MERCY RESTORATIVE CARE HOSPITAL INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
MERCY RESTORATIVE CARE HOSPITAL INC (EIN 75-3054855)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-05-14
IRS object ID
201901349349310545
Schema version
2017v2.3
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

FieldValueIRS element (for citing)
Return2019-05-14T20:12:44-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1425 HOUSTON ST STE 600AddressLine1Txt
CityFORT WORTHCityNm
State AbbreviationTXStateAbbreviationCd
ZIP76102ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN753054855EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mercy Restorative Care Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% MIKE MURRAYInCareOfNm
Business Name ControlMERCBusinessNameControlTxt
Phone9729436400PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17800 N DALLAS PARKWAY SUITE 200AddressLine1Txt
CityPlanoCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75024ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJAMES HILLPersonNm
Person TitleTREASURERPersonTitleTxt
Phone9729436400PhoneNum
Signature2019-05-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJodi RosserPreparerPersonNm
PTINP01255710PTIN
Phone8173351900PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address71.56.5.91IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id75306120191345000135FederalOriginalSubmissionId
Federal Original Submission Id2019-05-14FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id0FD3178183619286035AA06C9BAA1B15F55AB8A5AtSubmissionCreationDeviceId
At Submission Filing Device IdBEE816BADD25910960E744A98AF4267C63CAEDF6AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1See Schedule OBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerJAMES HILLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line17800 N Dallas Parkway STE 200AddressLine1Txt
CityPlanoCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75024ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$19,006,334GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTP://CONTINUECARE.ORG/PINEVILLE/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2000FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionOUR MISSION IS TO PROVIDE EXCEPTIONAL HEALTHCARE WITH DEDICATION AND COMPASSION TO MEDICALLY COMPLEX EXTENDED STAY PATIENTS.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee255TotalEmployeeCnt
Total Volunteers5TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$16,448,342PYProgramServiceRevenueAmt
CY Program Service Revenue$18,880,188CYProgramServiceRevenueAmt
PY Investment Income$11,389PYInvestmentIncomeAmt
CY Investment Income$8,070CYInvestmentIncomeAmt
PY Other Revenue$3,579PYOtherRevenueAmt
CY Other Revenue$118,076CYOtherRevenueAmt
PY Total Revenue$16,463,310PYTotalRevenueAmt
CY Total Revenue$19,006,334CYTotalRevenueAmt
PY Grants And Similar Paid$4,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,185,145PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,777,117CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$8,976,008PYOtherExpensesAmt
CY Other Expenses$13,886,470CYOtherExpensesAmt
PY Total Expenses$18,165,153PYTotalExpensesAmt
CY Total Expenses$21,663,587CYTotalExpensesAmt
PY Revenues Less Expenses-$1,701,843PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$2,657,253CYRevenuesLessExpensesAmt
Total Assets BOY$8,527,114TotalAssetsBOYAmt
Total Assets EOY$9,006,278TotalAssetsEOYAmt
Total Liabilities BOY$1,580,412TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,716,829TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,946,702NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,289,449NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionOUR MISSION IS TO PROVIDE EXCEPTIONAL HEALTHCARE WITH DEDICATION AND COMPASSION TO MEDICALLY COMPLEX EXTENDED STAY PATIENTS.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$18,571,402ExpenseAmt
Grant$0GrantAmt
Revenue$18,997,183RevenueAmt
DescMERCY RESTORATIVE CARE HOSPITAL INC., D/B/A CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE (CAROLINAS CCH AT PINEVILLE), IS A STAND-ALONE 40-BED LTACH HOUSED IN A MODERN FACILITY THAT WAS CUSTOM DESIGNED TO TREAT CRITICALLY ILL AND MEDICALLY COMPLEX PATIENTS. CAROLINAS CCH AT PINEVILLE IS LOCATED IN SOUTHERN CHARLOTTE ON THE CAROLINAS HEALTHCARE SYSTEM PINEVILLE CAMPUS. CAROLINAS CCH AT PINEVILLE IS SPECIFICALLY LICENSED AND ADMINISTERED TO PROVIDE CARE FOR PATIENTS WHO REQUIRE DAILY PHYSICIAN AND STAFF ATTENTION FOR COMPLEX CONDITIONS. CAROLINAS CCH AT PINEVILLE'S EMPLOYEES ARE A DEDICATED TEAM WHO WORK TOGETHER DELIVERING THE BEST POSSIBLE CARE FOR OUR PATIENTS. SINCE CAROLINAS CCH AT PINEVILLE HAS A LONGER LENGTH OF STAY, THE STAFF HAS THE OPPORTUNITY TO KNOW PATIENTS AND FAMILIES. CAROLINAS CCH AT PINEVILLE BELIEVES SPENDING QUALITY TIME MAKES A DIFFERENCE. CAROLINAS CCH AT PINEVILLE IS A SEPARATE YET FULLY LICENSED ACUTE-CARE HOSPITAL WITH THE ABILITY TO PROVIDE INTENSIVE AND COMPLEX MEDICAL TREATMENT. CAROLINAS CCH AT PINEVILLE'S SPECIALTY PROGRAMS ARE SPECIFICALLY DESIGNED TO MEET THE NEEDS OF LONG-TERM, ACUTE-CARE PATIENTS. DURING THE FISCAL YEAR ENDED JUNE 30, 2018, CAROLINAS CCH AT PINEVILLE'S TOTAL PATIENTS ADMITTED WERE 350 AND THE TOTAL NUMBER OF PATIENT CARE DAYS PROVIDED WAS 8,843. THE AVERAGE DAILY CENSUS WAS 24 PATIENTS AND THE AVERAGE LENGTH OF STAY OF THE DISCHARGED PATIENTS EXCEEDED 25.3 DAYS.Desc
Total Program Service Expenses$18,571,402TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredfalseScheduleORequiredInd
IRP Document21IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee255EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (true)DelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesfalseMinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldNCStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMIKE MURRAYPersonNm
Phone9729431225PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17800 N DALLAS PARKWAY SUITE 200AddressLine1Txt
CityPLANOCityNm
State AbbreviationTXStateAbbreviationCd
ZIP75024ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Joseph Bowers
Director1.00.0Yes (X)$0$0$0
Joyce Korzen
Director1.00.0Yes (X)$0$0$0
Alan Sauber
Director1.00.0Yes (X)$0$0$0
Earl Scott Warrick
Director1.00.0Yes (X)$0$0$0
COLLIN LANE
DIRECTOR1.00.0Yes (X)$0$0$0
JIM Kendrick
DIRECTOR1.039.0Yes (X)$0$670,443$103,823
APRIL MYERS
DIRECTOR/PRESIDENT1.039.0Yes (X)$0$210,488$43,747Yes (X)
David Butler
Secretary1.039.0$0$382,510$31,287Yes (X)
JAMES HILL
TREASURER1.039.0$0$254,689$38,013Yes (X)
DEREK MURZYN
CEO40.00.0$0$183,963$21,951Yes (X)
Hajrudin Begic
Registered Nurse40.00.0$127,992$0$27,818Yes (X)
Janet Combs
director of rehab40.00.0$117,811$0$4,905Yes (X)
Teshia Davis Carr
CNO40.00.0$0$132,672$8,242Yes (X)
Noreen Kipp
nursing manager40.00.0$109,394$0$24,582Yes (X)
Stephen Gambrell
Market Administrator40.00.0$0$108,767$7,263Yes (X)
Leslie Boney
FORMER Director/president0.00.0$0$109,271$0Yes (X)
Michael Williams
Former Director0.00.0$0$2,098,576$20,774Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$355,197TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$4,151,379TotReportableCompRltdOrgAmt
Total Other Compensation$332,405TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
McDermott Will Emery LLP
444 West Lake StreetCHICAGOIL60606legal services$324,956
Charlotte eye ears nose throat
6035 Fairview RoadCHARLOTTENC28210physician svcs$125,000
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescINPATIENT REVENUEDesc
Business623000BusinessCd
Total Revenue Column$18,880,188TotalRevenueColumnAmt
Related Or Exempt Func Income$18,880,188RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$18,880,188TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,070TotalRevenueColumnAmt
Exclusion$8,070ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICAL RECORDS900099$1,081$1,081
MISC. INCOME - RESPIRATORY THERAPY SVC.900099$116,995$116,995
FieldValueIRS element (for citing)
Other Revenue Total$118,076OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,006,334TotalRevenueColumnAmt
Related Or Exempt Func Income$18,997,183RelatedOrExemptFuncIncomeAmt
Exclusion$9,151ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,089,515TotalAmt
Program Services$5,494,570ProgramServicesAmt
Management And General$594,945ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$99,224TotalAmt
Program Services$89,302ProgramServicesAmt
Management And General$9,922ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,132,190TotalAmt
Program Services$1,018,971ProgramServicesAmt
Management And General$113,219ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$456,188TotalAmt
Program Services$410,570ProgramServicesAmt
Management And General$45,618ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$540,000TotalAmt
Program Services$540,000ProgramServicesAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$194,109TotalAmt
Program Services$194,109ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$111,512TotalAmt
Program Services$111,512ProgramServicesAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$1,863TotalAmt
Program Services$1,863ProgramServicesAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,805,665TotalAmt
Program Services$3,670,805ProgramServicesAmt
Management And General$134,860ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$27,386TotalAmt
Management And General$27,386ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$67,344TotalAmt
Management And General$67,344ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$50TotalAmt
Management And General$50ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,431,280TotalAmt
Management And General$1,431,280ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$35,109TotalAmt
Management And General$35,109ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$6,680TotalAmt
Management And General$6,680ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$73,143TotalAmt
Management And General$73,143ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$347,257TotalAmt
Management And General$347,257ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$205,372TotalAmt
Management And General$205,372ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
BAD DEBT EXPENSE$5,331,072$5,331,072
MEDICAL SUPPLIES$1,403,471$1,403,471
EQUIPMENT LEASES$110,261$110,261
MAINTENANCE CONTRACTS$66,569$66,569

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$128,327TotalAmt
Program Services$128,327ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$21,663,587TotalAmt
Program Services$18,571,402ProgramServicesAmt
Management And General$3,092,185ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$322,607BOYAmt
EOY$218,161EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,393,412BOYAmt
EOY$4,394,776EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$47,081BOYAmt
EOY$43,576EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$484,949BOYAmt
EOY$425,280EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,900,076LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,489,570LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,754,257BOYAmt
EOY$1,410,506EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$2,524,808BOYAmt
EOY$2,513,979EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,527,114BOYAmt
EOY$9,006,278EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,336,954BOYAmt
EOY$3,540,373EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$1,031,932BOYAmt
EOY$748,229EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY-$1,788,474BOYAmt
EOY$428,227EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,580,412BOYAmt
EOY$4,716,829EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,946,702BOYAmt
EOY$4,289,449EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,946,702BOYAmt
EOY$4,289,449EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,527,114BOYAmt
EOY$9,006,278EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$2,657,253ReconcilationRevenueExpnssAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$1,863OtherActivitiesAmt
Total Lobbying Expenditures$1,863TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind
Form4720 Filed4912 TaxfalseForm4720Filed4912TaxInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule C, Part II-B, Line 1iFormAndLineReferenceDesc
ExplanationMERCY RESTORATIVE CARE HOSPITAL, INC. PAID $5,417 TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) and $5,084 TO THE National Association of Long Term Hospitals (NALTH) IN FISCAL YEAR 2018. THE PORTION OF AHA DUES REPORTED FOR LOBBYING PURPOSES WAS 22.98% and THE PORTION OF NALTH DUES REPORTED FOR LOBBYING PURPOSES WAS 12.16%. TOTAL DUES PAID AND REPORTED FOR LOBBYING ACTIVITIES FOR AHA WERE $5,417 X 22.98% = $1,245 and FOR NALTH WERE $5,084 X 12.16% = $618.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp
BuildingsBuildingsGrp

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$94,894OtherCostOrOtherBasisAmt
Depreciation$36,304DepreciationAmt
Book Value$58,590BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,805,182OtherCostOrOtherBasisAmt
Depreciation$1,453,266DepreciationAmt
Book Value$1,351,916BookValueAmt
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildingsGrp
Total Book Value Land Buildings$1,410,506TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
INTERCOMPANY PAYABLES$365,201
ESTIMATED THIRD PARTY SETTLEMENTS$63,026
FieldValueIRS element (for citing)
Total Liability$428,227TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$301,094TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$215,335DirectOffsettingRevenueAmt
Net Community Benefit Expns$85,759NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$301,094TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$215,335DirectOffsettingRevenueAmt
Net Community Benefit Expns$85,759NetCommunityBenefitExpnsAmt
Total Expense0.00520TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,960TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,960NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,960TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,960NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$308,054TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$215,335DirectOffsettingRevenueAmt
Net Community Benefit Expns$92,719NetCommunityBenefitExpnsAmt
Total Expense0.00560TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$5,331,072BadDebtExpenseAmt
Reimbursed By Medicare$9,483,378ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$8,737,212CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$746,166MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Carolinas CCH at PinevilleBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line110648 PARK ROADAddressLine1Txt
CityCHARLOTTECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28210ZIPCd
FieldValueIRS element (for citing)
Website AddressHTTP://CONTINUECARE.ORG/PINEVILLE/WebsiteAddressTxt
State LicenseH0278StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Carolinas CCH at PinevilleBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSee Part V, Section COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSee Part V, Section CStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSee Part V, Section CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSee Part V, Section CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART V, SECTION CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyfalseNondisEmergencyCarePolicyInd
No Emergency CareYes (X)NoEmergencyCareInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp

FieldValueIRS element (for citing)
Form And Line ReferencePART V, LINE 3EFormAndLineReferenceDesc
ExplanationThe significant health needs of the community identified in the CHNA are presented as a prioritized description. Part V, Line 5 A comprehensive, six-step community health needs assessment (CHNA) was conducted for MERCY RESTORATIVE CARE HOSPITAL, INC. D/B/A CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE (CAROLINAS CCH AT PINEVILLE) by CHC ContinueCARE. This CHNA utilizes relevant health data and stakeholder input to identify the significant community health needs in Mecklenburg County, North Carolina. Community input was received during interviews conducted from January 27, 2017 - February 10, 2017. The Carolinas CCH at Pineville Board reviewed and adopted the 2016 Community Health Needs Assessment and Implementation Plan on May 3, 2017. Carolinas CCH at Pineville provided CHC ContinueCARE with a list of persons with special knowledge of public health in Mecklenburg County, including public health representatives, not-for-profit organization professionals, charities and other individuals who focus specifically on underrepresented groups. From that list, eleven in depth interviews were conducted using a structured interview guide with the two groups outlined in internal revenue service final regulations issued December 29, 2014. Discussed were the health needs of the community, access issues, barriers and issues related to specific populations. With respect to individuals providing input it was noted in the CHNA that 90.9% of those providing input are members of a medically underserved, low-income or minority population in the community, or individuals or organizations serving or representing the interests of such populations. 9.1% of those providing input work for a state, local, tribal or regional governmental public health department with knowledge, information or expertise relevant to the health needs of the community. Interviewees included: -Life share of the Carolinas -Program for all inclusive care for the elderly (PACE) of the Southern Piedmont -Brian Center Reddman -Carolinas Healthcare System -Helping Hands Specialized Transport -Pulmonary & Critical Care Consultants -Mecklenburg County Health Department -Carolinas Healthcare System North East -Carolinas Wound Care Center Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.) served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported. Populations that were identified as the most underserved in the community by interviewees were: the elderly, youth, veterans, and un/underinsured populations in the community. These underserved groups were identified as most at risk for inadequate care due to the following: Elderly -Transportation barriers -Issues affording health services and medication -Lack of long term care resources for low income seniors -Difficulty navigating and understanding the health care system Teen/Adolescents -High need for maternal services and preventive education -Tobacco control Veterans -Limited access to health care services -Need for more mental and behavioral health care sources Un/Underinsured -Lack of access to primary care services and providers -Lack of affordable care options -Overuse of the emergency room/lack of an established medical home Part V, Lines 7a & 10a The CHNA can be found on the following website: http://continuecare.org/pineville/community-health-needs-assessment/ Part V, Line 11 The most recently conducted CHNA indicated that there were three main needs in the community served by Carolinas CCH at Pineville. Hospital leadership prioritized those needs and decided to address the first two. OBJECTIVE #1: INCREASE HEALTHY LIFESTYLE EDUCATION AND PREVENTION RESOURCES AT THE HOSPITAL AND IN THE COMMUNITY. 1.A. Carolinas CCH at Pineville will continue to participate in and/or host community health fairs on a regular basis. 1.B. Carolinas CCH at Pineville will continue to provide various health screenings at no cost, such as glucose, pulse oximetry, and blood pressure checks, at its vendor/fair events. 1.C. Carolinas CCH at Pineville will continue to participate in lunch and learn seminar events to educate local health care providers and the community on services offered by the Long Term Acute Care (LTAC) facility on a regular basis. 1.D. Carolinas CCH at Pineville is available to speak at community events, provide information, or participate in other educational opportunities by request. 1.E. Carolinas CCH at Pineville will continue to offer liaisons to give education on LTAC services and patients who may need LTAC services as opportunities arise. 1.F. Carolinas CCH at Pineville will continue to train all clinical staff on Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) for all RN and Respiratory Therapy (RT) staff. 1.G. Carolinas CCH at Pineville will continue to provide meeting space at no cost for support groups and community organizations upon request. 1.H. Carolinas CCH at Pineville will continue to participate in or provide space for meetings held by various local, state and national organizations to share information about services offered at the LTAC facility, such as the Case Management Society of America meeting that includes a keynote speaker who provides education to the audience on a significant health topic within the community. Continuing Education Units (CEUs) may be offered at some of the events. 1.I. Carolinas CCH at Pineville will continue to participate in conferences focused around their patient population's needs, such as the American Case Management Association (ACMA) North Carolina Conference (bi-annually), Case Management Society of America (CMSA) North Carolina Conference (bi-annually), and the Northwest Area Health Education Center (NWAHEC) Annual High Country Conference on Respiratory Care. 1.J. Carolinas CCH at Pineville will continue to partner with and support the local chapter of the American Lung Association (ALA). 1.K. Carolinas CCH at Pineville staff will continue to provide board representation for ALA, as well as sponsorship and support for the ALA Climb event to raise money and awareness for ALA within the community. 1.L. Carolinas CCH at Pineville will engage in a variety of employee wellness initiatives, including a health plan that is prevention driven. If employees meet certain criteria they will receive a reduction on a portion of their premiums. Other initiatives include: promote employee and family wellness via Accountable Health (formerly Principal Wellness Program); offer Need Specific Special Programs; smoking cessation opportunities; and weight management. 1.M. Carolinas CCH at Pineville will continue to incentivize employees to maintain healthy lifestyles on their health plans through offering a reduction on a portion of their premiums if employees meet certain criteria. 1.N. Carolinas CCH at Pineville will continue to offer the Employee Assistance Program (EAP) through Beacon Health Options to help employees navigate various life challenges. 1.O. Carolinas CCH at Pineville employees have access to the healthier options in the cafeteria, such as a salad bar, as well as nutritional facts for food that is served. 1.P. Carolinas CCH at Pineville will continue to serve as a tobacco-free facility. 1.Q. Carolinas CCH at Pineville will continue to host interdisciplinary team meetings on a weekly basis that include all necessary persons in discussions regarding individual patient care for a more comprehensive, patient-centered approach. Carolinas CCH at Pineville staff encourage family members to attend as well in order to fully understand the needs of the patient. 1.R. Carolinas CCH at Pineville will continue to provide patients' other physicians with a copy of their discharge summaries upon request. 1.S. Carolinas CCH at Pineville will continue to conduct post discharge follow up calls for every patient that has been discharged. For patients that are discharged to their home, a call is placed within the first 24-72 hours to assess the transition home, and to identify and address any issues or problems (i.e., inability to obtain prescriptions, home health care start of care, pain and symptom management, equipment concerns, or effectiveness of discharge planning). Follow up calls are also performed on every patient 30 days after discharge from the LTAC to determine if patient was readmitted to a LTAC within 30 days of discharging. 1.T. Carolinas CCH at Pineville will continue to conduct a thorough medication management education process for patients that involves patient demonstration of proper medication methods and documentation of the patient's proper medication methods before allowing the patient to be discharged. OBJECTIVES #2: PARTICIPATE IN INITIATIVES AND CREATE OPPPORTUNITIES TO INCREASE ACCESS TO AFFORDABLE CARE AND REDUCE HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS. 2.A. Carolinas CCH at Pineville wilExplanationTxt

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7, COLUMN (F)COMMUNITY BENEFIT EXPENSE The TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) IS $21,663,587. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS 5,331,072 THIS LEFT A TOTAL EXPENSE OF $16,332,515 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). SINCE MERCY RESTORATIVE CARE HOSPITAL, INC. is a long term acute care hospital, it will have lower percentages than an acute care hospital.
PART III, LINE 2BAD DEBT COSTING METHODOLOGY THE BAD DEBT COSTING METHODOLOGY VARIES BY PAYER TYPE. FOR MEDICARE, BAD DEBT IS RECORDED WHEN RECOGNIZED TO THE EXTENT OF 35%. MEDICARE REIMBURSES THE ORGANIZATION FOR ALLOWABLE BAD DEBT AT 65%. MEDICARE BAD DEBT RELATES TO THE PRIVATE PAY PORTION OF CARE SUCH AS CO-PAY AND DEDUCTIBLE AMOUNTS. FOR MANAGED CARE, WE RESERVE BAD DEBT WHEN RECOGNIZED AT 100% OF CO-PAY AND DEDUCTIBLE AMOUNTS.
PART III, LINE 4BAD DEBT EXPENSE FOOTNOTE MERCY RESTORATIVE CARE HOSPITAL, INC. DOES NOT HAVE ITS OWN AUDIT. RATHER, IT IS PART OF COMMUNITY HOSPITAL CORPORATION AND THE BAD DEBT DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS DOES NOT COMPLETELY MATCH THE ORGANIZATION'S PRACTICE. THE BAD DEBT COSTING METHODOLOGY VARIES BY PAYER TYPE. FOR MEDICARE, BAD DEBT IS RECORDED WHEN RECOGNIZED TO THE EXTENT OF 35%. MEDICARE REIMBURSES THE ORGANIZATION FOR ALLOWABLE BAD DEBT AT 65%. MEDICARE BAD DEBT RELATES TO THE PRIVATE PAY PORTION OF CARE SUCH AS CO-PAY AND DEDUCTIBLE AMOUNTS. FOR MANAGED CARE, WE RESERVE BAD DEBT WHEN RECOGNIZED AT 100% OF CO-PAY AND DEDUCTIBLE AMOUNTS.
PART III, LINE 8COSTING METHODOLOGY THE COSTING METHODOLOGY USED ON LINE 6 COMES FROM THE COST REPORT (INPATIENT PPS COST-TO-CHARGE RATIO COMPUTATION).
PART III, LINE 9BApplication of collection practices to those qualifying for financial assistance IF A PATIENT OF MERCY RESTORATIVE CARE HOSPITAL, INC. QUALIFIES FOR ITS CHARITY CARE POLICY THE PATIENTS ACCOUNT IS ADJUSTED ACCORDINGLY. PATIENT ACCOUNTS WITH REMAINING BALANCES WILL BE REASSESSED TO DETERMINE THEIR ABILITY TO PAY AND WILL EITHER BE ELIGIBLE TO PARTICIPATE IN A PAYMENT PLAN OR THEIR ACCOUNT BALANCE WILL BE WRITTEN OFF.
PART VI, LINE 2NEEDS ASSESSMENT MERCY RESTORATIVE CARE HOSPITAL, INC. D/B/A CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE (MRC) IS A 40-BED LONG-TERM ACUTE CARE HOSPITAL. THE HOSPITAL WAS INCORPORATED UNDER THE LAWS OF NORTH CAROLINA FOR THE PURPOSE OF PROMOTING AND IMPROVING THE HEALTH STATUS OF THE COMMUNITY BY DEVELOPING AND PROVIDING LONG-TERM ACUTE CARE SERVICES FOR THE BENEFIT OF CITIZENS OF MECKLENBURG AND SURROUNDING COUNTIES. AS REPORTED IN SCHEDULE H, PART V, SECTION B, LINES 1-7, THE HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING 2017. The Carolinas ContinuCare Hospital at Pineville Board reviewed and adopted the 2017 Community Health Needs Assessment and Implementation Plan on May 3, 2017. THE HOSPITAL'S CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN THE FINAL REGULATIONS RELEASED DECEMBER 29, 2014. IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. Carolinas CONTINUECARE HOSPITAL AT Pineville WILL BE WORKING TO PROVIDE VARIOUS CHARITABLE SERVICES AND TO CONDUCT VARIOUS COMMUNITY ACTIVITIES TO AND WITHIN THE LOCAL COMMUNITY IN THE NEAR FUTURE.
PART VI, LINE 3PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES ARE INFORMED UPON ADMISSION TO THE HOSPITAL BY A FACE TO FACE VISIT WITH THE HOSPITAL/ADMISSIONS STAFF. THE PATIENT FINANCIAL OBLIGATION IS DISCUSSED WITH THE RESPONSIBLE PARTY. THE HOSPITAL CHARITY CARE POLICY IS DISCUSSED WITH EACH RESPONSIBLE PARTY AND IF IT IS FELT THAT THE PATIENT WOULD QUALIFY FOR THE CHARITY PROGRAM THEN THE NECESSARY DOCUMENTS WOULD BE PRESENTED BY THE RESPONSIBLE PARTY TO THE BUSINESS OFFICE ASSOCIATE FOR REVIEW. The charity care policy is also posted in the admissions office and on its website.
PART VI, LINE 4COMMUNITY INFORMATION MERCY RESTORATIVE CARE HOSPITAL, INC. (MRC) SERVES PRIMARILY THOSE PATIENTS WHO ARE FROM MECKLENBURG AND THE SURROUNDING COUNTIES OR THOSE WHO HAVE FAMILY SUPPORT FROM MEMBERS LIVING IN THESE COUNTIES. GIVEN THE SPECIALIZED SERVICES MRC REACHES OUT TO ALL OF THE NORTH AND SOUTH CAROLINA COMMUNITITES AS WELL AS SOUTHERN VIRGINIA AND SOUTHERN WEST VIRGINIA. MRC's PRIMARY SERVICE AREA (CABARRUS, NC, GASTON, NC, MECKLENBERG, NC, UNION, NC, AND YORK, SC - 2010 CENSUS) SERVES 1,731,090 RESIDENTS OF WHICH 173,584 ARE GREATER THAN 65 YEARS OF AGE. THE SECONDARY SERVICE AREA (CHESTER, SC, CLEVELAND, NC, IREDELL, NC, LANCASTER, SC, LINCOLN, NC, ROWAN, NC, AND STANLY, NC - 2010 CENSUS) SERVES 644,585 RESIDENTS OF WHICH 91,555, ARE GREATER THAN 65 YEARS OF AGE.
PART VI, LINE 5PROMOTION OF COMMUNITY HEALTH Mercy Restorative Care Hospital, Inc. is a community-based LTACH dedicated to serving the needs of the local community by delivering superior services with a collaborative spirit. The hospital is working to provide various charitable services as well as conduct various community activites to and within the local community. The hospital sponsored a healthcare convention and is exploring participating in drive events (ex: toy, food, school supply, and clothing drives). The hospital continues to serve in leadership roles and volunteers with many agencies in the community. Mercy Restorative Care Hospital, Inc. educates patients and families about LTACHs and about what services can be provided in conjunction with community resources through speaking at local events and by providing educational brochures.
PART VI, LINE 6AFFILIATED HEALTH CARE SYSTEM THE HOSPITAL IS HOUSED IN ANOTHER HOSPITAL BUT THE TWO ARE SEPARATE FOR PURPOSES OF SPONSORSHIP AND COMMUNITY RELATED HEALTHCARE EVENTS.
PART VI, LINE 7STATE FILING OF COMMUNITY BENEFIT REPORT N/A

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Leslie Boney
FORMER Director/president$0$0$0$0$0$109,271$0$0$0$0$0$109,271$0$0
Michael Williams
Former Director$0$527,618$0$0$0$1,570,958$0$7,950$0$12,824$0$2,119,350$0$0
David Butler
Secretary$0$359,967$0$0$0$22,543$0$5,505$0$25,782$0$413,797$0$0
Hajrudin Begic
Registered Nurse$116,063$0$8,500$0$3,429$0$4,025$0$23,793$0$155,810$0$0$0
JIM Kendrick
DIRECTOR$0$467,742$0$0$0$202,701$0$83,594$0$20,229$0$774,266$0$0
JAMES HILL
TREASURER$0$240,108$0$0$0$14,581$0$7,669$0$30,344$0$292,702$0$0
DEREK MURZYN
CEO$0$180,821$0$0$0$3,142$0$12,041$0$9,910$0$205,914$0$0
APRIL MYERS
DIRECTOR/PRESIDENT$0$199,139$0$0$0$11,349$0$14,954$0$28,793$0$254,235$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SUPPLEMENTAL COMPENSATION INFORMATIONSCHEDULE J, PART I, LINE 3 MERCY RESTORATIVE CARE HOSPITAL INC.'S EXECUTIVES ARE EMPLOYED BY ITS WHOLLY-OWNED SUBSIDIARY, COMMUNITY HOSPITAL CONSULTING, WHICH FOLLOWS THE COMPENSATION POLICIES OF COMMUNITY HOSPITAL CORPORATION (CHC). CHC ENGAGED SULLIVAN COTTER TO CONDUCT A COMPETITIVE MARKET ANALYSIS OF THE COMPENSATION OF CHC'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS AND KEY EMPLOYEES. SULLIVAN COTTER GATHERED DATA RELATED TO JOB DESCRIPTIONS, SCOPE OF RESPONSIBILITIES, AND CURRENT INCUMBENTS' COMPENSATION. SULLIVAN COTTER RECOMMENDED APPROPRIATE COMPARISON DATA AND UTILIZED SURVEY DATA FROM FOUR MAJOR EXECUTIVE COMPENSATION SURVEY PROVIDERS TO PROVIDE MARKET DATA AND EXECUTIVE COMPENSATION RECOMMENDATIONS THAT MEET CHC'S COMPENSATION PHILOSOPHY. SULLIVAN COTTER'S RECOMMENDATIONS WERE PRESENTED TO THE CHC COMPENSATION COMMITTEE OF THE BOARD FOR REVIEW AND APPROVAL. CHC ALSO CONDUCTS PERIODIC REVIEWS OF COMPENSATION TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. The organization followed the process for the year ended 6/30/18 for its officers, directors, trustees and key employees and other management officials. Schedule J, Part I, Line 4a Severance Payment MICHAEL WILLIAMS, A FORMER DIRECTOR, RECEIVED A SEVERANCE PAYMENT UPON HIS TERMINATION OF EMPLOYMENT. LESLIE BONEY, A FORMER DIRECTOR, RECEIVED $109,271 IN SEVERANCE PAYMENTS FROM A RELATED ORGANIZATION DURING 2018. Schedule J, Part I, Line 4b NONQUALIFIED RETIREMENT PLAN PARTICIPATION WAS PAID TO: MICHAEL WILLIAMS - $157,802 DAVID BUTLER - $12,706 JAMES HILL - $10,225 APRIL MYERS - $1,740 JIM KENDRICK - $76,924
SCHEDULE J, PART I, LINE 7COMPENSATION CONTINGENT ON NET EARNINGS A PORTION OF THE DISCRETIONARY INCENTIVE COMPENSATION PROGRAM WAS BASED ON THE EBIDA OF CHC.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
DOING BUSINESS ASFORM 990, BOX C MERCY RESTORATIVE CARE HOSPITAL, INC. IS DOING BUSINESS AS CAROLINAS CONTINUECARE HOSPITAL AT PINEVILLE. DESCRIPTION OF MANAGEMENT ARRANGEMENT FORM 990, PART VI, QUESTION 3 CHC COMMUNITY CARE, LLC PROVIDES CERTAIN FINANCIAL, TECHNICAL AND MANAGERIAL SUPPORT SERVICES TO THE HOSPITAL. DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 THE SOLE SHAREHOLDER OF MERCY RESTORATIVE CARE HOSPITAL, INC. IS CAROLINAS COMMUNITY CARE, LLC ("CARCC"). DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTION 7A THE SOLE SHAREHOLDER SHALL MAINTAIN A MINORITY VOTING INTEREST OF THE BOARD OF DIRECTORS. ANY DIRECTOR MAY BE REMOVED AT ANY TIME, WITH OR WITHOUT CAUSE BY THE SOLE MEMBER. THE BOARD OF DIRECTORS SHALL BE COMPRISED OF 5 VOTING DIRECTORS PLUS 2 NON-VOTING EX-OFFICIO DIRECTORS.
DESCR CLASSES OF PERSONS/DECISIONS REQUIRING APPR/TYPE OF VOTING RIGHTSFORM 990, PART VI, QUESTION 7B THE BOARD OF DIRECTORS MAY RECOMMEND, BUT SHALL NOT, WITHOUT EXPRESS WRITTEN CONSENT OF THE SOLE MEMBER, HAVE THE POWER TO TAKE ANY OF THE FOLLOWING ACTIONS: 1. ANY FUNDAMENTAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE HOSPITAL 2. THE INCURRANCE OF DEBT, INCLUDING WITHOUT LIMITATION, BORROWINGS, GUARANTEES, LOANS, ENCUMBRANCES, OPERATING LEASES, PURCHASE OF LEASE OF REAL ESTATE, AND CAPITAL LEASES 3. ANY MERGER OR CONSOLIDATION TO WHICH THE HOSPITAL IS A PARTY 4. THE SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL 5. POLICY CHANGES PERTAINING TO CHARITY CARE 6. APPOINTMENT AND REMOVAL OF CORPORATE DIRECTORS 7. ANY RELEASE OR CANCELLATION OF INDIVIDUAL CLAIMS IN EXCESS OF $25,000
GOVERNING BODYFORM 990, PART VI, QUESTION 8B THERE WERE NO COMMITTEES OF THE GOVERNING BODY.
DESCRIBE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990FORM 990, PART VI, QUESTION 11B THE DETAILED REVIEW OF THE FORM 990 IS CONDUCTED BY THE HOSPITAL'S MANAGEMENT FOLLOWING THE PREPARATION AND REVIEW OF THE RETURN BY THE ORGANIZATION'S PAID PREPARER. AN ELECTRONIC COPY OF THE FINAL FORM 990 IS EMAILED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE IRS.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTERESTFORM 990, PART VI, QUESTION 12C THE ORGANIZATION FOLLOWS THE CONFLICT OF INTEREST DISCLOSURE PROCESS ADOPTED BY ITS SOLE MEMBER, CAROLINAS COMMUNITY CARE, LLC, WHICH IN TURN FOLLOWS THE CONFLICT OF INTEREST DISCLOSURE PROCESS ADMINISTERED BY ITS PARENT, COMMUNITY HOSPITAL CORPORATION (CHC), WHICH REQUIRES ALL OFFICERS, DIRECTORS, KEY EMPLOYEES, HIGHLY COMPENSATED EMPLOYEES AND OTHER MANAGEMENT OFFICIALS ("COVERED PERSONS") TO DISCLOSE POTENTIAL CONFLICTS. THE ORGANIZATION'S BOARD FORMALLY ADOPTED CHC'S CONFLICT OF INTEREST POLICY FOR THE YEAR ENDED 6-30-15. PURSUANT TO THE POLICY, A DISCLOSURE STATEMENT IS CIRCULATED ANNUALLY TO COVERED PERSONS IN WHICH THE INDIVIDUAL MUST DISCLOSE TRANSACTIONS THAT MAY RESULT IN A CONFLICT. COVERED PERSONS ARE ALSO ENCOURAGED TO NOTIFY THE BOARD, APPROPRIATE MANAGEMENT PERSONNEL, CHIEF COMPLIANCE OFFICER, GENERAL COUNSEL OR THE AUDIT AND COMPLIANCE COMMITTEE OF THE GOVERNING BODY AS NECESSARY. WHEN NECESSARY, THE BOARD CHAIR OR APPROPRIATE BOARD COMMITTEE MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE POTENTIAL CONFLICT OF INTEREST AND RECOMMEND ALTERNATIVES TO THE APPLICABLE TRANSACTION OR ARRANGEMENT OR OTHERWISE DETERMINE IF THE CONFLICT CAN BE RESOLVED. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER THE CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF THE ORGANIZATION, AND WHETHER IT IS REASONABLE. THE GOVERNING BOARD OR COMMITTEE MAKES THE DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. ANY MEMBER OF THE BOARD OPERATING UNDER A CONFLICT IS NOT PERMITTED TO BE PRESENT OR OTHERWISE PARTICIPATE IN THE VOTE ON ANY MATTER TO WHICH THE CONFLICT RELATES. IF THE GOVERNING BOARD OR COMMITTEE OF THE ORGANIZATION HAS REASONABLE CAUSE TO BELIEVE THAT A COVERED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST AND AFTER INVESTIGATION THE BOARD OR COMMITTEE DETERMINES THAT THE COVERED PERSON FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE ORGANIZATION TAKES APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION, WHICH MAY INCLUDE, TERMINATION OF THE INDIVIDUAL'S MEMBERSHIP, EMPLOYMENT OR CONTRACT.
OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUNFORM 990, PART VI, QUESTIONS 15A & 15B THE ORGANIZATION FOLLOWS THE COMPENSATION POLICY OF COMMUNITY HOSPITAL CORPORATION (CHC). CHC ENGAGED SULLIVAN COTTER TO CONDUCT COMPETITIVE MARKET ANALYSIS OF THE COMPENSATION OF CHC'S TOP MANAGEMENT OFFICIALS, OFFICERS, DIRECTORS AND KEY EMPLOYEES. SULLIVAN COTTER GATHERED DATA RELATED TO JOB DESCRIPTIONS, SCOPE OF RESPONSIBILITIES AND CURRENT INCUMBENTS' COMPENSATION. SULLIVAN COTTER RECOMMENDED APPROPRIATE COMPARISON DATA AND UTILIZED SURVEY DATA FROM FOUR MAJOR EXECUTIVE COMPENSATION SURVEY PROVIDERS TO PROVIDE MARKET DATA AND EXECUTIVE COMPENSATION RECOMMENDATIONS THAT MEET CHC'S COMPENSATION PHILOSOPHY. SULLIVAN COTTER'S RECOMMENDATIONS WERE PRESENTED TO THE CHC COMPENSATION COMMITTEE OF THE BOARD FOR REVIEW AND APPROVAL. CHC ALSO CONDUCTS PERIODIC REVIEWS OF COMPENSATION TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, BASED ON COMPETENT SURVEY INFORMATION, AND THE RESULT OF ARM'S LENGTH BARGAINING. THE ORGANIZATION FOLLOWED THE PROCESS FOR THE YEAR ENDED 6-30-18 FOR ITS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES AND OTHER MANAGEMENT OFFICIALS. THIS PROCESS IS PERFORMED EACH YEAR PRIOR TO THE ANNUAL EMPLOYEE EVALUATION PROCESS, WHICH ENDS ON OCTOBER 1ST OF EACH YEAR.
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AVAILABLE TO PUBLICFORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE AT ITS BUSINESS OFFICE UPON REQUEST.
OVERSIGHT OR SELECTION PROCESSFORM 990, PART XII, QUESTION 2C THE AUDIT COMMITTEE OF COMMUNITY HOSPITAL CORPORATION, WHICH IS THE PARENT ORGANIZATION OF MERCY RESTORATIVE CARE HOSPITAL, INC. IS RESPONSIBLE FOR OVERSEEING THE EXTERNAL AUDIT OF THE CONSOLIDATED FINANCIALS.
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES - MEDICAL TOTAL FEES:2178524
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SVCS - PLANT MAINT. TOTAL FEES:542148
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES - PHARMACY TOTAL FEES:480856
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES - LAB TOTAL FEES:216167
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES - IT TOTAL FEES:193614
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES - OTHER TOTAL FEES:153326
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES - ADMIN TOTAL FEES:41030

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (23 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
SOUTHWEST COMMUNITY HOSPITAL INC
7800 N DALLAS PKWY STE 200PLANOTX75024752725353SUPPORT ORGTX501(C)(3)12C-III-FICHCfalse
YOAKUM COMMUNITY HOSPITAL
1200 CARL RAMERT DRIVEYOAKUMTX77995742323822HOSPITALTX501(C)(3)3CHCfalse
CONTINUECARE HOSPITAL OF TYLER
800 E DAWSON STREETTYLERTX75701200991990HOSPITALDE501(C)(3)3CCCfalse
CONTINUECARE HOSPITAL OF SOUTHEAST TEXAS
7800 N DALLAS PKWY STE 200PLANOTX75024201150480HOSPITALTX501(C)(3)3CCCfalse
ST MARK'S MEDICAL CENTER
ONE ST MARKS PLACELA GRANGETX78945743019849HOSPITALTX501(C)(3)3CHCfalse
CHC COMMUNITY CARE LLC
7800 N DALLAS PKWY STE 200PLANOTX75024371485773SUPPORT ORGDE501(C)(3)12C-III-FICHCfalse
CONTINUECARE HOSPITAL OF MIDLAND
4214 ANDREWS HIGHWAYMIDLANDTX79703463053684HOSPITALDE501(C)(3)3CCCfalse
CONTINUECARE HOSPITAL HENDRICK MED CTR
1900 PINE ST 5TH FLOORABILENETX79601463607347HOSPITALDE501(C)(3)3CCCfalse
CONTINUECARE HOSPITAL AT BAKERSFIELD
7800 N DALLAS PKWY STE 200PLANOTX75024465236524HOSPITALDE501(C)(3)3CCCfalse
CONTINUECARE HOSP BAP HLT MADISONVILLE
900 Hospital Drive 4th FloorMadisonvilleKY42431465033192HOSPITALDE501(C)(3)3CCCfalse
CONTINUECARE HOSP AT BAP HLT PADUCAH
2501 Kentucky Avenue 5th FlPaducahKY42003465032999HOSPITALDE501(C)(3)3CCCfalse
CONTINUECARE HOSPITAL AT BAPTIST HEALTH
1 TRILLIUM WAYCORBINKY40701200925675HOSPITALKY501(C)(3)3CCCfalse
CRAWLEY MEMORIAL HOSPITAL
706 KINGS STREETKINGS MOUNTAINNC28086560691100HOSPITALNC501(C)(3)3CAR CCfalse
CAROLINAS COMMUNITY CARE LLC
7800 N DALLAS PKWY STE 200PLANOTX75024465590355SUPPORT ORGDE501(C)(3)12B-IICHCfalse
JELLICO COMMUNITY HOSPITAL INC
188 Hospital LaneJellicoTN37762620924706HOSPITALTN501(C)(3)3CHCfalse
CONTINUECARE HOSPITAL AT ODESSA INC
500 W 4th StreetOdessaTX79761473539943HOSPITALDE501(C)(3)3CCCfalse
COMMUNITY HOSPITAL CORPORATION
7800 N DALLAS PKWY STE 200PLANOTX75024752638469SUPPORT ORGTX501(C)(3)12C-III-FINAfalse
BAPTIST HOSPITALS OF SOUTHEAST TEXAS
POST OFFICE BOX 1591BEAUMONTTX77704741303720HOSPITALTX501(C)(3)3SWCH INCfalse
BAPTIST PHYSICIAN NETWORK
3080 COLLEGE STREETBEAUMONTTX77701760453250PRIMARY CARETX501(C)(3)3BHSETfalse
YOAKUM COMMUNITY HOSPITAL FOUNDATION
1200 CARL RAMERT DRIVEYOAKUMTX77995453609830SUPPORT ORGTX501(C)(3)12A-IYCHfalse
BHSETX FOUNDATION
810 HOSPITAL DRIVE 235BEAUMONTTX77701611557670SUPPORT ORGTX501(C)(3)7BHSETfalse
CONTINUECARE HOSPITAL AT PALMETTO HEALTH
7800 N DALLAS PKWY STE 200PLANOTX75024813048423HOSPITALTX501(C)(3)3CCCfalse
RURAL AND COMMUNITY HEALTHCARE COLLABORA
7800 N DALLAS PKWY STE 200PLANOTX75024814337246SUPPORT ORGTX501(C)(3)7CHCfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Critical Access HospCoalitionBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1120 G St NW STE 1000AddressLine1Txt
CityWACityNm
State AbbreviationDCStateAbbreviationCd
ZIP11111ZIPCd
FieldValueIRS element (for citing)
Primary Activitieshosp. coalitiONPrimaryActivitiesTxt
Legal Domicile StateDELegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1naBusinessNameLine1Txt

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINLegal Domicile StateLegalDomicileStateCd
COMMUNITY HEALTH ASSURANCE SPC LTD
POB 69GTGRAND CAYMANCJcaptive insurANCECJCHCC Corpfalse
COMMUNITY HOSPITAL CONSULTING
MGMT CONSULTINGCHCC Corpfalse7800 N DALLAS PARKWAY 200PLANOTX75024204710183TX
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
Community Hospital Corporation
P$1,695,019cost
CHC Community Care LLC
p$615,642Cost
CHC Community Care LLC
o$314,096Cost

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