FURP.ORG / PUBLIC DATA EXPLORER

CUMBERLAND COUNTY HOSPITAL SYSTEM INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CUMBERLAND COUNTY HOSPITAL SYSTEM INC (EIN 56-0845796)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-15
IRS object ID
201412279349303846
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

FieldValueIRS element (for citing)
Timestamp2014-08-15T14:25:30-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1191 Peachtree Stree Suite 2000AddressLine1
CityAtlantaCity
StateGAState
ZIP Code303031749ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN560845796EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Cumberland County Hospital System IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCUMBNameControl
Phone9106154829Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 2000AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code283022000ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSANDRA WILLIAMS CFOName
TitleChief Financial OfficerTitle
Phone9106154829Phone
Date Signed2014-08-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJohn W Sadoff JrName
PTINP00540589PTIN
Phone4042201500Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSandra WilliamsNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 2000AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code283022000ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1046532901GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.capefearvalley.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionCumberland County Hospital System, Inc. exists to meet the health care needs of the residents of Cumberland and Bladen counties, and the surrounding area in North Carolina.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members20NbrIndependentVotingMembers
Total Nbr Employees6739TotalNbrEmployees
Total Nbr Volunteers492TotalNbrVolunteers
Total Gross UBI-82113TotalGrossUBI
Net Unrelated Business Txbl Income-82113NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year473794ContributionsGrantsPriorYear
Contributions Grants Current Year478450ContributionsGrantsCurrentYear
Program Service Revenue Prior Year802320052ProgramServiceRevenuePriorYear
Program Service Revenue CY827954023ProgramServiceRevenueCY
Investment Income Prior Year10908415InvestmentIncomePriorYear
Investment Income Current Year17194462InvestmentIncomeCurrentYear
Other Revenue Prior Year11056199OtherRevenuePriorYear
Other Revenue Current Year12438255OtherRevenueCurrentYear
Total Revenue Prior Year824758460TotalRevenuePriorYear
Total Revenue Current Year858065190TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year254315GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY262290GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year379001606SalariesEtcPriorYear
Salaries Etc Current Year383399136SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year422299786OtherExpensePriorYear
Other Expenses Current Year448335825OtherExpensesCurrentYear
Total Expenses Prior Year801555707TotalExpensesPriorYear
Total Expenses Current Year831997251TotalExpensesCurrentYear
Revenues Less Expenses Prior Year23202753RevenuesLessExpensesPriorYear
Revenues Less Expenses CY26067939RevenuesLessExpensesCY
Total Assets BOY929405691TotalAssetsBOY
Total Assets EOY935749959TotalAssetsEOY
Total Liabilities BOY524539582TotalLiabilitiesBOY
Total Liabilities EOY501306750TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY404866109NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY434443209NetAssetsOrFundBalancesEOY
Mission DescriptionCumberland County Hospital System, Inc. exists to meet the health care needs of the residents of Cumberland, Bladen and Hoke counties, and the surrounding area in North Carolina.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense763992483Expense
Grants262290Grants
Revenue857683099Revenue
DescriptionAs part of meeting the health care needs of the service area, CCHS, Inc. admitted 35,079 patients, provided 220,324 patient days of care, had 151,878 emergency room visits and had over 446,896 outpatient visits for other services.Description
Total Program Service Expense763992483TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096511NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees6739NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members20NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledNCStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1James DupeBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9106154829TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 2000AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code283022000ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
Bradley Broussard
Trustee2.00X000
Bryant Murphy
Trustee2.00X000
Charles Evans
Trustee2.00X000
Denise Mahone Wyatt
Trustee2.00X000
Divyang Patel
Trustee2.00X000
Ed Melvin
Trustee2.00X000
James Martin
Trustee2.00X000
Jeannette Council
Trustee2.00X000
Jennifer Twaddell
Trustee2.00X000
Jerry Dean
Trustee2.00X000
Jimmy Keefe
Trustee2.00X000
Kenneth Edge
Trustee2.00X000
Lucy Jones
Trustee2.00X000
Marion Gillis Olion
Trustee2.00X000
Marshall Faircloth
Trustee2.00X000
Mary Dickey
Trustee2.00X000
Rueben Rivers
Trustee2.00X000
Sanjeev Slehria
Trustee2.00X000
Billy King
Secretary/Treasurer2.00X000X
Donald L Porter
Vice Chairperson2.00X000X
Earnest Curry
Chairperson2.00X000X
John Henley
Board Chairperson2.00X000X
Michael Nagowski
CEO55.00976162095907X
Sandra Williams
CFO55.00509809020608X
William Pryor
CHRO55.00335381025540X
Inad Atassi
Staff Physician55.00722835023832X
John Spitalieri
Staff Physician55.00719878018498X
John Whitley
Staff Physician55.00753349010301X
Richard Osenbach
Medical Director55.00721970021145X
Stuart Shelton
Medical Director55.00654418029122X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5393802TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation244953TotalOtherCompensation
Number Individuals GT100 K440NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Simpli Fi Managed Services
1834 Sally Hill Farms BlvdFlorenceSC29501Professional Services19176239
Allied Barton Security Services
PO Box 534265AtlantaGA30353Security Services3738486
Greeley Company
PO Box 3049PeabodyMA01961Consulting2680312
RPA Design PC
5960 Fairview Rd Suite 500CharlotteNC28210Construction1997533
K&L Gates LLP
210 Sixth AvenuePittsburghPA15222Legal Services1638992
FieldValueIRS element (for citing)
Number Of Contractors GT100 K73NumberOfContractorsGT100K
Government Grants49760GovernmentGrants
All Other Contributions428690AllOtherContributions
Total Contributions478450TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenue900099814855137814855137
Ancillary Medical Services9000991289964812899648
Education/Outreach611710199238199238
FieldValueIRS element (for citing)
Total Program Service Revenue827954023TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column11646795TotalRevenueColumn
Exclusion$11,646,795ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real43122Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real11050Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real32072Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column32072TotalRevenueColumn
Unrelated Business Revenue14247UnrelatedBusinessRevenue
Exclusion$17,825ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities193958128Securities
Other46200Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities188321889Securities
Other134772Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities5636239Securities
Other-88572Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5547667TotalRevenueColumn
Exclusion$5,547,667ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
Purchase Rebates, Discounts, and8129007500146$7,500,146
Cafeteria And Parking Revenue9000993843288$3,843,288
Employee Daycare Revenue6244101159109$1,159,109

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column-96360TotalRevenueColumn
Unrelated Business Revenue-96360UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue12406183TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column858065190TotalRevenueColumn
Related Or Exempt Function Income827954023RelatedOrExemptFunctionIncome
Unrelated Business Revenue-82113UnrelatedBusinessRevenue
Exclusion$29,714,830ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total262290Total
Program Services262290ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1920500Total
Program Services1728450ProgramServices
Management And General192050ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total306261289Total
Program Services275635160ProgramServices
Management And General30626129ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total13532131Total
Program Services12178918ProgramServices
Management And General1353213ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total41041852Total
Program Services36937667ProgramServices
Management And General4104185ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total20643364Total
Program Services18579028ProgramServices
Management And General2064336ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total7653970Total
Program Services6888573ProgramServices
Management And General765397ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3227352Total
Program Services2904617ProgramServices
Management And General322735ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total535113Total
Program Services481602ProgramServices
Management And General53511ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total95000Total
Program Services95000ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total1039070Total
Program Services935163ProgramServices
Management And General103907ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4144354Total
Program Services3729919ProgramServices
Management And General414435ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total11416624Total
Program Services10355864ProgramServices
Management And General1060760ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total12243889Total
Program Services11019500ProgramServices
Management And General1224389ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total356293Total
Program Services320664ProgramServices
Management And General35629ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total649308Total
Program Services584377ProgramServices
Management And General64931ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total11125593Total
Program Services10013034ProgramServices
Management And General1112559ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total30372412Total
Program Services27335171ProgramServices
Management And General3037241ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total8026158Total
Program Services7223542ProgramServices
Management And General802616ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt150783234150783234
Medical and Other Suppl1110661109995949911106611
Contract Labor18815826169342431881583
Purchased Services17144872154303851714487

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total59640647Total
Program Services53676583ProgramServices
Management And General5964064ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total831997251Total
Program Services763992483ProgramServices
Management And General68004768ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY25364839BOY
EOY15257931EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY53332889BOY
EOY49368461EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY93594183BOY
EOY103653476EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY8609183BOY
EOY9275510EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4936431BOY
EOY6016216EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis720900282LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec401246357LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY303180956BOY
EOY319653925EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY266819448BOY
EOY286870967EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY173567762BOY
EOY145653473EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY929405691BOY
EOY935749959EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY85488984BOY
EOY51614285EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY180715BOY
EOY158310EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY292262366BOY
EOY280594642EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY38447999EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY146607517BOY
EOY130491514EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY524539582BOY
EOY501306750EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY393737598BOY
EOY423314698EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY404866109BOY
EOY434443209EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY929405691BOY
EOY935749959EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses26067939ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3509161ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$95,000DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB95000TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis23500091OtherCostOrOtherBasis
Book Value23500091BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis417767447OtherCostOrOtherBasis
Depreciation185070562Depreciation
Book Value232696885BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1740197OtherCostOrOtherBasis
Depreciation611134Depreciation
Book Value1129063BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis267650169OtherCostOrOtherBasis
Depreciation206437384Depreciation
Book Value61212785BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10242378OtherCostOrOtherBasis
Depreciation9127277Depreciation
Book Value1115101BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings319653925TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
Other Receivables21516074
Self Insurance Trusts43260503
Trusts - Bond Funds10334550
Other Assets5735066
Construction in Progress34451960
Derivative Instrument30355320
FieldValueIRS element (for citing)
Total Book Value Other Assets145653473TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Estimated Prof Liability & Worker Comp Costs$43,998,103
Due to Payor Agencies$56,138,091
Derivative Instrument$30,355,320
FieldValueIRS element (for citing)
Total Of Amounts130491514TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage500.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care0AmountsBudgetedForCharityCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense12274000TotalCommunityBenefitExpense
Direct Offsetting Revenue955000DirectOffsettingRevenue
Net Community Benefit Expense11319000NetCommunityBenefitExpense
Percent Of Total Expense0.01660PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense61875000TotalCommunityBenefitExpense
Direct Offsetting Revenue40330000DirectOffsettingRevenue
Net Community Benefit Expense21545000NetCommunityBenefitExpense
Percent Of Total Expense0.03160PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense74149000TotalCommunityBenefitExpense
Direct Offsetting Revenue41285000DirectOffsettingRevenue
Net Community Benefit Expense32864000NetCommunityBenefitExpense
Percent Of Total Expense0.04820PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense100000TotalCommunityBenefitExpense
Net Community Benefit Expense100000NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense3650000TotalCommunityBenefitExpense
Direct Offsetting Revenue3539040DirectOffsettingRevenue
Net Community Benefit Expense110960NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense34377000TotalCommunityBenefitExpense
Direct Offsetting Revenue16843000DirectOffsettingRevenue
Net Community Benefit Expense17534000NetCommunityBenefitExpense
Percent Of Total Expense0.02570PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense300000TotalCommunityBenefitExpense
Net Community Benefit Expense300000NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense38427000TotalCommunityBenefitExpense
Direct Offsetting Revenue20382040DirectOffsettingRevenue
Net Community Benefit Expense18044960NetCommunityBenefitExpense
Percent Of Total Expense0.02640PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense112576000TotalCommunityBenefitExpense
Direct Offsetting Revenue61667040DirectOffsettingRevenue
Net Community Benefit Expense50908960NetCommunityBenefitExpense
Percent Of Total Expense0.07460PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense185000TotalCommunityBuildingExpense
Net Community Building Expense185000NetCommunityBuildingExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense60000TotalCommunityBuildingExpense
Net Community Building Expense60000NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense245000TotalCommunityBuildingExpense
Net Community Building Expense245000NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$39,250,000BadDebtExpenseAmount
Amount Reimbursed By Medicare228039361AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare244098836CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-16059475MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities3NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (3 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursOtherOtherCritical Access HospitalCriticalAccessHospital
Cape Fear Valley Health System
11638 Owen DriveFayettevilleNC28304XXX
Highsmith Rainey Hospital
2150 Robeson StreetFayettevilleNC28301XLong Term Acute Care Hospital
Bladen County Hospital
3501 South Poplar StreetElizabethtownNC28337XXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (3 entries)

Hospital Facility NumberHospitalFacilityNumberCHNA ConductedCHNAConductedCommunity DefinitionCommunityDefinitionCommunity DemographicsCommunityDemographicsExisting ResourcesExistingResourcesHow Data ObtainedHowDataObtainedCommunity Health NeedsCommunityHealthNeedsOther Health IssuesOtherHealthIssuesIdentifying ProcessIdentifyingProcessConsulting ProcessConsultingProcessInformation GapsInformationGapsNeeds Assessment ConductedNeedsAssessmentConductedTake Into AccountTakeIntoAccountOther FacilitiesOtherFacilitiesCHNA Widely AvailableCHNAWidelyAvailableOwn WebsiteOwnWebsiteOn RequestOnRequestAdopt Implement StrategyAdoptImplementStrategyExecute Implement StrategyExecuteImplementStrategyDevelop Community PlanDevelopCommunityPlanParticipate Community PlanParticipateCommunityPlanInclude Operational PlansIncludeOperationalPlansAdopt BudgetAdoptBudgetPrioritize Health NeedsPrioritizeHealthNeedsPrioritize ServicesPrioritizeServicesAll Needs AddressedAllNeedsAddressedOrganization Incur Excise TaxOrganizationIncurExciseTaxEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeFPG Free PercentFPGFreePercentUses FPG DiscountedUsesFPGDiscountedFPG Discount PercentFPGDiscountPercentExplains BasisExplainsBasisIncome LevelIncomeLevelMedical IndigencyMedicalIndigencyUninsured DiscountUninsuredDiscountExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresAttached To InvoicesAttachedToInvoicesAvailable On RequestAvailableOnRequestOther PublicityOtherPublicityActions On NonpaymentActionsOnNonpaymentCollection ActivitiesCollectionActivitiesReport To Credit AgencyReportToCreditAgencyNotified All PatientsNotifiedAllPatientsNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyUsed Other MethodUsedOtherMethodAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
Cape Fear Valley Health System
11XXXXXXXXX12111XXXXXXXXXX1011200.0000000000001500.0000000000001XXX11XXX11XX1X00
Highsmith Rainey Hospital
21XXXXXXXXX12111XXXXXXXXXX1011200.0000000000001500.0000000000001XXX11XXX11XX1X00
Bladen County Hospital
31XXXXXXXXX12101XXXXXXXXXX1011200.0000000000001500.0000000000001XXX11XXX11XX1X00

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities41NumberOfOtherFacilities

Other Facilities OtherFacilities (41 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
CFV-Rehabilitation Center
1638 Owen DriveFayettevilleNC28304Rehabilitation Center
Cumberland Cty EMS of CFV
610 Gillespie StreetFayettevilleNC28306Emergency Medical Services
CFV Behavior Health Center
3425 Melrose RoadFayettevilleNC28304Behavior Health Center
CFV Detox Center
1724 Roxie AvenueFayettevilleNC28304Detoxication Center
Healthplex Wellness Center
1930 Skibo RoadFayettevilleNC28304Rehabilitation Center
Health Pavilion North
6387 Ramsey StreetFayettevilleNC28311Outpatient Services
Valley Medial Assoc-Cape Fear Valley
1638 Owen DriveFayettevilleNC28304Family Practice
Highsmith-Rainey Express Care
150 Robeson StreetFayettevilleNC28311Express Care
Cape Fear Valley Express Care
1638 Owen DriveFayettevilleNC28304Express Care
Cape Fear Valley OBGYN
1341 Walther Reed RoadFayettevilleNC28304OB/Gyn Services
Health Pavilion North Express Care
6287 Ramsey StreetFayettevilleNC28301Express Care
Cape Fear Valley Sleep Medicine
1213 Walter Reed RoadFayettevilleNC28304Sleep Center
Health Pavilion North Family Care
6387 Ramsey StreetFayettevilleNC28311Family Practice
Hope Mills Family Care
4092 Professional DriveHope MillsNC28348Family Practice
Cape Fear Valley Neurology
3308 Melrose RoadFayettevilleNC28304Neurology
Cape Fear Valley Perinatology
2109 Valleygate DriveFayettevilleNC28304Perinatology
Behavioral Health Center
3425 Melrose RoadFayettevilleNC28304Mental Health Clinic Inpatient
Valley Medial Associates - Highsmith
101 Robeson StreetFayettevilleNC28301Family Practice
Cape Fear Valley Urology
2301 Robeson Street Suite 203FayettevilleNC28305Urology
Hoke Family Medical Center
405 South Main StreetRaefordNC28376Family Practice
Senior Health Services
101 Robeson Street Suite 202FayettevilleNC28310Geriatrics
Bladen Medial Assoc- Elizabethtown
300 A East McKay StreetElizabethtownNC28337Family Practice
Stedman Medical Care
114 Forte RoadStedmanNC28391Family Practice
Cape Fear Valley Neurosurgery
3308 Melrose RoadFayettevilleNC28304Neurosurgery Outpatient
Cape Fear Valley Wound Care Center
101 Robeson St Suite 210FayettevilleNC28301Wound Center
Cape Fear Valley Pediatric Care
1262 Oliver StreetFayettevilleNC28304Pediatric Care
Westside Medical Care
1463 Pamalee DriveFayettevilleNC28303Family Practice
CFV Infectious Disease Care
101 Robeson Street Suite 300FayettevilleNC28301Infectious Disease
Cape Fear Valley Internal Medicine
101 Robeson Street Suite 300FayettevilleNC28301Internal Medicine
Women's Health Specialists
300 East McKay Street Suite FElizabethtownNC28337OB/GYN
CFV Pediatric Endocrinology
101 Robeson Street Suite 410FayettevilleNC28301Diabetes & Endocrinology Outpatient
Three Rivers Medical Center
580 West McLean StreetSt PaulsNC28384Family Practice
Bladen Medial Assoc - Bladenboro
106 Fourth StreetBladenboroNC28302Family Practice
Bladen Medial Associates - Dublin
16 3rd StreetDublinNC28332Family Practice
Diabetes & Endocrine Center
101 Robeson Street Suite 405FayettevilleNC28301Diabetes & Endocrinology Outpatient
Cape Fear Valley Pediatric Care
6387 Ramsey StreetFayettevilleNC28311Pediatric Care
Behavioral Health Clinic
3425 Melrose RoadFayettevilleNC28304Mental Health Outpatient Care
Convenient Care for Hoke
104 Southern AvenueRaefordNC28376Family Practice
Walmart Clinic Hoke
4545 Fayetteville RoadRaefordNC28376Express Care
Phillips Internal Medicine
507 Doctors DriveElizabethtownNC28337Internal Medicine
Bladen Surgical Specialist
107 East Dunham StreetElizabethtownNC28377Surgical Specialist

Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 6a: Cumberland County Hospital System files a community benefit report annually in the state of North Carolina to the North Carolina Hospital Association.
Part II: Cumberland County Hospital System, Inc. ("CCHS") reported coalition building and workforce development details in the Community Building Activities Part II. Coalition building promotes the health of the communities it serves by networking with other community agencies to address the health and safety issues of the community. The employees of CCHS utilize their clinical expertise to collaborate with other community agencies and county and state health departments to provide education and other initiatives that benefit the health of people in the community. Workforce development activities include the recruitment of physicians and other health professionals to medical shortage areas.
Part III, Line 4: A patient's record is reviewed for possible charity care and if the patient does not qualify for charity and the patient does not pay, their charges are written-off as bad debt. Amounts in line 2 are determined by calculating a cost-to-charge ratio. Total expenses (less bad debts and other operating revenue) are divided into total gross patient revenue. Total bad debt charges are multiplied by this percentage.
Part III, Line 8: Cumberland County Hospital Systems, Inc. treats the total shortfall of Medicare reimbursement compared to the amount of computed Medicare allowable costs as a community benefit. The Hospital improves access to patient care by providing services regardless of a patient's ability to pay or the hospital's ability to receive full cost reimbursement for services. The hospital also relieves the government of a financial burden when it provides care to publicly insured patients where reimbursement is less than cost of providing the service.
Part III, Line 9b: If patients are determined to qualify for charity, then the account is written-off to charity rather than to bad debt.
Part V, Section B, Line 3: The Health System established a Community Health Assessment Team (CHAT) to analyze the community health needs. Attendees provided input regarding community health strengths and concerns, as well as identified the top health concerns. Those individuals, representing diverse groups were chosen to participate in the CHAT because of their insights about the community's health needs. These individuals represented the local Health Departments, County Departments, and community organizations such as United Way and March of Dimes.Cape Fear Valley Health System
Part V, Section B, Line 4: Cape Fear Valley and Highsmith Rainey worked collaboratively with one another.Cape Fear Valley Health System
Part V, Section B, Line 14g: See the response to Part VI, Line 3Cape Fear Valley Health System
Part V, Section B, Line 14g: See the response to Part VI, Line 3Highsmith Rainey Hospital
Part V, Section B, Line 14g: See the response to Part VI, Line 3Bladen County Hospital
Part V, Section B, Line 20d: Patients are charged at the hospital Usual Customary and Reasonable rates minus 30%.Cape Fear Valley Health System
Part V, Section B, Line 20d: Patients are charged at the hospital Usual Customary and Reasonable rates minus 30%.Highsmith Rainey Hospital
Part V, Section B, Line 20d: Patients are charged at the hospital Usual Customary and Reasonable rates minus 30%.Bladen County Hospital
Part VI, Line 2: The mission of Cape Fear Valley Health System is to strengthen the health and well-being of the greater Cape Fear Valley region through high-quality, compassionate care provided to all who need it. As a community not-for-profit organization, we take seriously our responsibility to invest our resources and energies into understanding and meeting the diverse health care needs of all, and ensure that everyone, regardless of their ability to pay, receive the care they need. Our facility is a member of a group called Greater Fayetteville Futures. As a member of this group we participate in community meetings to gain insight needs and community suggestions. The Senior Administrative team serves in various capacities on several local community boards and groups. As members of these various groups, they are able to gain insight to needs of the community. Our community partners are critical to helping us improve the health and well-being of the Cape Fear Valley region. Together, we can combine resources and strengths, positively impacting the greatest number of people. By working closely with the community leaders, we also build a greater sense of community and a shared commitment toward our common goal of improving the community's health. The results help us to determine our short and long term priorities as well as strategies for improving community health. Those community groups and partners CCCC, SRAHEC, CCMAP, Chamber of Commerce, Fayetteville Area PR Alliance, Cumberland County Education Foundation, Communities in Schools of NC, Fort Bragg Regional Alliance, Care Clinic, and the Methodist University Physician Assistant program.
Part VI, Line 3: Uninsured patients are screened at the time of registration for their ability to pay for their health care services. If the patient has no ability to pay and is deemed ineligible for governmental programs (Medicare, Medicaid, etc.) then they are informed of the Hospital Charity program. They are provided with an application and a listing of the appropriate documents necessary to establish eligibility for the Hospital Charity program. All patients receive a copy of our Charity Care Application accompanying the first billing statement.
Part VI, Line 4: Cumberland County Hospital System, Inc. ("CCHS") doing business as Cape Fear Valley Medical Center ("CFVMC") is the flag ship of Cape Fear Valley Health System ("CFVHS"). CFVHS operates a variety of healthcare facilities from its headquarters in Fayetteville, North Carolina including a tertiary acute care hospital, a long-term acute care hospital, a critical access hospital, an inpatient rehabilitation facility, county emergency medical services, an outpatient psychiatric facility, a detoxification facility, a wellness center, 14 primary care clinics, 16 specialty care clinics, 5 walk-in clinics, and Health Pavilion North, an outpatient complex.Cape Fear Valley Health System serves a six-county service area made up of the five counties contiguous to Cumberland County, NC, which is its Primary Service Area. Per information from the 2012 Census Data, Cumberland has a population of over 324,000 residents; this was a growth of 6.9% from the 2000 Census Data. Approximately 53.5% of the 324,000 residents in our primary service area are minorities, compared to 35.3% for the state.
Part VI, Line 5: Chronic diseases like diabetes and obesity are increasing within our community. Our facility has opened a diabetes and endocrine clinic to help those patients diagnosed with diabetic. Our healthplex provides both nutritional and exercise programs to help those in the community address the problem of obesity. The goal is to help all residents learn to manage their conditions and live healthier lives by addressing the challenges associated with these conditions. Example of Program at Cape Fear Valley:Cape Fear Valley Health System's Take Charge of Your Health Program began as an initiative to close the healthcare gap between African-Americans and non-Hispanic Whites in Cumberland County through public service announcements, health fairs, screenings and speaking engagements. It has since broadened its focus to all of Cumberland County. Darvin Jones is the Coordinator of Take Charge of Your Health Program. He serves on the Board of Directors of Community Health Interventions & Sickle Cell Agency, a non-profit that works with individuals with sickle cell disease, hypertension and diabetes. Darvin is also a member of the Cumberland County Council for Healthy Living, a group assembled by the Health Department, and the Cumberland County Schools School Health Advisory Council. Take Charge of Your Health is affiliated with Eat Smart, Move More North Carolina, a statewide initiative. At Cape Fear Valley Health System, it is important to us to give back to our community. In addition to employee United Way donations and volunteer time, our employees participate in a variety of community service initiatives, to include Habitat for Humanity and the Friends of Cancer River Walk. Last year our employees gave over $150,000 in donations to various community organizations.
Part VI, Line 6: Cumberland County Hospital System is a stand-alone health care organization and is not a part of an affiliated health care system.
NCReports Filed With StatesPart VI, Line 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Cape Fear Valley Health FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 87526AddressLine1
CityFayettevilleCity
StateNCState
ZIP Code28304ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient561947017EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant262290AmountOfCashGrant
Purpose Of GrantGeneral SupportPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Cumberland County Hospital System awards grants to patients for purposes of assisting them in paying various bills and other expenses which the patients cannot pay due to their excessive medical expenses required for treating illness. Patients apply and applications are reviewed by hospital social workers. Any funds granted are not paid directly to the organization for which patient owes the bill and/or expense.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Michael Nagowski
CEO579760036609203031007257802332901072069000
Sandra Williams
CFO35632801110820423990101000105080530417000
William Pryor
CHRO28563704850201242036760218640360921000
Inad Atassi
Staff Physician6765300230000233050101000137320746667000
John Spitalieri
Staff Physician719068000810000184980738376000
John Whitley
Staff Physician72314200030207000103010763650000
Richard Osenbach
Medical Director70214801750002322051000160450743115000
Stuart Shelton
Medical Director34672302567850509100101000190220683540000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 6ReturnReference
ExplanationA component of the CEO's bonus at year end is dependent on the financial standing of the organization. No specific percentage is tied to net income.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
North Carolina Medical Care Commission
A5213094026579022Y72006-05-0437995351Construction and Equipment000
North Carolina Medical Care Commission
B52130940265821DAL52008-09-23285335000To refund bonds issued 5/4/2006000
North Carolina Medical Care Commission
C52130940265821DPP02012-12-19124978739To refund bonds issued 9/23/2008000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Bond ReferenceBondReferenceCdAmount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount Bond DefeasedAmountBondDefeasedOther Spent ProceedsOtherSpentProceedsRefunding EscrowRefundingEscrow
A316400003943971554938002974844352680683338123703541648320080011
B491500028533500037228381000717820081011128420000271604984
C1249787394840744163019101112949669120398879

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersTotal Private Business UseTotalPrivateBusinessUse
A00110000
B001100000.003800.00380
C001100000.003800.00380

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqsTerm Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied
(no name)
A000100000
Morgan Stanley
B0100101001.1000000000001
(no name)
C010000000

Form990 Schedule K Part V Form990ScheduleKPartV (3 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A0
B0
C0

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Schedule K Part IV, Arbitrage, Line 2cDate Rebate Computation PerformedIssuer Name: North Carolina Medical Care Commission Date the Rebate Computation was Performed: 11/20/2012
Schedule K Supplental InformationDifferences between the issue price (Part I) and total proceeds (Part II, line 3) are due to investment earnings. Part II, line 4, column A and C - The amount shown here consists of debt services fund deposits. Part IV, line 6, column C - This question is being answered without regard to a yield-restricted advance refunding escrow financed with proceeds of the bonds.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Section A, line 7aThe Board of Trustees of Cumberland County Hospital System shall be comprised of seven trustees who are the seven members of the Cumberland County Board of Commissioners. The Board of Trustees will also have eight at large trustees who are appointed by the Board of Commissioners. The remaining five at large members are appointed by the Board of Trustees.
Form 990, Part VI, Section B, line 11The process the organization uses to review the Form 990 consists of providing the Form 990 to the Cumberland County Hospital System's Board of Trustees by electronic copy. Board Members will be given time to do a thorough review before the filing date of August 15, 2014.
Form 990, Part VI, Section B, line 12cCumberland County Hospital System, Inc. regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Section B, line 15A human resources consulting firm is retained by Cumberland County Hospital Systems, Inc. to review the competitiveness and reasonableness of the compensation provided to the CEO and other top management personnel.
Form 990, Part VI, Section C, line 19Provided upon request.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (5 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile Foreign CountryLegalDomicileForeignCountryTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeLegal Domicile StateLegalDomicileState
Cape Fear Insurance LTD
PO Box 30600 SMB West Bay Road FGrand CaymanCJ980449284InsuranceCJ1358823133214299100
Bladen County Healthcare LLC
800164702Health Services4425379121179481100PO Box 2000FayettevilleNC28302NC
Cumberland Health Affiliates LLC
562275588Health Services100PO Box 2000FayettevilleNC28302NC
Valley Health Facilities LLC
204268819Health Services100PO Box 2000FayettevilleNC28302NC
Hoke Healthcare LLC
272763125Health Services184793849882796100PO Box 2000FayettevilleNC28302NC

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipControlled OrgControlledOrg
Highsmith-Rainey Medical Arts Center Assoc
PO Box 2000FayettevilleNC28302561747424Rental AssociationNCCumberland County HospitalC20220310635961.000000
Cumberland Health Partners Inc
PO Box 2000FayettevilleNC28302562043978Behavioral Health CareNCCumberland County HospitalC1.000000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg