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ObjectId: 202312279349302966 - Submission: 2023-08-15
TIN: 56-0845796
Form
990
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
21
Open to Public Inspection
A
For the 2021 calendar year, or tax year beginning
10-01-2021
, and ending
09-30-2022
B
Check if applicable:
Address change
Name change
Initial return
Final return/terminated
Amended return
Application pending
C
Name of organization
CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Doing business as
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 2000
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
FAYETTEVILLE
,
NC
283022000
D Employer identification number
56-0845796
E Telephone number
(910) 615-4829
G
Gross receipts $
1,261,481,133
F
Name and address of principal officer:
MICHAEL NAGOWSKI CEO
PO BOX 2000
FAYETTEVILLE
,
NC
283022000
I
Tax-exempt status:
501(c)(3)
501(c)
(
)
(insert no.)
4947(a)(1)
or
527
J
Website:
WWW.CAPEFEARVALLEY.COM
H(a)
Is this a group return for
subordinates?
Yes
No
H(b)
Are all subordinates
included?
Yes
No
If "No," attach a list. See instructions.
H(c)
Group exemption number
K
Form of organization:
Corporation
Trust
Association
Other
L
Year of formation:
1956
M
State of legal domicile:
NC
Part I
Summary
1
Briefly describe the organization’s mission or most significant activities:
SEE SCHEDULE O
2
Check this box
3
Number of voting members of the governing body (
Part VI
, line 1a)
........
3
22
4
Number of independent voting members of the governing body (
Part VI
, line 1b)
.....
4
20
5
Total number of individuals employed in calendar year 2021 (
Part V
, line 2a)
......
5
8,417
6
Total number of volunteers (estimate if necessary)
.............
6
149
7a
Total unrelated business revenue from
Part VIII
, column (C), line 12
........
7a
226,606
b
Net unrelated business taxable income from Form 990-T, Part I, line 11
.........
7b
0
Prior Year
Current Year
8
Contributions and grants (
Part VIII
, line 1h)
.........
75,418,689
24,345,333
9
Program service revenue (
Part VIII
, line 2g)
.........
1,111,084,328
1,200,502,235
10
Investment income (
Part VIII
, column (A), lines 3, 4, and 7d )
....
15,810,860
21,160,229
11
Other revenue (
Part VIII
, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)
11,527,958
15,355,488
12
Total revenue—add lines 8 through 11 (must equal
Part VIII
, column (A), line 12)
1,213,841,835
1,261,363,285
13
Grants and similar amounts paid (
Part IX
, column (A), lines 1–3 )
...
285,000
382,750
14
Benefits paid to or for members (
Part IX
, column (A), line 4)
.....
0
0
15
Salaries, other compensation, employee benefits (
Part IX
, column (A), lines 5–10)
516,866,455
535,516,533
16a
Professional fundraising fees (
Part IX
, column (A), line 11e)
.....
0
0
b
Total fundraising expenses (
Part IX
, column (D), line 25)
0
17
Other expenses (
Part IX
, column (A), lines 11a–11d, 11f–24e)
....
624,721,513
675,021,481
18
Total expenses. Add lines 13–17 (must equal
Part IX
, column (A), line 25)
1,141,872,968
1,210,920,764
19
Revenue less expenses. Subtract line 18 from line 12
.......
71,968,867
50,442,521
Beginning of Current Year
End of Year
20
Total assets (
Part X
, line 16)
.............
1,474,757,677
1,447,981,523
21
Total liabilities (
Part X
, line 26)
.............
732,954,971
760,660,924
22
Net assets or fund balances. Subtract line 21 from line 20
.....
741,802,706
687,320,599
Part II
Signature Block
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
2023-08-15
Signature of officer
Date
BRET JOHNSON
CFO
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
Check
if
self-employed
PTIN
P01226647
Firm's name
KPMG LLP
Firm's EIN
13-5565207
Firm's address
500 W 5TH ST STE 800
WINSTONSALEM
,
NC
27101
Phone no.
(336) 275-3394
May the IRS discuss this return with the preparer shown above? (see instructions)
..........
Yes
No
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form
990
(2021)
Page 2
Form 990 (2021)
Page
2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this
Part III
..............
1
Briefly describe the organization’s mission:
CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. EXISTS TO MEET THE HEALTH CARE NEEDS OF THE RESIDENTS OF CUMBERLAND, BLADEN, AND HOKE COUNTIES, AND THE SURROUNDING AREA IN NORTH CAROLINA.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ?
.....................
Yes
No
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services?
...........................
Yes
No
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a
(Code:
) (Expenses $
1,100,396,956
including grants of $
382,750
) (Revenue $
1,200,283,746
)
AS PART OF MEETING THE HEALTH CARE NEEDS OF THE SERVICE AREA, CCHS, INC. ADMITTED 35,285 PATIENTS, PROVIDED 219,006 PATIENT DAYS OF CARE, HAD 185,170 EMERGENCY ROOM VISITS AND HAD OVER 599,000 OUTPATIENT VISITS FOR OTHER SERVICES.
4b
(Code:
) (Expenses $
including grants of $
) (Revenue $
)
4c
(Code:
) (Expenses $
including grants of $
) (Revenue $
)
4d
Other program services (Describe in Schedule O.)
(Expenses $
including grants of $
) (Revenue $
)
4e
Total program service expenses
1,100,396,956
Form
990
(2021)
Page 3
Form 990 (2021)
Page
3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
If "Yes," complete Schedule A
.....................
1
Yes
2
Is the organization required to complete
Schedule B, Schedule of Contributors
? See instructions.
...
2
Yes
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office?
If "Yes," complete Schedule C,
Part I
.............
3
No
4
Section 501(c)(3) organizations.
Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year?
If "Yes," complete Schedule C,
Part II
.........
4
Yes
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19?
If "Yes," complete Schedule C,
Part III
..
5
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts?
If "Yes," complete
Schedule D,
Part I
.........................
6
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures?
If "Yes," complete Schedule D,
Part II
....
7
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets?
If "Yes,"
complete Schedule D,
Part III
..............
8
No
9
Did the organization report an amount in
Part X
, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in
Part X
; or provide credit counseling, debt management, credit repair, or debt negotiation services?
If "Yes," complete Schedule D,
Part IV
..............
9
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments?
If "Yes," complete Schedule D,
Part V
......
10
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in
Part X
, line 10?
If "Yes," complete
Schedule D,
Part VI
.
...................
11a
Yes
b
Did the organization report an amount for investments—other securities in
Part X
, line 12 that is 5% or more of its total assets reported in
Part X
, line 16?
If "Yes," complete Schedule D,
Part VII
.......
11b
No
c
Did the organization report an amount for investments—program related in
Part X
, line 13 that is 5% or more of its total assets reported in
Part X
, line 16?
If "Yes," complete Schedule D,
Part VIII
.......
11c
No
d
Did the organization report an amount for other assets in
Part X
, line 15 that is 5% or more of its total assets reported in
Part X
, line 16?
If "Yes," complete Schedule D,
Part IX
............
11d
Yes
e
Did the organization report an amount for other liabilities in
Part X
, line 25?
If "Yes," complete Schedule D,
Part X
11e
Yes
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)?
If "Yes," complete Schedule D,
Part X
11f
Yes
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete
Schedule D, Parts XI and XII
......................
12a
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year?
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
12b
Yes
13
Is the organization a school described in section 170(b)(1)(A)(ii)?
If "Yes," complete Schedule E
13
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?
.....
14a
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more?
If "Yes," complete Schedule F, Parts I and IV
.........
14b
Yes
15
Did the organization report on
Part IX
, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization?
If “Yes,” complete Schedule F, Parts II and IV
.....
15
No
16
Did the organization report on
Part IX
, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals?
If “Yes,” complete Schedule F, Parts III and IV
...
16
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on
Part IX
, column (A), lines 6 and 11e?
If "Yes," complete Schedule G,
Part I.
See instructions.
....
17
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on
Part VIII
, lines 1c and 8a?
If "Yes," complete Schedule G,
Part II
............
18
No
19
Did the organization report more than $15,000 of gross income from gaming activities on
Part VIII
, line 9a?
If "Yes," complete Schedule G,
Part III
...................
19
No
20a
Did the organization operate one or more hospital facilities?
If "Yes," complete Schedule H
....
20a
Yes
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on
Part IX
, column (A), line 1?
If “Yes,” complete Schedule I, Parts I and II
.....
21
Yes
Form
990
(2021)
Page 4
Form 990 (2021)
Page
4
Part IV
Checklist of Required Schedules
(continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on
Part IX
, column (A), line 2?
If “Yes,” complete Schedule I, Parts I and III
........
22
No
23
Did the organization answer "Yes" to
Part VII
, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees?
If "Yes," complete Schedule J
.......................
23
Yes
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002?
If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a
...............
24a
Yes
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
...
24b
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
...............
24c
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?
...
24d
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations.
Did the organization engage in an excess benefit transaction with a disqualified person during the year?
If "Yes," complete Schedule L,
Part I
....
25a
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ?
If "Yes," complete Schedule L,
Part I
.......................
25b
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons?
If "Yes," complete Schedule L,
Part II
...........
26
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L,
Part III
.........................
27
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L,
Part IV
instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor?
If "Yes," complete Schedule L,
Part IV
......................
28a
No
b
A family member of any individual described in line 28a?
If "Yes," complete Schedule L,
Part IV
.....
28b
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b?
If "Yes," complete Schedule L,
Part IV
.....................
28c
No
29
Did the organization receive more than $25,000 in non-cash contributions?
If "Yes," complete Schedule M
..
29
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions?
If "Yes," complete Schedule M
.................
30
No
31
Did the organization liquidate, terminate, or dissolve and cease operations?
If "Yes," complete Schedule N,
Part I
31
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?
If "Yes," complete Schedule N,
Part II
........................
32
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3?
If "Yes," complete Schedule R,
Part I
............
33
Yes
34
Was the organization related to any tax-exempt or taxable entity?
If "Yes," complete Schedule R,
Part II
, III, or IV, and
Part V
, line 1
.........................
34
Yes
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)?
If "Yes," complete Schedule R,
Part V
, line 2
...
35b
Yes
36
Section 501(c)(3) organizations.
Did the organization make any transfers to an exempt non-charitable related organization?
If "Yes," complete Schedule R,
Part V
, line 2
.............
36
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes?
If "Yes," complete Schedule R,
Part VI
37
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for
Part VI
, lines 11b and 19?
Note.
All Form 990 filers are required to complete Schedule O.
............
38
Yes
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this
Part V
...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable
..
1a
414
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable
.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?
..................
1c
Yes
Form
990
(2021)
Page 5
Form 990 (2021)
Page
5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
(continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return
..................
2a
8,417
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note.
If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?
...
3a
Yes
b
If “Yes,” has it filed a Form 990-T for this year?
If “No” to line 3b, provide an explanation in Schedule O
...
3b
Yes
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
..
4a
Yes
b
If "Yes," enter the name of the foreign country:
CJ
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
..
5a
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T?
............
5c
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?
...
6a
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?
......................
6b
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?
....................
7a
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?
.....
7b
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?
.........................
7c
No
d
If "Yes," indicate the number of Forms 8282 filed during the year
....
7d
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
..
7f
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
......................
7g
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
..........................
7h
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?
........
8
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?
........
9a
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?
...
9b
10
Section 501(c)(7) organizations.
Enter:
a
Initiation fees and capital contributions included on
Part VIII
, line 12
...
10a
b
Gross receipts, included on Form 990,
Part VIII
, line 12, for public use of club facilities
10b
11
Section 501(c)(12) organizations.
Enter:
a
Gross income from members or shareholders
.........
11a
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.)
..........
11b
12a
Section 4947(a)(1) non-exempt charitable trusts.
Is the organization filing Form 990 in lieu of Form 1041?
12a
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
.........
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans
....
13b
c
Enter the amount of reserves on hand
............
13c
14a
Did the organization receive any payments for indoor tanning services during the tax year?
.....
14a
No
b
If "Yes," has it filed a Form 720 to report these payments?
If "No," provide an explanation in Schedule O
..
14b
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year?
....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
Yes
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
..
If "Yes," complete Form 4720, Schedule O.
16
No
17
Section 501(c)(21) organizations.
Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953?
..
If "Yes," complete Form 6069.
17
Form
990
(2021)
Page 6
Form 990 (2021)
Page
6
Part VI
Governance, Management, and Disclosure.
For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines
8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this
Part VI
..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
22
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
20
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee?
.................
2
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person?
.
3
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
.
4
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets?
.
5
No
6
Did the organization have members or stockholders?
................
6
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body?
....................
7a
Yes
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body?
...................
7b
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body?
.......................
8a
Yes
b
Each committee with authority to act on behalf of the governing body?
............
8b
Yes
9
Is there any officer, director, trustee, or key employee listed in
Part VII
, Section A, who cannot be reached at the organization’s mailing address?
If "Yes," provide the names and addresses in Schedule O
.......
9
No
Section B. Policies
(
This Section B requests information about policies not required by the Internal Revenue Code.
)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates?
............
10a
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
............................
11a
Yes
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990.
.....
12a
Did the organization have a written conflict of interest policy?
If "No," go to line 13
.......
12a
Yes
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
..........................
12b
Yes
c
Did the organization regularly and consistently monitor and enforce compliance with the policy?
If "Yes," describe on Schedule O how this was done
...................
12c
Yes
13
Did the organization have a written whistleblower policy?
...............
13
Yes
14
Did the organization have a written document retention and destruction policy?
.........
14
Yes
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official
...........
15a
Yes
b
Other officers or key employees of the organization
................
15b
Yes
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year?
......................
16a
Yes
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements?
............
16b
No
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
Own website
Another's website
Upon request
Other (explain in Schedule O)
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
BRET JOHNSON
PO BOX 2000
FAYETTEVILLE
,
NC
283022000
(910) 615-4829
Form
990
(2021)
Page 7
Form 990 (2021)
Page
7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this
Part VII
..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a
Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
List all of the organization’s
current
officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.
List all of the organization’s
current
key employees, if any. See the instructions for definition of "key employee."
List the organization’s five
current
highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.
List all of the organization’s
former
officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.
List all of the organization’s
former directors or trustees
that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.
See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
(1)
CHUKWUEMEKA CHIMA MD
......................................................................
CHIEF OF STAFF & PHYSICIAN
5.00
.................
0.00
X
X
56,250
0
0
(2)
MYRON STICKLAND
......................................................................
TRUSTEE
2.00
.................
0.00
X
12,800
0
0
(3)
GLENN ADAMS
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(4)
AFUA ARHIN
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(5)
SANJAY SHAH
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(6)
TONI STEWART
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(7)
TAMMY S THURMAN
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(8)
PAMELA S STORY
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(9)
SHANNON MATTHEWS
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(10)
ALICIA MARKS
......................................................................
BOARD VICE CHAIR
2.00
.................
0.00
X
X
0
0
0
(11)
GENE LEWIS
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(12)
LARRY L LANCASTER
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(13)
JIMMY KEEFE
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(14)
MICHAEL JONES
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(15)
GIRUM FEYISSA MD
......................................................................
VICE CHEIF OF STAFF
2.00
.................
0.00
X
X
0
0
0
(16)
MARSHALL FAIRCLOTH
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
(17)
CHARLES EVANS
......................................................................
TRUSTEE
2.00
.................
0.00
X
0
0
0
Form
990
(2021)
Page 8
Form 990 (2021)
Page
8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(continued)
(A)
Name and title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)
(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(F)
Estimated amount of other compensation from the organization and related organizations
(18)
JEANNETTE COUNCIL
........................................................................
TRUSTEE
2.00
.......................
0.00
X
0
0
0
(19)
AMY CANNON
........................................................................
TRUSTEE
2.00
.......................
0.00
X
0
0
0
(20)
BRADLEY BROUSSARD MD
........................................................................
BOARD CHAIR & PHYSICIAN
2.00
.......................
0.00
X
X
0
0
0
(21)
MICHAEL BOOSE
........................................................................
TRUSTEE
2.00
.......................
0.00
X
0
0
0
(22)
RYAN AUL
........................................................................
TRUSTEE
2.00
.......................
0.00
X
0
0
0
(23)
MICHAEL NAGOWSKI
........................................................................
CEO
55.00
.......................
0.00
X
1,518,665
0
18,594
(24)
DANIEL WEATHERLY
........................................................................
COO
55.00
.......................
0.00
X
909,932
0
17,333
(25)
SAMUEL FLEISHMAN
........................................................................
CMO
55.00
.......................
0.00
X
736,972
0
14,478
(26)
BRET JOHNSON
........................................................................
CFO
55.00
.......................
0.00
X
368,408
0
14,573
(27)
MELISSA STAMATES
........................................................................
PHYSICIAN
40.00
.......................
0.00
X
877,982
0
14,000
(28)
PRITHVI NARAYAN
........................................................................
PHYSICIAN
40.00
.......................
0.00
X
834,139
0
14,619
(29)
MICHAEL ZAPPA
........................................................................
MEDICAL DIRECTOR
55.00
.......................
0.00
X
834,294
0
11,228
(30)
ROBERT MAUGHAN MD
........................................................................
PHYSICIAN
40.00
.......................
0.00
X
1,221,527
0
12,889
(31)
CHARLES HAWORTH MD
........................................................................
PHYSICIAN
40.00
.......................
0.00
X
1,462,258
0
19,236
(32)
SANDRA WILLIAMS
........................................................................
CFO
55.00
.......................
0.00
X
442,921
0
4,539
1b
Sub-Total
................
c
Total from continuation sheets to
Part VII
, Section A
....
d
Total (add lines 1b and 1c)
...........
9,276,148
0
141,489
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization
843
Yes
No
3
Did the organization list any
former
officer, director or trustee, key employee, or highest compensated employee on line 1a?
If "Yes," complete Schedule J for such individual
..............
3
Yes
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000?
If "Yes," complete Schedule J for such
individual
...........................
4
Yes
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization?
If "Yes," complete Schedule J for such person
........
5
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
AYA HEALTHCARE INC
PO BOX 123519
DALLAS
,
TX
75312
CONTRACT LABOR
24,853,973
AMN HEALTHCARE INC
4441 COLLECTIONS CENTER DR
CHICAGO
,
IL
60693
CONTRACT LABOR
21,611,943
MB KAHN CONSTRUCTION CO
PO BOX 1179
COLUMBIA
,
SC
29202
CONSTRUCTION
15,776,201
ARAMARK DALLAS LOCKBOX
PO BOX 978839
DALLAS
,
TX
75397
MANAGEMENT FEES
9,888,677
PROLINK HEALTHCARE LLC
PO BOX 772516
DETROIT
,
MI
482772516
CONTRACT LABOR
4,192,480
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization
140
Form
990
(2021)
Page 9
Form 990 (2021)
Page
9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this
Part VIII
.............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512 - 514
1a
Federated campaigns
..
1a
b
Membership dues
..
1b
c
Fundraising events
..
1c
d
Related organizations
1d
210,110
e
Government grants (contributions)
1e
20,381,917
f
All other contributions, gifts, grants, and similar amounts not included above
1f
3,753,306
g
Noncash contributions included in lines 1a - 1f:$
1g
h Total.
Add lines 1a-1f
.......
24,345,333
Business Code
2a
PATIENT SERVICE REVENU
900099
1,147,745,360
1,147,745,360
b
ANCILLARY MEDICAL SERV
900099
52,751,249
52,532,760
218,489
c
EDUCATION/OUTREACH
611710
5,626
5,626
d
e
f
All other program service revenue.
g
Total.
Add lines 2a–2f
.....
1,200,502,235
3
Investment income (including dividends, interest, and other
similar amounts)
......
14,259,168
8,117
14,251,051
4
Income from investment of tax-exempt bond proceeds
5
Royalties
...........
(ii) Personal
(i) Real
6a
Gross rents
313,083
6a
b
Less: rental expenses
117,848
6b
c
Rental income or (loss)
195,235
6c
d
Net rental income or (loss)
.......
195,235
195,235
(ii) Other
(i) Securities
7a
Gross amount from sales of assets other than inventory
6,901,061
7a
b
Less: cost or other basis and sales expenses
0
7b
c
Gain or (loss)
6,901,061
7c
d
Net gain or (loss)
.........
6,901,061
6,901,061
8a
Gross income from fundraising events (not including $
of contributions reported on line 1c).
See
Part IV
, line 18
....
8a
b
Less: direct expenses
...
8b
c
Net income or (loss) from fundraising events
..
9a
Gross income from gaming activities.
See
Part IV
, line 19
...
9a
b
Less: direct expenses
...
9b
c
Net income or (loss) from gaming activities
..
10a
Gross sales of inventory, less
returns and allowances
..
10a
b
Less: cost of goods sold
..
10b
c
Net income or (loss) from sales of inventory
..
Business Code
Miscellaneous Revenue
11a
CAFETERIA AND PARKING
900099
3,983,510
3,983,510
b
PURCHASE REBATES, DISC
812900
1,393,424
1,393,424
c
d
All other revenue
....
9,783,319
9,783,319
e
Total.
Add lines 11a–11d
......
15,160,253
12
Total revenue.
See instructions
.....
1,261,363,285
1,200,283,746
226,606
36,507,600
Form
990
(2021)
Page 10
Form 990 (2021)
Page
10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Check if Schedule O contains a response or note to any line in this
Part IX
..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of
Part VIII
.
(A)
Total expenses
(B)
Program service
expenses
(C)
Management and
general expenses
(D)
Fundraising
expenses
1
Grants and other assistance to domestic organizations and domestic governments. See
Part IV
, line 21
....
382,750
382,750
2
Grants and other assistance to domestic individuals. See
Part IV
, line 22
...........
3
Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See
Part IV
, lines 15 and 16.
.............
4
Benefits paid to or for members
.......
5
Compensation of current officers, directors, trustees, and key employees
...........
4,115,466
4,115,466
6
Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B)
.........
7
Other salaries and wages
........
449,286,863
408,663,598
40,623,265
8
Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions)
....
13,078,710
13,078,710
9
Other employee benefits
.......
39,433,448
39,397,395
36,053
10
Payroll taxes
...........
29,602,046
26,836,061
2,765,985
11
Fees for services (non-employees):
a
Management
......
10,708,246
10,698,547
9,699
b
Legal
.........
1,993,738
1,993,738
c
Accounting
...........
478,423
478,423
d
Lobbying
...........
e
Professional fundraising services.
See
Part IV
, line 17
f
Investment management fees
......
g
Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)
29,599,093
18,713,260
10,885,833
12
Advertising and promotion
....
994,816
986,790
8,026
13
Office expenses
.......
4,652,983
4,303,103
349,880
14
Information technology
......
18,920,523
23,826
18,896,697
15
Royalties
..
16
Occupancy
...........
9,169,059
9,169,059
17
Travel
............
522,595
483,434
39,161
18
Payments of travel or entertainment expenses for any federal, state, or local public officials
.
19
Conferences, conventions, and meetings
....
673,989
384,891
289,098
20
Interest
...........
10,170,712
9,352,211
818,501
21
Payments to affiliates
.......
22
Depreciation, depletion, and amortization
..
35,450,253
28,996,092
6,454,161
23
Insurance
...
2,067,645
610,135
1,457,510
24
Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a
MEDICAL & OTHER SUPPLIE
213,261,039
211,566,770
1,694,269
b
BAD DEBT EXPENSE
150,802,069
150,802,069
c
CONTRACT LABOR
104,137,934
100,383,497
3,754,437
d
REPAIRS & MAINTENANCE
17,850,069
14,565,593
3,284,476
e
All other expenses
63,568,295
50,999,165
12,569,130
25
Total functional expenses.
Add lines 1 through 24e
1,210,920,764
1,100,396,956
110,523,808
0
26
Joint costs.
Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation.
Check here
if following SOP 98-2 (ASC 958-720).
Form
990
(2021)
Page 11
Form 990 (2021)
Page
11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this
Part IX
..............
(A)
Beginning of year
(B)
End of year
1
Cash–non-interest-bearing
........
270,882,682
1
159,009,111
2
Savings and temporary cash investments
.........
20,250,854
2
251,411
3
Pledges and grants receivable, net
......
3
4
Accounts receivable, net
.............
95,221,475
4
129,366,631
5
Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons
.......
5
6
Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B)
...
6
7
Notes and loans receivable, net
...........
7
8
Inventories for sale or use
............
15,785,059
8
15,322,189
9
Prepaid expenses and deferred charges
......
6,804,471
9
8,624,575
10a
Land, buildings, and equipment: cost or other basis. Complete
Part VI
of Schedule D
10a
1,005,993,326
b
Less: accumulated depreciation
10b
529,892,339
439,311,078
10c
476,100,987
11
Investments—publicly traded securities
.
477,701,598
11
395,309,680
12
Investments—other securities. See
Part IV
, line 11
.....
12
13
Investments—program-related. See
Part IV
, line 11
..
13
14
Intangible assets
...............
14
15
Other assets. See
Part IV
, line 11
...........
148,800,460
15
263,996,939
16
Total assets.
Add lines 1 through 15 (must equal line 33)
...
1,474,757,677
16
1,447,981,523
17
Accounts payable and accrued expenses
.....
150,560,537
17
82,967,262
18
Grants payable
...
18
19
Deferred revenue
.........
7,086,730
19
4,376,547
20
Tax-exempt bond liabilities
.........
152,000,000
20
293,177,000
21
Escrow or custodial account liability.
Complete
Part IV
of Schedule D
21
22
Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons
.........
22
23
Secured mortgages and notes payable to unrelated third parties
..
188,237,317
23
179,458,904
24
Unsecured notes and loans payable to unrelated third parties
..
24
25
Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24).
Complete
Part X
of Schedule D
235,070,387
25
200,681,211
26
Total liabilities.
Add lines 17 through 25
..
732,954,971
26
760,660,924
Organizations that follow FASB ASC 958,
check here
and complete lines 27, 28, 32, and 33.
27
Net assets without donor restrictions
..........
27
28
Net assets with donor restrictions
...........
28
Organizations that do not follow FASB ASC 958,
check here
and complete lines 29 through 33.
29
Capital stock or trust principal, or current funds
.....
0
29
0
30
Paid-in or capital surplus, or land, building or equipment fund
...
0
30
0
31
Retained earnings, endowment, accumulated income, or other funds
741,802,706
31
687,320,599
32
Total net assets or fund balances
...........
741,802,706
32
687,320,599
33
Total liabilities and net assets/fund balances
........
1,474,757,677
33
1,447,981,523
Form
990
(2021)
Page 12
Form 990 (2021)
Page
12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this
Part XI
..............
1
Total revenue (must equal
Part VIII
, column (A), line 12)
............
1
1,261,363,285
2
Total expenses (must equal
Part IX
, column (A), line 25)
............
2
1,210,920,764
3
Revenue less expenses. Subtract line 2 from line 1
..............
3
50,442,521
4
Net assets or fund balances at beginning of year (must equal
Part X
, line 32, column (A))
..
4
741,802,706
5
Net unrealized gains (losses) on investments
...............
5
-108,924,629
6
Donated services and use of facilities
.................
6
7
Investment expenses
.....................
7
8
Prior period adjustments
.....................
8
4,000,001
9
Other changes in net assets or fund balances (explain in Schedule O)
........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal
Part X
, line 32, column (B))
10
687,320,599
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this
Part XII
.............
Yes
No
1
Accounting method used to prepare the Form 990:
Cash
Accrual
Other
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
Separate basis
Consolidated basis
Both consolidated and separate basis
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
Separate basis
Consolidated basis
Both consolidated and separate basis
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
b
If "Yes," did the organization undergo the required audit or audits?
If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
Form
990
(2021)
Form 990 (2021)
Additional Data
Software ID:
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Form 990, Special Condition Description:
Special Condition Description