CHARLES A CANNON JR MEMORIAL HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CHARLES A CANNON JR MEMORIAL HOSPITAL INC (EIN 56-0529974)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-03-14
IRS object ID
201310739349300536
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-03-14T15:03:46-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560747981EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 FRANKLIN RD SE SUITE 501AddressLine1
CityROANOKECity
StateVAState
ZIP Code240112114ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN560529974EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHARLES A CANNON JR MEMORIAL HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHARNameControl
Phone8282624119Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1434 HOSPITAL DRIVEAddressLine1
CityLINVILLECity
StateNCState
ZIP Code28646ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKEVIN B MAYName
TitleCFOTitle
Phone8282624119Phone
Date Signed2013-03-04DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL P NORTONName
PTINP00430694PTIN
Phone5409896144Phone
Date Prepared2013-03-04DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKEVIN B MAYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1434 HOSPITAL DRIVEAddressLine1
CityLINVILLECity
StateNCState
ZIP Code28646ZIPCode
FieldValueIRS element (for citing)
Gross Receipts20749344GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.APPRHS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1957YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers90TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year77719ContributionsGrantsPriorYear
Contributions Grants Current Year325060ContributionsGrantsCurrentYear
Program Service Revenue Prior Year19820513ProgramServiceRevenuePriorYear
Program Service Revenue CY20178161ProgramServiceRevenueCY
Investment Income Prior Year19742InvestmentIncomePriorYear
Investment Income Current Year-49397InvestmentIncomeCurrentYear
Other Revenue Prior Year188882OtherRevenuePriorYear
Other Revenue Current Year208420OtherRevenueCurrentYear
Total Revenue Prior Year20106856TotalRevenuePriorYear
Total Revenue Current Year20662244TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12699913SalariesEtcPriorYear
Salaries Etc Current Year13425732SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8854565OtherExpensePriorYear
Other Expenses Current Year8844684OtherExpensesCurrentYear
Total Expenses Prior Year21554478TotalExpensesPriorYear
Total Expenses Current Year22270416TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1447622RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1608172RevenuesLessExpensesCY
Total Assets BOY27723828TotalAssetsBOY
Total Assets EOY27703569TotalAssetsEOY
Total Liabilities BOY9319408TotalLiabilitiesBOY
Total Liabilities EOY10432375TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18404420NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY17271194NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense17429326Expense
Revenue20319481Revenue
DescriptionHEALTHCARE SERVICES PROVIDED FOR THE COMMUNITY OF LINVILLE, NORTH CAROLINA, CONSISTED OF THE FOLLOWING:ER VISITS 9,860 DISCHARGES 2,124 DAYS OF CARE 9,054Description
Total Program Service Expense17429326TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KEVIN B MAYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8282624100TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1336 DEERFIELD ROADAddressLine1
CityBOONECity
StateNCState
ZIP Code28607ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
PAUL MILLER JR
BOARD MEMBER1.00X000
JOHN BLACKBURN
BOARD MEMBER1.00X000
JIM DEAL
COUNTY REPRESENTATIVE1.00X000
JOE MILLER
BOARD MEMBER1.00X000
SUSAN ROGGENKAMP
BOARD MEMBER1.00X000
KENNETH WILCOX
CHAIR1.00X000
KEITH TESTER
VICE CHAIR1.00X000
SAM ADAMS
BOARD MEMBER1.00X000
CHARLES BAKER MD
BOARD MEMBER1.00X000
MARGARET HAYDEN
BOARD MEMBER1.00X000
JACK HOWARD
BOARD MEMBER1.00X000
PATTIE TENNILLE
BOARD MEMBER1.00X000
JAN WINKLER
BOARD MEMBER1.00X000
MARK MURREY MD
BOARD MEMBER1.00X000
MARK VANNOY
BOARD MEMBER1.00X000
RICHARD SPARKS
CEO ARHS40.000358851131660X
KEVIN MAY
CFO ARHS40.00024748125449X
CHUCK MANTOOTH
PRESIDENT WMC, CEO CMH & ARMA40.00017013520653X
CARMEN LACEY
PRESIDENT40.00010022225047X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs876689TotalReportableCompFrmRltdOrgs
Total Other Compensation202809TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions325060AllOtherContributions
Total Contributions325060TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PROG.SERV.REVENUE-RELA9000992010139920101399
CAFETERIA REVENUE9000997676276762
FieldValueIRS element (for citing)
Total Program Service Revenue20178161TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column17703TotalRevenueColumn
Exclusion$17,703ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real121082Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real121082Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column121082TotalRevenueColumn
Related Or Exempt Function Income121082RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other20000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other87100Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-67100Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-67100TotalRevenueColumn
Related Or Exempt Function Income-67100RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column87338TotalRevenueColumn
Related Or Exempt Function Income87338RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue87338TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20662244TotalRevenueColumn
Related Or Exempt Function Income20319481RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$17,703ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10951448Total
Program Services9489222ProgramServices
Management And General1462226ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1807851Total
Program Services1807851ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total666433Total
Program Services634748ProgramServices
Management And General31685ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6602Total
Management And General6602ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2051025Total
Program Services1765499ProgramServices
Management And General285526ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total478Total
Program Services478ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2406588Total
Program Services2405037ProgramServices
Management And General1551ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total740281Total
Program Services194107ProgramServices
Management And General546174ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total25148Total
Program Services24672ProgramServices
Management And General476ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2919Total
Program Services2919ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total420039Total
Management And General420039ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1222282Total
Program Services446311ProgramServices
Management And General775971ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total130207Total
Program Services130207ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
CORP. ALLOCATIONS10047481004748
EQUIPMENT RENTAL AND MA300822300822
EQUIPMENT RENTAL AND MA211846211846
MINOR EQUIPMENT112332112332

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total209367Total
Program Services115121ProgramServices
Management And General94246ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22270416Total
Program Services17429326ProgramServices
Management And General4841090ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2158322BOY
EOY2075884EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY803320BOY
EOY806066EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3426455BOY
EOY3670818EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY510497BOY
EOY563427EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY145580BOY
EOY171283EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis36193333LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec19265406LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY17671998BOY
EOY16927927EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3007656BOY
EOY3488164EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY27723828BOY
EOY27703569EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY339872BOY
EOY396918EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY7533509BOY
EOY7146251EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1446027BOY
EOY2889206EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9319408BOY
EOY10432375EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY17407505BOY
EOY16361379EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY996915BOY
EOY909815EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18404420BOY
EOY17271194EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY27723828BOY
EOY27703569EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1608172ReconcilationRevenueExpenses
Reconcilation Other Changes474946ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1220001OtherCostOrOtherBasis
Book Value1220001BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21812832OtherCostOrOtherBasis
Depreciation9159389Depreciation
Book Value12653443BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3241949OtherCostOrOtherBasis
Depreciation1678272Depreciation
Book Value1563677BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis9918551OtherCostOrOtherBasis
Depreciation8427745Depreciation
Book Value1490806BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings16927927TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
AUWIL366087
INTEREST IN ARHF2184477
OWNERSHIP EQUITY-OTHER22094
CONSTRUCTION IN PROGRESS12485
BOND ISSUE COST903021
FieldValueIRS element (for citing)
Total Book Value Other Assets3488164TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATE$2,976,259
ESTIMATED THIRD-PARTY SETTLEMENTS-$537,053
MISCELLANEOUS$450,000
FieldValueIRS element (for citing)
Total Of Amounts2889206TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationARHS AND THE COMPANIES FOR WHICH IT SERVES AS SOLE MEMBER ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS. THE SYSTEM HAS DETERMINED IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage175.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense591639TotalCommunityBenefitExpense
Net Community Benefit Expense591639NetCommunityBenefitExpense
Percent Of Total Expense0.02660PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2791798TotalCommunityBenefitExpense
Direct Offsetting Revenue1284479DirectOffsettingRevenue
Net Community Benefit Expense1507319NetCommunityBenefitExpense
Percent Of Total Expense0.06770PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3383437TotalCommunityBenefitExpense
Direct Offsetting Revenue1284479DirectOffsettingRevenue
Net Community Benefit Expense2098958NetCommunityBenefitExpense
Percent Of Total Expense0.09430PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense35623TotalCommunityBenefitExpense
Net Community Benefit Expense35623NetCommunityBenefitExpense
Percent Of Total Expense0.00160PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense29117TotalCommunityBenefitExpense
Net Community Benefit Expense29117NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense31660TotalCommunityBenefitExpense
Net Community Benefit Expense31660NetCommunityBenefitExpense
Percent Of Total Expense0.00140PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense96400TotalCommunityBenefitExpense
Net Community Benefit Expense96400NetCommunityBenefitExpense
Percent Of Total Expense0.00430PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3479837TotalCommunityBenefitExpense
Direct Offsetting Revenue1284479DirectOffsettingRevenue
Net Community Benefit Expense2195358NetCommunityBenefitExpense
Percent Of Total Expense0.09860PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,659,833BadDebtExpenseAmount
Amount Attributable To82992AmountAttributableTo
Amount Reimbursed By Medicare11522254AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare11522254CostOfCareReimbursedByMedicare

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 APPALACHIAN REGIONAL HEALTHCARE SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivitySOLE MEMBER OF CHARLES A. CANNON JR., MEMORIAL HOSPITAL, INC.DescriptionEntPrimaryActivity
Organization Profit Or Ownership1.00000OrganizationProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHARLES A CANNON JR MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1434 HOSPITAL DRIVEAddressLine1
CityLINVILLECity
StateNCState
ZIP Code28646ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained0EligibilityCriteriaExplained
Uses FPG Free0UsesFPGFree
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis0ExplainsBasis
Explains Application Method0ExplainsApplicationMethod
Includes Publicity Measures0IncludesPublicityMeasures
Actions On Nonpayment0ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy0NondiscrimEmergencyCarePolicy
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (2 entries)

ExplanationExplanation
PART III, LINE 4: AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS RECORDED BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENT'S EVALUATION OF THE ACCOUNTS RECEIVABLE. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE.WE ESTIMATE 5% OF CHARITY COSTS FAIRLY ESTIMATE AMOUNTS INCLUDED AS BAD DEBT THAT WOULD BE ELIGIBLE FOR CHARITY CARE BUT FAILED TO APPLY.
PART III, LINE 9B: CHARITY WRITE-OFFS ARE SEGREGATED FROM NORMAL BAD DEBTS THROUGH A SEPARATE TRANSACTION CODE. FAMILY INCOME BELOW 175% OF FPG ARE ELIGIBLE FOR 100% WRITE-OFF. PARTIAL WRITE-OFF IS AVAILABLE BETWEEN FAMILY INCOME BETWEEN 175% AND 250% OF FPG.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RICHARD SPARKS
032652903000002322012587705783049051100
KEVIN MAY
0246301000118001949905950027293000
CHUCK MANTOOTH
016980700032801470305950019078800

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3PARENT COMPANY, APPALACHIAN REGIONAL HEALTH CARE SYSTEM (ARHS) OVERSEES CMH OPERATIONS. ALSO NOTE THAT SALARIES AND OTHER COMON EXPENSES INCURRED BY ARHS ARE ALLOCATED APPROPRIATELY TO CMH. PAYMENTS TO VENDORS ARE PAID THROUGH ARHS AND ALL 1099'S ARE ISSUED THROUGH ARHS.
FORM 990, PART VI, SECTION A, LINE 7BAPPROVAL MAY BE NEEDED BY THE PARENT COMPANY, APPALACHIAN REGIONAL HEALTH CARE SYSTEM.
FORM 990, PART VI, SECTION B, LINE 11THE SVP/CFO AND THE VICE PRESIDENT OF FINANCE REVIEW THE 990 AND THEN IT IS MADE AVAILABLE TO THE BOARD UPON COMPLETION.
FORM 990, PART VI, SECTION B, LINE 12CREVIEW OF POLICY STATEMENT EACH YEAR.
FORM 990, PART VI, SECTION B, LINE 15INDEPENDENT COMPENSATION AND BENEFIT ANALYSIS WAS PERFORMED BY FINDLEY DAVIES IN DECEMBER 2011. THE EXECUTIVE COMMITTEE (COMPENSATION COMMITTEE) REVIEWED THIS INFORMATION IN DECEMBER, 2012 TO ESTABLISH APPROPRIATENESS OF TOTAL COMPENSATION, COMPLY WITH INTERMEDIATE SANCTION REGULATIONS, AND DETERMINE EXECUTIVE COMPENSATION FOR CEO AND CFO POSITIONS.
FORM 990, PART VI, SECTION C, LINE 19PROVIDED UPON REQUEST.
FORM 990, PART XI, LINE 5:TRANSFERS FROM AFFILIATE 474,946. TOTAL TO FORM 990, PART XI, LINE 5: 474,946.CHANGES IN NET ASSETS OR FUND BALANCES:
PART XII, LINE 2CTHE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
APPALACHIAN REGIONAL HEALTHCARE SYSTEM
PO BOX 2600BOONENC28607201067022PARENT COMPANYNC501(C)(3)11C0
BLOWING ROCK HOSPITAL INC
PO BOX 148BLOWING ROCKNC28605560513181HOSPITALNC501(C)(3)30
WATAUGA MEDICAL CENTER INC
336 DEERFIELD RDBOONENC28607560510824HOSPITALNC501(C)(3)30
APPALACHIAN REGIONAL HEALTHCARE FOUNDATION
336 DEERFIELD RDBOONENC28607204625618PHILANTHROPIC ORGANIZATION FOR THE SYSTEMNC501(C)(3)70
APPALACHIAN REGIONAL MEDICAL ASSOCIATES INC
PO BOX 2600BOONENC28607205755130EMPLOYMENT ALTERNATIVE TO BOTH NEW AND ESTABLISHED PHYSICIAN PRACTICESNC501(C)(3)90
ARHS PROPERTIES INC
336 DEERFIELD RDBOONENC28607203470765HOLD FUTURE PURCHASE OF NON-PROFIT LAND ACQUISITIONSNC501(C)(3)90
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1APPALACHIAN REGIONAL HEALTHCARE FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved325060AmountInvolved
Method Of Amt DeterminationACTUALMethodOfAmtDetermination

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