2020-01-31T08:08:57-06:00 2019-09-30 560570567 D M J & CO PLLC 703 GREEN VALLEY ROAD SUITE 201 GREENSBORO NC 27408 990 2019-01-01 561376378 HOSPICE OF RANDOLPH COUNTY INC HOSP 3366729300 416 VISION DRIVE ASHEBORO NC 27203 RHONDA BURCH MOFFITT CEO/PRESIDENT 3366729300 2020-01-27 1 SHIRLEY WEIGEL CPA P00838276 3362759886 174.46.138.125 2020-01-27 09:57:31 ES P 08F15AD488F4D83E28A3AC3EE7F094E468C5D467 D9095E370FDBF92A9D37A5E946780EE67026DC4C 2019 2020-11-19 02:30:22Z X RHONDA BURCH MOFFITT 416 VISION DRIVE ASHEBORO NC 27203 6015297 0 X WWW.HOSPICEOFRANDOLPH.ORG X 1981 NC MISSION: HOSPICE OF RANDOLPH COUNTY SERVES AS AN EDUCATION LEADER WHILE PROMOTING QUALITY OF LIFE AND SUPPORTING PATIENTS AND THEIR FAMILIES IN PREPARING FOR COMPLETION OF LIFE. ACTIVITIES: TO PROVIDE SUPPORT AND EMOTIONAL ASSISTANCE TO PATIENTS AND THEIR FAMILIES WITH PAIN MANAGEMENT, SYMPTOM CONTROL, AND REHABILITATION DURING EMOTIONAL CRISIS RELATED TO END-OF-LIFE CARE. SPECIAL THERAPIES, ACUTE CARE, CONTINUOUS CARE, AND RESPITE AND ROUTINE HOME CARE ARE REIMBURSED BY REVENUE RESOURCES ALONG WITH SOME SUPPLIES, DURABLE MEDICAL EQUIPMENT, AND DRUGS. SERVICES ARE DELIVERED UNDER A HOLISTIC PLAN OF CARE. X 12 11 136 55 0 0 166545 82754 8084053 5796466 16294 43039 133364 84037 8400256 6006296 0 0 0 0 5414773 4205907 0 0 57821 2094772 1640478 7509545 5846385 890711 159911 11873792 0 643358 0 11230434 0 HOSPICE OF RANDOLPH COUNTY SERVES AS AN EDUCATIONAL LEADER WHILE PROMOTING QUALITY OF LIFE AND SUPPORTING PATIENTS AND THEIR FAMILIES IN PREPARING FOR COMPLETION OF LIFE. 0 0 4030124 5796466 PROVIDE SUPPORT AND EMOTIONAL ASSISTANCE TO PATIENTS AND THEIR FAMILIES WITH PAIN MANAGEMENT, SYMPTOM CONTROL, REHABILITATION AND EMOTIONAL CRISIS. SPECIAL THERAPIES, ACUTE CARE, CONTINUOUS CARE, RESPITE AND ROUTINE HOME CARE ARE REIMBURSED BY THE ABOVE REVENUE RESOURCES ALONG WITH SOME SUPPLIES, DURABLE MEDICAL EQUIPMENT, AND DRUGS. SERVICES ARE DELIVERED UNDER A HOLISTIC PLAN OF CARE. DURING 2019, HOSPICE OF RANDOLPH COUNTY PROVIDED 34,972 DAYS OF PATIENT CARE FOR ITS 739 HOSPICE AND KIDS PATH PATIENTS. 4030124 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 46 0 136 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X TRACY WAGNER 3366729300 416 VISION DRIVE ASHEBORO NC 27203 JOHN S ROGERS DIRECTOR 1.00 X 0 0 0 SANDRA J ALLEN DIRECTOR 1.00 X 0 0 0 CURT LORIMER DIRECTOR 1.00 X 0 0 0 BEN C MORGAN DIRECTOR 1.00 X 0 0 0 BRIAN MUNLEY DIRECTOR 1.00 X 0 0 0 STANLEY BECK DIRECTOR 1.00 X 0 0 0 VICKIE GALLIMORE DIRECTOR 1.00 X 0 0 0 STEVE HEADLEE OD DIRECTOR 1.00 X 0 0 0 H DEAN SEXTON DIRECTOR 1.00 X 0 0 0 RHONDA BURCH MOFFITT CEO/PRESIDENT 40.00 X 108204 0 11904 TRACY B WAGNER CFO 40.00 X 57904 0 22705 RICK CRAWFORD TREASURER 1.00 X 0 0 0 AMY WILLIAMS SECRETARY 1.00 X 0 0 0 BILLIE VUNCANNON DIRECTOR - EMERITUS 1.00 X 0 0 0 RHONDA TROLLINGER BOARD CHAIR 1.00 X 0 0 0 PATRICIA SHEVILIN MD ASSOCIATE MEDICAL DIRECTOR 40.00 X 133813 0 10236 299921 0 44845 3 0 0 0 ADVANCED HOMECARE PO BOX 890492 CHARLOTTE NC 27289 MEDICAL SUPPLIES 392304 CIGNA HEALTHCARE 1700 LINCOLN ST LOWER LEVEL 3 DENVER CO 80274 EMPLOYEE INSURANCE COVERAGE 321369 CLAPP'S CONVALESCENT NURSING HOME 500 MOUNTAIN TOP DRIVE ASHEBORO NC 27203 PATIENT CARE FACILITY 307540 ENCLARA PHARMACIA 1601 CHERRY ST SUITE 1700 PHILADELPHIA PA 19102 PATIENT MEDICATIONS 193654 GRAYBRIER NURSING CENTER 116 LANE DR TRINITY NC 27370 PATIENT CARE FACILITY 184866 5 5918 76836 82754 MEDICARE PAYMENTS 621610 5535871 5535871 PRIVATE INSURANCE 621610 232494 232494 MEDICAID PAYMENTS 621610 28101 28101 5796466 43039 43039 93038 9001 84037 84037 6006296 5796466 0 127076 510720 510720 3021230 2568589 404811 47830 63498 56953 5473 1072 359024 279468 74296 5260 251435 194420 53356 3659 22863 22863 71043 71043 125633 116634 8999 174289 174289 23782 23782 MEDICINES AND DRUGS 362618 362618 DURABLE MEDICAL EQUIPME 181246 181246 PROFESSIONAL FEES 110229 110229 MEDICAL AND OFFICE SUPP 90705 73700 17005 478070 196496 281574 5846385 4030124 1758440 57821 2107912 0 4050145 0 0 1042593 0 0 0 0 0 126203 0 0 0 4365415 0 0 0 0 0 181524 0 11873792 0 643358 0 643358 0 X 11230434 0 11230434 0 11873792 0 X 159911 5107 -11395452 X 0 0 0 X 110449 153897 146549 166545 82754 660194 110449 153897 146549 166545 82754 660194 89428 570766 4109 5206 6650 23344 48146 87455 747649 37497720 0.76340 0.74300 X PART II, SHORT YEAR EXPLANATION: HOSPICE OF RANDOLPH COUNTY, INC. MERGED WITH AND INTO HOSPICE OF THE PIEDMONT ON OCTOBER 1, 2019. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 X PART III, LINE 4: THE ORGANIZATION HAS VARIOUS WORKS OF ART LOCATED AT ITS TWO LOCATIONS ON VISION DRIVE. THE ADMINISTRATIVE BUILDING HOUSES A FRAMED INK PRINT DONATED TO THE ORGANIZATION, AND ITS VALUE IS STATED AT $22,000 (WHICH WAS THE FAIR MARKET VALUE AT THE TIME OF THE DONATION). IN ADDITION, THE NEW INPATIENT FACILITY HOUSES SUCH PURCHASED WORKS OF ART AS FRAMED ORIGINAL PAINTINGS AND PHOTOGRAPHY, LARGE DECORATIVE POTTERY PIECES, MOUNTED MUSEUM-QUALITY HOMEMADE QUILTS, A METAL SCULPTURE, AND AN ORIGINAL HAND-PAINTED WALL MURAL. IN THE AGGREGATE, THESE PARTICULAR ITEMS ARE STATED AT THE $20,964 PRICE PAID BASED ON ARMS-LENGTH TRANSACTIONS. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, HAS NO PROVISION FOR INCOME TAXES. THE ORGANIZATION ACCOUNTS FOR UNCERTAIN INCOME TAX POSITIONS BY PRESCRIBING A MINIMUM PROBABILITY THRESHOLD A TAX POSITION MUST MEET BEFORE A FINANCIAL STATEMENT INCOME TAX BENEFIT IS RECOGNIZED. THE MINIMUM THRESHOLD IS DEFINED AS A TAX POSITION, BASED SOLELY ON ITS TECHNICAL MERITS, THAT WOULD MORE LIKELY THAN NOT BE SUSTAINED UPON EXAMINATION BY THE RELEVANT TAX AUTHORITY WITH KNOWLEDGE OF THE SAME FACTS. THE TAX BENEFIT TO BE RECOGNIZED IS MEASURED AS THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED UPON ULTIMATE RESOLUTION. BASED ON ALL KNOWN FACTS AND CIRCUMSTANCES AND CURRENT TAX LAW, THE ORGANIZATION BELIEVES THE TOTAL AMOUNT OF UNCERTAIN INCOME TAX POSITION LIABILITIES AND RELATED ACCRUED INTEREST ARE NOT MATERIAL TO ITS FINANCIAL POSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED WITH REVENUE ON TAX RETURN PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED WITH REVENUE ON TAX RETURN ANNUAL AUCTION BBQ 31501 31501 1392 HOLLY RIDGE CHARITY GOLF CLASSIC 19310 19310 169 7 26606 26606 25 77417 77417 1586 1586 75831 X X X 0 0 0 0 0 0 0 0 0 PART I, LINE 3 CEO/DIRECTOR COMPENSATION IS REVIEWED AND APPROVED ANNUALLY BY THE COMPENSATION COMMITTEE WHICH CONSISTS OF THREE BOARD MEMBERS APPOINTED BY THE BOARD CHAIR FOR DETERMINATION OF THIS EMPLOYEE'S COMPENSATION AMOUNT, HRC REFERS TO THE HOSPICE & HOME HEALTH SALARY & BENEFITS REPORT THAT IS PUBLISHED EVERY TWO YEARS BY THE HOSPITAL & HEALTHCARE COMPENSATION SERVICE (IN COOPERATION WITH THE NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE). IN ADDITION, A REVIEW IS MADE OF BENCHMARKING DATA FROM MULTI-VIEW INC.'S HOSPICE COMPENSATION SURVEY AS WELL AS COMPARABLE SALARIES ON PUBLICLY-ACCESSIBLE FORM 990S SUBMITTED BY HOSPICES OF OUR SIMILAR SIZE AND SCOPE. THEN THE COMPENSATION COMMITTEE MAKES THE RECOMMENDATION TO THE BOARD FOR APPROVAL. ALL FIXED ASSETS, INCLUDING BUILDING, LAND, FURNITURE AND FIXTURES, AND EQUIPMENT, WERE TRANSFERRED TO THE MERGED COMPANIES. 2019-09-30 4260335 RECORDED AT BOOK VALUE OF ASSETS 0 0 0 0 0 0 0 0 0 PART I, LINE 2E: PERSON(S) INVOLVED: RHONDA MOFFITT, SANDRA ALLEN, STAN BECK, RICK CRAWFORD, VICKIE GALLIMORE, STEVE HEADLEE, CURT LORIMER, BEN MORGAN, BRIAN MUNLEY, DEAN SEXTON, RHONDA TROLLINGER, AMY WILLIAMS PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: THE BOARD OF DIRECTORS WILL CONTINUE TO SERVE AS BOARD OF DIRECTORS AFTER THE MERGER OF HOSPICE OF RANDOLPH COUNTY, INC. AND HOSPICE OF THE PIEDMONT, INC. FORM 990, PART VI, SECTION A, LINE 2 SEVERAL OF THE BOARD MEMBERS DO BUSINESS WITH HOSPICE OF RANDOLPH COUNTY AND WITH EACH OTHER. FOR EXAMPLE, THERE ARE DOCTORS ON THE BOARD WHO MAY REFER THEIR PATIENTS FOR HOSPICE CARE WHEN APPROPRIATE. BOARD MEMBERS ARE PROHIBITED FROM VOTING ON ANY ISSUES WHERE A POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 11B BOARD MEMBERS REVIEW A DRAFT FORM OF THE 990 PRIOR TO FILING. THE REVIEW EITHER OCCURS DURING A BOARD MEETING OR THE RETURN IS SENT TO THE BOARD MEMBERS INDIVIDUALLY. FILING DOES NOT OCCUR UNTIL ALL BOARD MEMBERS HAVE INDICATED THEIR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C INDIVIDUALS IN CERTAIN SENSITIVE POSITIONS WHO MAKE SUBSTANTIAL AND FREQUENT DECISIONS AFFECTING THE INTERESTS OF HRC ARE REQUIRED TO COMPLETE AND SIGN AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE FORMS ARE DISTRIBUTED AND COLLECTED BY THE CORPORATE COMPLIANCE OFFICER (CCO). THE CCO REVIEWS WITH THE CEO/PRESIDENT ANY DISCLOSED CONFLICTS TO DETERMINE WHETHER DISQUALIFICATION FROM CERTAIN DECISIONS IS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 CEO/DIRECTOR COMPENSATION IS REVIEWED AND APPROVED ANNUALLY BY THE COMPENSATION COMMITTEE WHICH CONSISTS OF THREE BOARD MEMBERS APPOINTED BY THE BOARD CHAIR FOR DETERMINATION OF THIS EMPLOYEE'S COMPENSATION AMOUNT, HRC REFERS TO THE HOSPICE & HOME HEALTH SALARY & BENEFITS REPORT THAT IS PUBLISHED EVERY TWO YEARS BY THE HOSPITAL & HEALTHCARE COMPENSATION SERVICE (IN COOPERATION WITH THE NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE). IN ADDITION, A REVIEW IS MADE OF BENCHMARKING DATA FROM MULTI-VIEW INC.'S HOSPICE COMPENSATION SURVEY AS WELL AS COMPARABLE SALARIES ON PUBLICLY-ACCESSIBLE FORM 990S SUBMITTED BY HOSPICES OF OUR SIMILAR SIZE AND SCOPE. THEN THE COMPENSATION COMMITTEE MAKES THE RECOMMENDATION TO THE BOARD FOR APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 CFO HAS A COPY OF THE AGENCY'S 990 TAX RETURN, COPY OF AUDITED FINANCIAL STATEMENTS, COPY OF CONFLICT OF INTEREST POLICY AT THE AGENCY'S OFFICE FOR ANYONE TO REVIEW PLUS THE 990 TAX RETURN CAN BE ACCESSED VIA GUIDESTAR. FORM 990, PART XI, LINE 9: MERGER WITH AND INTO HOSPICE OF THE PIEDMONT, INC. -11,395,452.