CHARLES A CANNON JR MEMORIAL HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CHARLES A CANNON JR MEMORIAL HOSPITAL INC (EIN 56-0529974)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-05-14
IRS object ID
201241359349303869
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)
Timestamp2012-05-14T13:37:37-05:00Timestamp
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 Line1111 FRANKLIN RD SE SUITE 501AddressLine1
CityROANOKECity
StateVAState
ZIP Code240112114ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

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 Signed2012-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL P NORTONName
Phone5409896144Phone
Date Prepared2012-05-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts20106856GrossReceipts
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, NORTH CAROLINA. THIS INCLUDES A BEHAVORIAL HEALTH CENTER, NEW LIFE CENTER, PATIENT CARE CENTER, DIAGNOSTIC SERVICES, EMERGENCY DEPARTMENT AND A CRITICAL CARE UNIT.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers81TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year605360ContributionsGrantsPriorYear
Contributions Grants Current Year77719ContributionsGrantsCurrentYear
Program Service Revenue Prior Year20795236ProgramServiceRevenuePriorYear
Program Service Revenue CY19820513ProgramServiceRevenueCY
Investment Income Prior Year-127794InvestmentIncomePriorYear
Investment Income Current Year19742InvestmentIncomeCurrentYear
Other Revenue Prior Year216833OtherRevenuePriorYear
Other Revenue Current Year188882OtherRevenueCurrentYear
Total Revenue Prior Year21489635TotalRevenuePriorYear
Total Revenue Current Year20106856TotalRevenueCurrentYear
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 Year12095784SalariesEtcPriorYear
Salaries Etc Current Year12699913SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year9059281OtherExpensePriorYear
Other Expenses Current Year8854565OtherExpensesCurrentYear
Total Expenses Prior Year21155065TotalExpensesPriorYear
Total Expenses Current Year21554478TotalExpensesCurrentYear
Revenues Less Expenses Prior Year334570RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1447622RevenuesLessExpensesCY
Total Assets BOY29203737TotalAssetsBOY
Total Assets EOY27723828TotalAssetsEOY
Total Liabilities BOY9653546TotalLiabilitiesBOY
Total Liabilities EOY9319408TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY19550191NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY18404420NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH CARE SERVICES TO ENHANCE THE QUALITY OF LIFE FOR THE COMMUNITY OF LINVILLE, NORTH CAROLINA. THIS INCLUDES A BEHAVORIAL HEALTH CENTER, NEW LIFE CENTER, PATIENT CARE CENTER, DIAGNOSTIC SERVICES, EMERGENCY DEPARTMENT AND A CRITICAL CARE UNIT.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense16630892Expense
Revenue20029137Revenue
DescriptionHEALTHCARE SERVICES PROVIDED FOR THE COMMUNITY OF LINVILLE, NORTH CAROLINA, CONSISTED OF THE FOLLOWING:ER VISITS 10,119DISCHARGES 2,250DAYS OF CARE 9,730Description
Total Program Service Expense16630892TotalProgramServiceExpense
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 (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeFormerFormer
PAUL MILLER JR
BOARD MEMBER1.00X000
JOHN BLACKBURN
BOARD MEMBER1.00X000
JIM DEAL
BOARD MEMBER1.00X000
JOE MILLER
BOARD MEMBER1.00X000
SUSAN ROGGENKAMP
BOARD MEMBER1.00X000
KENNETH WILCOX
CHAIR1.00X000
KEITH TESTER
VICE CHAIR1.00X000
SAM ADAMS
BOARD MEMBER1.00X000
WILLIAM ATKINS MD
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
RICHARD SPARKS
SYSTEM CEO40.000371261111971XX
JOHN BARRETT
SYSTEM COO40.00025563911069X
KEVIN MAY
SYSTEM CFO40.00024068011374XX
CHUCK MANTOOTH
VP OF ANCILLARY SERVICES ARHS40.0001669049757XX
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1034484TotalReportableCompFrmRltdOrgs
Total Other Compensation144171TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions77719AllOtherContributions
Total Contributions77719TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PROG.SERV.REVENUE-RELA9000991974314419743144
CAFETERIA REVENUE9000997736977369
FieldValueIRS element (for citing)
Total Program Service Revenue19820513TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column19742TotalRevenueColumn
Exclusion$19,742ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real57359Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real57359Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column57359TotalRevenueColumn
Related Or Exempt Function Income57359RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column131523TotalRevenueColumn
Related Or Exempt Function Income131523RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue131523TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20106856TotalRevenueColumn
Related Or Exempt Function Income20009395RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$19,742ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total10221479Total
Program Services8880349ProgramServices
Management And General1341130ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1863861Total
Program Services1602920ProgramServices
Management And General260941ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total614573Total
Program Services590223ProgramServices
Management And General24350ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6702Total
Management And General6702ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2111704Total
Program Services1694898ProgramServices
Management And General416806ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total384Total
Program Services384ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2660726Total
Program Services2571833ProgramServices
Management And General88893ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total736293Total
Program Services213694ProgramServices
Management And General522599ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total18538Total
Program Services17607ProgramServices
Management And General931ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total2720Total
Program Services2720ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total452208Total
Management And General452208ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1273683Total
Program Services435666ProgramServices
Management And General838017ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total180221Total
Program Services180221ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
CORP. ALLOCATIONS653685653685
EQUIPMENT RENTAL AND MA462695193346269349
MISCELLANEOUS743474269531652
MINOR EQUIPMENT5904159041
DUES AND SUBSCRIPTIONS547722572529047

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total106846Total
Program Services51288ProgramServices
Management And General55558ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total21554478Total
Program Services16630892ProgramServices
Management And General4923586ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3436102BOY
EOY2158322EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY800177BOY
EOY803320EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3084651BOY
EOY3426455EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY415630BOY
EOY510497EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY146928BOY
EOY145580EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis35843483LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec18171485LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY18613220BOY
EOY17671998EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2707029BOY
EOY3007656EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY29203737BOY
EOY27723828EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY308273BOY
EOY339872EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY7892404BOY
EOY7533509EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1452869BOY
EOY1446027EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9653546BOY
EOY9319408EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY18212074BOY
EOY17407505EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY341202BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY996915BOY
EOY996915EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19550191BOY
EOY18404420EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY29203737BOY
EOY27723828EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1447622ReconcilationRevenueExpenses
Reconcilation Other Changes301851ReconcilationOtherChanges
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 Basis1307101OtherCostOrOtherBasis
Book Value1307101BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21812832OtherCostOrOtherBasis
Depreciation8470068Depreciation
Book Value13342764BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3156844OtherCostOrOtherBasis
Depreciation1503285Depreciation
Book Value1653559BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis9566706OtherCostOrOtherBasis
Depreciation8198132Depreciation
Book Value1368574BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings17671998TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
AUWIL1255447
INTEREST IN ARHF1719110
OWNERSHIP EQUITY-OTHER33099
FieldValueIRS element (for citing)
Total Book Value Other Assets3007656TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATE$1,260,027
ESTIMATED THIRD-PARTY SETTLEMENTS-$25,000
MISCELLANEOUS$211,000
FieldValueIRS element (for citing)
Total Of Amounts1446027TotalOfAmounts

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, 2011. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 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 Expense439401TotalCommunityBenefitExpense
Net Community Benefit Expense439401NetCommunityBenefitExpense
Percent Of Total Expense0.02040PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2348972TotalCommunityBenefitExpense
Direct Offsetting Revenue2240361DirectOffsettingRevenue
Net Community Benefit Expense108611NetCommunityBenefitExpense
Percent Of Total Expense0.00500PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2788373TotalCommunityBenefitExpense
Direct Offsetting Revenue2240361DirectOffsettingRevenue
Net Community Benefit Expense548012NetCommunityBenefitExpense
Percent Of Total Expense0.02540PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense45527TotalCommunityBenefitExpense
Net Community Benefit Expense45527NetCommunityBenefitExpense
Percent Of Total Expense0.00210PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense39457TotalCommunityBenefitExpense
Net Community Benefit Expense39457NetCommunityBenefitExpense
Percent Of Total Expense0.00180PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense47129TotalCommunityBenefitExpense
Net Community Benefit Expense47129NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense132113TotalCommunityBenefitExpense
Net Community Benefit Expense132113NetCommunityBenefitExpense
Percent Of Total Expense0.00610PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2920486TotalCommunityBenefitExpense
Direct Offsetting Revenue2240361DirectOffsettingRevenue
Net Community Benefit Expense680125NetCommunityBenefitExpense
Percent Of Total Expense0.03150PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,765,922BadDebtExpenseAmount
Amount Attributable To88296AmountAttributableTo
Amount Reimbursed By Medicare7207344AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare7207344CostOfCareReimbursedByMedicare

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 (4 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
0307589025000038672010321908752048323200
JOHN BARRETT
02333590750001478000011069026670800
KEVIN MAY
02176970100000129830538905985025205400
CHUCK MANTOOTH
0147666050000142380377205985017666100

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3PARENT COMPANY, APPALACHIAN REGIONAL HEALTH CARE SYSTEM (ARHS) OVERSEES CMH OPERATIONS. ALSO NOTE THAT SALARIES AND OTHER COMMON EXPENSES INCURRED BY ARHS ARE ALLOCATED APPROPRIATELY TO CMH AND THE OTHER ENTITES SUPPORTED BY ARHS. THIS IS WHY SALARIES EXPENSES IS REPORTED EVEN THOUGH NO EMPLOYEES ARE LISTED. ALL WAGES AND PAYMENTS TO VENDORS ARE PAID OUT 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 SYSTEM DIRECTOR OF FINANCE REVIEW THE 990 AND THEN IT IS MADE AVAILABLE TO THE BOARD UPON COMPLETION.
REVIEW OF POLICY STATEMENT EACH YEAR.FORM 990, PART VI, SECTION B, LINE 12C
INDEPENDENT COMPENSATION AND BENEFIT ANALYSIS WAS PERFORMED BY FINDLEY DAVIES IN DECEMBER 2011. THE EXECUTIVE COMMITTEE (COMPENSATION COMMITTEE) REVIEWED THIS INFORMATION IN DECEMBER, 2011 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 B, LINE 15
PROVIDED UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:TRANSFERS FROM AFFILIATE 301,851. TOTAL TO FORM 990, PART XI, LINE 5: 301,851.FORM 990, PART XI, LINE 5:

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 Involved184629AmountInvolved
Method Of Amt DeterminationACTUALMethodOfAmtDetermination

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