ANMED HEALTH CANNON: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- ANMED HEALTH CANNON (EIN 57-0342027)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-13
- IRS object ID
- 201442259349302094
- 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 O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-13T13:54:08-05:00 | 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 | 570342027 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANNON MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CANN | NameControl |
| Phone | 8648784791 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 123 WG ACKER DRIVE | AddressLine1 |
| City | PICKENS | City |
| State | SC | State |
| ZIP Code | 29671 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NORMAN RENTZ | Name |
| Title | CEO | Title |
| Phone | 8648784791 | Phone |
| Date Signed | 2014-08-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | NORMAN RENTZ | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 123 WG ACKER DRIVE | AddressLine1 |
| City | PICKENS | City |
| State | SC | State |
| ZIP Code | 29671 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 37694803 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CANNONHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1950 | YearFormation |
| State Legal Domicile | SC | StateLegalDomicile |
| Activity Or Mission Description | PROVIDING QUALITY HEALTHCARE IN A SAFE, COMPETENT, AND COMPASSIONATE MANNER | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 334 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1749417 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1265350 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 37392079 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 36239282 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 16017 | InvestmentIncomePriorYear |
| Investment Income Current Year | 7080 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 183254 | OtherRevenuePriorYear |
| Other Revenue Current Year | 183091 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 39340767 | TotalRevenuePriorYear |
| Total Revenue Current Year | 37694803 | 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 | 12495038 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 13137482 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 24063 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 26835729 | OtherExpensePriorYear |
| Other Expenses Current Year | 26483858 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 39330767 | TotalExpensesPriorYear |
| Total Expenses Current Year | 39621340 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 10000 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1926537 | RevenuesLessExpensesCY |
| Total Assets BOY | 18545591 | TotalAssetsBOY |
| Total Assets EOY | 16501617 | TotalAssetsEOY |
| Total Liabilities BOY | 10764226 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10680238 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7781365 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5821379 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF CANNON MEMORIAL HOSPITAL IS TO PROVIDE QUALITY HEALTHCARE IN A SAFE, COMPETENT, AND COMPASSIONATE MANNER. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 35401327 | Expense |
| Grants | 0 | Grants |
| Revenue | 36239282 | Revenue |
| Description | CANNON MEMORIAL HOSPITAL OFFERS A FULL RANGE OF STATE-OF-THE-ART MEDICAL TECHNOLOGY, EQUIPMENT, AND SERVICES TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY. THE EXPANDED SERVICES OF THE HOSPITAL INCLUDE A 24-HOUR EMERGENCY DEPARTMENT, A FULL SERVICE LABORATORY, PHYSICAL AND OCCUPATIONAL THERAPY, CRITICAL CARE UNIT, SLEEP CLINIC, WELLNESS PROGRAMS FOR BOTH CHILDREN AND ADULTS, AND DIAGNOSTIC IMAGING FOR BOTH INPATIENT AND OUTPATIENT TEST INCLUDING CT SCANS. FOR FISCAL YEAR 2013, THE HOSPITAL PROVIDED 3,032 PATIENT DAYS OF SERVICE.WE ALSO SPONSOR HEALTH FAIRS, FLU CLINICS, CPR TRAINING, FITNESS CLASSES, SUPPORT GROUPS, AND MANY OTHER COMMUNITY WELLNESS SERVICES THROUGH OUR WELLNESS CENTER LOCATED AT THE HOSPITAL. | Description |
| Total Program Service Expense | 35401327 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 30 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 334 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | 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 | SC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILL GRANT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8648784791 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 123 WG ACKER DRIVE | AddressLine1 |
| City | PICKENS | City |
| State | SC | State |
| ZIP Code | 29671 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| DR DONALD L MARLER | |||||||
| CHAIRMAN (SEE SCH. O) | 1.00 | X | X | 0 | 0 | 0 | |
| DR JAMES R MAHANES | |||||||
| VICE CHAIR | 1.00 | X | X | 75942 | 0 | 9508 | |
| J FLETCHER PERRY | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| KENNETH D ACKER | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| GEORGE D ACKER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LINDA S CASSELL | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| R JANINE PETERSEN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RANDALL P GRIFFIN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| TIMOTHY E MORGAN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| FRANCES C STOKES | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOHN E SPARKS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| NORMAN RENTZ | |||||||
| CEO | 40.00 | X | 152404 | 0 | 20520 | ||
| MARY ARNETTE | |||||||
| CFO (THROUGH APRIL 2013) | 40.00 | X | 85031 | 0 | 10110 | ||
| DONNA ANDERSON | |||||||
| CNO | 40.00 | X | 93752 | 0 | 17591 | ||
| GREG SCARBROUGH | |||||||
| CFO (BEGINNING JULY 2013) | 40.00 | X | 0 | 0 | 0 | ||
| DR PETER SCHRIVER | |||||||
| PHYSICIAN | 40.00 | 231554 | 0 | 19074 | X | ||
| DR BYRON MARSH | |||||||
| PHYSICIAN | 40.00 | 224256 | 0 | 6153 | X | ||
| DR DANIEL DAHLHAUSEN | |||||||
| PHYSICIAN | 40.00 | 173028 | 0 | 17776 | X | ||
| DR MARION CLINCH | |||||||
| PHYSICIAN | 40.00 | 156449 | 0 | 12675 | X | ||
| DR TRAVIS DAVIS | |||||||
| PHYSICIAN | 40.00 | 143019 | 0 | 17139 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1335435 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 130546 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ANMED HEALTH | |||||
| 800 NORTH FANT STREET | ANDERSON | SC | 29621 | MANAGMENT SERVICES | 521308 |
| MATRIX REHABILITATION | |||||
| PO BOX 11407 | BIRMINGHAM | AL | 35246 | REHABILITATION SERVICES | 329807 |
| MICHAEL DILLARD MD | |||||
| PO BOX 186 | PICKENS | SC | 29671 | PHYSICIAN | 325448 |
| JAMES CALDWELL MD | |||||
| 220 GLEN LAUREL DRIVE | EASLEY | SC | 29642 | PHYSICIAN | 292614 |
| MICHAEL DONALD MD | |||||
| 350 NORTH SUMMIT DRIVE | SENECA | SC | 29672 | PHYSICIAN | 252495 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 135000 | RelatedOrganizations |
| All Other Contributions | 1130350 | AllOtherContributions |
| Total Contributions | 1265350 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 36239282 | TotalRevenueColumn |
| Related Or Exempt Function Income | 36239282 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 36239282 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 7080 | TotalRevenueColumn |
| Exclusion | $7,080 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 26898 | 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 | 26898 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26898 | TotalRevenueColumn |
| Exclusion | $26,898 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA & FOODSERVICE | 722210 | 65242 | $65,242 |
| SALES TO EMPLOYEES | 446110 | 55231 | $55,231 |
| MEDICAL TRANSCRIPTION | 900099 | 20589 | $20,589 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15131 | TotalRevenueColumn |
| Exclusion | $15,131 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 156193 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 37694803 | TotalRevenueColumn |
| Related Or Exempt Function Income | 36239282 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $190,171 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 379408 | Total |
| Management And General | 379408 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9658752 | Total |
| Program Services | 8424941 | ProgramServices |
| Management And General | 1217343 | ManagementAndGeneral |
| Fundraising | 16468 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53688 | Total |
| Program Services | 45413 | ProgramServices |
| Management And General | 8183 | ManagementAndGeneral |
| Fundraising | 92 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2316917 | Total |
| Program Services | 1959832 | ProgramServices |
| Management And General | 353135 | ManagementAndGeneral |
| Fundraising | 3950 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 728717 | Total |
| Program Services | 616407 | ProgramServices |
| Management And General | 111068 | ManagementAndGeneral |
| Fundraising | 1242 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127684 | Total |
| Management And General | 127684 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90074 | Total |
| Management And General | 90074 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3124901 | Total |
| Program Services | 2251944 | ProgramServices |
| Management And General | 872468 | ManagementAndGeneral |
| Fundraising | 489 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48866 | Total |
| Management And General | 48866 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1956323 | Total |
| Program Services | 1147374 | ProgramServices |
| Management And General | 807127 | ManagementAndGeneral |
| Fundraising | 1822 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20121 | Total |
| Management And General | 20121 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 324053 | Total |
| Program Services | 324053 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74886 | Total |
| Program Services | 31910 | ProgramServices |
| Management And General | 42976 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 372778 | Total |
| Program Services | 372778 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1457227 | Total |
| Program Services | 1457227 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256362 | Total |
| Program Services | 138865 | ProgramServices |
| Management And General | 117497 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| BAD DEBT EXPENSE | 16577302 | 16577302 |
| MEDICAL SUPPLIES | 2053281 | 2053281 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39621340 | Total |
| Program Services | 35401327 | ProgramServices |
| Management And General | 4195950 | ManagementAndGeneral |
| Fundraising | 24063 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 140753 | BOY |
| EOY | 660160 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 993029 | BOY |
| EOY | 831769 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4492347 | BOY |
| EOY | 3998838 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 658851 | BOY |
| EOY | 645682 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 272626 | BOY |
| EOY | 174832 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 26703106 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 18486346 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9004186 | BOY |
| EOY | 8216760 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 653436 | BOY |
| EOY | 566487 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2330363 | BOY |
| EOY | 1407089 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18545591 | BOY |
| EOY | 16501617 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2611387 | BOY |
| EOY | 1665412 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4800000 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 880824 | BOY |
| EOY | 5497512 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2472015 | BOY |
| EOY | 3517314 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10764226 | BOY |
| EOY | 10680238 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7293292 | BOY |
| EOY | 5420255 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 488073 | BOY |
| EOY | 401124 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7781365 | BOY |
| EOY | 5821379 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18545591 | BOY |
| EOY | 16501617 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1926537 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -33449 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule 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 | $747 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 747 | 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 ORGANIZATION IS A MEMBER OF THE SOUTH CAROLINA HOSPITAL ASSOCIATION (SCHA). THIS ORGANIZATION ROUTINELY ENGAGES IN LOBBYING EFFORTS ON BEHALF OF ITS MEMBERSHIP BODIES, AND A PORTION OF THE DUES PAID TO THIS ORGANIZATIONS IS ALLOCATED TO THOSE EFFORTS EACH YEAR. FOR 2012, DUES PAID TO THIS ORGANIZATION ALLOCATED TO LOBBYING EFFORTS WERE APPROXIMATELY $747. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 758191 | OtherCostOrOtherBasis |
| Book Value | 758191 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11102979 | OtherCostOrOtherBasis |
| Depreciation | 7800252 | Depreciation |
| Book Value | 3302727 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 384370 | OtherCostOrOtherBasis |
| Depreciation | 231320 | Depreciation |
| Book Value | 153050 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14285979 | OtherCostOrOtherBasis |
| Depreciation | 10454774 | Depreciation |
| Book Value | 3831205 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 171587 | OtherCostOrOtherBasis |
| Book Value | 171587 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8216760 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | 246640 |
| DEFERRED FINANCE COSTS | 37034 |
| NON-PATIENT RECEIVABLES | 142586 |
| MEANINGFUL USE RECEIVABLE | 962729 |
| OTHER ASSET | 18100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1407089 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $529,679 |
| LINE OF CREDIT | $2,987,635 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3517314 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 21083086 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 53500 | OtherRevenues |
| Revenue Not Rptd F990 | 53500 | RevenueNotRptdF990 |
| Revenue Subtotal | 21029586 | RevenueSubtotal |
| Other Revenues Not Included | 16665217 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 16665217 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 37694803 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 23043072 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 23043072 | ExpensesSubtotal |
| Other Expenses Not Included | 16578268 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 16578268 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 39621340 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION UNDER INTERNAL REVENUE CODE SECTION 501 (C)(3) AND, ACCORDINGLY, NO PROVISION FOR INCOME TAX IS RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS DETERMINED THAT IT DOES 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. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT 53,500. | |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CHANGE IN VALUE OF EQUITY IN FOUNDATION NET ASSETS 86,949. BAD DEBT EXPENSE 16,577,302. EMPLOYEE SALES EXPENSE 966. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 16,577,302. EMPLOYEE SALES EXPENSE 966. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| 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 | 748681 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 748681 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03250 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4356693 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2651470 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1705223 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07400 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5105374 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2651470 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2453904 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10650 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 113986 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 57766 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 56220 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 51543 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 35676 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15867 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 165529 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 93442 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 72087 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5270903 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2744912 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2525991 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10960 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,291,863 | BadDebtExpenseAmount |
| Amount Attributable To | 1716745 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3372795 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16854083 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -13481288 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANNON MEMORIAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 123 WG ACKER DRIVE | AddressLine1 |
| City | PICKENS | City |
| State | SC | State |
| ZIP Code | 29671 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| 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 | CANNON 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 |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| CANNON ORTHOPEDIC | ||||
| 123 WG ACKER DRIVE | PICKENS | SC | 29671 | ORTHOPEDIC PRACTICE |
| CANNON SURGICAL | ||||
| 123 WG ACKER DRIVE | PICKENS | SC | 29671 | GENERAL SURGERY PRACTICE |
| CANNON FAMILY PRACTICE - EASTSIDE | ||||
| 111 WEST ROPER ROAD | PICKENS | SC | 29640 | RURAL HEALTH CLINIC |
| CANNON FAMILY PRACTICE - PICKENS | ||||
| 123 WG ACKER DRIVE | PICKENS | SC | 29671 | FAMILY PRACTICE |
| CANNON FAMILY PRACTICE - LIBERTY | ||||
| 105 LIBERTY BOULEVARD | PICKENS | SC | 29657 | FAMILY PRACTICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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 $ 16577302. | |
| PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT.WORKSHEET TWO OF THE 2012 SCHEDULE H INSTRUCTIONS WAS USED TO CALCULATE A COST-TO-CHARGES RATIO USED TO COMPUTE BAD DEBT AT COST. | |
| PART III, LINE 8: 100% OF THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. | |
| PART III, LINE 9B: CANNON UTILIZES AN EXTENDED BUSINESS OFFICE SERVICE THROUGH A THIRD PARTY VENDOR TO MANAGE ALL OF ITS ACTIVE SELF-PAY ACCOUNTS. CANNON RECOGNIZES THREE ASSISTANCE/CHARITY PROGRAMS FOR ITS PATIENTS. THOSE PROGRAMS ARE: 1) MEDICALLY INDIGENT ASSISTANCE PROGRAM (MIAP), 2) CANNON MEMORIAL'S UNCOMPENSATED ASSISTANCE PROGRAM AND 3) PATIENTS REFERRED BY THE SAMARITAN HEALTH CLINIC OF PICKENS COUNTY. AT THE TIME OF DETERMINATION OF ELIGIBILITY, BILLING & COLLECTION EFFORTS ARE DISCONTINUED FOR THE ELIGIBLE ACCOUNTS. CANNON PROVIDES HELP TO ALL PATIENTS WHO NEED ASSISTANCE COMPLETING THE FINANCIAL AIDE APPLICATION. | |
| PART V, SECTION B, LINE 3: A COMMUNITY BASED APPROACH WAS TAKEN WITH INPUT FROM LOCAL AND REGIONAL PUBLIC HEALTH PROFESSIONALS, COMMUNITY LEADERS, AND COMMUNITY BOARDS. | CANNON MEMORIAL HOSPITAL |
| PART V, SECTION B, LINE 14G: THE ORGANIZATION INCLUDES SUMMARY LANGUAGE ON BILLING INVOICES DIRECTING PATIENTS ON WHERE THEY CAN OBTAIN ADDITIONAL INFORMATION RELATING TO FINANCIAL ASSISTANCE. | CANNON MEMORIAL HOSPITAL |
| PART V, SECTION B, LINE 20D: IF A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THEIR ACCOUNT IS REDUCED ON A SLIDING SCALE, BASED ON THE FEDERAL POVERTY LEVEL. THE SCALE INCLUDES CHARGES LESS THAN AMOUNTS GENERAL BILLED. | CANNON MEMORIAL HOSPITAL |
| PART VI, LINE 2: WE CURRENTLY USE DATA PROVIDED BY THE STATE TO ASSESS OUR COMMUNITY. THAT DATA INCLUDES INFORMATION ABOUT PATIENTS WHO USE OUR HOSPITAL, AS WELL AS PATIENTS FROM OUR SERVICE AREA WHO ACCESS HEALTHCARE AT OTHER HOSPITALS AND WHAT CHARGE CODE THAT CARE IS UNDER. THIS GIVES US AN IDEA OF THE HEALTH PROBLEMS IN OUR SERVICE AREA. | |
| PART VI, LINE 3: THE ASSISTANCE/CHARITY PROGRAM POLICIES ARE POSTED ON CANNON'S WEBSITE AND THE PATIENT IS VERBALLY INFORMED DURING THE REGISTRATION PROCESS. | |
| PART VI, LINE 4: CANNON MEMORIAL HOSPITAL SERVES GREATER PICKENS COUNTY, WITH THE PRIMARY COMMUNITY SERVED BY THE HOSPITAL CLASSIFIED AS RURAL. POPULATION ESTIMATES AS OF 2009 ARE APPROXIMATELY 118,000. THE PER CAPITA INCOME IS $27,487. A SIGNIFICANT PERCENTAGE OF THE POPULATION LIVES BELOW THE FEDERAL POVERTY LEVEL. PICKENS HAS A 10% UNEMPLOYMENT RATE AND APRROXIMATELY 24,000 RESIDENTS (OR 21%) ARE UNINSURED. | |
| PART VI, LINE 5: CMH FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY IN SEVERAL WAYS. THE MAJORITY OF OUR BOARD IS COMPRISED OF INDIVIDUALS WHO RESIDE IN PICKENS WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF CMH. CMH EXTENDS MEDICIAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA FOR ALL OF OUR DEPARTMENTS. ANY SURPLUS IS USED TO FUND IMPROVEMENTS IN PATIENT CARE. A DIGITAL MAMMOGRPAHY MACHINE BECAME AVAILABLE TO THE PUBLIC STARTING IN 2011. THE HOSPITAL ALSO PROMOTES HEALTH WITHIN PICKENS COUNTY BY PROVIDING EMERGENCY ROOM CARE TO ALL INDIVIDUALS, REGARDLESS OF THEIR ABILITY TO PAY. CMH ALSO PARTICIPATES IN TRAINING OF STUDENTS FROM MULTIPLE CAREER CENTERS, TECHNICAL SCHOOLS AND UNIVERISTIES IN THE AREA. IN ADDITION, THE HOSPITAL PROVIDES VOLUNTEER OPPPORTUNITIES THROUGH THE AUXILIARY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NORMAN RENTZ | ||||||||||||||
| CEO | 140989 | 0 | 0 | 0 | 11415 | 0 | 6181 | 0 | 14339 | 0 | 172924 | 0 | 0 | 0 |
| DR PETER SCHRIVER | ||||||||||||||
| PHYSICIAN | 231554 | 0 | 0 | 0 | 0 | 0 | 4741 | 0 | 14333 | 0 | 250628 | 0 | 0 | 0 |
| DR BYRON MARSH | ||||||||||||||
| PHYSICIAN | 224256 | 0 | 0 | 0 | 0 | 0 | 4500 | 0 | 1653 | 0 | 230409 | 0 | 0 | 0 |
| DR DANIEL DAHLHAUSEN | ||||||||||||||
| PHYSICIAN | 148776 | 0 | 24252 | 0 | 0 | 0 | 3572 | 0 | 14204 | 0 | 190804 | 0 | 0 | 0 |
| DR MARION CLINCH | ||||||||||||||
| PHYSICIAN | 135066 | 0 | 21383 | 0 | 0 | 0 | 3167 | 0 | 9508 | 0 | 169124 | 0 | 0 | 0 |
| DR TRAVIS DAVIS | ||||||||||||||
| PHYSICIAN | 132523 | 0 | 10496 | 0 | 0 | 0 | 2971 | 0 | 14168 | 0 | 160158 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | THE FILING ORGANIZATION PROVIDES THESE BENEFITS THE CEO. NO PART OF THE BENEFIT WAS TREATED AS TAXABLE COMPENSATION DURING FY2013. ALL PERSONAL USE AMOUNTS ARE REQUIRED TO BE PAID BACK TO THE ORGANIZATION. |
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN (457(F)) AND/OR DEFINED BENEFIT PLAN FOR 2012, AS FOLLOWS. THE AMOUNTS ARE REPRESENTED IN PART II, COLUMN (C): DONNA ANDERSON $1,960 DR. BYRON MARSH 4,500 DR. PETER SCHRIVER 4,741 DR. DANIEL DALHAUSEN 3,572 DR. MARION CLINCH 3,167 DR. TRAVIS DAVIS 2,971 |
| PART I, LINE 5 | FULL TIME FAMILY PRACTICE PHYSICIANS ARE INCENTIVIZED THROUGH A BONUS DERVIED FROM A FORMULA THAT INCLUDES REVENUES. |
| PART I, LINE 6 | FULL TIME FAMILY PRACTICE PHYSICIANS ARE INCENTIVIZED THROUGH A BONUS DERVIED FROM A FORMULA THAT INCLUDES NET EARNINGS. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD AND THE CHAIRMEN OF THE STANDING COMMITTEES. THE PRESIDENT/CHIEF EXECUTIVE OFFICER SHALL BE AN EX-OFFICIO MEMBER. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL BETWEEN THE MEETINGS OF THE BOARD OF TRUSTEES, PROVIDED THAT ANY ACTION WHICH IT MAY TAKE SHALL NOT CONFLICT WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD OF TRUSTEES OR THE CHARTER AND THAT IT SHALL REFER ALL MATTERS OF MAJOR IMPORTANCE OF THE BOARD OF TRUSTEES. THIS COMMITTEE SHALL MEET UPON THE CALL OF THE CHAIRPERSON OF THE BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 2 | ONE MEMBER OF THE CANN BOARD OF DIRECTORS SERVES ON THE BOARD FOR A LOCAL BANK. | |
| FORM 990, PART VI, SECTION A, LINE 3 | ON OCTOBER 1, 2009, THE ORGANIZATION ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH ANMED HEALTH, A SOUTH CAROLINA NON-PROFIT HEALTHCARE ORGANIZATION. ANMED HEALTH HAS BEEN APPOINTED AS THE MANAGER FOR THE HOSPITAL DURING THE TERM OF THE AGREEMENT. IN ADDITION TO GERERAL MANAGMENT RESPONSIBILITIES OUTLINED IN THE AGREEMENT, ANMED HEALTH IS REQUIRED TO HIRE AND EMPLOY ON A FULL-TIME BASIS A PRESIDENT AND CEO, CFO, AND OTHER EXECUTIVES AS ARE DESIGNATED AND AGREED UPON BY CANNON AND ANMED HEALTH. ANMED HEALTH IS GRANTED THE AUTHORITY AND RESPONSIBILITY FOR MANAGEMENT OF THE HOSPITAL, SUBJECT TO GENERAL APPROVAL OF THE BOARD OF DIRECTORS OF CANNON MEMORIAL HOSPITAL. THE BOARD SHALL REVIEW AND ACT PROMPTLY ON REQUESTS FOR APPROVAL SUBMITTED TO THE BOARD BY ANMED HEALTH FOR CERTAIN MATTERS OUTLINED IN THE MANAGEMENT AGREEMENT, INCLUDING LARGE CAPITAL EXPENDITURES, SALE OR OTHER DISPOSAL OF HOSPITAL ASSETS, AND BORROWING OTHER THAN IN THE ORDINARY COURSE OF CONDUCT OF HOSPITAL AFFAIRS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS VIA E-MAIL. A PERIOD OF TIME WAS ALLOWED FOR QUESTIONS AND COMMENTS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ADMINISTRATION REQUIRES ALL MANAGEMENT, KEY OFFICIALS, AND BOARD MEMBERS TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS. ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER SHALL BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD AND MADE A MATTER OF RECORD THROUGH AN ANNUAL PROCEDURE AND ALSO WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY GOVERNING BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHALL NOT VOTE OR USE PERSONAL INFLUENCE ON THE MATTER, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. THE FOREGOING REQUIREMENTS SHALL NOT BE CONSTRUED AS PREVENTING THE GOVERNING BOARD MEMBER FROM BRIEFLY STATING A POSITION IN THE MATTER, NOR FROM ANSWERING PERTINENT QUESTIONS OF OTHER BOARD MEMBERS SINCE THE BOARD MEMBER'S KNOWLEDGE MAY BE OF GREAT ASSISTANCE. ANY NEW MEMBER OF THE BOARD WILL BE ADVISED OF THIS POLICY UPON ENTERING INTO THE DUTIES OF BOARD MEMBERSHIP. | |
| FORM 990, PART VI, SECTION B, LINE 15 | A COMMITTEE OF FOUR CANNON BOARD MEMBERS KNOWN AS THE "CEO REVIEW COMMITTEE" MEETS ANNUALLY TO REVIEW THE PROGRESS OF THE CEO AGAINST GOALS DETERMINED THE PREVIOUS YEAR. THE COMMITTEE MAKES A RECOMMENDATION TO THE BOARD FOR A SALARY INCREASE AND/OR BONUS FOR THE CEO BASED UPON THAT PROGRESS. THE RECOMMENDATION IS VOTED ON BY THE FULL BOARD. THE BOARD APPROVES THE GOALS FOR THE CEO FOR THE UPCOMING YEAR IN ACCORDANCE WITH THE ORGANIZATION'S STRATEGIC GOALS. SALARY AND BONUS ARE REVIEWED AND COMPARED PERIODICALLY TO APPLICABLE COMPENSATION SURVEYS. THE CEO REVIEWS THE PROGRESS OF THE OTHER OFFICERS/KEY EMPLOYEES AGAINST THE ESTABLISHED GOALS FOR THE PRIOR YEAR AND DETERMINES THE ANNUAL SALARY INCREASE AND/OR BONUS BASED UPON THAT PROGRESS. SALARIES ARE REVIEWED AND COMPARED PERIODICALLY TO APPLICABLE COMPENSATION SURVEYS. THE CEO DETERMINES THE GOALS FOR THE UPCOMING YEAR IN ACCORDANCE WITH THE ORGANIZATION'S STRATEGIC GOALS. THE BOARD APPROVES THE ORGANIZATIONAL BUDGET WHICH INCLUDES THESE SALARY INCREASES. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. | |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT -86,949. CHANGE IN VALUE OF EQUITY IN FOUNDATION NET ASSETS 53,500. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANNON MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 188 | AddressLine1 |
| City | PICKENS | City |
| State | SC | State |
| ZIP Code | 29671 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 570943822 | EIN |
| Primary Activities | SUPPORT/FUNDRAISING | PrimaryActivities |
| Legal Domicile State | SC | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 7 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CANNON MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 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 | 0 | 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 | CANNON MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 135000 | AmountInvolved |
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