
| SELF SCHOLARSHIP | $35,362 |
| COVID19 | $304,939 |
| INVESTMENTS CARE FIRST FUND | $684,126 |
| INVESTMENTS CLINICAL RESEARCH FUND | $17,747 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,600,466 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $2,212,090 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $3,236,932 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $3,236,932 | RevenueNotReportedAmt |
| Revenue Subtotal | -$1,024,842 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $29,185 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $3,699,629 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,728,814 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $2,703,972 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $442,901 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $442,901 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $29,185 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $3,699,629 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,728,814 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,171,715 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR SCHOLARSHIPS. |
| PART X, LINE 2: | THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2021 AND 2020. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | GRANTS IN REVENUES 3,699,629. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | GRANTS IN REVENUES 3,699,629. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CAROMONT REGIONAL MEDICAL CENTER | |||||||
| 2525 COURT DRIVE | GASTONIA | NC | 28054 | 560619359 | 501(C)(3) | $531,187 | COMMUNITY ASSISTANCE |
| GASTON COUNTY SHERRIFF | |||||||
| 425 DR MARTIN LUTHER KING JR W | GASTONIA | NC | 28052 | 501(C)(3) | $41,500 | COMMUNITY ASSISTANCE | |
| GASTON COLLEGE FOUNDATION | |||||||
| 201 HIGHWAY 321 SOUTH | DALLAS | NC | 28034 | 237079454 | 501(C)(3) | $30,800 | COMMUNITY ASSISTANCE |
| CANCER SERVICES OF GASTON COUNTY | |||||||
| 306 S COLUMBIA STREET | GASTONIA | NC | 28054 | 561164253 | 501(C)(3) | $20,000 | COMMUNITY ASSISTANCE |
| OLIVE BRANCH MINISTRY | |||||||
| 1223 1ST AVE NW | HICKORY | NC | 28601 | 474497173 | 501(C)(3) | $20,000 | OPERATIONAL SUPPORT |
| BACKPACK WEEKEND FOOD PROGRAM | |||||||
| PO BOX 551030 | GASTONIA | NC | 28055 | 471591744 | 501(C)(3) | $10,000 | OPERATIONAL SUPPORT |
| HEART SOCIETY OF GC | |||||||
| 1201 EAST GARRISON BLVD | GASTONIA | NC | 28054 | 561330921 | 501(C)(3) | $10,000 | OPERATIONAL SUPPORT |
| LEUKEMIA & LYMPHOMA SOCIETY | |||||||
| 3 INTERNATIONAL DRIVE SUITE 200 | RYE BROOK | NY | 10573 | 135644916 | 501(C)(3) | $10,000 | OPERATIONAL SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 8 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 37 | RecipientCnt |
| Cash Grant | $127,348 | CashGrantAmt |
| Non Cash Assistance | SHOVELIN, BUCCI, HUDSON AND MACKIE NURSING SCHOLARSHIPS | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MR K CHRISTOPHER PEEK | ||||||||||||||
| CEO | $0 | $776,638 | $0 | $272,457 | $0 | $113,343 | $0 | $203,933 | $0 | $21,300 | $0 | $1,387,671 | $0 | $89,251 |
| MR DAVID M O'CONNOR | ||||||||||||||
| EVP/ASST. TREASURER/DIRECTOR | $0 | $495,147 | $0 | $138,597 | $0 | $94,331 | $0 | $115,312 | $0 | $21,295 | $0 | $864,682 | $0 | $78,443 |
| DR GEORGE E ADCOCK III | ||||||||||||||
| VP/SECRETARY STARTING 1/1/2021 | $0 | $329,538 | $0 | $155,589 | $0 | $17,847 | $0 | $67,462 | $0 | $21,223 | $0 | $591,659 | $0 | $0 |
| DR RAMADA S SMITH | ||||||||||||||
| DIRECTOR | $0 | $441,563 | $0 | $8,976 | $0 | $2,964 | $0 | $20,437 | $0 | $13,130 | $0 | $487,070 | $0 | $0 |
| MS LEIGH HICKMAN | ||||||||||||||
| CLO/ASST. SEC. | $0 | $303,156 | $0 | $63,025 | $0 | $789 | $0 | $60,798 | $0 | $14,479 | $0 | $442,247 | $0 | $0 |
| MS ASHLEY LONG | ||||||||||||||
| DIRECTOR | $0 | $204,282 | $0 | $34,171 | $0 | $191 | $0 | $33,713 | $0 | $10,654 | $0 | $283,011 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | COMPENSATION PAID TO CEO OF CAROMONT HEALTH, INC. WAS PAID BY CAROMONT REGIONAL MEDICAL CENTER, A RELATED ORGANIZATION. CAROMONT REGIONAL MEDICAL CENTER UTILIZED THE FOLLOWING METHODS TO DETERMINE APPROPRIATE COMPENSATION FOR CEO THAT HAD INFLUENCE OVER THE ORGANIZATION'S ACTIVITIES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACTS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS BY RELATED ORGANIZATION CAROMONT REGIONAL MEDICAL CENTER FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 95,362 K. CHRISTOPHER PEEK - 188,258 LEIGH K. HICKMAN - 47,249 DR. GEORGE ADCOCK - 51,109 ASHLEY LONG - 21,958 |
| PART I, LINE 6 | EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES WHICH INCLUDE A FINANCIAL GOAL ATTRIBUTABLE TO OPERATING MARGIN. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS OF THE BOARD OF DIRECTOR ARE ELECTED AT WILL BY ITS SOLE MEMBER OF THE CORPORATION ACTING THROUGH ITS BOARD OF DIRECTORS AT ITS ANNUAL MEETING FROM A SLATE OF NOMINEES PROVIDED TO THE CAROMONT HEALTH, INC. BOARD BY THE FOUNDATION. ALL DIRECTORS ARE SUBJECT TO REMOVAL BY THE CAROMONT HEALTH BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION. IN ADDITION, DECISIONS OF THE GOVERNING BODY INCLUDING THE ELECTION AND REMOVAL OF MEMBERS OF THE BOARD OR DIRECTORS MUST BE APPROVED BY THE CORPORATION'S SOLE MEMBER, CAROMONT HEALTH, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | MEMBERS OF THE BOARD OF DIRECTORS, MEMBERS OF SENIOR LEADERSHIP, ANY PHYSICIAN HOLDING A LEADERSHIP OR ADMINISTRATIVE POSITION WITHIN THE ORGANIZATION, DIRECTORS, RESEARCH STUDY PERSONNEL, MANAGERS AND ALL STAFF MEMBERS OF THE PURCHASING AND MARKETING DEPARTMENTS AND ANY OTHER DEPARTMENT DEEMED TO HAVE MATERIAL DECISION MAKING RESPONSIBILITIES ON BEHALF OF CAROMONT HEALTH SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE INDIVIDUAL'S OBLIGATION TO IMMEDIATELY MAKE THE CORPORATE RESPONSIBILITY OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID INDIVIDUAL'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. QUESTIONNAIRES SUBMITTED BY DIRECTORS ARE REVIEWED ANNUALLY BY THE NOMINATING COMMITTEE OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO, CFO, COO, CMO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY CAROMONT REGIONAL MEDICAL CENTER, A SUBSIDIARY OF 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. A MAJORITY OF THE BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND ALL ARE FREE FROM 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 DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING 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 PERFORMANCE EVALUATION, 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 APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE MANAGEMENT, UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| 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 ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. |
| PART XII, LINE 2C | THE PROCESS FOR THIS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROMONT HEALTH INC | |||||||||||
| 2525 COURT DRIVE | GASTONIA | NC | 28054 | 581636959 | MEDICAL SERVICES | NC | 501(C)(3) | LINE 11B, II | N/A | 0 | |
| CAROMONT HEALTH SERVICES INC | |||||||||||
| 2526 COURT DRIVE | GASTONIA | NC | 28054 | 561455630 | OUTPATIENT SERVICES | NC | 501(C)(3) | LINE 3 | 0 | CAROMONT HEALTH INC | |
| CAROMONT MEDICAL GROUP INC | |||||||||||
| 2528 COURT DRIVE | GASTONIA | NC | 28054 | 561479712 | MEDICAL GROUP | NC | 501(C)(3) | LINE 9 | 0 | CAROMONT HEALTH INC | |
| HOSPICE OF GASTON COUNTY INC | |||||||||||
| 2529 COURT DRIVE | GASTONIA | NC | 28054 | 581341530 | HOSPICE CARE | NC | 501(C)(3) | LINE 7 | 0 | CAROMONT HEALTH INC | |
| GASTON MEMORIAL HOSPITAL INC | |||||||||||
| 2530 COURT DRIVE | GASTONIA | NC | 28054 | 560619359 | HOSPITAL | NC | 501(C)(3) | LINE 3 | 0 | CAROMONT HEALTH INC | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
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