CHATHAM HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CHATHAM HOSPITAL INC (EIN 56-0611546)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-09
- IRS object ID
- 201701299349300820
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-09T08:23:24-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 WEST TRADE STREET SUITE 800 | AddressLine1Txt |
| City | CHARLOTTE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560611546 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHAT | BusinessNameControlTxt |
| Phone | 9197994000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 649 | AddressLine1Txt |
| City | SILER CITY | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27344 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF LEGAY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9197994000 | PhoneNum |
| Signature | 2017-05-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN NORMAN | PreparerPersonNm |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | PhoneNum |
| Preparation | 2017-05-08 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT ENDERS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 649 | AddressLine1Txt |
| City | SILER CITY | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27344 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,272,402 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHATHAMHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1939 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | PROVIDES SHORT-TERM MEDICAL CARE ON AN INPATIENT AND OUTPATIENT BASIS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 287 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $371,287 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$100,473 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $34,929,341 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,972,973 | CYProgramServiceRevenueAmt |
| PY Investment Income | $90,863 | PYInvestmentIncomeAmt |
| CY Investment Income | $120,586 | CYInvestmentIncomeAmt |
| PY Other Revenue | $180,146 | PYOtherRevenueAmt |
| CY Other Revenue | $161,944 | CYOtherRevenueAmt |
| PY Total Revenue | $35,200,350 | PYTotalRevenueAmt |
| CY Total Revenue | $36,255,503 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,630 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,842,028 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,392,413 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,273,982 | PYOtherExpensesAmt |
| CY Other Expenses | $26,149,073 | CYOtherExpensesAmt |
| PY Total Expenses | $36,116,010 | PYTotalExpensesAmt |
| CY Total Expenses | $37,543,116 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$915,660 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,287,613 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $38,624,311 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,723,334 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $32,698,122 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,757,680 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,926,189 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,965,654 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PARTICIPATE IN AND PROMOTE THE PROVISION OF PATIENT CARE, FACILITATE THE EDUCATION OF PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, PROMOTE RESEARCH IN COLLABORATION WITH THE HEALTH SCIENCES SCHOOLS OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $32,396,620 | ExpenseAmt |
| Grant | $1,630 | GrantAmt |
| Revenue | $35,616,561 | RevenueAmt |
| Desc | CHATHAM HOSPITAL, INC. IS A PRIVATE, NOT-FOR-PROFIT HEALTH CARE ORGANIZATION LOCATED IN SILER CITY, NORTH CAROLINA. THE FACILITY IS A 25-BED CRITICAL ACCESS HOSPITAL. THE HOSPITAL HAS A 75-YEAR HISTORY OF PROVIDING QUALITY HEALTH SERVICES. THE HOSPITAL PROVIDES COMPREHENSIVE CARE, INCLUDING EMERGENCY, GENERAL SURGERY, INTENSIVE CARE, LAB, CT, MRI, NUCLEAR MEDICINE, PHARMACY, CARIOPULMONARY, CARDIAC REHABILITATION, PHYSICIAL THERAPY, AND DIABETES EDUCATION ON ITS CAMPUS. | Desc |
| Total Program Service Expenses | $32,396,620 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | 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 | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 23 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 287 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Form8899 Filedind | 0 | Form8899Filedind |
| Form1098 C Filed | 0 | Form1098CFiledInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9197994000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 649 | AddressLine1Txt |
| City | SILER CITY | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27344 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MARY BECK | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $53,866 | $8,193 | ||||
| JAMES DAVIS MD | ||||||||||
| DIRECTOR (LEFT 12/31/15) | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| CODY DEEN MD | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| ETTA FOUSHEE | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| BARRY HAYES | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| MEL HURSTON | ||||||||||
| DIRECTOR | 2.00 | 58.00 | Yes (X) | $0 | $304,294 | $73,046 | ||||
| JOHN LEWIS | ||||||||||
| DIRECTOR | 2.00 | 58.00 | Yes (X) | $0 | $796,972 | $284,421 | ||||
| TODD PETERSON | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| WALTER PETTY | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| PAUL POWELL DDS | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| DONALD SPENCER MD | ||||||||||
| DIRECTOR (LEFT 12/31/15) | 2.00 | 58.00 | Yes (X) | $0 | $386,434 | $88,035 | ||||
| BARRY WILKIE | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| MARK ZERINQUE MD | ||||||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||||
| BOB ENDERS | ||||||||||
| CEO | 60.00 | 0.00 | Yes (X) | $0 | $253,745 | $72,569 | Yes (X) | |||
| TAMMY NEEDHAM | ||||||||||
| CNO | 60.00 | 0.00 | $0 | $155,585 | $29,356 | Yes (X) | ||||
| DAVID PAUGH | ||||||||||
| CFO (LEFT 6/24/16) | 60.00 | 0.00 | $0 | $173,915 | $33,492 | Yes (X) | ||||
| SHERLYNN POWELL | ||||||||||
| DIRECTOR OF PHARMACY | 60.00 | 0.00 | $152,532 | $0 | $13,552 | Yes (X) | ||||
| DAVID STRONG | ||||||||||
| DIRECTOR (LEFT 3/31/15) | 0.00 | 0.00 | $0 | $1,226,662 | $16,758 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $152,532 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $3,351,473 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $619,422 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LABCORP | |||||
| 458 S MAIN STREET | BURLINGTON | NC | 27215 | LABORATORY | $942,861 |
| ALLIANCE HEALTHCARE | |||||
| 100 BAY VIEW CIRCLE | NEWPORT BEACH | CA | 92660 | MEDICAL EQUIPMENT | $368,171 |
| RAO KOTHAPALLI MD | |||||
| PO BOX 767 | SILER CITY | NC | 27344 | PHYSICIAN | $129,941 |
| ELLINGTON & SON CONTRACTING | |||||
| 183 ISAAC DRIVE | SILER CITY | NC | 27344 | CONSTRUCTION | $116,385 |
| KARL STORZ ENDOSCOPY AMERICAN | |||||
| 2151 E GRAND AVENUE | EL SEGUNDO | CA | 90245 | MEDICAL EQUIPMENT | $116,385 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT REVENUE | Desc |
| Business | 621110 | BusinessCd |
| Total Revenue Column | $35,503,495 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,503,495 | RelatedOrExemptFuncIncomeAmt |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $469,478 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $98,191 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $371,287 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,972,973 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,644 | TotalRevenueColumnAmt |
| Exclusion | $24,644 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $151,910 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $151,910 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $151,910 | TotalRevenueColumnAmt |
| Exclusion | $151,910 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $112,841 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $16,899 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $95,942 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $95,942 | TotalRevenueColumnAmt |
| Exclusion | $95,942 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $10,034 | TotalRevenueColumnAmt |
| Exclusion | $10,034 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $10,034 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,255,503 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,601,686 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $371,287 | UnrelatedBusinessRevenueAmt |
| Exclusion | $282,530 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,630 | TotalAmt |
| Program Services | $1,630 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,609,852 | TotalAmt |
| Program Services | $6,420,110 | ProgramServicesAmt |
| Management And General | $3,189,742 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,339 | TotalAmt |
| Program Services | $56,863 | ProgramServicesAmt |
| Management And General | $34,476 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,105,891 | TotalAmt |
| Program Services | $602,308 | ProgramServicesAmt |
| Management And General | $503,583 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $585,331 | TotalAmt |
| Program Services | $364,397 | ProgramServicesAmt |
| Management And General | $220,934 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,863,627 | TotalAmt |
| Program Services | $7,868,764 | ProgramServicesAmt |
| Management And General | $994,863 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,324 | TotalAmt |
| Program Services | $45 | ProgramServicesAmt |
| Management And General | $8,279 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $899,656 | TotalAmt |
| Program Services | $758,803 | ProgramServicesAmt |
| Management And General | $140,853 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $309 | TotalAmt |
| Management And General | $309 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $594,475 | TotalAmt |
| Program Services | $594,475 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,900 | TotalAmt |
| Program Services | $22,467 | ProgramServicesAmt |
| Management And General | $53,433 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,181,875 | TotalAmt |
| Program Services | $1,181,875 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,397,461 | TotalAmt |
| Program Services | $2,397,461 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $301,412 | TotalAmt |
| Program Services | $301,412 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BAD DEBT EXPENSE | $5,405,844 | $5,405,844 |
| HOME OFFICE ALLOCATION | $4,259,463 | $4,259,463 |
| PATIENT CARE SUPPLIES & | $1,414,967 | $1,414,967 |
| MINOR EQUIPMENT AND R&M | $535,406 | $535,406 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,354 | TotalAmt |
| Program Services | $210,330 | ProgramServicesAmt |
| Management And General | $24 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,543,116 | TotalAmt |
| Program Services | $32,396,620 | ProgramServicesAmt |
| Management And General | $5,146,496 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,031 | BOYAmt |
| EOY | $2,381 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,304,013 | BOYAmt |
| EOY | $3,184,919 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,357,077 | BOYAmt |
| EOY | $7,498,998 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $403,434 | BOYAmt |
| EOY | $337,240 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,126 | BOYAmt |
| EOY | $100,632 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $42,963,922 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,497,520 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,704,318 | BOYAmt |
| EOY | $21,466,402 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,692,634 | BOYAmt |
| EOY | $7,101,084 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,678 | BOYAmt |
| EOY | $31,678 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,624,311 | BOYAmt |
| EOY | $39,723,334 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,315,340 | BOYAmt |
| EOY | $3,536,912 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $138,738 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,672,209 | BOYAmt |
| EOY | $25,782,349 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,710,573 | BOYAmt |
| EOY | $4,299,681 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,698,122 | BOYAmt |
| EOY | $33,757,680 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,926,189 | BOYAmt |
| EOY | $5,965,654 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,926,189 | BOYAmt |
| EOY | $5,965,654 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,624,311 | BOYAmt |
| EOY | $39,723,334 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,287,613 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$7,520 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,334,598 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,157 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,157 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | AS A MEMBER OF AHA AND NCHA, A PERCENTAGE OF THE ORGANIZATION'S MEMBERSHIP DUES ARE ATTRIBUTED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $402,081 | OtherCostOrOtherBasisAmt |
| Book Value | $402,081 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,570,830 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,227,118 | DepreciationAmt |
| Book Value | $14,343,712 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,505,050 | OtherCostOrOtherBasisAmt |
| Depreciation | $558,640 | DepreciationAmt |
| Book Value | $1,946,410 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,139,916 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,711,762 | DepreciationAmt |
| Book Value | $4,428,154 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $346,045 | OtherCostOrOtherBasisAmt |
| Book Value | $346,045 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,466,402 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENTS | $508,331 | F |
| RESTRICTED ASSETS | $6,592,753 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $7,101,084 | TotalBookValueSecuritiesAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $30,842,139 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$7,520 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$5,405,844 | OtherRevenueAmt |
| Revenue Not Reported | -$5,413,364 | RevenueNotReportedAmt |
| Revenue Subtotal | $36,255,503 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $36,255,503 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $32,137,272 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $32,137,272 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $5,405,844 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $5,405,844 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $37,543,116 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS INCORPORATED AS A NONPROFIT ORGANIZATION UNDER THE LAWS OF THE STATE OF NORTH CAROLINA AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -5,405,844. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 5,405,844. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,900,596 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,900,596 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09030 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,603,451 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,654,009 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$2,050,558 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $624,610 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $51,117 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $573,493 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01780 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,128,657 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,705,126 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,423,531 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,128,657 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,705,126 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,423,531 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10810 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,638,778 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,701,731 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,157,779 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $13,866,356 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,708,577 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 475 PROGRESS BLVD | AddressLine1Txt |
| City | SILER CITY | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27344 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CHATHAM HOSPITAL | PART V, SECTION B, LINE 5: THE FIRST STEP OF THE CHNA PROCESS WAS TO FORM A STEERING COMMITTEE. THE STEERING COMMITTEE GUIDES THE PROCESS, PROVIDING INPUT AND FEEDBACK TO THOSE WORKING ON EACH TASK. THE STEERING COMMITTEE IS ALSO RESPONSIBLE FOR PRIORITIZING HEALTH ISSUES BASED ON THE DATA COLLECTED AND REVIEWING THE FINAL CHNA REPORT. HEALTH DEPARTMENT STAFF WORKED WITH COMMUNITY PARTNERS TO RECRUIT MEMBERS OF THE STEERING COMMITTEE.THE STEERING COMMITTEE MEMBERS REPRESENTED A BROAD DIVERSITY OF INDIVIDUALS WITH DIFFERENT BACKGROUNDS AND AREAS OF EXPERTISE FROM ALL AREAS OF THE COUNTY. THE RECRUITMENT PROCESS RESULTED IN A GROUP OF APPROXIMATELY FIFTY MEMBERS THAT INCLUDED COUNTY RESIDENTS AS WELL AS REPRESENTATIVES FROM VARIOUS LOCAL AGENCIES AND ORGANIZATIONS. THE STEERING COMMITTEE BROUGHT A WEALTH OF KNOWLEDGE AND EXPERTISE ON A VARIETY OF ISSUES AND POPULATIONS IN THE COUNTY, AND THE BROAD RANGE OF BACKGROUNDS ENSURED OBJECTIVITY THROUGHOUT THE PRIORITIZATION PROCESS. THE STEERING COMMITTEE MET SEVERAL TIMES BETWEEN DECEMBER 2013 AND DECEMBER2014 TO REVIEW STRATEGIES FOR CONDUCTING THE CHA AND TO STAY INFORMED OF THE PROCESS. WITHIN THE STEERING COMMITTEE, THE FOLLOWING SUBCOMMITTEES WERE FORMED TO FOCUS ON SPECIFIC TASKS: SURVEY DESIGN AND DATA COLLECTION, PRIORITIZING ISSUES, COMMUNITY FORUMS, AND DISSEMINATION OF FINDINGS. THESE SUBCOMMITTEES MET AS NEEDED TO PLAN THEIR DESIGNATED PHASE OF THE ASSESSMENT PROCESS.BEYOND THE STEERING COMMITTEE, THE HOSPITAL WORKED IN CONJUCTION WITH THE NORTH CAROLINA INSTITUTE FOR PUBLIC HEALTH TO CONDUCT SURVEYS AND FOCUS GROUPS IN THE COMMUNITY. |
| CHATHAM HOSPITAL | PART V, SECTION B, LINE 6B: CHATHAM COUNTY PUBLIC HEALTH DEPARTMENT |
| CHATHAM HOSPITAL | PART V, SECTION B, LINE 11: THE HOSPITAL HAS IDENTIFIED THE FOLLOWING AREAS AS THEIR TOP PRIORITIES:DECREASE OBESITYCHATHAM HOSPITAL, AS ONE OF THE TOP EMPLOYERS IN THE COUNTY WILL FOCUSON OBESITY / POPULATION HEALTH OF ITS EMPLOYEES THROUGH STRATEGIES THATENCOURAGE HEALTHY LIFESTYLES. STRATEGIES IDENTIFIED INCLUDE:- ADVOCATE FOR STAND-UP, ERGONOMIC OPTIONS FOR CHATHAM EMPLOYEES- PROVIDE HEALTHY EATING OPTIONS IN THE CHATHAM HOSPITAL CAFETERIA- COMMIT TO THE HEALTHY FOOD IN HEALTH CARE PLEDGE THROUGH THE HEALTH CARE WITHOUT HARM ORGANIZATION- PARTICIPATE IN THE CHATHAM HEALTH ALLIANCE SUBCOMMITTEE FOR REDUCING OBESITY- PARTICIPATE IN THE EXERCISE IS MEDICINEIMPROVE AND SUPPORT ACCESS TO MENTAL HEALTH SERVICESCHATHAM HOSPITAL WILL PROMOTE MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT AND COUNSELING SERVICES. CHATHAM HOSPITAL, IN PARTNERSHIP WITH THE LOCAL MANAGEMENT ENTITY (LME), CARDINAL INNOVATIONS, WILL CONTINUE TO FOCUS ON IMPROVING THE MENTAL HEALTH/SUBSTANCE ABUSE PATIENT EXPERIENCE BY PROVIDING THE RIGHT CARE, AT THE RIGHT PLACE, AT THE RIGHT TIME, BY THE RIGHT PROVIDER. STRATEGIES IDENTIFIED INCLUDE:- CONTINUE TO IMPROVE CHATHAM HOSPITAL RESOURCE OF PSYCHIATRIC TELEHEALTH- PARTICIPATE IN MENTAL HEALTH ROUNDTABLE THROUGH THE UNC HEALTH CARE SYSTEM- PARTICIPATE WITH COMMUNITY PARTNERS IN THE CHATHAM HEALTH ALLIANCE ACCESS TO MENTAL HEALTH CARE SUBCOMMITTEEIMPROVE ACCESS TO HEALTHCARE IN CHATHAM COUNTYCHATHAM HOSPITAL WILL COLLABORATE WITH STRATEGIC PARTNERS TO PROMOTE, PROVIDE AND ASSIST IN COORDINATION OF HEALTHCARE SERVICES. STRATEGIES IDENTIFIED INCLUDE:- CONTINUE CHATHAM HOSPITAL CHARITY CARE PROGRAM - CONTINUE CHATHAM HOSPITAL CARDIAC AND PULMONARYREHAB SCHOLARSHIP PROGRAM - SUPPORT AND PROMOTE RECENT CHATHAM HOSPITAL ADDITIONAL SERVICES PROVIDED BY SPECIALISTS IN THE CHATHAM PARK MEDICAL OFFICE (GENERAL SURGERY, ORTHOPEDICS, OPHTHALMOLOGY, CARDIOLOGY, ENT, IMAGING, PHYSICAL THERAPY) - PARTICIPATE WITH COMMUNITY PARTNERS IN THE CHATHAM HEALTH ALLIANCE SUBCOMMITTEE - ACCESS TO HEALTHCARETHE CHATHAM CHNA SIP TASK FORCE WILL MAKE ADJUSTMENTS ALONG THE WAY ENABLING COLLABORATION WITH COMMUNITY PARTNERS WHILE RESPONDING TO LOCAL CONDITIONS AND CHANGES IN COMMUNITY PRIORITIES AND LEADERSHIP. THE TASK FORCE WILL EVALUATE PROGRESS AT THE END OF EACH CALENDAR YEAR AND MODIFY THE PLAN ACCORDINGLY. |
| CHATHAM HOSPITAL | PART V, SECTION B, LINE 22D: DISCOUNTS ARE AVAILABLE BASED ON MEANS TESTING AND PROMPT PAY ARRANGEMENTS. |
| PART V, SECTION B, LINES 7A AND 10A | HTTPS://WWW.CHATHAMHOSPITAL.ORG/CH/ABOUT-US/COMUNITY-NEEDS-HEALTH-ASSESSEMENT/ |
| PART V, SECTION B, LINES 16A-C | HTTP://WWW.UNCMEDICALCENTER.ORG/UNCMC/PATIENTS-VISITORS/BILLING/FINANCIAL-ASSISTANCE-PROGRAMS/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - CHATHAM HOSPITAL MEDICAL OFFICE BUILDING | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 MEDICAL PARK DRIVE | AddressLine1Txt |
| City | SILER CITY | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27344 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | CARDIAC REHABILITATION, DIABETES EDUCATION, PT/OT, AND OTHER ADMIN FUNCTIONS | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | CHARITY CARE IS AVAILABLE FOR NORTH CAROLINA RESIDENTS WHO HAVE A HOUSEHOLD INCOME AT OR LESS THAN 250% OF THE FEDERAL POVERTY GUIDELINES FOR THEIR FAMILY SIZE. A COMPLETE APPLICATION WITH SUPPORTING DOCUMENTATION OF INCOME IS PROVIDED FOR A FINAL DETERMINATION TO BE MADE. CHARITY CARE IS A BENEFIT WHERE 100% OF THE PATIENTS BALANCE WILL BE WRITTEN OFF EXCEPT FOR CERTAIN LIMITATIONS SUCH AS ELECTIVE, NON-MEDICALLY NECESSARY SERVICES AND THOSE BALANCES COVERED BY OTHER EXTERNAL FUNDING SOURCES.FPG IS USED FOR CHARITY CARE/FREE CARE. FOR SELF PAY, PROVIDE STRAIGHT 35% DISCOUNT ON CHARGES. |
| PART I, LINE 7: | AMOUNTS SHOWN IN PART I, LINE 7, COLUMN C WERE COMPUTED USING THE COST-TO-CHARGE RATIO WORKSHEET (WORKSHEET 2) FROM THE IRS INSTRUCTIONS FOR SCHEDULE H. |
| PART I, LN 7 COL(F): | THE HOSPITAL DOES NOT HAVE A PROCESS FOR ESTIMATING THE AMOUNT OF THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | CHATHAM HOSPITAL STRIVES TO IMPROVE EMERGENCY CARE FOR KIDS BY INCREASING MEDICATION SAFETY. ALSO, THE HOSPITAL HAS A DIABETES SELF-MANAGEMENT PROGRAM FOR INDIVIDUALS WITH DIABETES WITHIN THE COMMUNITY. CHATHAM HOSPITAL PARTICIPATES IN NUMEROUS COMMUNITY HEALTH FAIRS, PARTNERS WITH OTHER COMMUNITY LEADERS IN ADDRESSING HEALTH RELATED MATERS, PARTICIPATES IN COMMUNITY FUND RAISING EVENTS. |
| PART III, LINE 4: | NET PATIENT SERVICE REVENUE IS RECORDED AT ESTABLISHED RATES WHEN SERVICES ARE PROVIDED WITH CONTRACTUAL ADJUSTMENTS, ESTIMATED BAD DEBT EXPENSES, AND SERVCIES QUALIFYING AS CHARITY CARE DEDUCTED TO ARRIVE AT NET PATIENT SERVCIE REVENUE. CONTRACTUAL ADJUSTMENTS ARISE UNDER REIMBURSEMENT AGREEMENTS WITH CERTAIN INSURANCE CARRIERS, HEALTH MAINTENANCE ORGANIZATIONS AND PREFERRED PROVIDER ORGANIZATIONS, WHICH PROVIDE FOR PAYMENTS THAT GENERALLY LESS THAN ESTABLISHED BILLING RATES. SPECIFIC PATIENT BALANCES ARE WRITTEN OFF AT THE TIME THEY ARE DETERMINED TO BE UNCOLLECTIBLE. |
| PART III, LINE 8: | AS A CRITICAL ACCESS HOSPITAL, THE DIFFERENCE BETWEEN REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COST IS THE AMOUNT DUE FROM THE PATIENTS IN THE FORM OF CO-PAYMENTS, CO-INSURANCE AND DEDUCTIBLES. THE PATIENT AMOUNTS THAT ARE NOT COLLECTED END UP AS BAD DEBTS WHICH ARE PARTIALLY RECOVERABLE ON FUTURE COST REPORTS. |
| PART III, LINE 9B: | POLICY DOES CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE |
| PART VI, LINE 2: | LESS THAN 20% OF OUR COUNTY'S RESIDENTS LIVE IN INCORPORATED TOWNS. THE COUNTY HAS ABOUT 85 RESIDENTS PER SQUARE MILE, WHICH REFLECTS ITS GENERALLY RURAL NATURE. A CRITICAL ACCESS HOSPITAL IS ESSENTIAL FOR A RURAL COMMUNITY SUCH AS THIS.CHATHAM HOSPITAL ADDRESSES THE COMMUNITY'S EMERGENCY HEALTH NEEDS BY PROVIDING AROUND-THE-CLOCK EMERGENCY SERVICES TO MORE THAN 1,000 PATIENTS EACH MONTH. OUR 5,500-SQUARE FOOT EMERGENCY ROOM IS NEWLY RENOVATED AND EQUIPPED WITH THE ADVANCED DIAGNOSTIC AND MONITORING EQUIPMENT REQUIRED TO DELIVER EXCELLENT CARE.CHATHAM HOSPITAL STRIVES TO IMPROVE EMERGENCY CARE FOR KIDS BY INCREASING MEDICATION SAFETY. ALSO, THE HOSPITAL HAS A DIABETES SELF-MANAGEMENT PROGRAM FOR INDIVIDUALS WITH DIABETES WITHIN THE COMMUNITY. |
| PART VI, LINE 3: | NOTICES OF PATIENT FINANCIAL PROGRAMS ARE POSTED IN SERVICE AREAS, AND BROCHURES ARE AVAILABLE DESCRIBING THE PROGRAMS AND PHONE NUMBERS FOR QUESTIONS OR TO REQUEST APPLICATIONS. FINANCIAL COUNSELORS ARE LOCATED IN SERVICE AREAS FOR DISCUSSIONS REGARDING FUNDING SOURCES, INCLUDING CHARITY CARE. AND, SELF PAY PATIENT ACCOUNTS ARE AUTOMATICALLY ROUTED TO MEDICAID ASSISTANCE COUNSELORS FOR REVIEW OF ELIGIBILITY POTENTIAL FOR MEDICAID. REGISTRATION COVERS THE CHARITY PROGRAM WITH PATIENTS DURING REGISTRATION AND GIVES CHARITY APPLICATIONS TO THOSE WHO DON'T HAVE INSURANCE OR WHO MEET CERTAIN CRITERIA. REGISTRATION ALSO INFORMS PATIENTS THAT PATIENT FINANCIAL SERVICES IS AVAILABLE TO PATIENTS WHO WISH TO DISCUSS PAYMENT OPTIONS. |
| PART VI, LINE 4: | POPULATION INFORMATION: THE OFFICIAL 2010 CENSUS PLACES OUR 2010 POPULATION AT 63,505, AN INCREASE OF 28.74% SINCE 2000. THE STATE AVERAGE GROWTH FOR THIS DECADE WAS 18.5%. LESS THAN 20% OF OUR COUNTY'S RESIDENTS LIVE IN INCORPORATED TOWNS. THE COUNTY HAS ABOUT 85 RESIDENTS PER SQUARE MILE, WHICH REFLECTS ITS GENERALLY RURAL NATURE. ETHNIC/RACIAL DIVERSITY: THE OVERALL, RACIAL/ETHNIC COMPOSITION OF CHATHAM COUNTY IS: 71% WHITE, 13% AFRICAN AMERICAN, 12% HISPANIC, 2% ASIAN AND 2% OTHER.AGE: THE 2009 ESTIMATED MEDIAN AGE FOR CHATHAM COUNTY RESIDENTS IS 42, UP FROM 38.7 IN 2007 AND ABOVE THE STATE AVERAGE. THE GREATEST PERCENTAGE OF OUR POPULATION (54%) IS IN THE RANGE OF 20 TO 60 YEARS OLD, AND 21.9% ARE AGE 60 OR OLDER. INCOME AND POVERTY: THE ESTIMATED MEDIAN HOUSEHOLD INCOME FOR CHATHAM COUNTY IN 2008 WAS $46,574, A SIGNIFICANT DROP FROM $51,794 IN 2007, BUT STILL RANKS US 8TH IN THE STATE PER CAPITA INCOME FOR 2008 WAS $43,894, WHICH RANKS THIRD OUT OF THE 100 COUNTIES. THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IN 2008 WAS ESTIMATED AT 10.3%, LOWER THAN THE STATE AVERAGE OF 14.6%, BUT STILL SIGNIFICANT. THIS POINTS OUT THE CHALLENGES OF A COUNTY WITH RESIDENTS AT EXTREME ENDS OF THE INCOME SPECTRUM. |
| PART VI, LINE 5: | CHATHAM HOSPITAL STRIVES TO FURTHER ITS EXEMPT PURPOSES BY PARTNERING IN THE COMMUNITY TO ASSESS HEALTH NEEDS AND TO HELP DEVELOP STRATEGIES TO FULLFUL THOSE NEEDS. CHATHAM HOSPITAL IS WELL ENGAGED IN THE COMMUNITY THROUGH JOINT EFFORTS WITH OTHER ORGANIZATIONS, COMMUNITY OUTREACH THROUGH EDUCATION AND HEALTH FAIRS, DIRECTLY CONTRIBUTING TO FUNDRAISING EFFORTS, WORKING TO QUALIFY PATIENTS FOR EITHER INSURANCE OR CHARITY CARE AND IF NOT, PROVIDING DISCOUNTS TO HEALTH SERVICES. |
| PART VI, LINE 6: | CHATHAM HOSPITAL AND UNC HEALTH CARE ARE PARTNERING TO BRING NATIONALLY-RECOGNIZED HEALTH CARE TO CHATHAM COUNTY. OUR PARTNERSHIP MEANS YOU'LL CONTINUE TO HAVE ACCESS TO ADVANCED HEALTH CARE CLOSE TO HOME, WITH THE PERSONAL TOUCH YOU'VE COME TO EXPECT FROM US. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NC |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 | Yes (1) | 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 (8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MEL HURSTON | ||||||||||||||
| DIRECTOR | $0 | $224,950 | $0 | $41,649 | $0 | $37,695 | $0 | $65,463 | $0 | $7,583 | $0 | $377,340 | $0 | $0 |
| JOHN LEWIS | ||||||||||||||
| DIRECTOR | $0 | $529,689 | $0 | $94,139 | $0 | $173,144 | $0 | $264,827 | $0 | $19,594 | $0 | $1,081,393 | $0 | $136,890 |
| DONALD SPENCER MD | ||||||||||||||
| DIRECTOR (LEFT 12/31/15) | $0 | $307,169 | $0 | $54,307 | $0 | $24,958 | $0 | $68,896 | $0 | $19,139 | $0 | $474,469 | $0 | $0 |
| BOB ENDERS | ||||||||||||||
| CEO | $0 | $215,146 | $0 | $34,115 | $0 | $4,484 | $0 | $52,975 | $0 | $19,594 | $0 | $326,314 | $0 | $0 |
| TAMMY NEEDHAM | ||||||||||||||
| CNO | $0 | $133,763 | $0 | $21,502 | $0 | $320 | $0 | $23,963 | $0 | $5,393 | $0 | $184,941 | $0 | $0 |
| DAVID PAUGH | ||||||||||||||
| CFO (LEFT 6/24/16) | $0 | $142,822 | $0 | $24,632 | $0 | $6,461 | $0 | $27,867 | $0 | $5,625 | $0 | $207,407 | $0 | $0 |
| SHERLYNN POWELL | ||||||||||||||
| DIRECTOR OF PHARMACY | $141,558 | $0 | $10,974 | $0 | $0 | $0 | $4,436 | $0 | $9,116 | $0 | $166,084 | $0 | $0 | $0 |
| DAVID STRONG | ||||||||||||||
| DIRECTOR (LEFT 3/31/15) | $0 | $153,361 | $0 | $0 | $0 | $1,073,301 | $0 | $13,919 | $0 | $2,839 | $0 | $1,243,420 | $0 | $246,929 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | DURING THE CALENDAR YEAR 2015, DAVID STRONG, FORMER DIRECTOR, RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN TOTALING $246,929, FROM A RELATED ORGANIZATION. DURING THE CALENDAR YEAR 2015, JOHN LEWIS RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN TOTALING $136,890. HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $159,496, WHICH IS PAYABLE IN THE FUTURE. |
| PART I, LINE 6 | EMPLOYEES IN MANAGERIAL ROLES PARTICIPATE IN AN ANNUAL INCENTIVE COMPENSATION PLAN. THE COMPENSATION EARNED UNDER THIS PLAN IS BASED PARTLY ON THE EARNINGS OF CHATHAM MEMORIAL HOSPITAL AND THE UNC HEALTH CARE SYSTEM. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH CAROLINA MEDICAL CARE COMMISSION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 521309402 | BondIssuerEIN |
| CUSIP | 657905ES0 | CUSIPNum |
| Bond Issued | 2007-02-08 | BondIssuedDt |
| Issue Price | $30,540,000 | IssuePriceAmt |
| Purpose | FHA INSURED MORTGAGE REVENUE BONDS | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $5,600,000 | RetiredAmt |
| Total Proceeds | $30,540,000 | TotalProceedsAmt |
| In Reserve Fund | $2,303,775 | InReserveFundAmt |
| Issuance Costs From Proceeds | $622,810 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $329,280 | CreditEnhancementAmt |
| Capital Expenditures | $28,221,503 | CapitalExpendituresAmt |
| Substantial Completion | 2008 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | Yes (1) | Form8038TFiledInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | SEE RESPONSE TO QUESTION 7A. |
| FORM 990, PART VI, SECTION A, LINE 7A | IN ADDITION TO SUCH POWERS AND RIGHTS AS ARE VESTED IN IT BY LAW, THE AMENDED AND RESTATED ARTICLES OF INCORPORATION OF THE CORPORATION OR THE AMENDED AND RESTATED BYLAWS, THE MEMBER ("UNCHCS") SHALL HAVE THE FOLLOWING POWERS: (A) THE POWER TO APPOINT THE CHAIRMAN OF THE BOARD, VICE CHAIRMAN, PRESIDENT, EXECUTIVE VICE PRESIDENTS, SECRETARY/TREASURER AND OTHER CORPORATE OFFICERS OF THE CORPORATION; (B) THE POWER TO APPOINT INDIVIDUAL MEMBERS OF THE CORPORATION'S BOARD OF TRUSTEES; (C) THE POWER TO ESTABLISH AND MAINTAIN QUALITY, SERVICE DELIVERY, AND FINANCIAL STANDARDS TO BE OBSERVED BY ALL MEMBERS OF UNCHCS, INCLUDING THE CORPORATION; (D) THE POWER TO ESTABLISH A SCHEDULE OF COST-BASED ASSESSMENTS PAYABLE BY PROVIDER COMPONENTS OF UNCHCS FOR THE SUPPORT OF THAT PORTION OF ITS OPERATING BUDGET ATTRIBUTABLE TO UNCHCS-WIDE ADMINISTRATION AND INITIATIVES AND REFLECTING OPERATING ENTITY PERFORMANCE; (E) THE POWER TO NEGOTIATE, DEVELOP, AND APPROVE ALL MANAGED CARE PRODUCTS AND CONTRACTS FOR THE CORPORATION; (F) THE POWER TO APPROVE (I) THE CORPORATION'S NAME, (II) CAPITAL AND OPERATING BUDGETS OF THE CORPORATION, AND (III) NON-BUDGETED MATERIAL EXPENDITURES OF THE CORPORATION (AS "MATERIAL" IS ESTABLISHED BY THE MEMBER FROM TIME TO TIME), PROVIDED THAT ONLY THE BOARD OF TRUSTEES SHALL HAVE THE AUTHORITY TO INITIATE A CHANGE IN THE NAME OF THE CORPORATION OF THE HOSPITAL, WHICH SHALL BE SUBJECT TO FINAL APPROVAL BY UNCHCS; AND (G) OTHER POWERS MUTUALLY AGREED TO BY UNCHCS AND THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | SEE RESPONSE TO QUESTION 7A. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WAS REVIEWED PRIOR TO FILING BY THE PRESIDENT AND CFO OF THE HOSPITAL. IN ADDITION, IT WAS MADE AVAILABLE TO EVERY MEMBER OF THE GOVERNING BODY BEFORE IT WAS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST STATEMENTS ARE COMPLETED BY THE BOARD MEMBERS ANNUALLY TO BE REVIEWED BY THE HOSPITAL PRESIDENT. THE CHATHAM HOSPITAL CONFLICT OF INTEREST POLICY OUTLINES THE PROCESS TO BE FOLLOWED IN DETERMINING THE EXISTENCE OF A POTENTIAL CONFLICT, AND HOW TO ADDRESS THE SITUATION. |
| FORM 990, PART VI, SECTION B, LINE 15 | EFFECTIVE AUGUST 1, 2006, THE HOSPITAL ENTERED INTO A FIVE-YEAR CONTRACT WITH UNCH TO PROVIDE A CEO AND A CFO TO MANAGE THE DAY-TO-DAY OPERATIONS OF THE HOSPITAL. THE PRESIDENT OF CHATHAM HOSPITAL REPORTS MONTHLY TO THE PRESIDENT OF UNC HOSPITALS, DISCUSSING SURVEYS OF COMPENSATION DATA AND PLANNED RANGES OF SALARY OFFERS FOR EMPLOYEES OF CHATHAM. TARGET LEVELS ARE BASED ON LEVEL OF EDUCATION AND EXPERIENCE. WITH INPUT FROM THE MANAGEMENT OF UNC HOSPITALS, THE PRESIDENT OF CHATHAM HOSPITAL MAKES THE FINAL DECISION ON SALARIES, WITH THE EXCEPTION OF HIS/HER OWN, WHICH IS SET BY THE PRESIDENT OF UNCH WITH INPUT FROM THE UNC HOSPITAL'S MANAGEMENT TEAM. |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE FORM 1023 AND RECENT COPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT COPIES OF FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART IX, LINE 11G | OTHER FEES: PROGRAM SERVICE EXPENSES 7,868,764. MANAGEMENT AND GENERAL EXPENSES 994,863. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,863,627. |
| FORM 990, PART XI, LINE 9: | CAPITAL CONTRIBUTED (TO) FROM SOLE MEMBER 1,334,598. |
| FORM 990, PART XII, LINE 2C: | PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM IMAGING SERVICES OF PITTSBORO LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 75 US-1 | AddressLine1Txt |
| City | PITTSBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 811651110 | EIN |
| Primary Activities | IMAGING SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Total Income | $251,621 | TotalIncomeAmt |
| End Of Year Assets | $251,621 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (11 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| UNC HEALTH CARE SYSTEM | |||||||||
| 101 MANNING DRIVE | CHAPEL HILL | NC | 27514 | 562206970 | HEALTHCARE | NC | SECTION 115 | SECTION 115 | 0 |
| UNC HOSPITALS | |||||||||
| 211 FRIDAY CENTER DRIVE SUITE 2029 | CHAPEL HILL | NC | 27517 | 561118388 | HEALTHCARE | NC | SECTION 115 | SECTION 115 | 0 |
| CALDWELL MEMORIAL HOSPITAL | |||||||||
| PO BOX 1890 | LENOIR | NC | 28645 | 560554204 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | 0 |
| CALDWELL MEMORIAL HOSPITAL FOUNDATION INC | |||||||||
| PO BOX 1890 | LENOIR | NC | 28645 | 581935514 | SUPPORT OF CALDWELL MEMORIAL HOSPITAL | NC | 501(C)(3) | LINE 7 | 0 |
| HIGH POINT REGIONAL HEALTH | |||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 560532309 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | 0 |
| HIGH POINT REGIONAL HEALTH SERVICES INC | |||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 561497163 | HEALTHCARE | NC | 501(C)(3) | LINE 11B, II | 0 |
| HIGH POINT REGIONAL HEALTH FOUNDATION INC | |||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 272854711 | SUPPORT OF HIGH POINT REGIONAL HEALTH | NC | 501(C)(3) | LINE 11A, I | 0 |
| REX HEALTHCARE INC | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 561509129 | HEALTHCARE | NC | 501(C)(3) | LINE 11A, I | 0 |
| REX HOSPITAL INC | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 561509260 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | 0 |
| THE REX HEALTHCARE FOUNDATION INC | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 566052117 | SUPPORT OF REX HOSPITAL, INC. | NC | 501(C)(3) | LINE 11B, II | 0 |
| UNCPN | |||||||||
| 1600 PERIMETER PARK DRIVE STE 225 | MORRISVILLE | NC | 27560 | 271081647 | HEALTHCARE | NC | SECTION 115/501(C )( | LINE 9 | 0 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Predominant Income TypePredominantIncomeTypeTxt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| HIGH POINT SURGERY CENTER | |||||||||
| 600 NORTH LINDSAY STREET | HIGH POINT | NC | 27260 | 561867005 | HEALTHCARE | NC | N/A | 0 | 0 |
| REGIONAL WELLNESS LLC | |||||||||
| 861 OLD WINSTON ROAD | KERNERSVILLE | NC | 27284 | 204475769 | HEALTHCARE | NC | N/A | 0 | 0 |
| REX SURGERY CENTER OF CARY | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 273684056 | ASC | NC | N/A | 0 | 0 |
| JRH VENTURES LLC | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 274092967 | MED CAMPUS DEVELOPMENT | NC | N/A | 0 | 0 |
| REX HEALTH VENTRUES I LP | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 371690478 | VENTURE CAPITAL INVST | NC | N/A | 0 | 0 |
| ORTHOPAEDIC SURGERY CENTER OF RALEIGH LLC | |||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 271740526 | ORTHOPAEDIC SURGERY | NC | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|
| HIGH POINT HEALTHCARE VENTURES INC | ||||||||
| 601 N ELM STREET | HIGH POINT | NC | 27261 | 561343468 | HOLDING COMPANY | NC | C | 0 |
| REX ENTERPRISES COMPANY INC | ||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 271740526 | OPERATIONS SUPPORT | NC | C | 0 |
| UNC PHYSICIANS NETWORK GROUP PRACTICES LLC | ||||||||
| 1600 PERIMETER PARK DRIVE SUITE 225 | MORRISVILLE | NC | 27560 | 461416986 | HEALTHCARE | NC | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | 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 | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |