2016-04-15T07:46:38-05:00 2015-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-07-01 560619359 GASTON MEMORIAL HOSPITAL INC GAST 7048342000 2525 COURT DRIVE GASTONIA NC 28054 SIGNING OFFICER EVP, CFO 7048342000 2016-04-15 1 AMY BIBBY P00445891 8282542254 2014 2016-08-17 19:52:53Z CAROMONT REGIONAL MEDICAL CTR DAVID O'CONNOR 2525 COURT DRIVE GASTONIA NC 28054 432925705 0 X WWW.CAROMONT.ORG X 1945 NC TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. 14 8 3381 239 374110 96417 440277 403474 414500109 426753833 98660 -1432 8902747 5300270 423941793 432456145 1026120 1154560 0 0 170707984 177029770 0 0 0 211881223 214914529 383615327 393098859 40326466 39357286 372724775 398347138 316668651 322645715 56056124 75701423 X TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. 0 0 366240992 1154560 426961973 2015 WAS A YEAR OF GROWTH AND COLLABORATION, A YEAR OF INNOVATION AND COMMITMENT. MOST OF ALL, IT WAS ANOTHER YEAR TO WORK TOWARD IMPROVING THE HEALTH OF ALL CITIZENS OF OUR COMMUNITY. WE ARE PROUD OF ALL OUR TEAM HAS ACCOMPLISHED IN PURSUIT OF INDIVIDUAL HEALTH AND A VIBRANT COMMUNITY.PLEASE SEE SCHEDULE O FOR A CONTINUATION OF PROGRAM SERVICE ACCOMPLISHMENTS.IN THE 2015 REPORT, YOU'LL FIND THAT CAROMONT'S PHILOSOPHY OF CARE PLAYS THREE DISTINCT ROLES. IT'S A HEALTH SYSTEM THAT STRATEGICALLY INVESTS IN THE FUTURE OF HEALTHCARE, FROM RESEARCH TO EDUCATION. IT'S AN ACTIVE COMMUNITY PARTNER, DRIVING PROGRAMS THAT ENCOURAGE HEALTHY CHOICES EVEN BEFORE PATIENTS WALK THROUGH OUR DOORS. IT'S A DYNAMIC ORGANIZATION ON A PATH OF CONTINUOUS IMPROVEMENT, DELIVERING BOTH WORLD-CLASS MEDICINE AND COMPASSIONATE, PERSONAL CARE-NOT SIMPLY ONE OR THE OTHER.THE FISCAL YEAR ENDING JUNE 30, 2015 SAW CAROMONT HEALTH LIVING ITS VISION TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED COMMUNITY PARTNER. THE LAST 12 MONTHS HAVE BEEN FILLED WITH MANY SUCCESSES. IN WAYS LARGE AND SMALL, SERIOUS AND EXUBERANT, WE'VE BEEN FULLY ENGAGED IN CARING FOR GASTON COUNTY AND THE SURROUNDING REGION, UNWAVERING IN OUR PROMISE OF UNCOMPROMISED CARE TO THOSE WE SERVE.THE COMPLETE 2015 COMMUNITY REPORT CAN BE FOUND AT WWW.CAROMONTHEALTH.ORG 366240992 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 X 709 0 1 3381 1 1 1 0 0 0 0 0 0 0 0 0 X 14 8 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X DAVID O'CONNOR 7048342000 2525 COURT DRIVE GASTONIA NC 28054 MR WILLIAM ANTHONY CHAIR - 2015 1.00 1.00 X X 0 0 0 SHEILA S REILLY PHD CHAIR - 2014 1.00 1.00 X X 0 0 0 MR W MICHAEL DICKSON VICE CHAIR - 2015 1.00 1.00 X X 0 0 0 MR DONNIE LOFTIS VICE CHAIR - 2014 1.00 1.00 X X 0 0 0 MR BARRY M POMEROY SECRETARY - 2015 1.00 1.00 X X 0 0 0 MS ANNETTE CARTER SECRETARY - 2014 1.00 1.00 X X 0 0 0 MR JAMES R BEAM TREASURER - 2015 1.00 1.00 X X 0 0 0 MR M VINCENT QUINN TREASURER - 2014 1.00 1.00 X X 0 0 0 K CHRISTOPHER PEEK DIRECTOR 1.00 1.00 X 0 0 0 MR HOLT D ROBINSON DIRECTOR 1.00 1.00 X 0 0 0 MR JAMES W BAILEY DIRECTOR 1.00 1.00 X 0 0 0 MRS MARY FRANCES FORRESTER DIRECTOR 1.00 1.00 X 0 0 0 DR CHARLES MEAKIN III DIRECTOR 1.00 1.00 X 0 0 0 MS PEARL BURRIS FLOYD DIRECTOR 1.00 1.00 X 0 0 0 MR H SPURGEON MACKIE JR DIRECTOR 1.00 1.00 X 0 0 0 MR DAVID ALLEN SMITH DIRECTOR 1.00 1.00 X 0 0 0 MR J CHRISTOPHER HOWELL DIRECTOR 1.00 1.00 X 0 0 0 MR R JASON WILLIAMS DIRECTOR 1.00 25.00 X 0 15418 0 DR GE WARD ADCOCK III CHIEF-OF-STAFF 1.00 39.00 X 0 360232 26646 DAVID O'CONNOR EVP/CFO/ASST. TREASURER 40.00 10.00 X 504341 0 103800 MARIA LONG EVP CHIEF LEGAL OFFICER/ASST. SECRETARY 40.00 10.00 X 418701 0 78558 DOUG LUCKETT CEO/PRESIDENT 40.00 10.00 X 857315 0 171735 KATHLEEN K BESSON EVP/COO 40.00 10.00 X 393054 0 92051 TODD DAVIS MD EVP/CMO 40.00 10.00 X 402490 0 75515 ANDREA K SERRA VP WELLNESS DEVELOPMENT 40.00 10.00 X 295753 0 58758 ELIZABETH MCCRAW VP HUMAN RESOURCES 40.00 10.00 X 291819 0 65901 MICHAEL R JOHNSON VP CIO 40.00 10.00 X 349291 0 75595 RICHARD C BLACKBURN VP SUPPORT SERVICES 40.00 10.00 X 268606 0 62770 BONNIE FAUST VP/CNO 40.00 10.00 X 251808 0 47785 RANDALL L KELLEY FORMER OFFICER 0.00 0.00 X 648281 0 0 JERRY LEVINE FORMER KEY EMPLOYEE 0.00 0.00 X 505682 0 0 PENNY P COWDEN FORMER HIGHLY COMPENSATED EMPLOYEE 0.00 0.00 X 209488 0 0 5396629 375650 859114 140 1 1 0 THE ROBINS AND MORTON GROUP 400 SHADES PARKWAY BIRMINGHAM AL 35209 GENERAL CONTRACTING 13544836 EPIC SYSTEMS CORP 1979 MILKY WAY VERONA WI 53593 SOFTWARE SYSTEMS 9148125 MERCY SPECIALIZED BILLINGS SERVICES 14528 S OUTER FORTY RD CHESTERFIELD MO 63017 CONSULTING 6090808 SIEMENS MEDICAL SOLUTIONS USA INC 51 VALLEY STREAM PARKWAY MALVERN PA 19355 INFORMATION SYSTEMS 5205498 VARROW INC 11006 DRUSHMORE DR CHARLOTTE NC 28277 INFORMATION SYSTEMS 4896169 54 397754 5720 49601 403474 PATIENT SERVICES REVENUE 621500 426282620 426282620 ANCILLARY REVENUE 621500 471213 456488 14725 426753833 330349 330349 3816 3258 332339 558 -332339 -331781 -331781 183734 133963 49771 49771 CAFETERIA & VENDING INCOME 722210 1994953 1994953 MEANINGFUL USE 621500 1892209 1892209 MISCELLANEOUS 900099 652388 652388 710949 222865 359385 128699 5250499 432456145 426961973 374110 4716588 1094691 1094691 59869 59869 2134450 426890 1707560 136695933 122105058 14590875 5064979 4470360 594619 23066963 20358943 2708020 10067445 8885545 1181900 396372 396372 1101550 1101550 160365 160365 30921 30921 34587174 31884983 2702191 291538 86007 205531 3150718 1795601 1355117 960661 960661 10276361 10276361 156911 98058 58853 534338 262728 271610 6935219 6935219 25346654 25346654 2652242 2652242 UBI TAX 58911 58911 SUPPLIES 70647524 70647524 BAD DEBT 46919846 46919846 NC MEDICAID ASSESSMENT 5023489 5023489 5683735 5553891 129844 393098859 366240992 26857867 0 677 18897 52885169 51995088 2499 7251509 7407651 9145373 8161745 537391182 279895058 210684414 257496124 10190 10020 1664300 3559270 2311646 2311646 88768998 67386697 372724775 398347138 47356576 44957674 195717418 189837913 73594657 87850128 316668651 322645715 X 56045938 75691404 10186 10019 56056124 75701423 372724775 398347138 X 39357286 -321 -51483356 31771690 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 118325 0 1 94408 212733 0 PART II-B, LINE 1: ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $26,953 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. AN ADDITIONAL $67,455 IN LEGAL FEES WERE PAID FOR LOBBYING EXPENDITURES. 10186 630 405 1219 10002 9488 1251 553 10186 8149 1500 962 1123 9488 6999 1500 221 571 8149 6513 966 480 6999 0 0 2717999 2717999 278997388 135045715 143951673 3440374 910046 2530328 203083725 143939297 59144428 49151696 49151696 257496124 NET PENSION ASSET & PENSION DEFERRAL 9585111 DEFERRED FINANCING COSTS 1739527 OTHER RECEIVABLES 4465541 457B PLAN ASSETS 7765179 DEFERRED CHARGE - INTEREST RATE SWAP 25306627 457F PLAN ASSETS 1704712 PREPAID COUNTY LEASE 16820000 67386697 457B PLAN LIABILITY 7765179 ESTIMATED 3RD PARTY SETTLEMENTS 47474188 INTEREST RATE SWAP LIABILITY 25306627 457F PLAN LIABILITY 1704712 PENSION DEFERRED INFLOW 5599422 87850128 X 417307668 -321 -15148156 -15148477 432456145 0 432456145 346179013 0 346179013 46919846 46919846 393098859 PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR ONCOLOGY MEDICATIONS FOR INDIGENT PATIENTS. PART X, LINE 2: THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2015 AND 2014, RESPECTIVELY. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT -46,919,846. INTERCOMPANY TRANSFER FROM AFFILIATE 33,266,678. CHANGE IN VALUE OF INTEREST RATE SWAP -1,494,988. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 46,919,846. 1 1 1 X 1 X 1 1 0 1 1 8312662 8312662 0.02400 63904420 46151042 17753378 0.05130 72217082 46151042 26066040 0.07530 1710170 37792 1672378 0.00480 2675252 138352 2536900 0.00730 75 1016443 315377 701066 0.00200 1290519 1290519 0.00370 75 6692384 491521 6200863 0.01780 75 78909466 46642563 32266903 0.09310 1227094 1227094 0.00350 1227094 1227094 0.00350 1 46919846 3512141 96301373 98389819 -2088446 X 1 1 1 1 CAROMONT REGIONAL MEDICAL CENTER 2525 COURT DRIVE GASTONIA NC 28054 X X X 4 DIAGNOSTIC IMAGING CENTERS AND 6 OP SERIVCE CENTER CAROMONT REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X X 12 1 0 1 1 X WWW.CAROMONTHEALTH.ORG X WWW.GASTONGOV.COM/DEPARTMENTS/HEALTH-AND-HUMAN-SERVICES X X 1 12 0 1 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X X 1 X CAROMONTHEALTH.ORG X X X X 1 0 1 X 0 0 CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: GASTON COUNTY COMMUNITY HEALTH ASSESSMENT WAS CONDUCTED BY THE FOLLOWING PARTNERS: THE GASTON COUNTY HEALTH DEPT, GASTON TOGETHER, UNITED WAY OF GASTON COUNTY, AND CAROMONT HEALTH. DATA IN THIS ASSESSMENT WAS DERIVED FROM THREE SOURCES: 1) GASTON COUNTY HEALTH DATA; 2) COUNTY HEALTH RANKINGS; 3) GASTON COUNTY QUALITY OF LIFE SURVEY, 2012. THE QUALITY OF LIFE SURVEY WAS CONDUCTED TO ASSESS THE OPINIONS OF GASTON COUNTY RESIDENTS REGARDING THEIR PERSONAL HEALTH. TO GET A COMPREHENSIVE PICTURE OF THESE OPINIONS, FOUR DIVERSE GROUPS WERE SURVEYED: COMMUNITY LEADERS, COMMUNITY RESIDENTS, HIGH SCHOOL STUDENTS, AND PERSONS LIVING IN LOW-INCOME AREAS THROUGHOUT THE COUNTY. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6B: THE HOSPITAL CONDUCTED THEIR CHNA WITH THE FOLLOWING ORGANIZATIONS: GASTON COUNTY HEALTH DEPARTMENT, GASTON TOGETHER, AND UNITED WAY OF GASTON COUNTY. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7D: 1) HOSPITAL'S FACEBOOK PAGE 2) PRESENTED FINDINGS TO COMMUNITY AT VARIOUS MEETINGS AT HOSPITAL IN JUNE, 2013 3) COPY IN GASTON COUNTY LIBRARY - HAD ADS PROMOTING THIS CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: MANY COMMUNITY ORGANIZATIONS, INCLUDING GASTON COUNTY BOARD OF HEALTH AND CAROMONT HEALTH HAVE COMMITTED TO REDUCE THE INCIDENCE OF OBESITY IN GASTON COUNTY, TO PREVENT AND REDUCE THE INCIDENCE OF TOBACCO USE AND TO DEVELOP, IMPLEMENT, AND ADVOCATE FOR THE INTEGRATION OF BEHAVIORAL HEALTH RESOURCES INTO THESE INITIATIVES. GASTON COMMUNITY HEALTHCARE COMMISSION STRUCTURE HAS BEEN THE VEHICLE FOR THIS WORK AND IS COMPOSED OF THE FOLLOWING RESOURCE TEAMS: 1) HEALTHY BEHAVIORS, 2) PUBLIC POLICY AND ENVIRONMENT, 3) CLINICAL CARE, 4) MENTAL AND EMOTIONAL HEALTH AND 5) MARKETING. A PILOT SITE, BETHLEHEM CHURCH, WEST CAMPUS, WAS IDENTIFIED. REPRESENTATIVES OF THE PILOT SITE AND THE RESOURCE TEAMS HAVE COLLABORATED ON HEALTH INITIATIVES FOR THIS SITE. HOLY WELL, AN 8 WEEK HEALTHY BEHAVIORS INITIATIVE WITH A SPIRITUAL ASPECT, HAS BEEN PROVIDED TO THIS POPULATION TWICE WITH SUCCESS. ADDITIONALLY, CAROMONT HEALTH IS PROVIDING EMPLOYER WELLNESS SERVICES TO LOCAL EMPLOYERS, INCLUDING THE COUNTY SCHOOL SYSTEM, COUNTY GOVERNMENT AND OTHERS WHICH ARE DEMONSTRATING HEALTH IMPROVEMENTS. THE NEEDS IDENTIFIED AND NOT ADDRESSED IN THIS WORK ARE: A) PREVENT ALCOHOL AND SUBSTANCE ABUSE; B) REDUCING TEEN PREGNANCY. PARTNERS HEALTH CARE IS A LOCAL PUBLIC AUTHORITY THAT MANAGES MENTAL HEALTH IN GASTON COUNTY AND GASTON COUNTY WORKS WITH THE ADOLESCENT PREGNANCY PREVENTION CAMPAIGN OF NC. THESE NEEDS ARE BEING ADDRESSED BY THOSE GROUPS. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13B: REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY: EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO ONE ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE ALSO EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 15E: CAROMONT HEALTH HAS A TEAM DEDICATED TO EDUCATING AND/OR ASSISTING PATIENTS WITH OTHER STATE OR GOVERNMENT AGENCIES THAT MAY BE A SOURCE OF ASSISTANCE. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16I: PLAIN LANGUAGE BROCHURES AT REGISTRATION SITES. PROACTIVELY COMMUNICATING VERBALLY OR IN WRITING TO SCHEDULED PATIENTS PRIOR TO SERVICE. COMMUNICATING IN-HOUSE, DURING SERVICE, OR AFTER SERVICE TO THOSE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE. CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 18D: COLLECTION ACTIONS ARE TAKEN AFTER REASONABLE EFFORTS HAVE BEEN MADE TO DETERMINE PATIENT'S ELIGIBILITY FOR ASSISTANCE. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY CAROMONT REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE: CAROMONTHEALTH.ORG PART I, LINE 3C: REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY:EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO (1) ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION.PART 1, LINE 6A:COMMUNITY BENEFIT REPORT: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT MADE AVAILABLE TO THE PUBLIC CONTAINS COMMUNITY BENEFITS FOR ALL RELATED ORGANIZATIONS TO THE HOSPITAL. PART I, LINE 7: THE COSTING METHODOLOGY USED IS A COST ACCOUNTING SYSTEM. ALL PATIENT SEGMENTS ARE INCLUDED. THIS SYSTEM ASSIGNS DIRECT COSTS TO SUPPLIES, PROCEDURES, ROUTINE AND SPECIALTY ROOM RATES BASED ON THE DEPARTMENT OF ORIGINATION. FIXED COSTS ARE ALLOCATED BASED ON STATISTICAL BASIS. THESE COSTS ARE THEN AGGREGATED AT THE PATIENT LEVEL AND TABULATED BY PAYOR TYPE. NO COST TO CHARGE RATIOS WERE USED IN THE CALCULATIONS. PART I, LN 7 COL(F): 46,919,846 BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES PRIOR TO CALCULATING PERCENT OF TOTAL EXPENSE. PART I, LINE 7H: RESEARCH ACTIVITIES: CAROMONT HEALTH IS INVOLVED IN APPROXIMATELY 75 RESEARCH STUDIES, APPROXIMATELY FORTY PERCENT OF WHICH ARE CLINICAL TRIALS COOPERATIVE GROUP PROGRAM STUDIES SPONSORED BY THE NATIONAL CANCER INSTITUTE (NCI). CAROMONT HEALTH ALSO PARTICIPATES IN DRUG AND DEVICE STUDIES SPONSORED BY VARIOUS PHARMACEUTICAL, BIOTECHNOLOGY, AND DEVICE COMPANIES, AS WELL AS UNFUNDED NURSING AND PHARMACY RESEARCH STUDIES. PART II, COMMUNITY BUILDING ACTIVITIES: WORKFORCE DEVELOPMENT - CAROMONT HEALTH'S RECRUITMENT OF PHYSICIANS AND ADVANCED CARE PRACTITIONERS INTO THE FIVE COUNTIES THE SYSTEM SERVES IS DRIVEN BY THE CHANGING LANDSCAPE OF HEALTH CARE REFORM. THE SYSTEM RECRUITS BASED ON A MEDICAL STAFF DEVELOPMENT PLAN THAT IDENTIFIES COMMUNITY HEALTH CARE NEEDS FOR THE NEXT FIVE YEARS. THE SYSTEM'S GOAL IS TO BE PRO-ACTIVE AND ANTICIPATORY SO THAT THE HEALTH CARE NEEDS OF THE COMMUNITY ARE MET IN A QUALITY-DRIVEN AND CONVENIENT MANNER, AND DURING THIS TIME PERIOD, THE SYSTEM RECRUITED NEARLY 40 PROVIDERS. PART III, LINE 2: CHARGES WRITTEN OFF TO BAD DEBT WERE TABULATED AT THE PATIENT LEVEL AND ARE REPORTED AT THE AMOUNT CHARGED TO PATIENTS. ACCOUNTS ARE RESERVED AS BAD DEBT BASED ON AN ACCOUNTS RECEIVABLE AGING METHODOLOGY. WHEN ACCOUNTS ARE SENT TO A COLLECTION AGENCY, THEY ARE WRITTEN OFF THE ACCOUNTS RECEIVABLE SYSTEM. ANY SUBSEQUENT COLLECTIONS ON THE ACCOUNTS ARE POSTED AS RECOVERIES AND REDUCE THE EXPENSE. ALL UNINSURED PATIENTS RECEIVE A DISCOUNT ON THEIR BILL, WHICH IS RECORDED AS A CONTRACTUAL ADJUSTMENT. THE AMOUNT OF THE UNINSURED DISCOUNTS ARE EXCLUDED FROM BAD DEBT EXPENSE. PART III, LINE 3: CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPARTMENT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING AND/OR APPLICATIONS FILED BY THE PATIENTS. IF NO MEANS TESTING IS DONE AND NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPARTMENT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. BAD DEBT EXPENSE IS REPORTED AS A DEDUCTION FROM PATIENT REVENUE. PART III, LINE 8: THE MEDICARE COST REPORT STANDARD COSTING METHODOLOGY WAS FOLLOWED WHEN FILING THE COST REPORT. THIS IS A STEP DOWN METHODOLOGY THAT APPLIES THE AVERAGE PATIENT COST TO MEDICARE PATIENTS. THE COST REPORT DOES NOT ALLOW HOSPITALS TO REPORT ALL OPERATING COSTS. BECAUSE OF THESE TWO ISSUES, THE MEDICARE COST REPORT METHODOLOGY UNDERSTATES THE TRUE COST OF TREATING MEDICARE PATIENTS. USING TOTAL COSTS FROM MEDICARE PATIENTS, THE HOSPITAL HAD AN ACTUAL MEDICARE SHORTFALL OF $24.2 MILLION. PART III, LINE 9B: THE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BELOW IS VERBIAGE FROM THE CHARITY POLICY:CAROMONT REGIONAL MEDICAL CENTER OFFERS MEDICAL SERVICES FREE OR AT A REDUCED RATE THROUGH THE CHARITY CARE PROGRAM. DETERMINATION OF FULL OR PARTIAL CHARITY CARE WILL BE BASED ON THE PATIENT'S INCOME, FAMILY SIZE, AND ASSETS. POTENTIAL ELIGIBILITY EXISTS ONLY AFTER REIMBURSEMENT EFFORTS FROM ALL OTHER THIRD PARTY RESOURCES, FEDERAL, STATE, AND LOCAL ASSISTANCE PROGRAMS HAVE BEEN EXHAUSTED. PART VI, LINE 2: CAROMONT HEALTH ESTABLISHES COMMUNITY PRIORITIES THROUGH A NUMBER OF MECHANISMS:- LEADERSHIP OPINIONS ARE SOUGHT TO HELP IDENTIFY NEEDED SERVICES IN THE COMMUNITY VIA PARTNERSHIPS WITH THE GASTON COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES, LOCAL NON-PROFIT ORGANIZATIONS FOCUSED ON HEALTH IMPROVEMENT IN OUR COMMUNITIES AND OTHER HEALTH-FOCUSED ENTITIES. CAROMONT HEALTH ALSO WORKS WITH COMMUNITY AGENCIES TO CONDUCT COMMUNITY NEEDS ASSESSMENTS AND QUALITY OF LIFE SURVEYS EVERY TWO TO THREE YEARS. - PATIENT SATISFACTION DATA IS ANALYZED TO DETERMINE WHERE AND/OR HOW SERVICES NEED TO BE IMPROVED.- SERVICE AREA DATA (VITAL STATISTICS, DEMOGRAPHICS AND UTILIZATION) ARE ANALYZED FOR TRENDS. THIS INFORMATION IS COORDINATED WITH PUBLIC HEALTH DATA TO DETERMINE VOIDS AND SERVICE AREA HEALTH PROBLEMS.- FINDINGS FROM COMMUNITY SURVEYS/REPORTS PUBLISHED BY OTHER ORGANIZATIONS (UNITED WAY, CHAMBER OF COMMERCE, PARTNERSHIP FOR CHILDREN, GASTON COUNTY, ETC.) ARE GATHERED AND REVIEWED FOR PERTINENCE TO COMMUNITY HEALTH PROBLEMS.- BOARD MEMBERS, SENIOR MANAGEMENT AND DEPARTMENT DIRECTORS ARE INVOLVED IN NUMEROUS ORGANIZATIONS IN THE COMMUNITY. THROUGH THIS NETWORK OF RELATIONSHIPS, FURTHER INFORMATION ABOUT THE COMMUNITY AND THE NEEDS OF AREA RESIDENTS AND ORGANIZATIONS ARE USED IN THE DEVELOPMENT OF PROGRAMS AND SERVICES AVAILABLE THROUGH CAROMONT HEALTH.- CAROMONT REGIONAL MEDICAL CENTER THROUGH THE GASTON COMMUNITY HEALTHCARE COMMISSION IN CONJUNCTION WITH THE GASTON COUNTY HEALTH DEPARTMENT CONDUCTS A COMMUNITY ASSESSMENT EVERY THREE YEARS. THE MOST RECENT STUDY CONCLUDED IN THE FALL OF 2012 AND WAS PUBLISHED IN JANUARY 2013. THIS ASSESSMENT GATHERS OPINIONS AND IS COMBINED WITH PUBLIC HEALTH DATA TO DETERMINE THE TOP FOUR COMMUNITY-WIDE HEALTH ISSUES. SERVICE AREA STRENGTHS, WEAKNESSES AND OPPORTUNITIES ARE USED AS A BASIS FOR ESTABLISHING COMMUNITY PRIORITIES. ALL THIS INFORMATION IS USED TO ESTABLISH ORGANIZATIONAL PRIORITIES, IDENTIFY AGENCIES AND ORGANIZATIONS TO BE INVOLVED IN RESOLVING COMMUNITY ISSUES, AND IMPLEMENT PROGRAMS TO RESOLVE IDENTIFIED ISSUES. GOALS, OBJECTIVES AND STRATEGIES ARE ESTABLISHED AND THE PROGRESS IS EVALUATED ON AN ANNUAL BASIS. PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES THE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE IN SEVERAL WAYS. A CHARITY AND FINANCIAL SUMMARY IS ON OUR WEBSITE, AND BROCHURES ARE DISTRIBUTED IN THE EMERGENCY ROOM AND ALL OTHER REGISTRATION SITES. SPECIFICALLY TRAINED STAFF (FINANCIAL COUNSELORS AND BENEFIT ELIGIBILITY SPECIALISTS) PROACTIVELY MAKE CONTACT WITH PATIENTS PRIOR TO, AT TIME OF SERVICE, AND/OR AFTER DISCHARGE TO DISCUSS ELIGIBILITY FOR MEDICAID AND OTHER INSURANCE BENEFITS AND OFFER ASSISTANCE WITH THE APPLICATIONS. THE COMMUNICATION IS ATTEMPTED AS SOON AS POSSIBLE. WRITTEN COMMUNICATION IS MADE PRIOR TO COLLECTION AGENCY PLACEMENT. PART VI, LINE 4: GASTON COUNTY, LOCATED IN THE PIEDMONT REGION OF NORTH CAROLINA, IS THE ORGANIZATION'S PRIMARY MARKET. LINCOLN, CLEVELAND AND YORK COUNTY, AS WELL AS THE NORTHWEST PORTION OF MECKLENBURG COUNTY, IS THE HOSPITAL'S SECONDARY MARKET. ACCORDING TO THE U.S. CENSUS BUREAU, GASTON COUNTY HAD AN ESTIMATED POPULATION OF 211,127 (2014), A MEDIAN HOUSEHOLD INCOME OF $42,017 (2009-2013) AND 19.2% PERSONS BELOW POVERTY LEVEL (2009-2013). THE ETHIC/RACIAL DEMOGRAPHICS STATE THAT 80.5% OF THE POPULATION IDENTIFY THEMSELVES AS WHITE, 16.1% AS BLACK OR AFRICAN AMERICAN, 6.4% AS HISPANIC AND 1.4% AS ASIAN. DURING FISCAL YEAR 2015, 7.0% OF THE HOSPITAL'S GROSS CHARGES WERE FROM UNINSURED PATIENTS AND 15.4% WERE FROM MEDICAID PATIENTS. PART VI, LINE 5: ACCOUNTABLE CARE ORGANIZATIONTHE INSTITUTE FOR HEALTHCARE IMPROVEMENT HAS ESTABLISHED A TRIO OF OBJECTIVES CALLED THE TRIPLE AIM, WHICH CAROMONT HEALTH HAS ADOPTED:1 IMPROVE THE HEALTH OF THE POPULATION2 ENHANCE THE PATIENT EXPERIENCE (QUALITY, ACCESS, RELIABILITY)3 CONTROL COSTSTHESE THREE OBJECTIVES ARE ALL CRITICAL COMPONENTS IN BEING WHAT IS KNOWN IN THE INDUSTRY AS AN ACCOUNTABLE CARE ORGANIZATION (ACO). AS AN ACO, CAROMONT HEALTH HAS EXECUTED CHANGES THAT HAVE LED, AND WILL CONTINUE TO LEAD, TO BETTER COORDINATED CARE WITH BETTER OUTCOMES AT LOWER COSTS FOR PATIENTS. WE ALSO EMBRACE THE "MEDICAL HOME" CONCEPT, WHICH IS A NATIONAL INITIATIVE DESIGNED TO IMPROVE HEALTH CARE QUALITY. MEDICAL HOMES ARE PATIENT CENTERED, TEAM-BASED APPROACHES TO CARE THAT HAVE BEEN SHOWN TO REDUCE HOSPITAL ADMISSIONS AND DECREASE COSTS. DURING FISCAL 2015, CAROMONT'S MEDICARE SHARED SAVINGS PROGRAM SUCCESSFULLY REPORTED SHARED SAVINGS WHILE PROVIDING EXCELLENT CARE FOR THE MORE THAN 10,000 BENEFICIARIES IN OUR AREA. COMMUNITY HEALTHOUR COMMUNITY HEALTH INITIATIVES ARE FOCUSED PRIMARILY ON DISEASE PREVENTION AND BETTER MANAGEMENT OF CHRONIC ILLNESSES. THAT INCLUDES WORKING WITH LOCAL EMPLOYERS ON INNOVATIVE PROGRAMS AND COLLABORATING WITH OUR HEALTH CARE NEIGHBORS, MANAGING ILLNESS WITHIN OUR OWN WORKFORCE AND HEAVILY FOCUSING ON SUCCESSFUL CARE COORDINATION FOR PATIENTS WITH CHRONIC DISEASE. THROUGH INNOVATION AND A FOCUS ON COMMUNITY WELLNESS, CAROMONT HEALTH IS DETERMINED TO MAKE POSITIVE IMPACT ON HEALTH AND WELLNESS OF THE POPULATIONS WE SERVE. PATIENT CENTERED MEDICAL HOMETHE PATIENT-CENTERED MEDICAL HOME IS A HEALTH CARE SETTING THAT FACILITATES PARTNERSHIPS BETWEEN PATIENTS AND THEIR PERSONAL PHYSICIANS. THE PROGRAM PROVIDES MEDICAL PRACTICES WITH INFORMATION ABOUT ORGANIZING PATIENT-CENTERED CARE, WORKING IN TEAMS, AND COORDINATING AND TRACKING DURING THE CONTINUUM OF CARE. CURRENTLY, ALL PRIMARY CARE PRACTICES IN OUR SYSTEM ARE RECOGNIZED AS LEVEL 3 PATIENT-CENTERED MEDICAL HOMES BY THE NATIONAL COMMITTEE OF QUALITY ASSURANCE (NCQA) - THE HIGHEST RECOGNITION A CLINIC CAN OBTAIN.HEALTHNET GASTONHEALTHNET GASTON (HNG) IS A PROGRAM DESIGNED TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO LOW-INCOME, UNINSURED RESIDENTS OF GASTON COUNTY. ITS SERVICES INCLUDE: A MEDICAL HOME/PRIMARY CARE PHYSICIAN SERVICES, SPECIALTY PHYSICIAN SERVICES, MEDICATION ASSISTANCE, CASE MANAGEMENT/HEALTH COACHING ACTIVITIES, AND HOSPITAL SERVICES. HNG OPERATES THROUGH THE LEADERSHIP AND COLLABORATION OF ITS FOUR FOUNDING STRATEGIC PARTNERS, INCLUDING: CAROMONT REGIONAL MEDICAL CENTER, GASTON FAMILY HEALTH SERVICES, COMMUNITY HEALTH PARTNERS, AND GASTON COMMUNITY HEALTH COMMISSION. OTHER STRATEGIC PARTNERS INVOLVED WITH THIS INITIATIVE INCLUDE COMMUNITY PHYSICIANS, GASTON COUNTY DEPARTMENT OF SOCIAL SERVICES, GASTON COUNTY HEALTH DEPARTMENT, AND OTHER LOCAL LEADERS. COMMUNITY HEALTH IMPROVEMENT ADVOCACYCAROMONT HEALTH HAS SIGNIFICANTLY IMPACTED ITS COMMUNITY IN PROVIDING MANY DIFFERENT HEALTH IMPROVEMENT PROJECTS, GROUPS, EVENTS, EDUCATION PROGRAMS AND SPONSORSHIPS. IN FISCAL YEAR 2015, CAROMONT HEALTH INVESTED OVER $7.9 MILLION IN THE COMMUNITY THROUGH HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, COMMUNITY BENEFIT OPERATIONS, DONATIONS, AND IN-KIND DONATIONS OF GOOD AND SERVICES. OTHER EFFORTS TO PROMOTE HEALTH IN THE COMMUNITY ARE FACILIATED BY HAVING A MAJORITY OF THE ORAGANIZATION'S GOVERNING BOARD COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR MOST OR ALL DEPARTMENTS. THE ORGANIZATION APPLIES ITS SURPLUS OF FUNDS TO FURTHER ITS MISSION OF "PROVIDING EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE". THIS IS ACCOMPLISHED BY INVESTING IN NEW SERVICES, CAPITAL EQUIPMENT, INFORMATION TECHNOLOGY, RENOVATION OF THE PHYSICAL PLANT, PHYSICIAN ACQUISITIONS, ETC. PART VI, LINE 6: CAROMONT REGIONAL MEDICAL CENTER IS A 435-BED ACUTE CARE HOSPITAL ASSOCIATED WITH CAROMONT HEALTH, A REGIONAL, INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE SYSTEM LOCATED IN GASTONIA, NC. THE SYSTEM IS ALSO COMPRISED OF COURTLAND TERRACE, A 96-BED SKILLED NURSING FACILITY; GASTON HOSPICE, WHICH INCLUDES THE 12-BED ROBIN JOHNSON HOUSE INPATIENT FACILITY; AND CAROMONT MEDICAL GROUP, A NETWORK OF 42 PRIMARY AND SPECIALTY PHYSICIAN OFFICES. CAROMONT HEALTH'S VISION IS TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED PARTNER IN PROMOTING INDIVIDUAL HEALTH AND VIBRANT COMMUNITIES.CAROMONT HEALTH HAS 3 OFF-SITE IMAGING LOCATIONS, 2 SAME-DAY SURGERY CENTERS, 1 FREE-STANDING ENDOSCOPY CENTER, 1 OCCUPATIONAL MEDICINE CLINIC, AND 1 OFF-SITE EMERGENCY DEPARTMENT. PART VI, LINE 7, REPORTS FILED WITH STATES NC 1 GASTON FAMILY HEALTH SERVICES 991 WEST HUDSON BOULEVARD GASTONIA NC 28052 581958398 501(C)(3) 300000 FEDERALLY QUALIFIED HEALTH DEPARTMENT OFFERING MEDICAL CARE TO LOW INCOME RESIDENTS. MOUNT HOLLY COMMUNITY DEVELOPMENT FOUNDATION 1068 SOUTH MAIN STREET MOUNT HOLLY NC 28120 200738339 501(C)(3) 105000 COMMUNITY ASSISTANCE GASTON REGIONAL CHAMBER 601 W FRANKLIN BLVD GASTONIA NC 28053 560232990 501(C)(6) 32600 COMMUNITY ASSISTANCE GASTON TOGETHER PO BOX 817 GASTONIA NC 28053 562048064 501(C)(3) 77500 COMMUNITY ASSISTANCE CITY OF BELMONT RAIL TRAIL 115 N MAIN STREET BELMONT NC 28012 770338658 GOVERNMENT 60000 COMMUNITY ASSISTANCE COMMUNITY FOUNDATION 1201 E GARRISON BLVD GASTONIA NC 28052 581340834 501(C)(3) 20000 COMMUNITY ASSISTANCE MONTCROSS AREA CHAMBER OF COMMERCE PO BOX 368 BELMONT NC 28012 560710166 501(C)(6) 21000 COMMUNITY ASSISTANCE GASTONIA GRIZZLIES PO BOX 177 GASTONIA NC 28053 421554288 N/A 36500 COMMUNITY ASSISTANCE HOLY ANGELS FOUNDATION 660 WILKINSON BLVD BELMONT NC 28012 561762654 501(C)(3) 16235 COMMUNITY ASSISTANCE MCADENVILLE FOUNDATION PO BOX 1939 MCADENVILLE NC 28101 560623961 501(C)(3) 15000 COMMUNITY ASSISTANCE AS ONE MINISTRIES 805 WEST AIRLINE AVENUE GASTONIA NC 28054 562180931 501(C)(3) 26400 COMMUNITY ASSISTANCE BOYS & GIRLS CLUBS OF GREATER GASTON PO BOX 23 GASTONIA NC 28053 561419498 501(C)(3) 6000 COMMUNITY ASSISTANCE BELMONT ABBEY COLLEGE PARTNERSHIP 100 BELMONT-MT HOLLY ROAD BELMONT NC 28012 560547498 501(C)(3) 5000 COMMUNITY ASSISTANCE CANCER SERVICES OF GASTON COUNTY 306 SOUTH COLUMBIA ST GASTONIA NC 28054 561164253 501(C)(3) 5500 7487 FMV NUTRITIONAL SUPPLEMENTS COMMUNITY ASSISTANCE CHARLOTTE REGIONAL PARTNERSHIP 550 S CALDWELL STREET SUITE 760 CHARLOTTE NC 28202 581457132 501(C)(3) 5000 COMMUNITY ASSISTANCE GASTON COUNTY MEDICAL SOCIETY ALLIANCE 3131 CHANNEL VIEW LANDING BELMONT NC 28012 561493811 501(C)(3) 20000 COMMUNITY ASSISTANCE DANIEL STOWE BOTANICAL GARDEN 6500 S NEW HOPE RD BELMONT NC 28012 208362933 501(C)(3) 30000 COMMUNITY ASSISTANCE BELMONT MERCHANT ASSOCIATION 7 SOUTH MAIN ST BELMONT NC 28012 260300353 501(C)(6) 25000 COMMUNITY ASSISTANCE GASTON COUNTY HABITAT FOR HUMANITY PO BOX 1584 GASTONIA NC 28053 561634454 501(C)(3) 10000 COMMUNITY ASSISTANCE GASTON COUNTY HEALTH DEPARTMENT 991 WEST HUDSON BOULEVARD GASTONIA NC 28052 566000300 GOVERNMENT 10000 COMMUNITY ASSISTANCE GASTON COUNTY MUSEUM 131 WEST MAIN ST DALLAS NC 28034 561122208 501(C)(3) 5000 COMMUNITY ASSISTANCE GASTON HOSPICE 2525 COURT DRIVE GASTONIA NC 28054 581341530 501(C)(3) 5000 COMMUNITY ASSISTANCE LUMIERE MEDICAL MINISTRIES PO BOX 26 LOWELL NC 28098 561574483 501(C)(3) 14179 FMV MISC MED EQUIPMENT COMMUNITY ASSISTANCE 19 4 AUXILIARY SCHOLARSHIPS 43 58650 ONCOLOGY PHARMACY ASSISTANCE 6 1219 PART I, LINE 2: OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED. SCHEDULE I, PART III THE PURPOSE OF THE GERTRUDE CLINTON HEALTH CAREERS SCHOLARSHIP IS TO ENCOURAGE MEDICAL AND HEALTH-RELATED PROFESSIONALS IN THE FIELD OF HUMAN SERVICES TO PRACTICE THEIR SPECIALTIES AT CAROMONT REGIONAL MEDICAL CENTER OR IN GASTON COUNTY. X X X X X 1 1 0 0 0 1 1 0 0 DR GE WARD ADCOCK III CHIEF-OF-STAFF 0 199551 0 155454 0 5227 0 11299 0 15347 0 386878 0 0 DAVID O'CONNOR EVP/CFO/ASST. TREASURER 384792 0 118632 0 917 0 87558 0 16242 0 608141 0 0 0 MARIA LONG EVP CHIEF LEGAL OFFICER/ASST. SECRET 319988 0 98155 0 558 0 76460 0 2098 0 497259 0 0 0 DOUG LUCKETT CEO/PRESIDENT 606383 0 250230 0 702 0 154427 0 17308 0 1029050 0 0 0 KATHLEEN K BESSON EVP/COO 304620 0 87535 0 899 0 76198 0 15853 0 485105 0 0 0 TODD DAVIS MD EVP/CMO 309334 0 92689 0 467 0 59647 0 15868 0 478005 0 0 0 ANDREA K SERRA VP WELLNESS DEVELOPMENT 226583 0 68275 0 895 0 50680 0 8078 0 354511 0 0 0 ELIZABETH MCCRAW VP HUMAN RESOURCES 222496 0 68998 0 325 0 50443 0 15458 0 357720 0 0 0 MICHAEL R JOHNSON VP CIO 264588 0 82878 0 1825 0 60458 0 15137 0 424886 0 0 0 RICHARD C BLACKBURN VP SUPPORT SERVICES 201956 0 62560 0 4090 0 47418 0 15352 0 331376 0 0 0 BONNIE FAUST VP/CNO 195231 0 56279 0 298 0 38200 0 9585 0 299593 0 0 0 RANDALL L KELLEY FORMER OFFICER 0 0 0 0 648281 0 0 0 0 0 648281 0 0 0 JERRY LEVINE FORMER KEY EMPLOYEE 0 0 0 0 505682 0 0 0 0 0 505682 0 0 0 PENNY P COWDEN FORMER HIGHLY COMPENSATED EMPLOYEE 0 0 0 0 209488 0 0 0 0 0 209488 0 24988 0 PART I, LINE 3 THE CEO, CFO, CMO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY CAROMONT REGIONAL MEDICAL CENTER, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND FREE OF ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE DIRECTORS AND MANAGEMENT, UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. PART I, LINES 4A-B DURING THE YEAR THE ORGANIZATION PAID SEVERANCE PAYMENTS TO THE FORMER OFFICER, KEY EMPLOYEE, AND HIGHLY COMPENSATED EMPLOYEE IDENTIFIED BELOW: RANDALL L. KELLEY, FORMER OFFICER $648,281 JERRY LEVINE, FORMER KEY EMPLOYEE $505,682 PENNY P. COWDEN, FORMER KEY EMPLOYEE $184,500 THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM THE FILING ORGANIZATION FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 71,958 MARIA LONG - 59,531 DOUG LUCKETT - 141,984 ANDREA K. SERRA - 33,049 KATHLEEN K. BESSON - 57,539 ELIZABETH MCCRAW - 33,365 TODD DAVIS, MD - 45,614 MICHAEL R. JOHNSON - 39,331 RICHARD C. BLACKBURN - 30,163 DONNETTA L. HORSEMAN - 22,803 THE FOLLOWING HIGHLY COMPENSATED EMPLOYEE RECEIVED A PAYOUT FROM A DEFERRED COMPENSATION PLAN BY THE FILING ORGANIZATION THAT IS TAXABLE IN THE CURRENT PERIOD: PENNY COWDEN - $24,988 THE PAYOUT LISTED ABOVE IS COMPRISED OF DEFERRED COMPENSATION REPORTED ON A PRIOR FORM 990. PART I, LINE 6 EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES WHICH INCLUDE A FINANCIAL GOAL ATTRIBUTABLE TO OPERATING MARGIN. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS. CERTAIN CAROMONT MEDICAL GROUP, INC. PHYSICIAN'S COMPENSATION PACKAGES ARE BASED ON THE INDIVIDUAL PHYSICIANS NET RESULTS FROM OPERATIONS AS CALCULATED BASED SOLELY ON HIS/HER NET CHARGES LESS HIS/HER ALLOCABLE SHARE OF CLINIC OVERHEAD COSTS. A NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HVF7 2003-01-23 120000000 SEE PART VI 0 0 0 B NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HG64 2008-01-31 118400000 SEE PART VI 0 0 0 A 1100000 123594002 5150936 1256069 3386000 91583288 22217709 2005 0 1 1 1 B 43770000 118649831 610174 917471 1553718 28952424 86616044 2009 1 0 1 1 A 0 0 1 1 1 1 0.00210 0.00000 0.00210 0 1 0.00110 0 1 B 0 0 1 1 1 1 0.00010 0.00010 0.00020 0 1 0.00040 0 1 A 0 0 0 1 1 1 MERRILL LYNCH CAPITAL SERVICES 31.600000000000 1 0 0 0 1 B 0 0 1 1 0 1 MERRILL LYNCH DERIVATIVE PRODUCTS 21.000000000000 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 03/18/2013 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 02/25/2013 SCHEDULE K SUPPLENTAL INFORMATION THREE 501(C)(3) ORGANIZATIONS WITHIN THE PARENT-SUBSIDIARY CONTROLLED GROUP BENEFIT FROM THE BONDS AS FOLLOWS: GASTON MEMORIAL HOSPITAL, INC. (56-0619359) CAROMONT HEALTH, INC. (58-1636959) CAROMONT HEALTH SERVICES, INC. (56-1455630) CAROMONT REGIONAL MEDICAL CENTER HOLDS THE LIABILITY FOR THE BONDS, PER AUDITED FINANCIAL STATEMENTS. SCHEDULE K, PART I, LINE A, COLUMN (C): THIS BOND ISSUE INCLUDES TWO CUSIPS MATURING ON THE SAME DATE: 65820HVG5 AND 65820HVF7. SCHEDULE K, PART I, COLUMN (F); DESCRIPTION OF PURPOSE: ISSUE A - THE SYSTEM USED THE PROCEEDS FROM THESE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO A NEW WOMEN'S CENTER AND PARKING DECK, RENOVATIONS TO EXISTING FACILITIES, AND EQUIPMENT. IN ADDITION, PROCEEDS WERE USED TO REFUND IN ADVANCE OF THEIR MATURITIES $17,000,000 IN PRINCIPAL AMOUNT OF THE SERIES 1998 HOSPITAL REVENUE BONDS, ISSUED ON AUGUST 27, 1998. ISSUE B - THE SYSTEM USED THE PROCEEDS FROM THE BONDS FOR VARIOUS CAPITAL IMPROVEMENTS, INCLUDING, BUT NOT LIMITED TO, THE RENOVATION OF CERTAIN FLOORS OF THE PATIENT TOWER, RENOVATION OF THE DAY OF SURGERY UNIT, INSTALLATION OF FIRE SPRINKLERS IN NON-SPRINKLED AREAS, AND THE UPGRADE OF LIFE SAFETY AND CRITICAL POWER. IN ADDITION, THE HOSPITAL USED THE PROCEEDS TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1995 REVENUE BONDS, ISSUED ON NOVEMBER 15, 1995, IN THE AMOUNT OF $41,210,000 AND TO REFUND THE AGGREGATE PRINCIPAL AMOUNT OF THE SERIES 1998 REVENUE BONDS, ISSUED ON AUGUST 27, 1998, IN THE AMOUNT OF $49,710,000. SCHEDULE K, PART II, LINE 3 COLUMN (A): LINE 3 COLUMN (A) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 3,594,002. SCHEDULE K, PART II, LINE 3 COLUMN (B): LINE 3 COLUMN (B) INCLUDES THE TOTAL INVESTMENT EARNINGS ON BOND PROCEEDS IN THE AMOUNT OF $ 249,831. SCHEDULE K, PART II, LINE 11; OTHER SPENT PROCEEDS: OTHER SPENT PROCEEDS INCLUDE DEPOSITS MADE INTO A REFUNDING ESCROW ACCOUNT ALONG WITH INTEREST EARNED ON THE ACCOUNT, BOTH OF WHICH WERE SUBSEQUENTLY USED TO PAY PRINCIPLE AND INTEREST ON THE REFUNDED BONDS. SEE THE RESPONSE FOR PART I, COLUMN (F) FOR DETAILS. SCHEDULE K, PART IV, LINES 3 AND 4A, COLUMN (B): THE SERIES 2008 BONDS WERE ORIGINALLY ISSUED AS VARIABLE BONDS BEARING INTEREST AT WEEKLY RATES. CAROMONT HEALTH, INC. ENTERED INTO INTEREST SWAP AGREEMENTS TO HEDGE ITS INTEREST RISK WITH RESPECT TO A PORTION OF THE SERIES 2008 BONDS. ON SEPTEMBER 1, 2010, THE SERIES 2008 BONDS WERE CONVERTED TO FIXED INTEREST RATES TO MATURITY. HOWEVER, THE INTEREST RATE SWAPS WERE NOT TERMINATED IN CONNECTION WITH SUCH FIXED RATE CONVERSION AND REMAIN IN EFFECT. SCHEDULE K, PART IV, LINE 4C, COLUMN (B): THIS BOND ISSUE HAS TWO HEDGE TERMS: 11.0 YEARS AND 21.0 YEARS. GENA POMEROY FAMILY RELATIONSHIP WITH BOARD MEMBER 48133 COMPENSATION FOR EMPLOYEE SERVICES 0 TRAVIS O'CONNOR FAMILY RELATIONSHIP WITH OFFICER 12354 COMPENSATION FOR EMPLOYEE SERVICES 0 STEPHEN O'CONNOR FAMILY RELATIONSHIP WITH OFFICER 13244 COMPENSATION FOR EMPLOYEE SERVICES 0 SUZANNE HOWELL FAMILY RELATIONSHIP WITH BOARD MEMBER 74790 COMPENSATION FOR EMPLOYEE SERVICES 0 X 1 49601 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 1B: BOARD MEMBER INDEPENDENCE: IN CALENDAR YEAR 2014, THE BOARD OF DIRECTORS OF CAROMONT HEALTH CONDUCTED A COMPREHENSIVE REVIEW OF BEST PRACTICES REGARDING INDEPENDENCE OF BOARD MEMBERS. THIS REVIEW RESULTED IN THE DEVELOPMENT OF A BOARD POLICY ON INDEPENDENCE OF BOARD MEMBERS. USING IRS REGULATIONS AND GUIDANCE, INDUSTRY BEST PRACTICES, GUIDANCE AND COMMENTARY APPLICABLE TO NON-PROFIT HEALTHCARE INSTITUTIONS, AND ADVICE OF COUNSEL, THE BOARD OF DIRECTORS DEVELOPED AND IMPLEMENTED A ROBUST POLICY THAT DEFINES INDEPENDENT AND NON-INDEPENDENT DIRECTORS AND CLASSIFIES DIRECTORS ON AN ANNUAL BASIS AS INDEPENDENT OR NON-INDEPENDENT. USING THE IRS REPORTING REQUIREMENTS AS A MINIMUM SET OF CRITERIA FOR DETERMINING THE INDEPENDENT STATUS OF BOARD MEMBERS, THE BOARD'S POLICY GOES BEYOND THE MINIMUM CRITERIA AND DEFINES ADDITIONAL CRITERIA THAT RENDER A BOARD MEMBER NON-INDEPENDENT. ONCE DETERMINED TO HAVE A DISQUALIFYING CONDITION THAT RENDERS THE MEMBER NON-INDEPENDENT, A BOARD MEMBER WHOSE DISQUALIFYING CONDITION HAS BEEN REMEDIED MAY ONLY BE RESTORED TO INDEPENDENT STATUS FOLLOWING A SPECIFIED TIME LIMIT DEFINED IN THE POLICY. IN REPORTING THE NUMBER OF INDEPENDENT DIRECTORS IN PART I, LINE 4 AND PART VI, SECTION A, LINE 1B, CAROMONT REGIONAL MEDICAL CENTER USES THE CAROMONT HEALTH POLICY TO DETERMINE AND REPORT THE INDEPENDENT STATUS OF IT'S DIRECTORS. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS DURING THE FISCAL YEAR TO CHANGE THE COMPOSITION, QUALIFICATION AND APPOINTMENT OF BOARD MEMBERS AS FOLLOWS. THE BOARD OF DIRECTORS SHALL CONSIST OF FOURTEEN (14) MEMBERS, EIGHT (8) ALL OF WHOM ARE MEMBERS OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC., ONE OF WHICH SHALL BE A GASTON COUNTY COMMISSIONER, FIVE (5) MEMBERS OF WHOM WILL BE APPOINTED BY THE EXISTING BOARD OF DIRECTORS OF THE ORGANIZATION, AND ONE (1) MEMBER WHO WILL BE THE CHIEF OF STAFF OF CAROMONT REGIONAL MEDICAL CENTER. THE ORGANIZATION SHALL APPOINT A TOTAL OF FIVE (5) MEMBERS OF THE BOARD AND THE CHIEF OF STAFF OF CAROMONT REGIONAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION SHALL BE CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL CONSIST OF FOURTEEN (14) MEMBERS, ALL OF WHOM SHALL BE THE MEMBERS OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC., AND ALL OF WHOM SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF CAROMONT HEALTH. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH EMPLOYEE AND DIRECTOR SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE INDIVIDUAL'S OBLIGATION TO IMMEDIATELY MAKE THE CORPORATE COMPLIANCE OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID INDIVIDUAL'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE COMPLIANCE OFFICER. QUESTIONNAIRES SUBMITTED BY DIRECTORS ARE REVIEWED ANNUALLY BY THE NOMINATING COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, CFO, COO, CMO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY CAROMONT REGIONAL MEDICAL CENTER, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. PURSUANT TO THE COMMITTEE CHARTER FOR THE COMPENSATION COMMITTEE OF THE BOARD, THE BOARD OF DIRECTORS APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, WHICH ESTABLISHES THE PARAMETERS FOR ALL EXECUTIVE COMPENSATION DECISIONS. THE BOARD OF DIRECTORS DELEGATES ALL COMPENSATION DECISIONS FOR ALL EXECUTIVES TO THE COMPENSATION COMMITTEE, PROVIDED SUCH DECISIONS ARE CONSISTENT WITH THE COMPENSATION PHILOSOPHY. BOARD APPROVAL MUST BE OBTAINED WHEN COMPENSATION DECISIONS DEVIATE FROM THE COMPENSATION PHILOSOPHY. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND FREE OF ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE APPROVED BY THE COMPENSATION COMMITTEE, AS LONG AS THE COMPENSATION DECISIONS ARE CONSISTENT WITH THE EXECUTIVE COMPENSATION PHILOSOPHY. THE PROCESS FOR DETERMINING COMPENSATION FOR EXECUTIVE MANAGEMENT UTILIZES COMPENSATION SURVEYS AND STUDIES. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFER FROM AFFILIATE 33,266,678. CHANGE IN VALUE OF INTEREST RATE SWAP -1,494,988. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM LAST YEAR. FORM 990, PART V AND PART VII COMMON PAYMASTER: THE FILING ORGANIZATION USES A RELATED ORGANIZATION FOR ITS PAYROLL FUNCTION. ALL W-2S ARE FILED BY THE COMMON PAYMASTER. HOWEVER, AMOUNTS PAID BY THE COMMON PAYMASTER ARE TREATED AS IF PAID DIRECTLY BY THE ORGANIZATION FOR WHICH SERVICES ARE PERFORMED. CAROMONT HEALTH INC 2525 COURT DRIVE GASTONIA NC 28054 581636959 MEDICAL SERVICES NC 501(C)(3) LINE 11B, II N/A 0 CAROMONT HEALTH SERVICES INC 2526 COURT DRIVE GASTONIA NC 28054 561455630 OUTPATIENT SERVICES NC 501(C)(3) LINE 3 CAROMONT HEALTH INC 0 GASTON MEMORIAL HOSPITAL FOUNDATION INC 2527 COURT DRIVE GASTONIA NC 28054 561479699 FOUNDATION NC 501(C)(3) LINE 9 CAROMONT HEALTH INC 0 CAROMONT MEDICAL GROUP INC 2528 COURT DRIVE GASTONIA NC 28054 561479712 MEDICAL GROUP NC 501(C)(3) LINE 9 CAROMONT HEALTH INC 0 HOSPICE OF GASTON COUNTY INC 2529 COURT DRIVE GASTONIA NC 28054 581341530 HOSPICE CARE NC 501(C)(3) LINE 7 CAROMONT HEALTH INC 0 GASTON EMERGENCY PHYSICIANS INC 2531 COURT DRIVE GASTONIA NC 28054 562209423 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11A, I CAROMONT HEALTH INC 0 GASTON COUNTY PO BOX 1578 GASTONIA NC 280531578 566000300 GOVERNMENT ADMINISTRATION NC N/A 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1