ALLEGHANY COUNTY MEMORIAL HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ALLEGHANY COUNTY MEMORIAL HOSPITAL INC (EIN 56-0525657)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-13
- IRS object ID
- 201422259349300932
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-13T09:21:08-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560525657 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLEGHANY COUNTY MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ALLE | NameControl |
| Phone | 3363725511 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 9 | AddressLine1 |
| City | SPARTA | City |
| State | NC | State |
| ZIP Code | 28675 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRETT LIVERMAN | Name |
| Title | CFO | Title |
| Phone | 3363725511 | Phone |
| Date Signed | 2014-08-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEREMY NAESS | Name |
| PTIN | P01306905 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WARREN TAYLOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 233 DOCTORS STREET | AddressLine1 |
| City | SPARTA | City |
| State | NC | State |
| ZIP Code | 28675 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12955336 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.AMHSPARTA.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1948 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE TOP QUALITY HEALTH CARE SERVICES TO OUR LOCAL COMMUNITY AND SURROUNDING COMMUNITIES. SERVICES ARE PROVIDED TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 197 | TotalNbrEmployees |
| Total Nbr Volunteers | 54 | TotalNbrVolunteers |
| Total Gross UBI | 95827 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 37018 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 258244 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 598335 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11504672 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 11997145 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 59434 | InvestmentIncomePriorYear |
| Investment Income Current Year | 35453 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 415264 | OtherRevenuePriorYear |
| Other Revenue Current Year | 324403 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12237614 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12955336 | 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 | 5882773 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6549813 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 7590 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6776274 | OtherExpensePriorYear |
| Other Expenses Current Year | 6990726 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12659047 | TotalExpensesPriorYear |
| Total Expenses Current Year | 13540539 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -421433 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -585203 | RevenuesLessExpensesCY |
| Total Assets BOY | 9391285 | TotalAssetsBOY |
| Total Assets EOY | 9223470 | TotalAssetsEOY |
| Total Liabilities BOY | 5085199 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5508344 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4306086 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3715126 | NetAssetsOrFundBalancesEOY |
| Mission Description | ALLEGHANY MEMORIAL HOSPITAL PROVIDES TOP QUALITY HEALTHCARE SERVICES, FACILITATES EDUCATION FOR HEALTHCARE NEEDS, AND COORDINATES HEALTHCARE SERVICES THAT EXCEEDS THE SCOPE OF OUR FACILITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 11579635 | Expense |
| Revenue | 8833446 | Revenue |
| Description | ALLEGHANY MEMORIAL HOSPITAL PROVIDED NECESSARY HEALTHCARE SERVICES TO INDIVIDUALS IN THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. CARE WAS PROVIDED THROUGH 669 INPATIENT AND SWING BED ADMISSIONS, 7,339 ER VISITS, 3,813 DAYS OF CARE, 11,857 X-RAYS, AND 57,575 LAB TESTS. ADDITIONALLY, WAKE FOREST SPECIALTY CLINIC, A PRIMARY CARE PROVIDER, WAS OPENED EFFECTIVE JULY 1, 2013. TOP QUALITY HEALTHCARE IS THE NUMBER ONE GOAL. | Description |
| Total Program Service Expense | 11579635 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 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 | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 1 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 66 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 197 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| 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 | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | BRETT LIVERMAN CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3363723276 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 9 | AddressLine1 |
| City | SPARTA | City |
| State | NC | State |
| ZIP Code | 28675 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| WARREN TAYLOR | ||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 |
| WALT MCMILLAN | ||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 |
| GEORGE WHITE | ||||||
| FINANCE CHAIR | 1.00 | X | X | 0 | 0 | 0 |
| FRANCES BUCKLE | ||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| FIELDS R YOUNG JR | ||||||
| VICE SECRETARY | 1.00 | X | X | 0 | 0 | 0 |
| PAT POLLEY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| REX HALSEY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| FRANK DOWELL | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JOHN MILLER | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| H V LINDSEY | ||||||
| TRUSTEE (THRU 02/2013) | 1.00 | X | 0 | 0 | 0 | |
| DAN R MURRAY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MARVIN MYERS | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| WHITNEY IVEY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| TAMMY THORE MD | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JOE AROCHA MD | ||||||
| TRUSTEE | 40.00 | X | 133372 | 0 | 2144 | |
| ROCKY PROFITT | ||||||
| TRUSTEE (BEGAN 03/2013) | 1.00 | X | 0 | 0 | 0 | |
| JIM HEITZENRATER | ||||||
| CEO (06/2012 - 05/2013) | 40.00 | X | 88795 | 0 | 29737 | |
| BRETT LIVERMAN | ||||||
| CFO (BEGAN 01/2013) | 40.00 | X | 0 | 0 | 0 | |
| KATIE MYERS WOODLE | ||||||
| CFO (THRU 10/2012) | 40.00 | X | 63976 | 0 | 20938 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 286143 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 52819 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ALLEGHANY EMERGENCY PHYSICIANS | |||||
| PO BOX 20351 | HOUSTON | TX | 77216 | ER PHYSICIANS | 481417 |
| QUORUM HEALTH RESOURCES | |||||
| 105 CONTINENTAL PLACE | BRENTWOOD | TN | 37027 | MANAGEMENT COMPANY | 356193 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | COMPUTER SUPPORT | 240969 |
| MEDCOST BENEFIT SERVICES | |||||
| PO BOX 24042 | WINSTON | NC | 27114 | TPA | 193184 |
| DAN SMITH | |||||
| PO BOX 185 | SPARTA | NC | 28676 | CRNA | 176225 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Related Organizations | 32381 | RelatedOrganizations |
| Government Grants | 318605 | GovernmentGrants |
| All Other Contributions | 247349 | AllOtherContributions |
| Total Contributions | 598335 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT REVENUE | 621500 | 11816508 | 11720681 | 95827 |
| MEANINGFUL USE INCENTIVE | 621500 | 124713 | 124713 | |
| MRI GAP SUPPLEMENT | 621500 | 55924 | 55924 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 11997145 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13700 | TotalRevenueColumn |
| Exclusion | $13,700 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 76393 | 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 | 76393 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 76393 | TotalRevenueColumn |
| Exclusion | $76,393 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 19385 | Securities |
| Other | 2368 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 19385 | Securities |
| Other | 2368 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21753 | TotalRevenueColumn |
| Exclusion | $21,753 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA INCOME | 900099 | 45609 | $45,609 |
| THRIFT SHOP | 900099 | 29071 | $29,071 |
| PURCHASE DISCOUNTS | 900099 | 19129 | $19,129 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 154201 | TotalRevenueColumn |
| Exclusion | $154,201 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 248010 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12955336 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11901318 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 95827 | UnrelatedBusinessRevenue |
| Exclusion | $359,856 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 144525 | Total |
| Program Services | 12601 | ProgramServices |
| Management And General | 124698 | ManagementAndGeneral |
| Fundraising | 7226 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5085979 | Total |
| Program Services | 4485993 | ProgramServices |
| Management And General | 599986 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 963742 | Total |
| Program Services | 830216 | ProgramServices |
| Management And General | 133260 | ManagementAndGeneral |
| Fundraising | 266 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 355567 | Total |
| Program Services | 306303 | ProgramServices |
| Management And General | 49166 | ManagementAndGeneral |
| Fundraising | 98 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131353 | Total |
| Management And General | 131353 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78802 | Total |
| Management And General | 78802 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69623 | Total |
| Management And General | 69623 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1192522 | Total |
| Program Services | 910841 | ProgramServices |
| Management And General | 281681 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19944 | Total |
| Management And General | 19944 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1689167 | Total |
| Program Services | 1436470 | ProgramServices |
| Management And General | 252697 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 165780 | Total |
| Program Services | 165780 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16195 | Total |
| Program Services | 12878 | ProgramServices |
| Management And General | 3317 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109490 | Total |
| Program Services | 77899 | ProgramServices |
| Management And General | 31591 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 729558 | Total |
| Program Services | 729558 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120984 | Total |
| Program Services | 2906 | ProgramServices |
| Management And General | 118078 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 1330539 | 1330539 | |
| BAD DEBT EXPENSE | 1213967 | 1213967 | |
| MISCELLANEOUS | 122802 | 63684 | 59118 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13540539 | Total |
| Program Services | 11579635 | ProgramServices |
| Management And General | 1953314 | ManagementAndGeneral |
| Fundraising | 7590 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11792 | BOY |
| EOY | 315320 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 106186 | BOY |
| EOY | 147379 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1325552 | BOY |
| EOY | 1521839 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46911 | BOY |
| EOY | 39489 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 255290 | BOY |
| EOY | 274522 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129594 | BOY |
| EOY | 83033 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18650156 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 12901149 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6361193 | BOY |
| EOY | 5749007 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 935098 | BOY |
| EOY | 902745 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 219669 | BOY |
| EOY | 190136 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9391285 | BOY |
| EOY | 9223470 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1734138 | BOY |
| EOY | 2011429 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3081107 | BOY |
| EOY | 3084613 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 269954 | BOY |
| EOY | 412302 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5085199 | BOY |
| EOY | 5508344 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3940818 | BOY |
| EOY | 3349858 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 365268 | BOY |
| EOY | 365268 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4306086 | BOY |
| EOY | 3715126 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9391285 | BOY |
| EOY | 9223470 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -585203 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 55585 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -61342 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule 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 | $940 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 940 | 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 | THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE NORTH CAROLINA HOSPITAL ASSOCIATION. DUES PAID TO THESE ORGANIZATIONS ARE ALLOCATED IN PART TO LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES. FOR THE YEAR, APPROXIMATELY $940 OF DUES PAID ARE ALLOCATED TO LOBBYING EXPENDITURES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 362325 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 8033 | InvestmentEarningsOrLosses |
| End Of Year Balance | 370358 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 330226 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 32099 | InvestmentEarningsOrLosses |
| End Of Year Balance | 362325 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 356418 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -26192 | InvestmentEarningsOrLosses |
| End Of Year Balance | 330226 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 331822 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 24596 | InvestmentEarningsOrLosses |
| End Of Year Balance | 356418 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 347127 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -15305 | InvestmentEarningsOrLosses |
| End Of Year Balance | 331822 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 351517 | OtherCostOrOtherBasis |
| Book Value | 351517 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6227235 | OtherCostOrOtherBasis |
| Depreciation | 3778907 | Depreciation |
| Book Value | 2448328 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1460715 | OtherCostOrOtherBasis |
| Depreciation | 981585 | Depreciation |
| Book Value | 479130 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10610439 | OtherCostOrOtherBasis |
| Depreciation | 8140657 | Depreciation |
| Book Value | 2469782 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 250 | OtherCostOrOtherBasis |
| Book Value | 250 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5749007 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CAPITAL LEASE OBLIGATION | $199,231 |
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | $213,071 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 412302 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE HOSPITAL'S ENDOWMENT CONSISTS OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES TO SUPPORT HEALTH CARE SERVICES. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | INCOME TAXES - THE HOSPITAL AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND FOUNDATION HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| 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 | 106664 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 106664 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00870 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1221446 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1089985 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 131461 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01070 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1328110 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1089985 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 238125 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01940 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1328110 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1089985 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 238125 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01940 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,213,967 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 5287177 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4850021 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 437156 | 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 | 0 | 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 | ALLEGHANY MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 233 DOCTORS STREET | AddressLine1 |
| City | SPARTA | City |
| State | NC | State |
| ZIP Code | 28675 | 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 | ALLEGHANY COUNTY MEMORIAL 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 |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| 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 | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| 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 | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| ALLEGHANY ORTHOPEDIC CLINIC | ||||
| 12 WILLIS ST | SPARTA | NC | 28675 | ORTHOPEDIC SURGEON OFFICE |
| ALLEGHANY HEALTH SERVICES | ||||
| PO BOX 9 | SPARTA | NC | 28675 | FAMILY PRACTICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: WORKSHEET 2 OF THE 2012 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE/FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID AT COST FOR PURPOSES OF PART I, LINE 7A AND 7B. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1213967. | ||
| PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE GROSS BAD DEBT EXPENSE PER AUDITED FINANCIAL STATEMENTS REDUCED TO COST USING THE COST TO CHARGE RATIO CALCULATED THROUGH WORKSHEET 2 PROVIDED IN THE INSTRUCTIONS TO SCHEDULE H. | ||
| PART III, LINE 8: THE ORGANIZATION USED CALCULATIONS FROM ITS MEDICARE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS FOR PART III. | ||
| PART III, LINE 9B: A PATIENT IS DETERMINED INDIGENT IF THEY MEET THE ELIGIBILITY REQUIREMENTS FOR ALLEGHANY MEMORIAL HOSPITAL'S UNCOMPENSATED CARE PROGRAMS. | ||
| PART V, SECTION B, LINE 3: COMMUNITY INPUT WAS TAKEN INTO ACCOUNT THROUGH COORDINATED EFFORTS WITH AND BETWEEN THE APPALACHIAN DISTRICT HEALTH DEPARTMENT AND OTHER COMMUNITY PROVIDERS. | ALLEGHANY COUNTY MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 5C: THROUGH COORDINATED EFFORTS OF THE APPLACHIAN DISTRICT HEALTH DEPARTMENT | ALLEGHANY COUNTY MEMORIAL HOSPITAL | |
| PART VI, LINE 2: THE HOSPITAL IS PART OF THE APPALACHIAN DISTRICT CHA TEAM, WHICH INCLUDES LEADERSHIP FROM ALLEGHANY MEMORIAL HOSPITAL, ALLEGHANY LIVES, ASHE MEMORIAL HOSPITAL, ASHE COUNTY HEALTH COUNCIL/HEALTHY CAROLINIANS, APPALACHIAN REGIONAL HEALTHCARE SYSTEM, WATAUGA HEALTHY CAROLINIANS, AND WESTERN YOUTH NETWORK. TOGETHER, THE TEAM DEVELOPED A MULTI-PHASE PLAN FOR CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT. THE PHASES INCLUDED: (1) A RESEARCH PHASE TO IDENTIFY, COLLECT AND REVIEW DEMOGRAPHIC, SOCIOECONOMIC AND HEALTH DATA; (2) A SURVEY PHASE TO SOLICIT INFORMATION AND OPINION FROM THE GENERAL PUBLIC; (3) A STAKEHOLDER SURVEY PHASE TO GATHER INFORMATION AND OPINION FROM LOCAL COMMUNITY LEADERS AND HEALTH AND HUMAN SERVICE AGENCIES; AND (4) A DATA SYNTHESIS AND ANALYSIS PHASE. THESE PHASES HELPED DESIGN THE COMPONENTS OF THE COMMUNITY HEALTH ASSESSMENT. THE CURRENT ASSESSMENT WAS COMPLETED IN 2014. ALLEGHANY'S LOCAL PRIORITY ISSUE IS THE ACCESS AND AFFORDABILITY OF HEALTHCARE SERVICES. | ||
| PART VI, LINE 3: THE ORGANIZATION IDENTIFIES ELIGIBLE PATIENTS THROUGH THE REGISTRATION AND COLLECTION PROCESS. EACH ELIGIBLE PATIENT IS GIVEN INSTRUCTIONS AND AN APPLICATION TO COMPLETE AND RETURN TO THE ORGANIZATION. | ||
| PART VI, LINE 4: THE PRIMARY AND SECONDARY SERVICE AREAS INCLUDE APPROXIMATELY 18,000 IN BOTH NORTHWESTERN NC AND SOUTHWESTERN VA. APPROXIMATELY 4,000 INDIVIDUALS IN THE PRIMARY AND SECONDARY SERVICE AREAS ARE OVER AGE 65. THE CLOSEST FACILITY IS APPROXIMATELY 30 MINUTES AWAY DOWN A MOUNTAINOUS TERRAIN. THE HOSPITAL IS LOCATED IN A PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA AND A MEDICALLY UNDERSERVED AREA ACCORDING TO HRSA. THE MEDIAN HOUSEHOLD INCOME AS OF 2012 WAS $34,046 VERSUS A NC STATE AVERAGE OF $45,195. THE UNEMPLOYMENT RATE IS AT ROUGHLY 10.6% AS OF 2012 VERSUS A STATEWIDE AVERAGE OF 9.5%. | ||
| PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. IN ADDITION, THE ORGANIZATION EXTENDS HOSPITAL PRIVILEDGES TO ALL QUALIFIED LOCAL PHYSICIANS FOR THE MAJORITY OF ITS DEPARTMENTS. | ||
| PART VI, LINE 6: THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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 | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | PART VII, LINE 5: THE ORGANIZATION HAS A MANAGEMENT AGREEMENT WITH QUORUM HEALTH RESOURCES TO PROVIDE ADMINISTRATIVE SERVICES BY PLACEMENT OF CEO AND CFO POSITIONS. THESE INDIVIDUALS ARE COMPENSATED BY AN UNRELATED ORGANIZATION FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. SEE PART II. | Explanation |
Schedule L IRS990ScheduleL
Loan Table LoanTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JOE AROCHA MD | NamePerson |
| Purpose Of Loan | PHYSICIAN RECRUITMENT | PurposeOfLoan |
| Loan From Organization | X | LoanFromOrganization |
| Original Principal | $60,000 | OriginalPrincipalAmount |
| Balance Due | 39489 | BalanceDue |
| Default | 0 | Default |
| Approved By Board | 1 | ApprovedByBoard |
| Written Agreement | 1 | WrittenAgreement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 39489 | TotalBalanceDue |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL ENTERED INTO A MANAGEMENT AGREEMENT WITH QUORUM HEALTH RESOURCES THAT ENTAILS THAT THEY WILL PERFORM MANAGEMENT AND ADMINISTRATIVE SERVICES FROM DAY TO DAY. THE ORGANIZATION CONTRACTS ITS EXECUTIVE DIRECTOR AND FINANCIAL DIRECTOR FROM QHR MANAGMENT, LLC. UNDER THE TERMS OF A MANAGEMENT AGREEMENT, MANAGEMENT SERVICES ARE PROVIDED TO THE ORGANIZATION BY QUORUM HEALTH RESOURCES. THESE SERVICES INCLUDE THE SUPERVISION OF ALL ASPECTS OF NORMAL OPERATIONS INCLUDING BUDGETING, HIRING OF EMPLOYEE, BILLING, PAYROLL, ACCOUNTS PAYABLE, AND OTHER MANAGEMENT RESPONSIBILITIES. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. PRIOR TO THE FILING DATE OF THE FORM 990, A COPY OF THE FORM 990 WAS PROVIDED TO EACH VOTING BOARD OF TRUSTEE. THE ENTIRE VOTING BOARD OF TRUSTEES REVIEWED THE FORM 990. AFTER A DISCUSSION PERIOD AND QUESTION & ANSWER PERIOD WITH ASSISTANCE FROM FORM 990 PREPARER, THE BOARD OF TRUSTEES VOTED TO APPROVE AND ACCEPT THE FORM 990 AS PRESENTED. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE HOSPITAL HAS AN ETHICS AND COMPLIANCE POLICY THAT EACH BOARD MEMBER MUST FOLLOW. THIS POLICY IS REINFORCED EACH YEAR AT A REGULAR BOARD MEETING. ALL BOARD MEMBERS SIGN A COMPLIANCE STATEMENT AT THAT BOARD MEETING THAT STATES THE BOARD MEMBER WILL ABIDE BY THE POLICY. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF TRUSTEES EXECUTIVE COMMITTEE HAS ESTABLSHED AND APPROVED AN EXECUTIVE COMPENSATION COMMITTEE THAT REVIEWS AND MONITORS COMPENSATION RECOMMENDATIONS FOR ALL OFFICERS, KEY EMPLOYEES, AND HIGHLY COMPENSATED EMPLOYEES. MULTIPLE SOURCES (AT LEAST THREE) OF INDEPENDENT COMPARISON DATA FROM ORGANIZATIONS OF SIMILAR SIZE, REVENUE, GEOGRAPHIC LOCATION, ORGANIZATION MISSION, AND OFFICER/STAFF RESPONSIBILITIES ARE USED TO DETERMINE COMPENSATION RECOMMENDATIONS. SALARY RATES FOR OFFICER, KEY EMPLOYEES, ETC. ARE FAIR AND EQUITABLE BASED ON COMPARISON DATA SOURCES. THE EXECUTIVE COMPENSATION COMMITTEE MAINTAINS DOCUMENTATION TO SHOW THAT THE COMPENSATION REVIEW PROCESS WAS GIVEN APPROPRIATE DUE DILIGENCE IN REGARD TO DISCUSSION, MEMBERS PRESENT, USE OF COMPARISON DATA AND HOW IT WAS OBTAINED, DATE OF APPROVAL, VIEWS OF DISSENTING MEMBERS, AND THAT ADEQUATE TIME WAS ALLOTTED FOR DISCUSSION BEFORE MAKING DETERMINATIONS. ALL COMPENSATION PACKAGE RECOMMENDATIONS DEVELOPED BY THE EXECUTIVE COMPENSATION COMMITTEE ARE APPROVED BY THE ENTIRE BOARD. | |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION MAKES IT'S FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, RECENT COPIES OF THE FORM CAN BE ACCESSED ON GUIDESTAR.ORG. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 9: | INTERCOMPANY ELIMINATION (EIN # 56-2012634) EQUITY TRANSFER TO FOUNDATION -61,342. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| ALLEGHANY MEMORIAL HOSPITAL FOUNDATION INC | ||||||||||
| 233 DOCTORS STREET | SPARTA | NC | 28675 | 562012634 | PROMOTES AND SUPPORTS THE HOSPITAL | NC | 501(C)(3) | LINE 11A, I | ALLEGHANY COUNTY MEMORIAL HOSPITAL INC | 1 |
| ALLEGHANY HEALTH SERVICES | ||||||||||
| 233 DOCTORS STREET | SPARTA | NC | 28675 | 201189450 | COMMUNITY HEALTH SERVICES | NC | 501(C)(3) | LINE 3 | ALLEGHANY COUNTY MEMORIAL HOSPITAL INC | 1 |
| 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | 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
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLEGHANY MEMORIAL HOSPITAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 32381 | AmountInvolved |
| Method Of Amt Determination | CASH | MethodOfAmtDetermination |