GASTON MEMORIAL HOSPITAL FOUNDATION INC: Form 990, tax year 2012
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- Organization
- GASTON MEMORIAL HOSPITAL FOUNDATION INC (EIN 56-1479699)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-11
- IRS object ID
- 201401319349300210
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-11T17:52:24-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561479699 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GASTON MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GAST | NameControl |
| Phone | 7048342000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 28054 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID O'CONNOR | Name |
| Title | EVP, CFO | Title |
| Phone | 7048342000 | Phone |
| Date Signed | 2014-05-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID O'CONNOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE PO BOX 1747 | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 28054 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6752537 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CAROMONT.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO DELIVER EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2606923 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2096539 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -65559 | InvestmentIncomePriorYear |
| Investment Income Current Year | 877217 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2541364 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2973756 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 3045308 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 940179 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 89044 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8346 | OtherExpensePriorYear |
| Other Expenses Current Year | 52279 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3053654 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1081502 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -512290 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1892254 | RevenuesLessExpensesCY |
| Total Assets BOY | 15940285 | TotalAssetsBOY |
| Total Assets EOY | 18862054 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 18542 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 15940285 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 18843512 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO DELIVER EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1081502 | Expense |
| Grants | 940179 | Grants |
| Revenue | 0 | Revenue |
| Description | SEE SCHEDULE OTHE PRIMARY PURPOSE OF THE CAROMONT HEALTH FOUNDATION IS TO PARTNER WITH COMMUNITY DONORS TO FUND INITIATIVES AND EQUIPMENT THAT WILL IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. THE FOUNDATION PROVIDES GRANTS TO PROGRAMS WITHIN CAROMONT HEALTH. IN FISCAL YEAR 2013, THE FOUNDATION AWARDED $317,197 THAT FUNDED PROGRAMS SUCH AS: MEDICATIONS AND SERVICES TO INDIGENT PATIENTS, EDUCATION TO STAFF AND THE COMMUNITY ON HEART FAILURE AND STROKE AWARENESS, SPONSORSHIP OF A SUMMER CAMP FOR CHILDREN WITH ASTHMA, AND THE DEVELOPMENT OF A COMMUNITY OBESITY PROGRAM.THE FOUNDATION PROVIDES EXTERNAL FUNDING TO PARTNER GROUPS. IN FISCAL YEAR 2013, THE FOUNDATION PROVIDED $240,000 TO GASTON FAMILY HEALTH SERVICES; A LOCAL FEDERALLY QUALIFIED HEALTHCARE CLINIC THAT PROVIDES HEALTH CARE, HEALTH EDUCATION, AND PREVENTIVE CARE SERVICES TO PATIENTS WITHOUT REGARD TO THEIR ABILITY TO PAY. THE FOUNDATION ALSO PROVIDES SCHOLARSHIPS TO SEVERAL AREA COLLEGE STUDENTS WHO PLAN TO ENTER THE HEALTH CARE FIELD. IN FISCAL YEAR 2013, THE FOUNDATION AWARDED $85,592 TO 18 STUDENTS THROUGH FOUR SEPARATE SCHOLARSHIP PROGRAMS. | Description |
| Total Program Service Expense | 1081502 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID O'CONNOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7048342000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 COURT DRIVE | AddressLine1 |
| City | GASTONIA | City |
| State | NC | State |
| ZIP Code | 28054 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| MR JAMES R BEAM | |||||||
| CHAIRMAN 2012 | 1.00 | 1.00 | X | X | 0 | 0 | 0 |
| MR W BARRY SMITH | |||||||
| CHAIRMAN 2013 | 1.00 | 1.00 | X | X | 0 | 0 | 0 |
| MRS MARY FRANCES FORRESTER | |||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | |
| SUSIE BROWN | |||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | |
| MR DAVID ALLEN SMITH | |||||||
| DIRECTOR | 1.00 | 1.00 | X | 0 | 0 | 0 | |
| MR WILLIAM K GARY SR | |||||||
| DIRECTOR AS OF JANUARY 2013 | 1.00 | X | 0 | 0 | 0 | ||
| KELVIN C HARRIS MD | |||||||
| DIRECTOR AS OF JANUARY 2013 | 1.00 | 41.00 | X | 0 | 310185 | 20271 | |
| DR CHARLES NIEMEYER | |||||||
| DIRECTOR AS OF JANUARY 2013 | 1.00 | X | 0 | 0 | 0 | ||
| RANDALL L KELLEY | |||||||
| CEO THROUGH APRIL 2013 | 1.00 | 49.00 | X | 0 | 832695 | 166291 | |
| DOUG LUCKETT | |||||||
| EVP/COO THROUGH APRIL'13/INTERIM CEO | 1.00 | 49.00 | X | 0 | 508051 | 85174 | |
| DAVID O'CONNOR | |||||||
| EVP/CFO/ASST. TREASURER | 1.00 | 49.00 | X | 0 | 483333 | 93652 | |
| MARIA LONG | |||||||
| EVP/CHIEF LEGAL OFFICER/ASST. SEC | 1.00 | 49.00 | X | 0 | 383962 | 47836 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2518226 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 413224 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Related Organizations | 2089906 | RelatedOrganizations |
| All Other Contributions | 6633 | AllOtherContributions |
| Total Contributions | 2096539 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 327658 | TotalRevenueColumn |
| Exclusion | $327,658 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 4328340 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 3778781 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 549559 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 549559 | TotalRevenueColumn |
| Exclusion | $549,559 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2973756 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $877,217 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 854587 | Total |
| Program Services | 854587 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 85592 | Total |
| Program Services | 85592 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89044 | Total |
| Program Services | 89044 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20010 | Total |
| Program Services | 20010 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 696 | Total |
| Program Services | 696 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23472 | Total |
| Program Services | 23472 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8101 | Total |
| Program Services | 8101 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1081502 | Total |
| Program Services | 1081502 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 469425 | BOY |
| EOY | 99938 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 1163 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12849220 | BOY |
| EOY | 15926015 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2621640 | BOY |
| EOY | 2834938 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15940285 | BOY |
| EOY | 18862054 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 18542 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 18542 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13318645 | BOY |
| EOY | 16008574 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2621640 | BOY |
| EOY | 2834938 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15940285 | BOY |
| EOY | 18843512 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15940285 | BOY |
| EOY | 18862054 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1892254 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 1010973 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1553180 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 774819 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3788620 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2606923 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2096539 | CurrentTaxYear |
| Total | 10820081 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1553180 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 774819 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3788620 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 2606923 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2096539 | CurrentTaxYear |
| Total | 10820081 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 1997831 | AmountsSubstContributorsTotal |
| Public Support Total170 | 8822250 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 463406 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 262328 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 372927 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 287217 | CurrentTaxYearMinus1Year |
| Current Tax Year | 327658 | CurrentTaxYear |
| Total | 1713536 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 74835 | CurrentTaxYearMinus4Years |
| Total | 74835 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 12608452 | TotalSupport |
| Public Support Pertcentage170 | 0.69970 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.63320 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2621640 | BeginningOfYearBalance |
| Contributions | 3620 | Contributions |
| Investment Earnings Or Losses | 295268 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 85592 | GrantsOrScholarships |
| End Of Year Balance | 2834936 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2342709 | BeginningOfYearBalance |
| Contributions | 364160 | Contributions |
| Investment Earnings Or Losses | 9986 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 95215 | GrantsOrScholarships |
| End Of Year Balance | 2621640 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 750985 | BeginningOfYearBalance |
| Contributions | 1505133 | Contributions |
| Investment Earnings Or Losses | 100784 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 7680 | GrantsOrScholarships |
| Other Expenditures | 6513 | OtherExpenditures |
| End Of Year Balance | 2342709 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 40686 | BeginningOfYearBalance |
| Contributions | 750000 | Contributions |
| Investment Earnings Or Losses | -39463 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 238 | GrantsOrScholarships |
| End Of Year Balance | 750985 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 30235 | BeginningOfYearBalance |
| Contributions | 15043 | Contributions |
| Investment Earnings Or Losses | -1785 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 2807 | GrantsOrScholarships |
| End Of Year Balance | 40686 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 1.00000 | BoardDesignatedEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| MACKIE SCHOLARSHIP FUND | 45622 |
| SHOVELIN SCHOLARSHIP FUND | 2385938 |
| HUDSON NURSING SCHOLARSHIP FUND | 397854 |
| BUCCI SCHOLARSHIP FUND | 5524 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2834938 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 3044550 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1010973 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 1010973 | RevenueNotRptdF990 |
| Revenue Subtotal | 2033577 | RevenueSubtotal |
| Other Revenues Not Included | 940179 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 940179 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2973756 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 141323 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 141323 | ExpensesSubtotal |
| Other Expenses Not Included | 940179 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 940179 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1081502 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR SCHOLARSHIPS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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, 2013 AND 2012, RESPECTIVELY. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES NETTED AGAINST REVENUE ON FINANCIAL STATEMENTS 940,179. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES NETTED AGAINST REVENUE ON FINANCIAL STATEMENTS 940,179. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| GASTON FAMILY HEALTH SERVICES | |||||||
| 991 WEST HUDSON BOULEVARD | GASTONIA | NC | 28054 | 581958398 | 501(C)(3) | 240389 | FEDERALLY QUALIFIED HEALTH DEPARTMENT OFFERING MEDICAL CARE TO LOW INCOME RESIDENTS OF GASTON COUNTY |
| GASTON MEMORIAL HOSPITAL INC | |||||||
| 2525 COURT DRIVE | GASTONIA | NC | 28054 | 560619359 | 501(C)(3) | 588905 | VARIOUS COMMUNITY HEALTH INITIATIVES |
| CAROMONT MEDICAL GROUP | |||||||
| 2525 COURT DRIVE | GASTONIA | NC | 28053 | 561479712 | 501(C)(3) | 25293 | PATIENT CARE MEDICAL DEVICE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | NURSING EDUCATION SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 18 | NumberOfRecipients |
| Amount Of Cash Grant | 85592 | AmountOfCashGrant |
| Method Of Valuation | FMV | MethodOfValuation |
| Description Of Non Cash Assistance | SHOVELIN, BUCCI, AND HUDSON NURSING SCHOLARSHIPS | DescriptionOfNonCashAssistance |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KELVIN C HARRIS MD | ||||||||||||||
| DIRECTOR AS OF JANUARY 2013 | 0 | 165127 | 0 | 144758 | 0 | 300 | 0 | 6976 | 0 | 13295 | 0 | 330456 | 0 | 0 |
| RANDALL L KELLEY | ||||||||||||||
| CEO THROUGH APRIL 2013 | 0 | 577693 | 0 | 232988 | 0 | 22014 | 0 | 156204 | 0 | 10087 | 0 | 998986 | 0 | 0 |
| DOUG LUCKETT | ||||||||||||||
| EVP/COO THROUGH APRIL'13/INTERIM CEO | 0 | 372857 | 0 | 127707 | 0 | 7487 | 0 | 74601 | 0 | 10573 | 0 | 593225 | 0 | 0 |
| DAVID O'CONNOR | ||||||||||||||
| EVP/CFO/ASST. TREASURER | 0 | 351082 | 0 | 124821 | 0 | 7430 | 0 | 79460 | 0 | 14192 | 0 | 576985 | 0 | 0 |
| MARIA LONG | ||||||||||||||
| EVP/CHIEF LEGAL OFFICER/ASST. SEC | 0 | 280995 | 0 | 102230 | 0 | 737 | 0 | 45890 | 0 | 1946 | 0 | 431798 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS RECEIVED DEFERRED COMPENSATION ALLOCATIONS BY RELATED ORGANIZATION GASTON MEMORIAL HOSPITAL FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): DAVID O'CONNOR - $ 69,460 MARIA LONG - 34,427 DOUG LUCKETT - 72,101 RANDALL L. KELLEY - 152,984 |
| PART I, LINE 6 | EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES AND FINANCIAL PERFORMANCE OF THE CONSOLIDATED SYSTEM. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 MEMBERS OF THE BOARD OF DIRECTOR SHALL BE ELECTED AND MAY BE REMOVED AT WILL BY ITS SOLE MEMBER OF THE CORPORATION ACTING THROUGH ITS BOARD OF DIRECTORS AT ITS ANNUAL MEETING FROM A SLATE OF NOMINEES PROVIDED TO THE CAROMONT HEALTH, INC. BOARD BY THE FOUNDATION. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION. IN ADDITION, DECISIONS OF THE GOVERNING BODY INCLUDING THE ELECTION AND REMOVAL OF MEMBERS OF THE BOARD OR DIRECTORS MUST BE APPROVED BY THE CORPORATION'S SOLE MEMBER, CAROMONT HEALTH, INC. | |
| FORM 990, PART VI, SECTION B, LINE 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 APPLICABLE EMPLOYEE AND DIRECTOR SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE EMPLOYEE'S OBLIGATION TO IMMEDIATELY MAKE THE CORPORATE RESPONSIBILITY OFFICER AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID EMPLOYEE'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES SHALL BE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND THE CORPORATE RESPONSIBILITY OFFICER. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO, CFO AND CHIEF LEGAL OFFICER ARE COMPENSATED FOR THEIR SERVICES BY GASTON MEMORIAL HOSPITAL, 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 LEAVES THE MEETING AND DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF 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. | |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART VI, SECTION C, LINE 19 | AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. | |
| PART XII, LINE 2C | THE PROCESS FOR THIS HAS NOT CHANGED FROM THE PRIOR YEAR. | RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CAROMONT HEALTH INC | |||||||||||
| 2525 COURT DRIVE | GASTONIA | NC | 28054 | 581636959 | MEDICAL SERVICES | NC | 501(C)(3) | LINE 11B, II | N/A | 0 | |
| CAROMONT HEALTH SERVICES INC | |||||||||||
| 2526 COURT DRIVE | GASTONIA | NC | 28054 | 561455630 | OUTPATIENT SERVICES | NC | 501(C)(3) | LINE 3 | 0 | CAROMONT HEALTH INC | |
| CAROMONT MEDICAL GROUP INC | |||||||||||
| 2528 COURT DRIVE | GASTONIA | NC | 28054 | 561479712 | MEDICAL GROUP | NC | 501(C)(3) | LINE 9 | 0 | CAROMONT HEALTH INC | |
| HOSPICE OF GASTON COUNTY INC | |||||||||||
| 2529 COURT DRIVE | GASTONIA | NC | 28054 | 581341530 | HOSPICE CARE | NC | 501(C)(3) | LINE 7 | 0 | CAROMONT HEALTH INC | |
| GASTON MEMORIAL HOSPITAL INC | |||||||||||
| 2530 COURT DRIVE | GASTONIA | NC | 28054 | 560619359 | HOSPITAL | NC | 501(C)(3) | LINE 3 | 0 | CAROMONT HEALTH INC | |
| GASTON EMERGENCY PHYSICIANS INC | |||||||||||
| 2531 COURT DRIVE | GASTONIA | NC | 28054 | 562209423 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | 0 | CAROMONT HEALTH INC | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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