2021-08-13T14:27:13-05:00 2020-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2019-10-01 561346589 HOSPICE OF SURRY COUNTY INC HOSP 3367892922 401 TECHNOLOGY LANE NO 200 MOUNT AIRY NC 27030 BARRY S DOWELL CFO 3367892922 2021-08-13 1 AMY BIBBY P00445891 8282542254 2021-08-13 2019 2022-09-23 18:48:47Z MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE DENISE WATSON 401 TECHNOLOGY LANE NO 200 MOUNT AIRY NC 27030 29324059 0 X WWW.MTNVALLEYHOSPICE.ORG X 1982 NC TO IMPROVE THE QUALITY OF LIFE FOR THOSE WITH A LIMITED LIFE EXPECTANCY AND THEIR FAMILIES 2 2 394 0 0 0 493882 1804836 27127574 27518983 1045 240 172697 0 27795198 29324059 0 0 0 0 15980829 18297023 0 0 241484 11615013 10937031 27595842 29234054 199356 90005 15792536 16477943 3372495 3967897 12420041 12510046 X THE MISSION OF HOSPICE OF SURRY COUNTY, INC. DBA MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE IS TO IMPROVE THE QUALITY OF LIFE TO THOSE WITH A LIMITED LIFE EXPECTANCY AND THEIR FAMILIES. 0 0 24649500 27519223 MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE STARTED IN 1983 THROUGH A GRASSROOTS EFFORT IN THE BASEMENT OF A CHURCH. TODAY OUR FOUNDERS' LEGACY HAS CARRIED OUT THE MISSION AND VISION OF THE ORGANIZATION SERVING MORE THAN 2,100 HOSPICE PATIENTS PER YEAR, 200 PALLIATIVE CARE PATIENTS AND 300 TRANSITION PATIENTS. WE CONTINUE TO INVEST IN INNOVATIVE PROGRAMS THAT BRING VALUE AND COMFORT TO OUR PATIENTS LIVING WITH TERMINAL, SERIOUS AND ADVANCED ILLNESSES. 2019 WAS A YEAR OF GROWTH IN HOSPICE CARE FOR OUR ORGANIZATION. AVERAGE DAILY CENSUS INCREASED FROM 382 TO 397. DAYS OF CARE INCREASED FROM 126,427 TO 143,428. IN 2019, VOLUNTEER HOURS EXCEEDED THE 5% REQUIREMENT IN BOTH NC AND VA. VOLUNTEER SERVICES PROVIDES SIGNIFICANT COST SAVINGS FOR MVHPC AS INDICATED BELOW. DIRECT PATIENT CARE AND OFFICE ADMINISTRATIVE VOLUNTEERS ALONE PROVIDED APPROXIMATELY 6.1% OF ALL CLINICAL STAFF HOURS IN 2019. VOLUNTEER SERVICES CONTINUES TO FOCUS HEAVILY ON RECRUITMENT AND RETENTION OF FAMILY SERVICES AND ADMINISTRATIVE VOLUNTEERS ACROSS THE SERVICE REGION. OUR STRATEGIC GOALS WERE FOCUSED ON QUALITY OF CARE, GROWTH, MARKET SHARE, IMPROVED FINANCIAL PERFORMANCE IN OUR INPATIENT UNITS, DECREASED EMPLOYEE TURNOVER, FOCUSED AR DAYS MANAGEMENT, IMPROVED LEADERSHIP PERFORMANCE, AND INCREASED PALLIATIVE CARE PROGRAM SUPPORT. 24649500 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 105 0 1 394 1 0 0 0 0 0 0 0 0 0 0 0 0 X 2 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BARRY DOWELL 3367892922 401 TECHNOLOGY LANE STE 200 MOUNT AIRY NC 27030 PAUL HAMMES CHAIRMAN 1.00 X X 0 0 0 CHRIS LUMSDEN VICE CHAIRMAN 1.00 X X 0 0 0 ANDREA HICKLING TREASURER 1.00 X X 0 0 0 DON TRIPPEL SECRETARY 1.00 X X 0 0 0 SYLVIA DENISE WATSON EXECUTIVE DIRECTOR 40.00 X 193980 0 19389 BARRY S DOWELL CFO 40.00 X 113450 0 18864 GLENN D GOLASZEWSKI DIRECTOR OF MEDICAL SERVIC 40.00 X 248193 0 35786 PENELOPE MCDONALD PHYSICIAN 40.00 X 195770 0 18864 TRACEY DOBSON HOSPICE CLINICAL DIRECTOR 40.00 X 130447 0 6522 881840 0 99425 5 0 1 0 CENTRAL CONTINUING CARE 1287 NEWSOME STREET MOUNT AIRY NC 27030 HEALTH CARE 726832 MT AIRY OPERATING COMPANY 542 ALLRED MILL ROAD MOUNT AIRY NC 27030 HEALTH CARE 569736 NORTHERN HOSPITAL OF SURRY COUNTY PO BOX 1101 MOUNT AIRY NC 27030 HEALTH CARE 416658 HEALTHCARE OF ELKIN 700 JOHNSON RIDGE ROAD ELKIN NC 27030 HEALTH CARE 401319 CMG CIT ACQUISITION 655 SOUTH WILLOW STREET MANCHESTER NH 03103 HEALTH CARE 384018 7 1122000 682836 1804836 PATIENT SERVICE REVENUE 623000 24655366 24655366 NURSING HOME SUPPORT 623000 2863617 2863617 27518983 240 240 29324059 27518983 0 240 X 555623 62048 493575 18878 18878 13466849 10943984 2383202 139663 153755 120725 31501 1529 3061947 2404163 627328 30456 1039971 816559 213068 10344 10886 10886 72070 72070 4963561 4727980 210040 25541 202360 202360 1038775 843545 170958 24272 267658 259786 7872 719833 719833 271285 139036 130442 1807 72289 72289 72829 72829 979503 979503 32711 32711 MEDICAL SUPPLIES 2182935 2182935 BAD DEBT 48879 48879 MISCELLANEOUS EXPENSES 1457 1457 29234054 24649500 4343070 241484 3100845 4427101 272494 209164 3702668 3697288 75223 87543 608068 241176 14572595 6868434 7920336 7704161 66313 64007 46589 47503 15792536 16477943 1973954 2764224 1398541 1203673 3372495 3967897 X 11989207 12164372 430834 345674 12420041 12510046 15792536 16477943 90005 0 X X 0 1 X 1 0 X 1083813 1723445 1915726 1452630 1804836 7980450 1083813 1723445 1915726 1452630 1804836 7980450 340357 7640093 126 92 182 1045 240 1685 7982135 118811460 0.95710 0.93360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 910 910 0 PART II-B, LINE 1: A PORTION OF THE ANNUAL MEMBERSHIP DUES TO THE FOLLOWING ORGANIZATIONS WERE USED FOR LOBBYING ACTIVITIES: NHPCO - $860 VIRGINIA ASSOCIATION FOR HOSPICES AND PALLIATIVE CARE - $50 501326 501326 5183736 2530273 2653463 8887533 4338161 4549372 7704161 CAPITAL LEASE OBLIGATION 854819 PROVIDER RELIEF FUND ADVANCE 348854 1203673 X 29324059 0 29324059 0 29324059 29234054 0 29234054 0 29234054 PART X, LINE 2: THE HOSPICE IS A NOT-FOR-PROFIT ORGANIZATION THAT HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAXEXEMPT UNDER INTERNAL REVENUE CODE SECTION 501 (C)(3). THE HOSPICE FOLLOWS THE FASB'S AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE HOSPICE'S FINANCIAL STATEMENTS. THE HOSPICE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2020. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSES NETTED IN REVENUES ON FINANCIALS X X 0 0 0 0 0 0 0 0 0 SYLVIA DENISE WATSON EXECUTIVE DIRECTOR 193980 0 0 0 0 0 18274 0 1115 0 213369 0 0 0 GLENN D GOLASZEWSKI DIRECTOR OF MEDICAL SERVIC 248193 0 0 0 0 0 16922 0 18864 0 283979 0 0 0 PENELOPE MCDONALD PHYSICIAN 195770 0 0 0 0 0 0 0 18864 0 214634 0 0 0 DEBRA TRIPPEL SPOUSE OF OFFICER 18878 COMPENSATION AS EMPLOYEE 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL, INC, AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY CONSISTS OF REPRESENTATIVES APPOINTED BY THE ORGANIZATION'S MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY. FORM 990, PART VI, SECTION A, LINE 7B THE GOVERNING BODY CONSISTS OF REPRESENTATIVES APPOINTED BY THE ORGANIZATION'S MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY. DECISIONS OF THE REPRESENTATIVES ARE SUBJECT TO APPROVAL OF THE MEMBER ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. UPON COMPLETION OF THE FORM 990, THE ORGANIZATION'S MANAGEMENT REVIEWED THE FORM 990. THE FORM 990 WAS THEN PROVIDED TO THE MEMBERS FOR THEIR REVIEW PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF MEMBERS, ADVISORY BOARD AND HOSPICE STAFF SUBMIT A FORM TO DISCLOSE PERSONAL OR FINANCIAL INTERESTS THAT COULD POSSIBLY INTERFERE WITH THEIR DUTIES AND RESPONSIBILITIES TO THE ORGANIZATION. DISCLOSURE FORMS ARE SUBMITTED AT THE TIME OF HIRE OR BOARD APPOINTMENT, ANNUALLY AND/OR WHENEVER A POTENTIAL CONFLICT ARISES. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLOYMENT OR BOARD APPOINTMENT. FORM 990, PART VI, SECTION B, LINE 15 SALARY RANGES ARE ESTABLISHED FOR EACH PAID POSITION IN THE ORGANIZATION. EACH SALARY RANGE HAS A MINIMUM AND MAXIMUM AMOUNT. THE MEMBERS DETERMINE THE SALARY FOR THE EXECUTIVE DIRECTOR, CFO AND MEDICAL DIRECTOR OF THE ORGANIZATION. THE EXECUTIVE DIRECTOR AND CFO DETERMINE THE SALARY RANGES FOR OTHER PAID POSITIONS IN THE ORGANIZATION. SALARY RANGES ARE REVIEWED ANNUALLY AND BENCHMARKED AGAINST INDUSTRY DATA. FORM 990, PART VI, SECTION C, LINE 18 RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART IX, LINE 11G ROOM AND BOARD FEES: PROGRAM SERVICE EXPENSES 3,221,468. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,221,468. MEDICAL FEES: PROGRAM SERVICE EXPENSES 1,175,612. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,175,612. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 330,900. MANAGEMENT AND GENERAL EXPENSES 209,553. FUNDRAISING EXPENSES 5,860. TOTAL EXPENSES 546,313. OTHER EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 487. FUNDRAISING EXPENSES 19,681. TOTAL EXPENSES 20,168. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.