2020-08-14T08:01:47-05:00 2019-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-10-01 561925492 ROANOKE VALLEY HEALTH SERVICES INC ROAN 2525358130 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 SHERRY JENSEN CFO 2525358130 2020-08-14 1 AMY BIBBY P00445891 8282542254 2020-08-11 99.47.28.203 2020-08-14 06:34:11 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 48FB394F9AA065459641371F168D9F2AFFFBB473 2018 2020-09-22 18:59:49Z SHERRY JENSEN 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 9008853 0 X WWW.HALIFAXREGIONAL.ORG X 1994 NC TO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA. 2 0 79 0 0 0 199996 183338 6827573 8820685 0 -142 180681 4830 7208250 9008711 0 0 0 0 7405095 8165384 0 0 0 3964037 3665982 11369132 11831366 -4160882 -2822655 2041838 2133623 19363770 19878210 -17321932 -17744587 X TO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA. 0 0 11214896 8825515 OBTAINED GEOGRAPHIC HPSA DESIGNATION IN SEPTEMBER 2019 ALLOWING FOR ADDITIONAL BONUS OF 10% OF ALL PAYMENT FOR MEDICARE FFS CLAIMS TO ALL PROVIDERS PROVIDING SERVICES WITHIN THE ZIP CODE OF 27870.MET ALL OF THE QUALITY METRICS FOR COASTAL PLAINS ACO AND SURPASSED ALL OTHER MEMBERS' SCORES IN 8/10 METRICS. CROSS TRAINED ALL STAFF (CLINICAL AND CLERICAL) TO BE ABLE TO WORK ACROSS MULTIPLE LOCATIONS TO LEVERAGE STAFFING CAPABILITIES.SUCCESSFULLY SUBMITTED MIPS ATTESTATIONS IN 2019 FOR ALL ELIGIBLE RVHS PROVIDERS FOR 2018 DATA. SURGEONS AND CARDIOLOGIST RECEIVED A POSITIVE REIMBURSEMENT STRUCTURE. ROANOKE CLINIC PROVIDERS PASSED THE SUBMISSION BUT ARE NOT ELIGIBLE TO RECEIVE THE POSITIVE BONUS RELATED TO OUR RURAL HEALTH STATUS. UPDATE AND/OR RETIRED ALL POLICIES AND TRANSITIONED THEM TO VIDANT'S POLICY STAT SYSTEM.CHART AUDITS FOR DOCUMENTATION AND CODING COMPLETED BY THIRD PART COMPANY IN JANUARY 2019. 11214896 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 79 1 0 0 0 0 0 0 0 0 0 0 0 0 X 2 0 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NC X SHERRY JENSEN 2525358005 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 WILLIAM MAHONE CEO 1.00 40.00 X X 0 0 0 SHERRY JENSEN CFO 1.00 40.00 X X 0 286286 59524 JASON HARRELL COO 0.00 40.00 X 0 0 0 KAREN DANIELS CNO 1.00 40.00 X 0 126366 19593 DR HAILE JONES CARDIOLOGIST 1.00 40.00 X 0 497506 57681 DR JAMES KETOFF SURGEON 1.00 40.00 X 0 451640 63202 DR TOCHUKWU AGBATA HOSPITALIST 1.00 40.00 X 0 421192 57681 DR HAZEL DUCAN-GUY HOSPITALIST 1.00 40.00 X 0 375292 63681 DR NIKECHRNYERE OBIEFUNA HOSPITALIST 1.00 40.00 X 0 394264 57681 0 2552546 379043 14 0 1 0 JO MEDICALS 824 BENTBURY WAY CARY NC 275188809 HOSPITALIST PHYSICIAN 471600 AXIA PHYSICIAN SOLUTIONS 101 N CHERRY ST STE 600 WINSTONSALEM NC 27101 PHYSICIAN BILLING SVCS 450801 COMPHEALTH PO BOX 972651 DALLAS TX 753972651 PHYSICIAN CONTRACTING 369341 JOSEPH AKANINYENE - DAMAK MEDICS 113 ASPEN RIDGE DR HOLLY SPRINGS NC 27540 HOSPITALIST PHYSICIAN 347400 SURAFEAL ABRAHA MD 5028 MYRTLE OAK DR CARY NC 27519 HOSPITALIST PHYSICIAN 342337 5 183338 183338 NET PATIENT SERVICE RE 621610 8820685 8820685 8820685 4830 0 4830 4830 4830 142 -142 -142 -142 9008711 8825515 0 -142 X 6984585 6523444 461141 714613 667432 47181 466186 435407 30779 11900 11900 16800 16800 2219865 2216130 3735 2995 2995 111791 87329 24462 55986 55986 35441 35441 25305 25305 116097 116097 101537 101537 BAD DEBT EXPENSE 611210 611210 MEDICAL SUPPLIES 326774 326774 RECRUITMENT AND RELOCAT 20472 20472 OTHER EXPENSES 9809 9809 11831366 11214896 616470 0 51648 40972 515212 885203 2512275 1304827 1356985 1207448 117993 0 2041838 2133623 188066 1182418 19175704 18695792 19363770 19878210 X -17324577 -17747232 2645 2645 -17321932 -17744587 2041838 2133623 X -2822655 2400000 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1558624 809519 749105 842161 437402 404759 111490 57906 53584 1207448 DUE TO HALIFAX REGIONAL MEDICAL CENTER 18695792 18695792 0 0 0 0 0 1 0 0 0 SHERRY JENSEN CFO 0 243088 0 43198 0 0 0 43000 0 16524 0 345810 0 0 DR HAILE JONES CARDIOLOGIST 0 322506 0 175000 0 0 0 37000 0 20681 0 555187 0 0 DR JAMES KETOFF SURGEON 0 415841 0 35799 0 0 0 42521 0 20681 0 514842 0 0 DR TOCHUKWU AGBATA HOSPITALIST 0 407317 0 13875 0 0 0 37000 0 20681 0 478873 0 0 DR HAZEL DUCAN-GUY HOSPITALIST 0 365542 0 9750 0 0 0 43000 0 20681 0 438973 0 0 DR NIKECHRNYERE OBIEFUNA HOSPITALIST 0 381514 0 12750 0 0 0 37000 0 20681 0 451945 0 0 PART I, LINE 3 INDEPENDENT REVIEW OF COMPENSATION: THE ORGANIZATION DOES NOT DIRECTLY COMPENSATE ANY OFFICER OR KEY EMPLOYEE. SOME OFFICERS AND BOARD MEMBERS OF THE ORGANIZATION ARE EMPLOYEES OF HALIFAX REGIONAL MEDICAL CENTER, INC., A RELATED ORGANIZATION. THE BOARD OF DIRECTORS OF THAT ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION AMOUNTS FOR ITS CEO AND OTHER KEY PERSONNEL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANTS - WRITTEN EMPLOYEMENT CONTRACTS - COMPENSATION STUDY OR SURVEY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 6 INCENTIVE PAYMENTS FOR THE VPS ARE BASED ON MEETING CERTAIN GOALS ON THE ORGANIZATION'S BALANCED SCORECARD. PERCENTAGES ARE GIVEN FOR EACH GOAL MET. THIS AT RISK PAY IS USUALLY NOT GIVEN UNLESS THERE IS AN OPERATING MARGIN FOR THE ORGANIZATION PART II WILLIAM MAHONE, CEO, AND JASON HARRELL, VP OF OPERATIONS, BOTH WERE EMPLOYEES OF NOVANT HEALTH THROUGH MAY 31, 2019. WE CONTRACTED WITH NOVANT FOR THESE EMPLOYEES AND PAID THEIR FEES QUARTERLY AS BILLED ON NOVANT INVOICES. JUNE 1, 2019, THESE EMPLOYEES BECAME PART OF VIDANT MEDICAL CORP. HEADER: REASON FOR AMENDMENT THE RETURN HAS BEEN AMENDED TO UPDATE PART VI AND PART VII OF THE RETURN TO ALIGN WITH THE ORGANIZATION'S GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL SYSTEM HAD A MANAGEMENT SERVICES AGREEMENT WITH NOVANT HEALTH INC. THE BOARD OF HRMC CONTINUES TO OVERSEE THE OPERATIONS OF THE HEALTHCARE FACILITY AND RELATED EXEMPT ACTIVITIES. HRMC RECEIVES MANAGEMENT SERVICES AS WELL AS EXPENSE SAVINGS FOR AN ANNUAL MANAGEMENT FEE. NOVANT PROVIDES HRMC WITH A CEO AND COO AND HRMC PROVIDES REIMBURSEMENT FOR THOSE COSTS. DURING THE 2018 CALENDAR YEAR YEAR, NOVANT PAID COMPENSATION OF $369,835 TO THE ORGANIZATION'S CEO AND $216,187 TO THE ORGANIZATION'S COO. FORM 990, PART VI, SECTION A, LINE 4 MERGED WITH VIDANTH HEALTH JUNE 1, 2019. FORM 990, PART VI, SECTION B, LINE 11B THE 990 RETURNS ARE PRESENTED BY DIXON HUGHES GOODMAN TO THE FINANCE COMMITTEE OF THE HRMC BOARD. THE FINANCE COMMITTEE RECOMMENDS TO THE FULL BOARD APPROVAL OF THE TAX RETURNS. THESE RETURNS ARE MADE AVAILABLE DURING THESE PRESENTATIONS FOR DISCUSSION AND REVIEW. THE RETURNS ARE NOT TAKEN OUT OF THE MEETING BUT ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION FOLLOWS THE SAME CONFLICT OF INTEREST POLICY AS ITS AFFILIATE, HALIFAX REGIONAL MEDICAL CENTER. THE POLICY IS REVIEWED ANNUALLY, AND BOARD MEMBERS AND MANAGEMENT ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE EVERY YEAR. FORM 990, PART VI, SECTION B, LINE 15 AN OUTSIDE CONSULTANT IS USED TO DETERMINE THE APPROPRIATE COMPENSATION BASED ON COMPARABLE POSITIONS AND BENCHMARKS. THE CONSULTANT EVALUATES THE SALARIES FOR THE VP OF FINANCE. THE CEO APPROVES THE VP OF FINANCE SALARY. NOVANT DETERMINED THE COMPENSATION FOR THE CEO AND THE VP OF OPERATIONS BASED ON THE SAME PROCESS UNTIL WE MERGED WITH VIDANT JUNE 1, 2019. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. 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 WRITEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. PART VI LN 1: BOARD INDEPENDENCE THE ORGANIZATION'S BOARD OF DIRECTORS CONSISTS OF TOP MANAGEMENT OFFICIALS OF HALIFAX REGIONAL MEDICAL CENTER, INC A RELATED ORGANIZATION. THESE INDIVIDUALS ARE OVERSEEN AND GOVERNED BY THE MEDICAL CENTER'S INDEPENDENT BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,613,915. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,613,915. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 10,237. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,237. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 591,978. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 591,978. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,735. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,735. FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY FROM AFFILIATE 2,400,000. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PITT COUNTY MEMORIAL HOSPITAL INC (DBA VIDANT MEDICAL CENTER) 2100 STANTONSBURG RD GREENVILLE NC 27835 560585243 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH INC (DBA VIDANT COMMUNITY HOSPITALS - CENTRAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562003393 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 PCMH MANAGEMENT INC (DBA VIDANT PROPERTIES) 2100 STANTONSBURG RD GREENVILLE NC 27835 561690740 MEDICAL PROPERTY MANAGEMENT NC 501(C)(2) VIDANT HEALTH 0 HEALTHACCESS INC 2100 STANTONSBURG RD GREENVILLE NC 27835 561396133 HEALTHCARE NC 501(C)(3) LINE 12B, II VIDANT HEALTH 0 VIDANT MEDICAL GROUP INC 2100 STANTONSBURG RD GREENVILLE NC 27835 383740839 HEALTHCARE NC 501(C)(3) LINE 12C, III-FI VIDANT HEALTH 0 THE OUTER BANKS HOSPITAL INC 2100 STANTONSBURG RD GREENVILLE NC 27835 562112733 HOSPITAL NC 501(C)(3) LINE 3 EAST CAROLINA HEALTH 0 EAST CAROLINA HEALTH - BERTIE (DBA VIDANT BERTIE HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562072002 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH - CHOWAN (DBA VIDANT CHOWAN HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562101090 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH - HERITAGE (DBA VIDANT EDGECOMBE HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562093700 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH - BEAUFORT (DBA VIDANT BEAUFORT HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 452436270 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 DUPLIN GENERAL HOSPITAL (DBA VIDANT DUPLIN HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 566011594 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH INC (DBA VIDANT ROANOKE-CHOWAN HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 264634725 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 VIDANT NORPUNGO DISTRICT HOSPITAL CORPORATION DBA VIDANT PUNGO HOSPITALTH 2100 STANTONSBURG RD GREENVILLE NC 27835 560518757 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 VIDANT NORTH 2100 STANTONSBURG RD GREENVILLE NC 27835 560989789 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 ACCESS EAST 2410 STATONSBURG RD STANTON SQUARE GREENVILLE NC 27834 561949493 HEALTHCARE NC 501(C)(3) LINE 10 VIDANT HEALTH 0 UNIVERSITY HEALTH SYSTEMS OF EASTERN CAROLINA INC 2100 STANTONSBURG RD GREENVILLE NC 27835 562141073 HEALTHCARE NC 501(C)(3) LINE 12A, I N/A 0 HALIFAX REGIONAL MEDICAL CENTER FOUNDATION INC 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 561698825 SUPPORT/FUNDRAISING NC 501(C)(3) LINE 7 VIDANT NORTH 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 HRMC C 21210412 HRMC R 7205225 HRMC S 7421289