2019-08-15T11:36:51-05:00 2018-09-30 560747981 Dixon Hughes Goodman LLP 500 Ridgefield Court Asheville NC 28806 990 2017-10-01 383740839 Vidant Medical Group LLC VIDA 2528475129 2100 Stantonsburg Rd Greenville NC 27835 David S Hughes Treasurer 2528475129 2019-08-15 1 Amy Bibby P00445891 8282542254 2019-08-15 24.241.144.70 2019-08-15 08:21:18 ED P 083993E8E059FCB3C563BE1594239D73DD9572BD 48FB394F9AA065459641371F168D9F2AFFFBB473 2017 2019-02-21 02:37:17Z David S Hughes 2100 Stantonsburg Rd Greenville NC 27835 210731129 0 X www.vidanthealth.com X 2006 NC To provide medical services in Eastern North Carolina. 6 0 542 0 0 0 0 15523 178081637 210589455 30567 28616 0 95636 178112204 210729230 0 0 0 0 153847220 172199331 0 0 0 84198422 106401552 238045642 278600883 -59933438 -67871653 39692742 46341159 29615151 36189213 10077591 10151946 To enhance the quality of life for the people and communities we serve, touch and support. 0 0 266491262 210685091 Vidant Health professionals provided evaluations, clinical care management and medically necessary procedures. 266491262 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 542 1 0 0 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X Brian Dunn 2528477479 2100 Stantonsburg Rd Greenville NC 27835 Michael R Waldrum MD CEO 2.00 50.00 X X 0 1066517 208266 Roger Robertson President Of VCom (Rotated Off) 2.00 46.00 X 0 2308007 268975 David Hughes Treasurer 2.00 50.00 X X 0 496699 183355 William Floyd President Of VMC 2.00 42.00 X 0 505672 142795 Mark Rumans MD Chief Medical Officer (Rotated Off) 2.00 40.00 X 0 485485 100836 Anthony Bartholomew VP Of Operations 40.00 0.00 X 210798 0 44708 Daniel Drake PhD President of VMG 40.00 2.00 X 237513 0 115593 Jay Briley Board Member (Rotated On) 2.00 40.00 X 0 214114 84127 Kenneth Lee Physician 40.00 0.00 X 892013 0 34926 Richard Dalyai Physician 40.00 0.00 X 878191 0 32562 Michael Johnson Physician 40.00 0.00 X 860398 0 46800 Gary Fontana Physician 40.00 0.00 X 821819 0 40764 Rony Shummas Physician 40.00 0.00 X 808964 0 43954 4709696 5076494 1347661 390 0 1 0 ECU School of Medicine PO Box 75514 Charlotte NC 282750514 Physician Services 7933874 Bunn Medical Associates 606 Ashburton Drive Greenville NC 27858 Physician Services 2195535 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Physician Services 1614463 Center for Neuropsychiatric Services PA 12417 Moriah Way Raleigh NC 27614 Physician Services 1588473 Varian Medical Systems Inc 70140 Network Place Chicago IL 606731701 Contracted Services 828086 47 15523 15523 Patient Services 621110 165014722 165014722 Contract Management Fees 621110 45574733 45574733 210589455 30515 30515 95636 0 95636 95636 95636 1899 -1899 -1899 -1899 210729230 210685091 0 28616 X 447611 428543 19068 151616404 145157299 6459105 2906018 2782222 123796 9358376 8959709 398667 7870922 7535621 335301 87238 83522 3716 23746 22734 1012 53590807 52709065 881742 1317480 1261355 56125 16317352 15622233 695119 151895 145424 6471 888267 850426 37841 639173 415462 223711 68365 65453 2912 1962702 1879091 83611 4940444 2223200 2717244 Bad Debt 25986513 25986513 Other expenses 259818 248845 10973 Membership Dues 53102 4779 48323 Quality Initiatives 50887 48719 2168 63763 61047 2716 278600883 266491262 12109621 0 3358412 2184295 12495407 17924119 285855 1122835 1746451 1611771 875970 31056297 14779654 16194173 16276643 12046 4910144 7035780 39692742 46341159 22862856 31090919 44993 6707302 5098294 29615151 36189213 X 10077591 10151946 10077591 10151946 39692742 46341159 X -67871653 67946008 X X 0 1 X 1 0 X 15523 15523 152362129 164114286 164870197 178081637 165014722 824442971 152362129 164114286 164870197 178081637 165030245 824458494 0 0 0 824458494 13857 17182 17268 30567 30515 109389 13857 17182 17268 30567 30515 109389 152375986 164131468 164887465 178112204 165060760 824567883 0.99990 0.99990 0.00010 0.00010 X 349169 349169 13072737 3411442 9661295 16015645 10974055 5041590 1618746 394157 1224589 16276643 Other Assets 5513893 Other Receivables 1485524 Deferred Pension Outflows 36363 7035780 Reserve for Professional Liability 5077712 Deferred Pension Inflows 10580 Other liability 10002 5098294 X Part X, Line 2: Vidant Medical Group has been determined to qualify as a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code. Vidant Medical Gruop has reviewed its tax positions for all open years and has concluded that no material liabilities exist as of September 30, 2018 and 2017. Vidant Medical Group files tax returns with the U.S. federal jurisdiction. With few exceptions, Vidant Medical Group is no longer subject to U.S. federal examinations by tax authorities for years before 2015. 0 1 0 0 0 0 0 0 0 Michael R Waldrum MD CEO 0 1004252 0 53854 0 8411 0 157846 0 50420 0 1274783 0 0 Roger Robertson President Of VCom (Rotated Off) 0 406671 0 0 0 1901336 0 234440 0 34535 0 2576982 0 0 David Hughes Treasurer 0 494998 0 0 0 1701 0 145740 0 37615 0 680054 0 0 William Floyd President Of VMC 0 504929 0 0 0 743 0 101932 0 40863 0 648467 0 0 Mark Rumans MD Chief Medical Officer (Rotated Off) 0 485485 0 0 0 0 0 68761 0 32075 0 586321 0 0 Anthony Bartholomew VP Of Operations 210448 0 350 0 0 0 21477 0 23231 0 255506 0 0 0 Daniel Drake PhD President of VMG 237163 0 350 0 0 0 75345 0 40248 0 353106 0 0 0 Jay Briley Board Member (Rotated On) 0 213764 0 350 0 0 0 48964 0 35163 0 298241 0 0 Kenneth Lee Physician 867013 0 25000 0 0 0 0 0 34926 0 926939 0 0 0 Richard Dalyai Physician 853191 0 25000 0 0 0 0 0 32562 0 910753 0 0 0 Michael Johnson Physician 825398 0 35000 0 0 0 0 0 46800 0 907198 0 0 0 Gary Fontana Physician 783902 0 37917 0 0 0 0 0 40764 0 862583 0 0 0 Rony Shummas Physician 765214 0 43750 0 0 0 0 0 43954 0 852918 0 0 0 Part I, Line 1a All compensation and reimbursement listed for such items are paid at the Vidant Health entity, and the written policy and adherence to the policy is maintained at VH. Part I, Line 3 The compensation is determined by the Compensation and Benefits Committee of the VH Board using comparative data from like organizations and input from consultants. All compensation discussions and actions are documented and approved in the minutes of the Committee. Compensation of Roger Robertson: of the compensation reported in Column (b)(iii) of Part II, $1,901,336 is attributable to a distribution from a supplemental executive retirement plan. Of the total amount, $855,601 was paid to federal and state government as withheld taxes. The remainder is held by a trustee with actuarially determined monthly payments, consisting of principal and earnings, being made to Robertson over a specified number of years. This retirement compensation was earned by the recipient over 28 years of service. Part I, Line 4b As of January 1, 2013, the supplemental nonqualified retirement plan was frozen and no further amounts have accrued to its benefit. In lieu of the SERP, the comprehensive defined benefit pension plan will provide an equivalent benefit. The increase in the value of such plans is reflected in the sum of Part II, Column (C). Form 990, Part VI, Section A, line 6 University Health Systems of Eastern Carolina, Inc. ("Vidant Health") is the sole corporate member of Vidant Medical Group, LLC. Form 990, Part VI, Section A, line 7a As the corporate member, Vidant Health shall have the responsibility to elect or appoint the seven individual voting members of Vidant Medical Group, LLC. Form 990, Part VI, Section A, line 7b The rights reserved to the corporate member include the rights of: a. Selling, leasing or otherwise disposing of, or agreeing to sell, lease or otherwise dispose of, all or substantially all of the assets of Vidant Medical Group, LLC; b. Winding up, dissolving, liquidating, reorganizing, or otherwise terminating the existence of Vidant Medical Group, LLC; c. Merging or consolidating Vidant Medical Group, LLC with or into any other entity or converting into any other type of entity; d. Amending the Articles of Organization or Operating Agreement, and; e. Admitting additional Members or issuing additional Membership Interests. Form 990, Part VI, Section B, line 11b The Board Member is provided a copy of the return for review prior to filing. The return is also reviewed by the Chief Financial Officer, Chief General Counsel and the Chief Audit and Compliance Officer of University Health Systems of Eastern Carolina, Inc. (D/B/A Vidant Health) prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c As described in the Conflict of Interest policy maintained by VH, all Officers, Board Members and Key Employees are required to complete a yearly comprehensive conflict of interest questionnaire. These are reviewed by legal counsel and any potential or actual conflicts are brought to the Board for disposition. Board Members are instructed to report any potential conflicts arising during the year for review. Board Members are required to recuse themselves from voting on issues in which they are deemed to have a conflict. Form 990, Part VI, Section B, line 15 The compensation is determined by the Compensation and Benefits Committee of the VH Board using comparative data from like organizations and input from consultants. Compensation of other officers and key employees is also determined by the Compensation and Benefits Committee of the VH Board using comparative data from like organizations and input from consultants. All compensation discussions and actions are documented and approved in the minutes of the Committee. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request for the same period of disclosure as set forth in IRC Section 6104(d). Form 990, Part IX, line 11g Purchased Services: Program service expenses 52,709,065. Management and general expenses 881,742. Fundraising expenses 0. Total expenses 53,590,807. Form 990, Part XI, line 9: Net Asset Transfer 67,946,008. Form 990, Part XII, Line 2C This process has not changed from the prior year. Vidant Medical Group Affiliates LLC 2100 Stantonsburg Rd Greenville NC 27835 472875992 Healthcare NC 0 0 Vidant Medical Group LLC Tarboro Endoscopy Center LLC 201 Clinic Dr Tarboro NC 27886 271345858 Healthcare NC 0 0 Vidant Medical Group LLC University Health Systems Of Eastern Carolina DBA Vidant Health 2100 Stantonsburg Rd Greenville NC 27835 562141073 Healthcare NC 501(c)(3) Line 12c, III-FI N/A 0 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 Surgicenter Services Of Pitt Inc 102 Bethesda Dr Greenville NC 27835 561690553 Medical Property Management NC 501(c)(3) Line 12b, II Vidant Medical Center 0 The Outer Banks Hospital Inc 2100 Stantonsburg Rd Greenville NC 27835 562112733 Hospital NC 501(c)(3) Line 3 East Carolina 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 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 HealthAccess Inc 2100 Stantonsburg Rd Greenville NC 27835 561396133 Healthcare NC 501(c)(3) Line 12b, II Vidant 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 Pungo District Hospital Corporation DBA Vidant Pungo Hospital 2100 Stantonsburg Rd Greenville NC 27835 560518757 Hospital NC 501(c)(3) Line 3 Vidant Health 0 0 1 1 0 0 0 0 0 0 1 1 1 1 0 1 1 1 0 0