GASTON MEMORIAL HOSPITAL FOUNDATION INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: GASTON MEMORIAL HOSPITAL FOUNDATION INC (EIN 56-1479699)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-04-05
IRS object ID: 201220969349300227
Schema version: 2010v3.4
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 D
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-04-05T15:57:59-05:00	Timestamp
Tax Period End Date	2011-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

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	2010-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	561479699	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	GASTON MEMORIAL HOSPITAL FOUNDATION INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	GAST	NameControl
Phone	7048342000	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2525 COURT DRIVE PO BOX 1747	AddressLine1
City	GASTONIA	City
State	NC	State
ZIP Code	28054	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	DAVID O'CONNOR	Name
Title	CFO	Title
Phone	7048342000	Phone
Date Signed	2012-03-28	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	AMY BIBBY	Name
Phone	8282542254	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	DAVID O'CONNOR	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	2525 COURT DRIVE PO BOX 1747	AddressLine1
City	GASTONIA	City
State	NC	State
ZIP Code	28054	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	5505833	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.CAROMONT.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1985	YearFormation
State Legal Domicile	NC	StateLegalDomicile
Activity Or Mission Description	TO DELIVER EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	3	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	2	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	774819	ContributionsGrantsPriorYear
Contributions Grants Current Year	3788620	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	0	ProgramServiceRevenuePriorYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	242605	InvestmentIncomePriorYear
Investment Income Current Year	476176	InvestmentIncomeCurrentYear
Other Revenue Prior Year	0	OtherRevenuePriorYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	1017424	TotalRevenuePriorYear
Total Revenue Current Year	4264796	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	480778	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	667258	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	0	SalariesEtcPriorYear
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	9195	OtherExpensePriorYear
Other Expenses Current Year	3195	OtherExpensesCurrentYear
Total Expenses Prior Year	489973	TotalExpensesPriorYear
Total Expenses Current Year	670453	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	527451	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	3594343	RevenuesLessExpensesCY
Total Assets BOY	11182026	TotalAssetsBOY
Total Assets EOY	15964319	TotalAssetsEOY
Total Liabilities BOY	70000	TotalLiabilitiesBOY
Total Liabilities EOY	0	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	11112026	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	15964319	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO DELIVER EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	670453	Expense
Grants	667258	Grants
Description	SEE SCHEDULE O.THE GASTON MEMORIAL HOSPITAL FOUNDATION (A SUBSIDIARY OF CAROMONT HEALTH) WAS ESTABLISHED IN 1985. IN ADDITION TO THE FOUNDATION UTILIZING ITS INVESTMENT EARNINGS FOR DONATIONS, CAROMONT HEALTH DONATES UP TO 10% OF ITS OPERATING INCOME TO THE GMH FOUNDATION EACH YEAR. THE FOUNDATION PARTNERS WITH DONORS, CORPORATIONS AND COMMUNITY ORGANIZATIONS TO SUPPORT CAROMONT HEALTH'S MISSION TO PROMOTE INDIVIDUAL HEALTH AND VIBRANT COMMUNITIES. THE FOUNDATION PROVIDES GRANTS TO COMMUNITY ORGANIZATIONS THAT SPONSOR PROGRAMS THAT DIRECTLY SUPPORT CAROMONT HEALTH'S MISSION.DURING FISCAL YEAR 2011, THE FOUNDATION DISTRIBUTED $667,258 TO CHARITABLE CAUSES THROUGHOUT GASTON COUNTY, INCLUDING GASTON FAMILY HEALTH SERVICES, GASTON TOGETHER, UNITED WAY, GASTON COUNTY SCHOOLS, HEALTHNET GASTON AND INDIGENT MEDICATION AND SERVICES.THE WAYNE F. SHOVELIN SCHOLARSHIP FUND, A $2.25 MILLION ENDOWMENT PLEDGED BY DUKE KIMBRELL, PROMOTES HIGHER EDUCATION AND ENGAGES LEARNING FOR CAROMONT HEALTH EMPLOYEES, VOLUNTEERS AND FAMILIES. RECIPIENTS ARE SELECTED BASED ON INDIVIDUAL FINANCIAL NEEDS, FUTURE CAREER ASPIRATIONS IN HEALTH CARE, AND CURRENT SCHOLASTIC STANDING. WAYNE SHOVELIN RETIRED IN SEPTEMBER 2009, CONCLUDING 23 YEARS AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF CAROMONT HEALTH.	Description
Total Program Service Expense	670453	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
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	0	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	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	0	Hospital
Grants To Organizations	1	GrantsToOrganizations
Grants To Individuals	1	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	0	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	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	0	NumberOfEmployees
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	3	NbrVotingGoverningBodyMembers
Number Independent Voting Members	2	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
Other Website	X	OtherWebsite
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	DAVID O'CONNOR	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	7048342000	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2525 COURT DRIVE	AddressLine1
City	GASTONIA	City
State	NC	State
ZIP Code	28054	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	FormerFormer
JAMES R BEAM
CHAIRMAN	1.00	X	X	0	0	0
MARY FRANCES FORRESTER
DIRECTOR	1.00	X		0	0	0
DAVID ALLEN SMITH
DIRECTOR	1.00	X		0	0	0
MICKEY PRICE
DIRECTOR	1.00	X		0	0	0
VALINDA L RUTLEDGE
CEO	1.00		X	0	1076425	38634
DAVID O'CONNOR
CFO/ASST. TREASURER	1.00		X	0	692572	39820
MARIA LONG
EVP GEN. COUNSEL/ASST. SEC.	1.00		X	0	487588	33654
WAYNE F SHOVELIN
FORMER CEO	0.00			0	5914978	0	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	0	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	8171563	TotalReportableCompFrmRltdOrgs
Total Other Compensation	112108	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	1	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
Related Organizations	2288110	RelatedOrganizations
All Other Contributions	1500510	AllOtherContributions
Total Contributions	3788620	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	372926	TotalRevenueColumn
Exclusion	$372,926	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	1344287	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	1241037	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	103250	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	103250	TotalRevenueColumn
Exclusion	$103,250	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4264796	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$476,176	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	667258	Total
Program Services	667258	ProgramServices

Other Expenses OtherExpenses (2 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
OTHER EXPENSE	3067	3067
BANK SERVICE CHARGE	128	128

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	670453	Total
Program Services	670453	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
EOY	382	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	10163963	BOY
EOY	13621227	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	267078	BOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	750985	BOY
EOY	2342710	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	11182026	BOY
EOY	15964319	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	70000	BOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	70000	BOY
EOY	0	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	10361040	BOY
EOY	13621608	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	750986	BOY
EOY	2342711	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	11112026	BOY
EOY	15964319	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	11182026	BOY
EOY	15964319	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	3594343	ReconcilationRevenueExpenses
Reconcilation Other Changes	1257950	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited
Audit Committee	1	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1547946	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	7205	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1553180	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	774819	CurrentTaxYearMinus1Year
Current Tax Year	3788620	CurrentTaxYear
Total	7671770	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1547946	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	7205	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1553180	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	774819	CurrentTaxYearMinus1Year
Current Tax Year	3788620	CurrentTaxYear
Total	7671770	Total

Field	Value	IRS element (for citing)
Amounts Subst Contributors Total	2045057	AmountsSubstContributorsTotal
Public Support Total170	5626713	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1023903	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	377967	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	463406	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	262328	CurrentTaxYearMinus1Year
Current Tax Year	372927	CurrentTaxYear
Total	2500531	Total

Other Income170 OtherIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus2 Years	74835	CurrentTaxYearMinus2Years
Total	74835	Total

Field	Value	IRS element (for citing)
Total Support	10247136	TotalSupport
Public Support Pertcentage170	0.54910	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.57620	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

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 D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	750985	BeginningOfYearBalance
Contributions	1505133	Contributions
Investment Earnings Or Losses	100784	InvestmentEarningsOrLosses
Grants Or Scholarships	7680	GrantsOrScholarships
Other Expenditures	6513	OtherExpenditures
End Of Year Balance	2342709	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	40686	BeginningOfYearBalance
Contributions	750000	Contributions
Investment Earnings Or Losses	-39463	InvestmentEarningsOrLosses
Grants Or Scholarships	238	GrantsOrScholarships
End Of Year Balance	750985	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	30235	BeginningOfYearBalance
Contributions	15043	Contributions
Investment Earnings Or Losses	-1785	InvestmentEarningsOrLosses
Grants Or Scholarships	2807	GrantsOrScholarships
End Of Year Balance	40686	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	1.00000	BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	0	EndowmentsHeldByRelatedOrgs
Total Of Book Value Land Buildings	0	TotalOfBookValueLandBuildings

Other Assets OtherAssets (2 entries)

DescriptionDescription	Book ValueBookValue
MACKIE SCHOLARSHIP FUND	39753
SHOVELIN SCHOLARSHIP FUND	2302957

Field	Value	IRS element (for citing)
Total Book Value Other Assets	2342710	TotalBookValueOtherAssets
Total Revenue	4264796	TotalRevenue
Total Expenses	670453	TotalExpenses
Excess Or Deficit For Year	3594343	ExcessOrDeficitForYear
Net Unrealized GL On Investments	1264996	NetUnrealizedGLOnInvestments
Other	-$7,046	OtherAmount
Total Adjustments	1257950	TotalAdjustments
Excess Or Deficit Per FS	4852293	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	4862067	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	1264996	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	1264996	RevenueNotRptdF990
Revenue Subtotal	3597071	RevenueSubtotal
Other Revenues Not Included	667725	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	667725	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	4264796	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	2728	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	2728	ExpensesSubtotal
Other Expenses Not Included	667725	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	667725	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	670453	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:	PART V, LINE 4:	THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR SCHOLARSHIPS AND CANCER ASSISTANCE.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X:	THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2011 AND 2010, RESPECTIVELY.
PART XI, LINE 8 - OTHER ADJUSTMENTS:		EQUITY TRANSFER -7,046.
PART XII, LINE 4B - OTHER ADJUSTMENTS:		EXPENSES NETTED AGAINST REVENUE ON FINANCIAL STATEMENTS 667,725.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:		EXPENSES NETTED AGAINST REVENUE ON FINANCIAL STATEMENTS 667,725.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	1	RecordsMaintained

Recipient Table RecipientTable (5 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Method Of ValuationMethodOfValuation	Purpose Of GrantPurposeOfGrant
GASTON FAMILY HEALTH SERVICES
991 WEST HUDSON BOULEVARD	GASTONIA	NC	28054	581958398	501(C)(3)	480778	FMV	FEDERALLY QUALIFIED HEALTH DEPARTMENT OFFERING MEDICAL CARE TO LOW INCOME RESIDENTS OF GASTON COUNTY
HEALTHNET GASTON
700 SOUTH MARIETTA STREET	GASTONIA	NC	28052	561913112	501(C)(3)	150000	FMV	CASE MANAGER, CARE NAVIGATOR AND PROGRAM COORDINATOR
REIKI EDUCATION INC
PO BOX 298	PINEVILLE	NC	28134	412275839	501(C)(3)	6000	FMV	SYMPTOM MANAGEMENT CLINIC
UNITED WAY OF GASTON COUNTY
200 EAST FRANKLIN BLVD	GASTONIA	NC	28052	560653356	501(C)(3)	10000	FMV	GENERAL ASSISTANCE
ALLIANCE CHILDREN AND YOUTH
PO BOX 1695	GASTONIA	NC	28053	561471862	501(C)(3)	10000	FMV	HARVESTING FOR HEALTHY YOUTH ASSISTANCE

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	5	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	NURSING EDUCATION SCHOLARSHIP	TypeOfGrant
Number Of Recipients	5	NumberOfRecipients
Amount Of Cash Grant	7680	AmountOfCashGrant
Method Of Valuation	FMV	MethodOfValuation
Description Of Non Cash Assistance	SHOVELIN AND MACKIE NURSING SCHOLARSHIPS	DescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	PROCEDURE FOR MONITORING GRANTS IN THE U.S.:	Identifier
Return Reference	PART I, LINE 2:	ReturnReference
Explanation	SCHEDULE I, PART I, LINE 2: OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	1	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	1	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	1	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

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
VALINDA L RUTLEDGE
0	577086	0	316937	0	182402	0	3613	0	35021	0	1115059	0	30281
DAVID O'CONNOR
0	322191	0	135109	0	235272	0	7350	0	32470	0	732392	0	81255
MARIA LONG
0	240185	0	107347	0	140056	0	7350	0	26304	0	521242	0	54573
WAYNE F SHOVELIN
0	0	0	0	0	5914978	0	0	0	0	0	5914978	0	472568

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReference

ExplanationExplanation

PART I, LINES 4A-B

WAYNE F. SHOVELIN, FORMER CEO PARTICIPATED IN A SUPPLEMENTAL SALARY CONTINUATION RETIREMENT PLAN. GROSS PAYMENTS FOR 2010 WERE $5,914,978. PLEASE REFER TO THE SCHEDULE O DISCLOSURE FOR PART VI, SECTION B, LINE 15 FOR MORE DETAIL.

PART I, LINE 6

CERTAIN CAROMONT MEDICAL GROUP INC. PHYSICIAN'S COMPENSATION PACKAGES ARE BASED ON THE INDIVIDUAL PHYSICIAN'S NET RESULTS FROM OPERATIONS AS CALCULATED BASED SOLEY ON HIS/HER NET CHARGES LESS HIS/HER ALLOCABLE SHARE OF CLINIC OVERHEAD COSTS. EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES AND FINANCIAL PERFORMANCE OF THE CONSOLIDATED SYSTEM. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE CORPORATION SHALL BE CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE MEMBERS OF THE BOARD OF DIRECTOR SHALL BE ELECTED AND MAY BE REMOVED AT WILL BY ITS SOLE MEMBER OF THE CORPORATION ACTING THOUGHT ITS BOARD OF DIRECTORS AT ITS ANNUAL MEETING FROM A SLATE OF NOMINEES PROVIDED TO THE CAROMONT HEALTH, INC. BOARD BY THE FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 7B	DECISIONS OF THE GOVERNING BODY INCLUDING THE ELECTION AND REMOVAL OF MEMBERS OF THE BOARD OR DIRECTORS MUST BE APPROVED BY THE CORPORATION'S SOLE MEMBER, CAROMONT HEALTH, INC.
FORM 990, PART VI, SECTION B, LINE 11	THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS.
	EACH APPLICABLE EMPLOYEE AND DIRECTOR SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE EMPLOYEE'S OBLIGATION TO IMMEDIATELY MAKE THE PRESIDENT AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID EMPLOYEE'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES SHALL BE REVIEWED ANNUALLY BY THE EXECUTIVE VICE PRESIDENT/GENERAL COUNSEL AND THE CORPORATE RESPONSIBILITY OFFICER.	FORM 990, PART VI, SECTION B, LINE 12C
	THE CEO, CFO/ASSISTANT TREASURER AND EVP GENERAL COUNSEL/ASSISTANT SECRETARY ARE COMPENSATED FOR THEIR SERVICES BY GASTON MEMORIAL HOSIPIAL, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND FREE OF ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION LEAVES THE MEETING AND DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE RECOMMENDED BY THE COMPENSATION COMMITTEE AND APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR ALL OTHER EXECUTIVES IS ESTABLISHED THROUGH PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE CEO OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR EXECUTIVES ARE RECOMMENDED BY THE CEO AND APPROVED BY THE COMPENSATION COMMITTEE. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. IN 2009, THE BOARD OF DIRECTORS, BY AND THROUGH THE COMPENSATION COMMITTEE, CONDUCTED TWO DETAILED REVIEWS OF THE RETIREMENT BENEFIT TO BE PAID TO ITS RETIRING CEO. IN CONDUCTING THESE REVIEWS, THE COMPENSATION COMMITTEE WORKED THROUGH AN EVALUATION OF THE RETIRING CEO'S PERFORMANCE DURING HIS 33-YEAR TENURE WITH THE ORGANIZATION. THE COMPENSATION COMMITTEE CONCLUDED THAT IN THE AREAS OF FINANCE AND QUALITY MEASURES, THE RETIRING CEO'S PERFORMANCE CONSISTENTLY EXCEEDED EXPECTATIONS AND HAS POSITIONED CAROMONT HEALTH AS A LEADER IN THE REGION. HIS PERFORMANCE IN THE AREA OF PATIENT SATISFACTION HAS, IN THE MISSION-CRITICAL AREA OF EMERGENCY SERVICES, EXCEEDED THE BOARD OF DIRECTOR'S EXPECTATIONS. OVERALL, AND OVER THE ARC OF HIS CAREER AT CAROMONT, THE RETIRING CEO'S LEADERSHIP HAS LED CAROMONT HEALTH FROM A MERE COMMUNITY HOSPITAL INTO A REGIONAL HEALTHCARE POWERHOUSE. THE COMMITTEE CONCLUDED THAT HIS LEADERSHIP HAD OUTPERFORMED THE REGION AND FULFILLED THE COMMUNITY'S DESIRE TO KEEP ITS HEALTHCARE SYSTEM UNDER LOCAL CONTROL, THEREBY JUSTIFYING HIS RETIREMENT PAYMENT AS FAIR AND REASONABLE COMPENSATION FOR OUTSTANDING PERFORMANCE.	FORM 990, PART VI, SECTION B, LINE 15
	THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND ON WWW.GUIDESTAR.ORG.	FORM 990, PART VI, SECTION C, LINE 18
	AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.	FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:	NET UNREALIZED GAINS ON INVESTMENTS: 1,264,996. EQUITY TRANSFER -7,046. TOTAL TO FORM 990, PART XI, LINE 5: 1,257,950.	FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA	Controlled OrgControlledOrg	Business Name Line1DirectControllingEntityName/BusinessNameLine1
CAROMONT HEALTH INC
2525 COURT DRIVE	GASTONIA	NC	28054	581636959	MEDICAL SERVICES	NC	501(C)(3)	LINE 11B, II	N/A	0
CAROMONT HEALTH SERVICES INC
2526 COURT DRIVE	GASTONIA	NC	28054	561455630	OUTPATIENT SERVICES	NC	501(C)(3)	LINE 3		0	CAROMONT HEALTH INC
CAROMONT MEDICAL GROUP INC
2528 COURT DRIVE	GASTONIA	NC	28054	561479712	MEDICAL GROUP	NC	501(C)(3)	LINE 9		0	CAROMONT HEALTH INC
HOSPICE OF GASTON COUNTY INC
2529 COURT DRIVE	GASTONIA	NC	28054	581341530	HOSPICE CARE	NC	501(C)(3)	LINE 7		0	CAROMONT HEALTH INC
GASTON MEMORIAL HOSPITAL INC
2530 COURT DRIVE	GASTONIA	NC	28054	560619359	HOSPITAL	NC	501(C)(3)	LINE 3		0	CAROMONT HEALTH INC
GASTON EMERGENCY PHYSICIANS INC
2531 COURT DRIVE	GASTONIA	NC	28054	562209423	SUPPORTING ORGANIZATION	NC	501(C)(3)	LINE 11A, I		0	CAROMONT HEALTH INC

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
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	0	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	1	OtherTransferToOtherOrg
Other Transfer From Other Org	1	OtherTransferFromOtherOrg