SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public Inspection
Name of the organization
CUMBERLAND COUNTY HOSPITAL SYSTEM INC
 
Employer identification number

56-0845796
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    20,008,370 1,629,044 18,379,326 2.120 %
b Medicaid (from Worksheet 3, column a) . . . . .     178,760,452 152,538,446 26,222,006 3.020 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     1,046,720 581,626 465,094 0.050 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     199,815,542 154,749,116 45,066,426 5.190 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .     17,892,641 2,432,885 15,459,756 1.780 %
g Subsidized health services (from Worksheet 6) . . . .     26,563,558 9,556,560 17,006,999 1.960 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     44,456,199 11,989,445 32,466,755 3.740 %
k Total. Add lines 7d and 7j .     244,271,741 166,738,561 77,533,181 8.930 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building     133,500 0 133,500 0.020 %
7 Community health improvement advocacy            
8 Workforce development     53,550 0 53,550 0.010 %
9 Other            
10 Total     187,050 0 187,050 0.030 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
250,273,822
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
168,089,904
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
167,821,177
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
268,727
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2018
Schedule H (Form 990) 2018
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?4Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Cape Fear Valley Health System
1638 Owen Drive
Fayetteville,NC28304
www.capefearvalley.com 		X X         X     A
2 Highsmith Rainey Hospital
150 Robeson Street
Fayetteville,NC28301
www.capefearvalley.com 		X               Long Term Acute Care Hospital A
3 Bladen County Hospital
501 South Poplar Street
Elizabethtown,NC28337
www.capefearvalley.com 		X       X   X     A
4 Hoke Hospital
210 Medical Pavilion Drive
Raeford,NC28376
www.capefearvalley.com 		X                 A
Schedule H (Form 990) 2018
Page 4
Schedule H (Form 990) 2018
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1 Yes  
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.capefearvalley.com/hospitals/cfvmc.html
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2018
Page 5
Schedule H (Form 990) 2018
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.capefearvalley.com/patients
b
www.capefearvalley.com/patients
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2018
Page 6
Schedule H (Form 990) 2018
Page 6
Part VFacility Information (continued)

Billing and Collections
A
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2018
Page 7
Schedule H (Form 990) 2018
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
A
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2018
Page 8
Schedule H (Form 990) 2018
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Cape Fear Valley Health System PART V, SECTION B, LINE 3: Cape Fear Valley Health System performed a new Community Health Needs Assessment for FY 2019. For our 2019 CHNA we collaborated with HealthENC, a collaborative of 22 hospitals and 21 health departments from across Eastern NC, including the Bladen, Cumberland and Hoke County Health Departments. Community Health Assessment Teams (CHAT) were developed in each of the respective counties. The CHAT consisted of community members, stakeholders, and those working in public health. The CHATs were instrumental in the distribution of our surveys in the community in electronic and paper format. Utilizing the surveys (primary data) and data from the state plus federal sources (secondary data), and CHAT led focused groups, HealthENC created a comprehensive report for each of the three counties Cape Fear Valley has a hospital. There were a few continuous themes despite the geographical differences in the counties. Working with the respective health departments in each county, Cape Fear Valley Health System identified Community Outreach & Screening for Early Intervention, Access to Health Services, and Substance Abuse as the areas that needed to be addressed. These areas are all among the most mentioned areas amongst our survey respondents and focus group attendees. CFVHS hosted over 200 outreach events in the community in 2019 to address the issues in our service area. Preventive education, screening, and support groups were just a few of the ways we address our community needs. The CFVHS foundation has funded over 212 screening mammograms to catch breast cancer in earlier stages. CPR instruction and Blood Pressure checks are a service we offer at most outreach events. Our Residency program fosters outreach amongst our residents, and last year they performed over 1,000 blood pressure screenings at events. In addition to providing screenings, our residents were able to raise awareness of our residency program and its expected impact. We performed over 250 free pulmonary function tests to help detect those who may be at risk of lung cancer. We will continue our aggressive outreach efforts to help educate our patients about the various risk factors associated with all the identified needs. The health system has added new access points in the forms of urgent care and primary care practices, so patients have greater access to physicians. CFVHS just completed our Physician Needs Assessment to identify immediate and future needs of our community. We are strengthening our relationships with our local health departments and identifying potential collaborations with community stakeholders. Cape Fear Valley Health System has established a system-wide Opioid Stewardship Program. We have established several Community Partnerships to address substance abuse issues in our area (Fighting addiction through Community Empowerment Teams with SRAHEC & Cumberland-Fayetteville Opioid Response Teams). Cape Fear Valley Health System is constantly evolving to meet the needs of the communities we serve. We have already begun the next steps for our next Community Needs Assessment to learn if we are heading in the right direction. Our vision is to improve the quality of life of every life we touch.
Cape Fear Valley Health System Part V, Section B, Line 4: Cape Fear Valley and Highsmith Rainey worked collaboratively with one another. Part V, Section B, Line 5: Community Health Assessment Teams (CHAT) were developed in each of the respective counties. The CHAT consisted of community members, stakeholders, and those working in public health. The CHAT's developed community health assessment surveys and distributed them in the community in electronic and paper format. Utilizing the surveys (primary data) and data from the state plus federal sources (secondary data), CFVHS was able to identify the most pressing needs in our communities. Part V, Section B, Line 11: CFVHS will continue our aggressive outreach efforts to help educate our patients about the various risk factors associated with all the identified needs. We are strengthening our relationships with our local health departments and identifying potential collaborations with community stakeholders. Going forward the hospital is developing an additional cardiac catheterization lab. Our Lung Nodule Clinic has moved to the main campus for better coverage of potential lung cancer patients.
Cape Fear Valley Health System Part V, Section B, Line 16I: See the response to Part VI, Line 3
Highsmith Rainey Hospital Part V, Section B, Line 16I: See the response to Part VI, Line 3
Bladen County Hospital Part V, Section B, Line 16I: See the response to Part VI, Line 3
Hoke Hospital Part V, Section B, Line 16I: See the Response to part VI, Line 3
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2018
Page 9
Schedule H (Form 990) 2018
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?40
Name and address Type of Facility (describe)
1 CFV-Rehabilitation Center
1638 Owen Drive
Fayetteville,NC28304 		Rehabilitation Center
2 Cumberland Cty EMS of CFV
610 Gillespie Street
Fayetteville,NC28306 		Emergency Medical Services
3 CFV Behavior Health Center
3425 Melrose Road
Fayetteville,NC28304 		Behavior Health Center
4 CFV Detox Center
1724 Roxie Avenue
Fayetteville,NC28304 		Detoxication Center
5 Healthplex Wellness Center
1930 Skibo Road
Fayetteville,NC28304 		Rehabilitation Center
6 Health Pavilion North
6387 Ramsey Street
Fayetteville,NC28311 		Outpatient Services
7 Highsmith-Rainey Express Care
150 Robeson Street
Fayetteville,NC28311 		Express Care
8 Cape Fear Valley Express Care
1638 Owen Drive
Fayetteville,NC28304 		Express Care
9 Cape Fear Valley OBGYN
1341 Walther Reed Road
Fayetteville,NC28304 		OB/Gyn Services
10 Health Pavilion North Express Care
6287 Ramsey Street
Fayetteville,NC28301 		Express Care
11 Cape Fear Valley Sleep Medicine
1213 Walter Reed Road
Fayetteville,NC28304 		Sleep Center
12 Health Pavilion North Family Care
6387 Ramsey Street
Fayetteville,NC28311 		Family Practice
13 Hope Mills Family Care
4092 Professional Drive
Hope Mills,NC28348 		Family Practice
14 Cape Fear Valley Perinatology
2109 Valleygate Drive
Fayetteville,NC28304 		Perinatology
15 Behavioral Health Center
3425 Melrose Road
Fayetteville,NC28304 		Mental Health Clinic Inpatient
16 Valley Medical Associates-Highsmith
101 Robeson Street
Fayetteville,NC28301 		Family Practice
17 Cape Fear Valley Urology
2301 Robeson Street Suite 203
Fayetteville,NC28305 		Urology
18 Hoke Family Medical Center
405 South Main Street
Raeford,NC28376 		Family Practice
19 Senior Health Services
101 Robeson Street Suite 202
Fayetteville,NC28310 		Geriatrics
20 Bladen Medical Assoc-Elizabethtown
300 A East McKay Street
Elizabethtown,NC28337 		Family Practice
21 Stedman Medical Care
114 Forte Road
Stedman,NC28391 		Family Practice
22 Cape Fear Valley Neurosurgery
3308 Melrose Road
Fayetteville,NC28304 		Neurosurgery Outpatient
23 Cape Fear Valley Wound Care Center
101 Robeson St Suite 210
Fayetteville,NC28301 		Wound Center
24 Cape Fear Valley Pediatric Care
1262 Oliver Street
Fayetteville,NC28304 		Pediatric Care
25 Westside Medical Care
1463 Pamalee Drive
Fayetteville,NC28303 		Family Practice
26 Cape Fear Valley Internal Medicine
101 Robeson Street Suite 100
Fayetteville,NC28301 		Internal Medicine
27 Women's Health Specialists
300 East McKay Street Suite F
Elizabethtown,NC28337 		OB/GYN
28 Three Rivers Medical Center
580 West McLean Street
St Pauls,NC28384 		Family Practice
29 Bladen Medical Assoc - Bladenboro
106 Fourth Street
Bladenboro,NC28302 		Family Practice
30 Bladen Medical Associates-Dublin
16 3rd Street
Dublin,NC28332 		Family Practice
31 Diabetes & Endocrine Center
101 Robeson Street Suite 405
Fayetteville,NC28301 		Diabetes & Endocrinology Outpatient
32 CFV Pediatric Endocrinology
101 Robeson Street Suite 410
Fayetteville,NC28301 		Diabetes & Endocrinology Outpatient
33 Behavioral Health Clinic
3425 Melrose Road
Fayetteville,NC28304 		Mental Health Outpatient Care
34 Bladen Surgical Specialist
107 East Dunham Street
Elizabethtown,NC28377 		Surgical Specialist
35 Health Pavilion North Pediatric Care
6387 Ramsey Street Suite 240
Fayetteville,NC28311 		Pediatric Care
36 Health Pavilion Hoke Primay Care
300 Medical Pavilion Drive Suite 1
Raeford,NC28376 		Family Practice
37 Hoke OBGYN
300 Medical Pavilion Drive Suite 2
Raeford,NC28376 		Family Practice
38 Hoke Express Care
300 Medical Pavilion Drive Suit 10
Raeford,NC28376 		Express Care
39 CFV Infectious Disease Care
101 Robeson Street Suite 300
Fayetteville,NC28301 		Infectious Disease
40 Cape Fear Valley Neurology
3308 Melrose Road
Fayetteville,NC28304 		Neurology
Schedule H (Form 990) 2018
Page 10
Schedule H (Form 990) 2018
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 6a Cumberland County Hospital System files a community benefit report annually in the state of North Carolina to the North Carolina Hospital Association.
Part I, Line 7, column (f) Exclusions from percent of total expense $250,273,822 in bad debt deductions were offset from revenues in the financial statements. There is no need to adjust the total expense used to calculate the percentages in Part I, Line 7, column (f).
Part I, Line 7 Charity care costs were calculated using a Medicaid specific cost-to-charge ratio (CCR) from the Medicare cost report. A Medicaid CCR was used because the Medicaid population better represents the utilization and acuity of the Charity population that the use of an overall CCR as calcuated in worksheet 2. A CCR was used instead of a cost accounting system because charity, as well as bad debts, represent only a portion of a patient account that is being written off.
Part I, Line 7b, 7c, & 7g A medicaid CCR was used to estimate the Medicaid FFS & Medicaid Managed Care amounts reported on Line 7b, the NC Healthchoice (NC SCHIP program) reported on Line 7c and the Subsidized Health Services reported on Line 7c. The cost accounting system data used did INCLUDE INFORMATION FROM ALL PATIENT SEGMENTS REGARDLESS OF PAYOR.
Part II, Community Building Activities Cumberland County Hospital System, Inc. ("CCHS") continues to engage in coalition building and workforce development activities in the Community. Coalition building promotes the health of the communities it serves by networking with other community agencies to address the health and safety issues of the community. The employees of CCHS utilize their clinical expertise to collaborate with other community agencies and county and state health departments to provide education and other initiatives that benefit the health of people in the community. Workforce development activities include the recruitment of physicians and other health professionals to medical shortage areas.
Part III, Line 2 In the current year, Bad Debts are reported at charges written off in the period plus an allowance for uncollectible accounts based on managment's assessment of historial and expected net collections. See the Line 4 note below for a more detailed description of the methodology used in determining the amount reported on Line 2 per the financial statement footnote related to "provision for uncollecible account". Discounts and payments on patient accounts are reflected in the patient balance prior to accounts being written off to bad debt.
Part III, Line 4 Audited Financial Statement Footnote -The Health system's patient accounts receivable is recorded net of allowances for uncollectible accounts of $113,398,000 at September 30, 2019. The Health System's net patient service revenue is presented net of provision of uncollectible accounts of $192,626,000 for the year ended September 30, 2019.
Part III, Line 8 The cost reported on line 6 are per the Medicare cost report and were calculated based on cost-to-charge ratios. Since the amounts reported on lines 5 & 6 only include Medicare Part A costs and payments, the other Medicare (i.e. - Medicare Pt C, physician services, fee schedule, non-allowable) costs and payments are included in the attached Medicare Reconciliation. $7,767,674 of the Medicare shortfall reported on line 7 should be treated as community benefit since that portion of the shortfall was related to those patients that had Medicaid as a secondary payor and therefore deemed indigent for Medicare bad debt purposes.
Part III, Line 9b If patients are determined to qualify for charity, then the account is treated as charity rather than bad debt.
Part VI, Line 2 The mission of Cape Fear Valley Health System is to strengthen the health and well-being of the greater Cape Fear Valley region through high-quality, compassionate care provided to all who need it. As a community not-for-profit organization, we take seriously our responsibility to invest our resources and energies into understanding and meeting the diverse health care needs of all, and ensure that everyone, regardless of their ability to pay, receives the care they need. The Senior Administrative team serves in various capacities on several local community boards and groups. As members of these various groups, they are able to gain insight to needs of the community. Our community partners are critical to helping us improve the health and well-being of the Cape Fear Valley region. Together, we can combine resources and strengths, positively impacting the greatest number of people. By working closely with the community leaders, we also build a greater sense of community and a shared commitment toward our common goal of improving the community's health. The results help us to determine our short and long term priorities as well as strategies for improving community health. Those community groups and partners CCCC, SRAHEC, CCMAP, Chamber of Commerce, Fayetteville Area PR Alliance, Cumberland County Education Foundation, Communities in Schools of NC, Fort Bragg Regional Alliance, Care Clinic, and the Methodist University Physician Assistant program.
Part VI, Line 3 Uninsured patients are screened at the time of registration for their ability to pay for their health care services. If the patient has no ability to pay and is deemed ineligible for government programs (Medicare, Medicaid, etc.) then they are informed of the Hospital Charity program. They are provided with an application and a listing of the appropriate documents necessary to establish eligibility for the Hospital Charity program. All patients receive a copy of our Charity Care Application accompanying the first billing statement.
Part VI, Line 4 Cumberland County Hospital System, Inc. ("CCHS") doing business as Cape Fear Valley Medical Center ("CFVMC") is the flagship of Cape Fear Valley Health System ("CFVHS"). CFVHS operates a variety of the healthcare facilities from its headquarters in Fayetteville, North Carolina including a tertiary acute care hospital, a long-term acute care hospital, a critical access hospital, an inpatient rehabilitation facility, county emergency medical services, an outpatient psychiatric facility, a detoxification facility, a wellness center, 14 primary care clinics, 16 specialty care clinics, 4 walk-in clinics, and Health Pavilion North, an outpatient complex. Cape Fear Valley Health System serves a six-county service area made up of the five counties contiguous to Cumberland County, NC, which is its Primary Service Area. Per information from the 2012 Estimated Census Data, Cumberland has a population of over 326,000 residents; this was a growth of 6.9% from the 2000 Census Data. Approximately 54.2% of the 326,000 residents in our primary service area are minorities, compared to 35.6% for the state.
Part VI, Line 5 Chronic diseases like diabetes and obesity are increasing within our community. Our facility has opened a diabetes and endocrine clinic to help those patients diagnosed with diabetes. Our healthplex provides both nutritional and exercise programs to help those in the community address the problem of obesity. The goal is to help all residents learn to manage their conditions and live healthier lives by addressing the challenges associated with these conditions. Example of Program at Cape Fear Valley: Cape Fear Valley Health System's "Take Charge of Your Health" Program began as an initiative to close the healthcare gap between African-Americans and non-Hispanic Whites in Cumberland County through public service announcements, health fairs, screenings and speaking engagements. It has since broadened its focus to all of Cumberland County. Darvin Jones is the Coordinator of the "Take Charge of Your Health" Program. He serves on the Board of Directors of Community Health Interventions & Sickle Cell Agency, a non-profit that works with individuals with sickle cell disease, hypertension and diabetes. Darvin is also a member of the Cumberland County Council for Healthy Living, a group assembled by the Health Department, and the Cumberland County Schools School Health Advisory Council. Take Charge of Your Health is affiliated with Eat Smart, Move More North Carolina, a statewide initiative. At Cape Fear Valley Health System, it is important to us to give back to our community. In addition to employee United Way donations and volunteer time, our employees participate in a variety of community service initiatives, to include the Habitat for Humanity and the Friends of Cancer River Walk. Last year our employees gave over $150,000 in donations to various community organizations.
Part VI, Line 6 Cumberland County Hospital System is a stand-alone health care organization and is not a part of an affiliated health care system.
Part VI, Line 7, List of States Receiving Community Benefit Report NC
Schedule H (Form 990) 2018
Additional Data


Software ID:  
Software Version: