CHATHAM HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHATHAM HOSPITAL INC (EIN 56-0611546)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201411349349305366
- 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
- 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) |
|---|---|---|
| Timestamp | 2014-05-14T15:34:21-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 N TRYON STREET SUITE 1000 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28246 | 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 | 560611546 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHAT | NameControl |
| Phone | 9197994000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 649 | AddressLine1 |
| City | SILER CITY | City |
| State | NC | State |
| ZIP Code | 27344 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT ENDERS | Name |
| Title | PRESIDENT | Title |
| Phone | 9197994000 | Phone |
| Date Signed | 2014-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN NORMAN | Name |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | 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 | ROBERT ENDERS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 649 | AddressLine1 |
| City | SILER CITY | City |
| State | NC | State |
| ZIP Code | 27344 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 28196614 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CHATHAMHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1939 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | PROVIDES SHORT-TERM MEDICAL CARE ON AN INPATIENT AND OUTPATIENT BASIS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 9 | TotalNbrVolunteers |
| Total Gross UBI | 1164827 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -112205 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 5000 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 28228156 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 27795038 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 82127 | InvestmentIncomePriorYear |
| Investment Income Current Year | 184396 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 192993 | OtherRevenuePriorYear |
| Other Revenue Current Year | 217180 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 28508276 | TotalRevenuePriorYear |
| Total Revenue Current Year | 28196614 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10577873 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10817512 | 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 | 21202461 | OtherExpensePriorYear |
| Other Expenses Current Year | 20028006 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 31780334 | TotalExpensesPriorYear |
| Total Expenses Current Year | 30845518 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -3272058 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2648904 | RevenuesLessExpensesCY |
| Total Assets BOY | 47781140 | TotalAssetsBOY |
| Total Assets EOY | 42721602 | TotalAssetsEOY |
| Total Liabilities BOY | 36436831 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 33296840 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11344309 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9424762 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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, AND FACILITATE AND PROMOTE THE DELIVERY OF OTHER SERVICES DESIGNED TO PROMOTE THE HEALTH AND WELL-BEING OF THE CITIZENS OF NORTH CAROLINA. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 23108150 | Expense |
| Revenue | 26630211 | Revenue |
| Description | CHATHAM HOSPITAL, INC. (THE "HOSPITAL") 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 70-YEAR HISTORY OF PROVIDING QUALITY HEALTH SERVICES. THE HOSPITAL PROVIDES COMPREHENSIVE CARE, INCLUDING EMERGENCY, GENERAL SURGERY, INTENSIVE CARE, LAB, CT, MRI, NUCLEUR MEDICINE, PHARMACY, CARDIOPULMANARY, CARIAC REHABILITATION, PHYSICAL THERAPY, AND DIABETES EDUCATION ON ITS CAMPUS. THE HOSPITAL REACHES BEYOND THE HOSPITAL SETTING TO PROVIDE DIABETES EDUCATION, PHYSICAL THERAPY, AND CARDIAC REHABILITATION IN TEMPORARY LEASED SPACE LOCATED IN SILER CITY NEAR THE MAIN HOSPITAL CAMPUS FOR A PORTION OF THE FISCAL YEAR. THE HOSPITAL CONTINUED ITS FOCUS ON QUALITY MEASURES FROM THE YEAR BEFORE WHICH RESULTED IN SIGNIFICANT IMPROVEMENTS. DURING 2012, CHATHAM HAD 1,695 ACUTE PATIENT DAYS AND AN AVERAGE LENGTH OF STAY OF 3.1 DAYS. THERE WERE 548 DISCHARGES AND 228 INPATIENT AND OUTPATIENT SURGERIES AS WELL AS 380 ENDOSCOPIC PROCEDURES. THERE WERE 14,565 EMERGENCY ROOM VISITS. | Description |
| Total Program Service Expense | 23108150 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | 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 | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 34 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| 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 | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID PAUGH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9197994000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 649 | AddressLine1 |
| City | SILER CITY | City |
| State | NC | State |
| ZIP Code | 27344 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| LAURA CLAPP | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| BARRY WILKIE | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MARY BECK | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 301484 | 52226 | 59.00 | ||
| BARRY HAYES | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MEL HURSTON | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 303991 | 79587 | 59.00 | ||
| CHARLES JOHNSON | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JOHN LEWIS | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 528291 | 66303 | 59.00 | ||
| TODD PETERSON | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 114164 | 40026 | 59.00 | ||
| GABRIEL SOLTREN | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| TIM WEINER MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MARK ZERINGUE MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JAMES DAVIS MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DONALD SPENCER MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 151752 | 9757 | 59.00 | ||
| ROBERT ENDERS | ||||||||
| CEO | 1.00 | X | 0 | 188086 | 28328 | 59.00 | X | |
| ETTA FOUSHEE | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| WALTER PETTY | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| PAUL POWELL DDS | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| DAVID W STRONG | ||||||||
| PRESIDENT | 1.00 | X | 0 | 1312317 | 267356 | 59.00 | X | |
| TAMMY NEEDHAM | ||||||||
| CNO | 1.00 | 0 | 47241 | 9591 | 59.00 | X | ||
| LINDA ELLINGTON | ||||||||
| ACTING CNO | 60.00 | 100616 | 0 | 0 | X | |||
| SHERLYNN POWELL | ||||||||
| DIRECTOR | 60.00 | 0 | 124864 | 0 | X | |||
| DONNA SESSOMS | ||||||||
| DIRECTOR | 60.00 | 138553 | 0 | 0 | X | |||
| CHARLES PULLIAM | ||||||||
| PHARMACIST | 60.00 | 103370 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 342539 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3072190 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 553174 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| LABCORP | |||||
| 458 S MAIN | BURLINGTON | NC | 27215 | LABORATORY | 769186 |
| ALLIANCE HEALTH CARE SERVICES | |||||
| 100 BAY VIEW CIRCLE | NEWPORT BEACH | CA | 92660 | MEDICAL EQUIPMENT | 380407 |
| ARAMARK CTS | |||||
| 10510 TWIN LAKES PARKWAY | CHARLOTTE | NC | 28265 | MEDICAL EQUIPMENT | 190653 |
| FIRST HEALTH OF THE CAROLINAS | |||||
| 155 MEMORIAL DRIVE | PINEHURST | NC | 28374 | 148269 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT REVENUE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 27665819 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26500992 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1164827 | UnrelatedBusinessRevenue |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 129219 | TotalRevenueColumn |
| Related Or Exempt Function Income | 129219 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 27795038 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 184396 | TotalRevenueColumn |
| Exclusion | $184,396 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 214202 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 214202 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 214202 | TotalRevenueColumn |
| Exclusion | $214,202 | ExclusionAmount |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2978 | TotalRevenueColumn |
| Exclusion | $2,978 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2978 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28196614 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26630211 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1164827 | UnrelatedBusinessRevenue |
| Exclusion | $401,576 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3153127 | Total |
| Program Services | 496784 | ProgramServices |
| Management And General | 2656343 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5547422 | Total |
| Program Services | 5068020 | ProgramServices |
| Management And General | 479402 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63112 | Total |
| Program Services | 40366 | ProgramServices |
| Management And General | 22746 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1480310 | Total |
| Program Services | 866043 | ProgramServices |
| Management And General | 614267 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 573541 | Total |
| Program Services | 366832 | ProgramServices |
| Management And General | 206709 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2722000 | Total |
| Management And General | 2722000 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48685 | Total |
| Management And General | 48685 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5709 | Total |
| Management And General | 5709 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5703350 | Total |
| Program Services | 5469300 | ProgramServices |
| Management And General | 234050 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7261 | Total |
| Management And General | 7261 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2178584 | Total |
| Program Services | 1475582 | ProgramServices |
| Management And General | 703002 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1866990 | Total |
| Program Services | 1866990 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35714 | Total |
| Program Services | 2041 | ProgramServices |
| Management And General | 33673 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11282 | Total |
| Program Services | 7761 | ProgramServices |
| Management And General | 3521 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2371149 | Total |
| Program Services | 2371149 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 275970 | Total |
| Program Services | 275970 | ProgramServices |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| BAD DEBT EXPENSE | 4712831 | 4712831 |
| FOOD | 88481 | 88481 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30845518 | Total |
| Program Services | 23108150 | ProgramServices |
| Management And General | 7737368 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2325 | BOY |
| EOY | 2502 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3904871 | BOY |
| EOY | 5415437 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22815 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3519280 | BOY |
| EOY | 2472670 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 262019 | BOY |
| EOY | 266330 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58176 | BOY |
| EOY | 141099 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 41386189 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 14342484 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28175829 | BOY |
| EOY | 27043705 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5259998 | BOY |
| EOY | 5761357 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6575827 | BOY |
| EOY | 1618502 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47781140 | BOY |
| EOY | 42721602 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6562086 | BOY |
| EOY | 2924584 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29175611 | BOY |
| EOY | 28353933 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 699134 | BOY |
| EOY | 2018323 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36436831 | BOY |
| EOY | 33296840 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11321494 | BOY |
| EOY | 9424762 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22815 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11344309 | BOY |
| EOY | 9424762 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47781140 | BOY |
| EOY | 42721602 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2648904 | ReconcilationRevenueExpenses |
| Reconcilation Prior Adjustment | -965598 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 1694955 | 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 Separate | X | FinancialStatementSeparate |
| 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) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $5,709 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5709 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | TOTAL NCHA AND AHA DUES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 402081 | OtherCostOrOtherBasis |
| Book Value | 402081 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 32943251 | OtherCostOrOtherBasis |
| Depreciation | 8547497 | Depreciation |
| Book Value | 24395754 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8040857 | OtherCostOrOtherBasis |
| Depreciation | 5794987 | Depreciation |
| Book Value | 2245870 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 27043705 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENTS | 508374 | F |
| RESTRICTED ASSETS | 5252983 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 5761357 | TotalOfBookValueSecurities |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 25178738 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -3017876 | OtherRevenues |
| Revenue Not Rptd F990 | -3017876 | RevenueNotRptdF990 |
| Revenue Subtotal | 28196614 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 28196614 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 26132687 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 26132687 | ExpensesSubtotal |
| Other Expenses Not Included | 4712831 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 4712831 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 30845518 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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: | CAPITAL CONTRIBUTED FROM SOLE MEMBER 1,694,955. BAD DEBT EXPENSE -4,712,831. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 4,712,831. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 250.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1092687 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1092687 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04180 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3755976 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2441915 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1314061 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4848663 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2441915 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2406748 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09210 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8954 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8954 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8954 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8954 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4857617 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2441915 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2415702 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09240 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 19843 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 19843 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 19843 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 19843 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,839,661 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 6471869 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7023405 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -551536 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 475 PROGRESS BLVD | AddressLine1 |
| City | SILER CITY | City |
| State | NC | State |
| ZIP Code | 27344 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 250.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATHAM HOSPITAL MEDICAL OFFICE BUILDING | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 MEDICAL PARK DRIVE | AddressLine1 |
| City | SILER CITY | City |
| State | NC | State |
| ZIP Code | 27344 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | CARDIAC REHABILITATION, DIABETES EDUCATION, PT/OT, AND OTHER ADMIN FUNCTIONS | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| 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, CHATHAM HOSPITAL PROVIDES A STRAIGHT 35% DISCOUNT ON CHARGES. | ||
| PART I, LINE 6A: PART OF UNC HEALTH CARE SYSTEM REPORTING | ||
| 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, L7 COL(F): SPECIFIC PATIENT BALANCES ARE WRITTEN OFF AT THE TIME THEY ARE DETERMINED TO BE UNCOLLECTIBLE. | ||
| PART II: 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, AND 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 SERVICES 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 ARE 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 V, SECTION B, LINE 20D: SELF PAY GETS A STRAIGHT 35% DISCOUNT. CHARITY CARE IS AVAILABLE AS OUTLINED IN THE FINANCIAL ASSISTANCE POLICY. | CHATHAM HOSPITAL | |
| 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. SELF PAY PATIENT ACCOUNTS ARE AUTOMATICALLY ROUTED TO MEDICAID ASSISTANCE COUNSELORS FOR REVIEW OF POTENTIAL ELIGIBILITY 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. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARY BECK | ||||||||||||||
| BOARD MEMBER | 0 | 253690 | 0 | 22012 | 0 | 25782 | 0 | 49233 | 0 | 2993 | 0 | 353710 | 0 | 0 |
| MEL HURSTON | ||||||||||||||
| BOARD MEMBER | 0 | 238072 | 0 | 19449 | 0 | 46470 | 0 | 71883 | 0 | 7704 | 0 | 383578 | 0 | 0 |
| JOHN LEWIS | ||||||||||||||
| BOARD MEMBER | 0 | 462833 | 0 | 20297 | 0 | 45161 | 0 | 65129 | 0 | 1174 | 0 | 594594 | 0 | 0 |
| TODD PETERSON | ||||||||||||||
| BOARD MEMBER | 0 | 47053 | 0 | 0 | 0 | 67111 | 0 | 40026 | 0 | 0 | 0 | 154190 | 0 | 0 |
| DONALD SPENCER MD | ||||||||||||||
| BOARD MEMBER | 0 | 98187 | 0 | 22444 | 0 | 31121 | 0 | 9366 | 0 | 391 | 0 | 161509 | 0 | 0 |
| ROBERT ENDERS | ||||||||||||||
| CEO | 0 | 145636 | 0 | 0 | 0 | 42450 | 0 | 28328 | 0 | 0 | 0 | 216414 | 0 | 0 |
| DAVID W STRONG | ||||||||||||||
| PRESIDENT | 0 | 524539 | 0 | 226405 | 0 | 561373 | 0 | 252208 | 0 | 15148 | 0 | 1579673 | 0 | 529812 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | DURING THE CALENDAR YEAR 2012, DAVID STRONG PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED DISTRIBUTIONS TOTALING $529,812. HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $226,442. THE CURRENT YEAR EARNINGS ARE 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 THE ORGANIZATION. ADDITIONALLY, THE INCENTIVE COMPENSATION OF THE PRESIDENT AND CFO IS BASED PARTLY ON THE EARNINGS OF THE UNC HEALTH CARE SYSTEM. OTHER PERFORMANCE MEASURES USED TO DETERMINE INCENTIVE COMPENSATION ARE PHYSICIAN SATISFACTION, PATIENT CARE QUALITY OUTCOMES, EFFECTIVE USE OF TECHNOLOGY AND INDIVIDUAL GOALS. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| 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 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 521309402 | IssuerEIN |
| CUSIP Number | 657905ES0 | CUSIPNumber |
| Date Issued | 2007-02-08 | DateIssued |
| Issue Price | 30540000 | IssuePrice |
| Description Of Purpose | FHA INSURED MORTGAGE REVENUE BONDS | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Total Proceeds | 30540000 | TotalProceeds |
| Amount In Reserve Fund | 639326 | AmountInReserveFund |
| Issuance Costs From Proceeds | 1370283 | IssuanceCostsFromProceeds |
| Capital Expenditures | 29976186 | CapitalExpenditures |
| Year Of Subst Completion | 2008 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 1 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 | FORM 990, PART VI, SECTION A,LINE 10: 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 WHEN DECISIONS FACE A FHA INSURED MORTGAGE REVENUE BONDS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | EFFECTIVE AUGUST 1, 2006, THE HOSPITAL ENETERED 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 HOSPITALS 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 XI, LINE 9: | CAPITAL CONTRIBUTED FROM SOLE MEMBER 1,694,955. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | NO CHANGE IN METHOD FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|
| UNIVERSITY OF NORTH CAROLINA HEALTHCARE SYSTEM | ||||||||
| 211 FRIDAY CENTER DRIVE | CHAPEL HILL | NC | 27517 | 562206970 | HEALTHCARE | NC | 501(C)(3) | 0 |
| REX HOSPITAL INC | ||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 561509260 | HEALTHCARE | NC | 501(C)(3) | 0 |
| UNIVERSITY OF NORTH CAROLINA HOSPITALS | ||||||||
| 101 MANNING DRIVE | CHAPEL HILL | NC | 27514 | 561118388 | HEALTHCARE | NC | 501(C)(3) | 0 |
| REX HEALTHCARE INC | ||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 561509129 | HEALTHCARE | NC | 501(C)(3) | 0 |
| REX HEALTHCARE FOUNDATION INC | ||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 566052117 | HEALTHCARE | NC | 501(C)(3) | 0 |
| REX HOME SERVICES INC | ||||||||
| 4420 LAKE BOONE TRAIL | RALEIGH | NC | 27607 | 561636242 | HEALTHCARE | NC | 501(C)(3) | 0 |
| TRIANGLE PHYSICIAN NETWORK | ||||||||
| 211 FRIDAY CENTER DRIVE | CHAPEL HILL | NC | 27517 | 271081647 | HEALTHCARE | NC | 501(C)(3) | 0 |
| UNC DEPARTMENT OF FAMILY MEDICINE | ||||||||
| 590 MANNING DRIVE | CHAPEL HILL | NC | 27599 | 566001393 | HEALTHCARE | NC | 501(C)(3) | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REX ENTERPRISES COMPANY INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4420 LAKE BOONE TRAIL | AddressLine1 |
| City | RALEIGH | City |
| State | NC | State |
| ZIP Code | 27607 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activity | HOLDING COMPANY | PrimaryActivity |
| Legal Domicile State | NC | LegalDomicileState |
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | 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 | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| UNIVERSITY OF NORTH CAROLINA HOSPITALS | ||
| M | 1473046 | FMV CALCULATION |
| UNIVERSITY OF NORTH CAROLINA HOSPITALS | ||
| M | 2721954 | FMV CALCULATION |
| UNIVERSITY OF NORTH CAROLINA HOSPITALS | ||
| Q | 677735 | CASH |
| UNIVERSITY OF NORTH CAROLINA HEALTH CARE SERVICES | ||
| C | 2000000 | CASH |
| UNIVERSITY OF NORTH CAROLINA HEALTH CARE SERVICES | ||
| P | 338788 | CASH |