Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ALAMANCE REGIONAL MEDICAL CENTER INC
Employer identification number
56-0529994
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ALAMANCE REGIONAL MEDICAL CENTER INC
Employer identification number
56-0529994
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 DOCUMENTS ARE MADE AVAILABLE FOR REVIEW TO EVERY BOARD MEMBER PRIOR TO FILING VIA ACCESS TO A WEB PORTAL.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED, ACCEPTED, AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THIS POLICY, EACH OFFICER AND BOARD MEMBER WILL RECUSE THEMSELVES FROM ANY DISCUSSION AND VOTE FOR WHICH A CONFLICT EXIST FOR THEMSELVES OR THEIR FAMILY. DETERMINATIONS OF WHETHER A CONFLICT EXISTS ARE MADE AT A MANAGEMENT, BOARD MEMBER, OFFICER AND INDIVIDUAL LEVEL. ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD WITHOUT PRESENCE OF THE INTERESTED PARTY.
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD OF DIRECTORS APPOINTS A COMPENSATION COMMITTEE WHICH RETAINS THE SERVICES OF AN INDEPENDENT COMPENSATION CONSULTANT TO GATHER COMPARATIVE DATA WITH WHICH TO MAKE RECOMMENDATIONS TO THE BOARD ON MATTERS OF EXECUTIVE COMPENSATION. SPECIFIC GROUP AND INDIVIDUAL PERFORMANCE INDICATORS ARE ESTABLISHED AND FACTORED IN ALONG WITH COMPARISONS OF COMPARABLE EXTERNAL FACTORS SUCH AS THE SIZE OF THE ORGANIZATION, THE GEOGRAPHIC LOCATION OF THE ORGANIZATION, AND THE EXECUTIVE'S TENURE. THIS PROCESS IS CONDUCTED ANNUALLY FOR THE CEO, CFO, SENIOR VICE PRESIDENTS AND OFFICERS OF THE ORGANIZATION. THE ORGANIZATION FOLLOWS THE PROCESS DESCRIBED IN THE TREASURY REGULATION 4958(6)(C) FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS IN THE REVIEW, APPROVAL, AND DOCUMENTATION OF OFFICER AND SENIOR EXECUTIVE COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION'S FORM 990 IS AVAILABLE FOR PUBLIC INSPECTION AT GUIDESTAR.COM OR IN THE ADMINISTRATIVE OFFICES AT ALAMANCE REGIONAL MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES THESE DOCUMENTS AVAILABLE UPON REQUEST AT THE ADMINISTRATIVE OFFICES.
FORM 990, PART XI, LINE 9:
NET ASSETS RELEASED FROM RESTRICTION -86,942. TRANSFER TO AFFILIATE -10,454,360. INHERENT CONTRIBUTION -2,154,490. EXTRAORDINARY LOSS -5,454,950. EQUITY TRANSFER FROM PARENT 84,772,673.
FORM 990, PART VIII, LINE 2C
THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR IN THIS PROCESS.
SCHEDULE D, PART VI
THE AMOUNTS INCLUDE A FAIR MARKET VALUATION EFFECTIVE 5/1/2013 THAT WAS A RESULT OF THE MERGER WITH CONE HEALTH
SCHEDULE H, LINE 7
ALAMANCE REGIONAL 2012 COMMUNITY BENEFIT INVENTORY TRADITIONAL CHARITY CARE AND OTHER FINANCIAL ASSISTANCE ON BEHALF OF UNINSURED AND LOW-INCOME PERSONS MEANS-TESTED PUBLIC PROGRAMS WITH UNPAID COSTS COMMUNITY HEALTH IMPROVEMENT SERVICES: HEALTH EDUCATION ( CLASSES OR LECTURES, SUPPORT GROUPS, SELF HELP PROGRAMS) HEALTH FAIRS HEALTH SMART AD HEALTHY WOMAN ADVANCE DIRECTIVES ALAMANCE BURLINGTON SCHOOL SYSTEM ALAMANCE COMMUNITY COLLEGE ALAMANCE CARES FREE HIV TESTING ALAMANCE ELDER CARE ALAMAP AMERICAN CANCER SOCIETY RESOURCE ROOM ARMC MED ALERT ARTHRITIS SUPPORT GROUP ASK THE DOCTOR ASSISTANCE TO ENROLLMENT IN PUBLIC PROGRAMS BACK TO SCHOOL HEALTH & SAFETY FAIR BE HEALTHY NOW BIG BROTHER/BIG SISTER CLASSES BCCCP BONE DENSITY SCREENINGS BOOT CAMP FOR NEW DADS BREAST CANCER SUPPORT GROUP BREAST HEALTH EVENTS BREASTFEEDING AND INFANT NUTRITION CARE FOR YOUR HEART CARE QUEST CHARITABLE FOUNDATION CANCER REGISTRY CASH DONATIONS CASH DONATIONS CHARITY EVENTS CBISA GENERAL ACCOUNTING CBISA COMMUNITY BENEFIT EDUCATION AND PLANNING CBISA SOFTWARE CHAMBER OF COMMERCE CLINICAL ENGINEERING SERVICES CLINICAL ROTATIONS RESPIRATORY THERAPY CLINICAL ROTATIONS - CLINICAL PASTORAL EDUCATION CLINICAL ROTATIONS NURSING CLINICAL ROTATIONS OTHER CLINICAL ROTATINS - PHARMACY CLINICAL ROTATIONS PHYSICAL THERAPY COALITION BUILDING SAFE KIDS COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION COMMUNITY BENEFIT OTHER RESOURCES COMMUNITY BOARD AND COMMITTEE LEADERSHIP COMMUNITY EVENT ADVERTISING COMMUNITY FOUNDATION IMPACT ALAMANCE COMMUNITY HEALTH ASSESSMENT COMMUNITY HEALTH IMPROVEMENT ADVOCACY CONSUMER HEALTH LIBRARY CDPD SCREENING DIABETES EDUCATION EACP FRESHSTART SMOKING CESSATION CLASSES FUNDRAISING FOR ARMC CHARITABLE FOUNDATION GENETIC RISK ASSESSMENTS HEALTH FAIRS HEALTHY ALAMANCE HEALTHY WOMAN HEART SMART WOMEN INFANT CPR AND CHILD SAFETY IN KIND DONATIONS FOOD/WATER/REFRESHMENTS IN KIND DONATIONS DEVELOPMENT OF EDUCATION/ADVERTISING MATERIALS IN KIND DONATIONS MEDICAL SUPPLIES AND EQUIPMENT IN KIND DONATIONS MEETING SPACE INFANT CPR AND CHILD SAFETY INSTITUTIONAL REVIEW BOARD JCCRP JDRF KIDS CAN LACTATION CONSULTATIONS LEGS FOR LIFE 5K LEGS FOR LIFE VASCULAR SCREENING MARCH OF DIMES MEBANE BUSINESS ASSOCIATION MENTAL HEALTH CARE AND COORDINATION NCNA CONTINUING EDUCATION NEW LEAF SOCIETY OPEN DOOR CLINIC PATRICIA BYNUM FUND PEDIATRIC ASTHMA CENTER PEDIATRIC ORIENTATION PROGRAM (POP) PHARMACY RESIDENCY PROGRAM PHYSICIAN FEES (NO PAY ED) PHYSICIAN RECRUITMENT PHYSICIAN REFERRAL PHYSICIAN'S ASSISTANT FEASIBILITY TASK FORCE, ELON UNIVERSITY PINK RIBBON FUND PRENATAL EDUCATION PROGRAM PRESS RELEASES FOR SUPPORT GROUPS PROTOCOL PROGRAM RAD-TECH PROGRAM RED CROSS BLOOD DRIVES REHAB STUDENT EDUCATION RELAY FOR LIFE SENIOR ADVANTAGE SEXUAL ASSAULT NURSE EXAMINER PROGRAM (SANE) SKIN CANCER SCREENING SNF/AL HOSPICE COMMUNITY RECEPTION SPEAKERS BUREAU SPECIAL CARE NURSERY REUNION STROKE CARE TEAM ADVISORY STROKE SUPPORT GROUP STUDENT MENTORING PROGRAMS SUBSTANCE ABUSE PREVENTION SUSAN G. KOMEN RACE FOR THE CURE UNDERSTANDING CANCER UNITED WAY WEIGHT LOSS SUPPORT WELL NOW HEALTH CARE SUPPORT SERVICES (ENROLLMENT ASSISTANCE FOR GOVERNMENT-FUNDED HEALTH PROGRAM, INFORMATION AND REFERRAL, TRANSPORTATION TO IMPROVE ACCESS) ONCOLOGY TRANSPORTATION REHABILITATION TRANSPORTATION TAXI AND GAS VOUCHERS FOR LOW-INCOME PERSONS OTHER: LIFELINE RED CROSS BLOOD DRIVES SUPPLIES FOR BOY SCOUT CAMP AND RED CROSS DISASTER PROGRAM C. R. BYRD FUND PATRICIA BYNUM FUND EARL PARDUE CARDIOLOGY FUND INFANTS AND CHILDRENS FUND ONCOLOGY ANGELS FUND PINK RIBBON FUND CHILDHOOD ASTHMA FUND SEXUAL ASSAULT NURSE EXAMINER PROGRAM HEALTH PROFESSIONS EDUCATION CLINICAL ROTATIONS HELPING TO PREPARE FUTURE HEALTH CARE PROFESSIONALS. NUMEROUS INTERNSHIP PROGRAMS NURSE SHADOWING PROGRAMS PHYSICAL THERAPY GRADUATE PROGRAM UNC STUDENTS IN NUCLEAR MEDICINE RAD-TECH PROGRAM UNC SCHOOL OF SOCIAL WORK PROGRAMS AND FINANCIAL ASSISTANCE FOR PHYSICIANS AND MEDICAL STUDENTS, NURSES AND NURSING STUDENTS, PASTORAL CARE RESIDENTS AND INTERNS AND OTHER HEALTH PROFESSIONALS. COMMUNITY HEALTH EDUCATION SCHOLARSHIP PROGRAM FREE IMMUNIZATION FOR ALAMANCE COUNTY NURSING STUDENTS EFFORTS TO GENERATE INTEREST IN THE HEALTH PROFESSIONS, SUCH AS MENTORING PROGRAMS JCCRP- JOINT COMMUNITY CLINICAL RESOURCE PLANNING HIGH SCHOOL STUDENT OBSERVATIONAL EXPERIENCES LOCAL SCHOOL CAREER FAIRS VISITATION PROGRAMS FOR NON-COMMUNITY AND FOREIGN PHYSICIANS SUBSIDIZED HEALTH SERVICES (MUST BE A DISTINCT SERVICE, NOT A SUBSET OF A SERVICE) EXAMPLES: EMERGENCY AND TRAUMA OUTPATIENT SERVICES OUTPATIENT HOSPICE AND PALLIATIVE CARE SERVICES PALLIATIVE CARE ON THE INPATIENT UNIT BEHAVIORAL HEALTH INPATIENT BEHAVIORAL HEALTH RESEARCH ACTIVITIES CLINICAL RESEARCH PHYSICAL THERAPY RESEARCH CANCER CENTER CLINICAL TRIALS COMMUNITY HEALTH RESEARCH HEALTHY ALAMANCE COMMUNITY ASSESSMENT RESEARCH ON INNOVATIVE HEALTH CARE DELIVERY
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.