ANMED HEALTH CANNON: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ANMED HEALTH CANNON (EIN 57-0342027)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-09-14
IRS object ID
201222589349300627
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-09-14T12:27:25-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN570342027EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CANNON MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCANNNameControl
Phone8648784791Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1123 WG ACKER DRIVEAddressLine1
CityPICKENSCity
StateSCState
ZIP Code29671ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMARY ARNETTEName
TitleCFOTitle
Phone8648784791Phone
Date Signed2012-09-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonNORMAN RENTZNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1123 WG ACKER DRIVEAddressLine1
CityPICKENSCity
StateSCState
ZIP Code29671ZIPCode
FieldValueIRS element (for citing)
Gross Receipts35515793GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CANNONHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1950YearFormation
State Legal DomicileSCStateLegalDomicile
Activity Or Mission DescriptionPROVIDING QUALITY HEALTHCARE IN A SAFE, COMPETENT, AND COMPASSIONATE MANNERActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees324TotalNbrEmployees
Total Nbr Volunteers102TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year115224ContributionsGrantsPriorYear
Contributions Grants Current Year89506ContributionsGrantsCurrentYear
Program Service Revenue Prior Year33993183ProgramServiceRevenuePriorYear
Program Service Revenue CY35165469ProgramServiceRevenueCY
Investment Income Prior Year44499InvestmentIncomePriorYear
Investment Income Current Year29932InvestmentIncomeCurrentYear
Other Revenue Prior Year261822OtherRevenuePriorYear
Other Revenue Current Year230713OtherRevenueCurrentYear
Total Revenue Prior Year34414728TotalRevenuePriorYear
Total Revenue Current Year35515620TotalRevenueCurrentYear
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 Year12010326SalariesEtcPriorYear
Salaries Etc Current Year11696413SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year52058TotalFundrsngExpCurrentYear
Other Expense Prior Year21116405OtherExpensePriorYear
Other Expenses Current Year24034116OtherExpensesCurrentYear
Total Expenses Prior Year33126731TotalExpensesPriorYear
Total Expenses Current Year35730529TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1287997RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-214909RevenuesLessExpensesCY
Total Assets BOY16173472TotalAssetsBOY
Total Assets EOY15708412TotalAssetsEOY
Total Liabilities BOY8319106TotalLiabilitiesBOY
Total Liabilities EOY8070816TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7854366NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7637596NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF CANNON MEMORIAL HOSPITAL IS TO PROVIDE QUALITY HEALTHCARE IN A SAFE, COMPETENT, AND COMPASSIONATE MANNER.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense32939255Expense
Revenue35165469Revenue
DescriptionCANNON 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 2011, THE HOSPITAL PROVIDED 3,999 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 Expense32939255TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
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 Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
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 Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
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 Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109637NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees324NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
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 Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
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 Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledSCStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MARY ARNETTEBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8648784791TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1123 WG ACKER DRIVEAddressLine1
CityPICKENSCity
StateSCState
ZIP Code29671ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DR CALVIN SNIPES JR
CHAIRMAN (SEE SCH. O)1.00XX2719500
FRANCES C STOKES
VICE CHAIR1.00XX000
DR WILLIAM W SPEARMAN
SECRETARY1.00XX000
KENNETH D ACKER
TREASURER1.00XX000
GEORGE D ACKER
BOARD MEMBER1.00X000
CHARLES E DALTON
BOARD MEMBER1.00X000
BRIAN C DEESE
BOARD MEMBER1.00X000
RANDALL P GRIFFIN
BOARD MEMBER1.00X000
TIMOTHY E MORGAN
BOARD MEMBER1.00X000
DR DONALD L MARLER
BOARD MEMBER1.00X000
J FLETCHER PERRY
BOARD MEMBER1.00X000
JOHN E SPARKS
BOARD MEMBER1.00X000
NORMAN RENTZ
CEO40.00X153845021136
MARY ARNETTE
CFO40.00X7604706967
DONNA ANDERSON
CNO40.00X91018017307
PETER SCHRIVER
PHYSICIAN40.00231510012141X
BYRON MARSH
PHYSICIAN40.0024783901653X
JAKE HOLCOMBE
PHYSICIAN40.0013640000X
MARION CLINCH
PHYSICIAN40.0013212708849X
TRAVIS DAVIS
PHYSICIAN40.00127604012027X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1223585TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation80080TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ANMED HEALTH
800 NORTH FANT STREETANDERSONSC29621MANAGMENT SERVICES601297
MICHAEL DILLARD MD
PO BOX 186PICKENSSC29671PHYSICIAN294543
JAMES CALDWELL MD
220 GLEN LAUREL DRIVEEASLEYSC29642PHYSICIAN286678
MICHAEL DONALD MD
350 NORTH SUMMIT DRIVESENECASC29672PHYSICIAN260990
JAMES COCHRAN MD
235 SCENIC HEIGHTS ROADWEST UNIONSC29696PHYSICIAN218955
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Related Organizations60000RelatedOrganizations
Government Grants26000GovernmentGrants
All Other Contributions3506AllOtherContributions
Total Contributions89506TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICEDescription
Business Code621400BusinessCode
Total Revenue Column35165469TotalRevenueColumn
Related Or Exempt Function Income35165469RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue35165469TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column29305TotalRevenueColumn
Exclusion$29,305ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real27795Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real27795Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column27795TotalRevenueColumn
Exclusion$27,795ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other800Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other173Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other627Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column627TotalRevenueColumn
Exclusion$627ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA & FOODSERVIC722210124323$124,323
SALES TO EMPLOYEES44611053315$53,315
MEDICAL TRANSCRIPTION90009922036$22,036

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column3244TotalRevenueColumn
Exclusion$3,244ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue202918TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column35515620TotalRevenueColumn
Related Or Exempt Function Income35165469RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$260,645ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total393515Total
Management And General393515ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9440836Total
Program Services8839776ProgramServices
Management And General561516ManagementAndGeneral
Fundraising39544Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total263386Total
Program Services236749ProgramServices
Management And General25578ManagementAndGeneral
Fundraising1059Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total906442Total
Program Services814771ProgramServices
Management And General88026ManagementAndGeneral
Fundraising3645Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total692234Total
Program Services622227ProgramServices
Management And General67224ManagementAndGeneral
Fundraising2783Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total417215Total
Management And General417215ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total86182Total
Management And General86182ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3149498Total
Program Services2665166ProgramServices
Management And General483941ManagementAndGeneral
Fundraising391Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total45620Total
Management And General45620ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3850518Total
Program Services3537347ProgramServices
Management And General308689ManagementAndGeneral
Fundraising4482Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total12826Total
Management And General12826ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total303789Total
Program Services303789ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total71529Total
Program Services38293ProgramServices
Management And General33082ManagementAndGeneral
Fundraising154Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total310111Total
Program Services310111ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total894698Total
Program Services894698ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total341553Total
Program Services125751ProgramServices
Management And General215802ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionBAD DEBT EXPENSEDescription
Total14550577Total
Program Services14550577ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total35730529Total
Program Services32939255ProgramServices
Management And General2739216ManagementAndGeneral
Fundraising52058Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1176147BOY
EOY446120EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1911820BOY
EOY2404368EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY8800BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4680926BOY
EOY3561593EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY15733BOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY31852BOY
EOY15926EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY665554BOY
EOY645507EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY221574BOY
EOY237625EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis23402445LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15919469LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6592251BOY
EOY7482976EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY455564BOY
EOY419204EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY413251BOY
EOY495093EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY16173472BOY
EOY15708412EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1423104BOY
EOY1414395EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5470000BOY
EOY5140000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY983426BOY
EOY1203151EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY442576BOY
EOY313270EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8319106BOY
EOY8070816EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7230127BOY
EOY7236492EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY624239BOY
EOY401104EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7854366BOY
EOY7637596EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16173472BOY
EOY15708412EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-214909ReconcilationRevenueExpenses
Reconcilation Other Changes-1861ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$879OtherActivitiesAmount
Total Lobbying Expenditures IIB879TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationTHE 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 2010, DUES PAID TO THIS ORGANIZATION ALLOCATED TO LOBBYING EFFORTS WERE APPROXIMATELY $879.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis923554OtherCostOrOtherBasis
Book Value923554BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10948637OtherCostOrOtherBasis
Depreciation7992235Depreciation
Book Value2956402BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis384370OtherCostOrOtherBasis
Depreciation280581Depreciation
Book Value103789BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10475221OtherCostOrOtherBasis
Depreciation7646653Depreciation
Book Value2828568BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis670663OtherCostOrOtherBasis
Book Value670663BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7482976TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
INTEREST RATE SWAP AGREEMENT$291,000
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS$22,270
FieldValueIRS element (for citing)
Total Of Amounts313270TotalOfAmounts
Total Revenue35515620TotalRevenue
Total Expenses35730529TotalExpenses
Excess Or Deficit For Year-214909ExcessOrDeficitForYear
Other-$1,861OtherAmount
Total Adjustments-1861TotalAdjustments
Excess Or Deficit Per FS-216770ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt35513760TotRevenueEtcAuditedFinclStmt
Other Revenues34500OtherRevenues
Revenue Not Rptd F99034500RevenueNotRptdF990
Revenue Subtotal35479260RevenueSubtotal
Other Revenues Not Included36360OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt36360RevenueNotRptdOnFinStmt
Total Revenue Per Form99035515620TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt35730530TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal35730530ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99035730530TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X: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, 2010. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2007 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT -36,361. CHANGE IN VALUE OF EQUITY IN FOUNDATION NET ASSETS 34,500.
PART XII, LINE 2D - OTHER ADJUSTMENTS:CHANGE IN VALUE OF EQUITY IN FOUNDATION NET ASSETS 34,500.
PART XII, LINE 4B - OTHER ADJUSTMENTS:CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT 36,360.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available0ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense193136TotalCommunityBenefitExpense
Net Community Benefit Expense193136NetCommunityBenefitExpense
Percent Of Total Expense0.00910PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1557554TotalCommunityBenefitExpense
Direct Offsetting Revenue1143219DirectOffsettingRevenue
Net Community Benefit Expense414335NetCommunityBenefitExpense
Percent Of Total Expense0.01960PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1750690TotalCommunityBenefitExpense
Direct Offsetting Revenue1143219DirectOffsettingRevenue
Net Community Benefit Expense607471NetCommunityBenefitExpense
Percent Of Total Expense0.02870PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense486570TotalCommunityBenefitExpense
Direct Offsetting Revenue99828DirectOffsettingRevenue
Net Community Benefit Expense386742NetCommunityBenefitExpense
Percent Of Total Expense0.01830PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense486570TotalCommunityBenefitExpense
Direct Offsetting Revenue99828DirectOffsettingRevenue
Net Community Benefit Expense386742NetCommunityBenefitExpense
Percent Of Total Expense0.01830PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2237260TotalCommunityBenefitExpense
Direct Offsetting Revenue1243047DirectOffsettingRevenue
Net Community Benefit Expense994213NetCommunityBenefitExpense
Percent Of Total Expense0.04700PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,925,746BadDebtExpenseAmount
Amount Reimbursed By Medicare4243092AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare19604336CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-15361244MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1CANNON MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1123 WG ACKER DRIVEAddressLine1
CityPICKENSCity
StateSCState
ZIP Code29671ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
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 V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
CANNON ORTHOPEDIC
123 WG ACKER DRIVEPICKENSSC29671ORTHOPEDIC PRACTICE
CANNON SURGICAL
123 WG ACKER DRIVEPICKENSSC29671GENERAL SURGERY PRACTICE
CANNON FAMILY PRACTICE - EASTSIDE
111 WEST ROPER ROADPICKENSSC29640RURAL HEALTH CLINIC
CANNON FAMILY PRACTICE - PICKENS
123 WG ACKER DRIVEPICKENSSC29671FAMILY PRACTICE
CANNON FAMILY PRACTICE - LIBERTY
105 LIBERTY BOULEVARDPICKENSSC29657FAMILY PRACTICE

Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)

ExplanationExplanation
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 $ 14550577.
PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT.WORKSHEET TWO OF THE 2010 SCHEDULE H INSTRUCTIONS WAS USED TO CALCULATE A COST-TO-CHARGES RATIO USED TO COMPUTE BAD DEBT AT COST.
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 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. AS OF THE YEAR 2000, PICKENS COUNTY'S POPULATION WAS A LITTLE OVER 110,000 AND IT IS EXPECTED TO GROW BY 37,000 RESIDENTS IN THE NEXT 14 YEARS. THE MEDIUM HOUSEHOLD INCOME IS $36,214 WITH 13% OF THE COMMUNITY RESIDENTS HAVING INCOMES BELOW THE FEDERAL POVERTY GUIDELINE. PICKENS COUNTY HAS A 9% UNEMPLOYMENT RATE AND AN ESTIMATED 34.6% OF THE WORKING-AGE ADULTS (18-64) LIVING IN PICKENS COUNTY LACK HEALTH INSURANCE. THIS NUMBER REPRESENTS APPROXIMATELY 6,862 RESIDENTS.
PART VI, LINE 6: 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

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
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
NORMAN RENTZ
1342800001956507010204350174981000
PETER SCHRIVER
2315100000000121410243651000
BYRON MARSH
2242560235830000016530249492000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE FILING ORGANIZATION PROVIDES THESE BENEFITS THE CEO. NO PART OF THE BENEFIT WAS TREATED AS TAXABLE COMPENSATION DURING FY2010. ALL PERSONAL USE AMOUNTS ARE REQUIRED TO BE PAID BACK TO THE ORGANIZATION.
PART I, LINE 5FULL TIME FAMILY PRACTICE PHYSICIANS ARE INCENTIVIZED THROUGH A BONUS DERVIED FROM A FORMULA THAT INCLUDES REVENUES.
PART I, LINE 6FULL TIME FAMILY PRACTICE PHYSICIANS ARE INCENTIVIZED THROUGH A BONUS DERVIED FROM A FORMULA THAT INCLUDES NET EARNINGS.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1SC JOBS-ECONOMIC DEVELOPMENT AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN570960018IssuerEIN
CUSIP Number83703EHX6CUSIPNumber
Date Issued2004-06-15DateIssued
Issue Price6250000IssuePrice
Description Of PurposeSEE PART VDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired1110000AmountRetired
Total Proceeds6251328TotalProceeds
Issuance Costs From Proceeds125000IssuanceCostsFromProceeds
Credit Enhancement76836CreditEnhancement
Capital Expenditures1386152CapitalExpenditures
Other Spent Proceeds4663340OtherSpentProceeds
Year Of Subst Completion2002YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged1BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1NAT'L BANK OF SCBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge10.000000000000TermOfHedge
Superintegrated Hedge1SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate1ExceptionToRebate

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PART I, COLUMN (F):PURPOSE OF SERIES 2004A ISSUE:(I) TO DEFRAY THE COST OF REFINANCING THE EMERGENCY ROOM EXPANSION AND ACQUIRING EQUIPMENT, INCLUDING IMAGING EQUIPMENT AND INFORMATION TECHNOLOGY EQUIPMENT IN ADDITION TO ROUTINE CAPITAL EQUIPMENT TO BE USED AT THE FACILITIES OF THE HOSPITAL. (II) TO REFUND THE OUTSTANDING PRINCIPAL AMOUNT OF THE $5,805,000 PICKENS COUNTY, SOUTH CAROLINA, FIRST MORTGAGE HOSPITAL FACILITIES REFUNDING REVENUE BONDS (CANNON MEMORIAL HOSPITAL) SERIES 1996A, THE PROCEEDS OF WHICH WERE USED TO REFUND THE PICKENS COUNTY, SOUTH CAROLINA, HOSPITAL FACILITIES REFUNDING REVENUE BONDS, SERIES 1987 (CANNON MEMORIAL HOSPITAL PROJECT), WHICH WERE ISSUED TO REFINANCE THE COSTS OF THE ACQUISITION, CONSTRUCTION, FURNISHING, AND EQUIPPING OF A 55-BED ACUTE CARE HOSPITAL LOCATED AT 123 W.G. ACKER DRIVE, PICKENS, SOUTH CAROLINA, AND OWNED BY THE HOSPITAL; AND (III) TO PREPAY THE $650,000 NOTE OF THE PEOPLES NATIONAL BANK DATED JUNE 17, 2002, AND THE $200,000 NOTE OF THE PEOPLES NATIONAL BANK DATED SEPTEMBER 4, 2003; AND (IV) TO PAY COSTS OF ISSUANCE OF THE BONDS
PART II, LINE 11:OTHER SPENT PROCEEDS:THE AMOUNT PRESENTED ON PART II, LINE 11 REPRESENTS AMOUNTS USED TO REFUND PRIOR BONDS ISSUED DECEMBER 19, 1996.

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonNORMAN RENTZ CEONamePerson
Purpose Of LoanPERSONAL PORTION OF BENEFITS RECEIVEDPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$15,733OriginalPrincipalAmount
Default0Default
Approved By Board0ApprovedByBoard
Written Agreement0WrittenAgreement

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3ON 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 11THE 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.
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 12C
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 B, LINE 15
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 18
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 VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT -36,361. CHANGE IN VALUE OF EQUITY IN FOUNDATION NET ASSETS 34,500. TOTAL TO FORM 990, PART XI, LINE 5: -1,861.FORM 990, PART XI, LINE 5:
BOARD MEMBER COMPENSATION:COMPENSATION PAID TO CHAIRMAN OF THE BOARD, DR. CALVIN SNIPES, IS PAID FOR MEDICAL SERVICES PROVIDED TO THE HOSPITAL. NO PART OF THE COMPENSATION IS PAID FOR SERVICES IN HIS CAPACITY AS A BOARD MEMBER.FORM 990, PART VII, LINE 1:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CANNON MEMORIAL HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 188AddressLine1
CityPICKENSCity
StateSCState
ZIP Code29671ZIPCode
FieldValueIRS element (for citing)
EIN570943822EIN
Primary ActivitiesSUPPORT/FUNDRAISINGPrimaryActivities
Legal Domicile StateSCLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status7PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
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 Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
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 Line1CANNON MEMORIAL HOSPITAL FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType

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