FURP.ORG / PUBLIC DATA EXPLORER

RANDOLPH HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
RANDOLPH HOSPITAL INC (EIN 56-0530234)
Tax period
2016-10-01 to 2017-09-30
Filed
2018-08-15
IRS object ID
201842279349300119
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-08-15T07:35:23-05:00ReturnTs
Tax Period End2017-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1227 WEST TRADE STREET SUITE 800AddressLine1Txt
CityCHARLOTTECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28202ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN560530234EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1RANDOLPH HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlRANDBusinessNameControlTxt
Phone3366255151PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1364 WHITE OAK STREETAddressLine1Txt
CityASHEBOROCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27204ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonLORETTA LONGPersonNm
Person TitleINTERIM CFOPersonTitleTxt
Phone3366255151PhoneNum
Signature2018-08-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJOHN NORMANPreparerPersonNm
PTINP01506766PTIN
Phone7049985200PhoneNum
Preparation2018-08-14PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1RANDOLPH HEALTHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerANGELA P ORTHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1364 WHITE OAK STREETAddressLine1Txt
CityASHEBOROCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27203ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$108,384,707GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.RANDOLPHHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1928FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO PROVIDE QUALITY HEALTH CARE AND FOSTER HEALTH AND WELLNESS IN OUR COMMUNITIES.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee1214TotalEmployeeCnt
Total Volunteers214TotalVolunteersCnt
Total Gross UBI$85,309TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$88,088NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$515,907PYContributionsGrantsAmt
CY Contributions Grants$346,956CYContributionsGrantsAmt
PY Program Service Revenue$112,058,886PYProgramServiceRevenueAmt
CY Program Service Revenue$106,955,770CYProgramServiceRevenueAmt
PY Investment Income$595,276PYInvestmentIncomeAmt
CY Investment Income$323,584CYInvestmentIncomeAmt
PY Other Revenue$558,053PYOtherRevenueAmt
CY Other Revenue$578,276CYOtherRevenueAmt
PY Total Revenue$113,728,122PYTotalRevenueAmt
CY Total Revenue$108,204,586CYTotalRevenueAmt
PY Grants And Similar Paid$3,788,770PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,864,129CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$53,348,030PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$53,143,560CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$88,256CYTotalFundraisingExpenseAmt
PY Other Expenses$60,765,401PYOtherExpensesAmt
CY Other Expenses$62,861,334CYOtherExpensesAmt
PY Total Expenses$117,902,201PYTotalExpensesAmt
CY Total Expenses$118,869,023CYTotalExpensesAmt
PY Revenues Less Expenses-$4,174,079PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$10,664,437CYRevenuesLessExpensesAmt
Total Assets BOY$136,061,375TotalAssetsBOYAmt
Total Assets EOY$125,229,349TotalAssetsEOYAmt
Total Liabilities BOY$78,771,274TotalLiabilitiesBOYAmt
Total Liabilities EOY$74,392,554TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$57,290,101NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$50,836,795NetAssetsOrFundBalancesEOYAmt
MissionRANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$107,243,631ExpenseAmt
Grant$2,864,129GrantAmt
Revenue$107,192,589RevenueAmt
DescRANDOLPH HOSPITAL, A NOT-FOR-PROFIT, 145-BED COMMUNITY HOSPITAL WAS ESTABLISHED IN 1928 WITH THE APPROVAL OF A COOPERATIVE PLAN WITH THE DUKE ENDOWMENT AT A JOINT MEETING OF THE ASHEBORO ROTARY CLUB, THE KIWANIS CLUB, THE CHAMBER OF COMMERCE, THE TOWN COUNCIL AND INTERESTED CITIZENS. THE PLAN CALLED FOR THE BUILDING OF A 40-BED HOSPITAL.Desc
Total Program Service Expenses$107,243,631TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related InvstYes (1)ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded EntityYes (1)DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document195IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee1214EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LORETTA LONGBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3366298810PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1364 WHITE OAK STREETAddressLine1Txt
CityASHEBOROCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27203ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
CRANDFORD KNOTT
BOARD MEMBER2.00Yes (X)$0$0$0
ELBERT J LASSITER
BOARD MEMBER2.00Yes (X)$0$0$0
MICHAEL C MILLER
SECRETARY2.00Yes (X)$0$0$0Yes (X)
GLENN MAC PUGH
CHAIR4.00Yes (X)$0$0$0Yes (X)
SAMUEL A RANKIN JR
VICE CHAIR2.00Yes (X)$0$0$0Yes (X)
DAVID BRYANT
BOARD MEMBER2.00Yes (X)$0$0$0
LINDA BROWN
BOARD MEMBER2.00Yes (X)$0$0$0
REYNOLDS LISK
BOARD MEMBER2.00Yes (X)$0$0$0
CRIS R RICHARDSON
BOARD MEMBER2.00Yes (X)$0$0$0
ROBERT S SHACKLEFORD JR
BOARD MEMBER2.00Yes (X)$0$0$0
THOMAS LAWRENCE
BOARD MEMBER2.00Yes (X)$0$0$0
STEVE E EBLIN
CEO40.00Yes (X)$195,325$0$29,295Yes (X)
MURRAY S MARSH JR
CFO40.00Yes (X)$188,125$0$24,901Yes (X)
DEVIN GRIFFITH
VP40.00Yes (X)$96,926$0$495Yes (X)
BARBARA E WOLFE
VP40.00Yes (X)$167,967$0$19,072Yes (X)
ROBERT S CLAUSER
VP40.00Yes (X)$206,689$0$27,709Yes (X)
ANGELA P ORTH
VP40.00Yes (X)$102,982$0$15,308Yes (X)
CHARLES B WEST
CMO40.00$61,591$183,109$13,915Yes (X)
TREMONTEO CRAWFORD
VP40.00$177,047$0$26,932Yes (X)
LISA D HAMPTON
PHARMACY DIRECTOR40.00$155,093$0$695Yes (X)
MICHELLE C LUTHER
PHARMACIST40.00$154,018$0$2,767Yes (X)
WILLIAM T WARD
PHARMACIST40.00$138,211$0$3,326Yes (X)
DAVID R BECKHAM
PHYSICAL THERAPIST60.00$136,937$0$4,281Yes (X)
ANGELA B BURGESS
CIO40.00$136,721$0$1,000Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,917,632TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$183,109TotReportableCompRltdOrgAmt
Total Other Compensation$169,696TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K42IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CONE HEALTH
1200 NORTH ELM STREETGREENSBORONC27401CONSULTING, LAB, PHARM, MANAGEMENT FEE$1,699,889
SODEXHO INC & AFFILIATES
PO BOX 536922ATLANTAGA303536922FOOD MANAGEMENT SERVICES$1,624,221
ARAMARK CORPORATION
10510 TWIN LAKES PARKWAYCHARLOTTENC272697658REPAIRS AND MAINT$1,424,195
QUANTUM HEALTH GROUP
1025 VIEWMONT DRIVEASHEBORONC27205CONTRACT LABOR-MEDICAL DIRE$765,788
HEALOGICS WOUND CARE
28525 NETWORK PLACECHICAGOIL60673HYPERBARIC CONTRACT SERVICES$612,559
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K86CntrctRcvdGreaterThan100KCnt
Government Grants$29,322GovernmentGrantsAmt
All Other Contributions$317,634AllOtherContributionsAmt
Total Contributions$346,956TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621400$103,467,652$103,467,652
MRI OF ASHEBORO LLC621400$1,363,031$1,363,031
CANCER CENTER REVENUES621400$895,323$895,323

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,229,764TotalRevenueColumnAmt
Related Or Exempt Func Income$1,229,764RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$106,955,770TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$503,705TotalRevenueColumnAmt
Exclusion$503,705ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$416,940RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$416,940RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$416,940TotalRevenueColumnAmt
Related Or Exempt Func Income$416,940RelatedOrExemptFuncIncomeAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$180,121SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities-$180,121SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$180,121TotalRevenueColumnAmt
Related Or Exempt Func Income-$180,121RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
RANDOLPH NEWCO LLC900009$78,786$78,786
COFFEE/GIFT SHOP453220$76,027$76,027
PREMIER PARTNERSHIP900009$6,523$6,523
FieldValueIRS element (for citing)
Other Revenue Total$161,336OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$108,204,586TotalRevenueColumnAmt
Related Or Exempt Func Income$107,192,589RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$85,309UnrelatedBusinessRevenueAmt
Exclusion$579,732ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$2,864,129TotalAmt
Program Services$2,864,129ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,917,632TotalAmt
Management And General$1,917,632ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$36,909,516TotalAmt
Program Services$33,456,816ProgramServicesAmt
Management And General$3,413,905ManagementAndGeneralAmt
Fundraising$38,795FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,690,163TotalAmt
Program Services$2,281,259ProgramServicesAmt
Management And General$406,214ManagementAndGeneralAmt
Fundraising$2,690FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,685,528TotalAmt
Program Services$7,390,089ProgramServicesAmt
Management And General$1,286,917ManagementAndGeneralAmt
Fundraising$8,522FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,940,721TotalAmt
Program Services$2,493,732ProgramServicesAmt
Management And General$444,049ManagementAndGeneralAmt
Fundraising$2,940FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$3,436,293TotalAmt
Program Services$2,278,263ProgramServicesAmt
Management And General$1,158,030ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$394,057TotalAmt
Management And General$394,057ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$75,858TotalAmt
Management And General$75,858ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$9,315,958TotalAmt
Program Services$9,297,357ProgramServicesAmt
Management And General$16,741ManagementAndGeneralAmt
Fundraising$1,860FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$994,918TotalAmt
Program Services$716,341ProgramServicesAmt
Management And General$255,694ManagementAndGeneralAmt
Fundraising$22,883FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$8,842,028TotalAmt
Program Services$7,725,409ProgramServicesAmt
Management And General$1,108,095ManagementAndGeneralAmt
Fundraising$8,524FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,887,294TotalAmt
Program Services$1,819,352ProgramServicesAmt
Management And General$67,942ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,045,617TotalAmt
Program Services$3,835,245ProgramServicesAmt
Management And General$210,372ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$317,677TotalAmt
Program Services$271,615ProgramServicesAmt
Management And General$44,792ManagementAndGeneralAmt
Fundraising$1,270FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$9,061TotalAmt
Program Services$9,061ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,926,740TotalAmt
Program Services$1,926,740ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,828,618TotalAmt
Program Services$5,828,618ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$442,386TotalAmt
Management And General$442,386ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
BAD DEBT$13,328,513$13,328,513
MEDICAL SUPPLIES$11,335,956$11,335,956
MISCELLANEOUS$510,838$385,136$124,930$772
RECRUITMENT$169,522$169,522

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$118,869,023TotalAmt
Program Services$107,243,631ProgramServicesAmt
Management And General$11,537,136ManagementAndGeneralAmt
Fundraising$88,256FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,173,906BOYAmt
EOY$7,135,928EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,378,559BOYAmt
EOY$2,061,364EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$17,348,339BOYAmt
EOY$13,366,688EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$2,771,735BOYAmt
EOY$2,555,280EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$938,426BOYAmt
EOY$935,109EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$155,867,646LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$103,784,537LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$54,894,042BOYAmt
EOY$52,083,109EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$21,278,132BOYAmt
EOY$18,998,690EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$6,595,048BOYAmt
EOY$7,490,371EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$18,683,188BOYAmt
EOY$20,602,810EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$136,061,375BOYAmt
EOY$125,229,349EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$10,572,842BOYAmt
EOY$11,074,650EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$43,326,528BOYAmt
EOY$40,545,909EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$24,871,904BOYAmt
EOY$22,771,995EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$78,771,274BOYAmt
EOY$74,392,554EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$56,490,948BOYAmt
EOY$50,440,662EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$799,153BOYAmt
EOY$396,133EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$57,290,101BOYAmt
EOY$50,836,795EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$136,061,375BOYAmt
EOY$125,229,349EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$10,664,437ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$4,211,131OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$5,227OtherActivitiesAmt
Total Lobbying Expenditures$5,227TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationA PORTION OF THE DUES PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES CARRIED OUT BY THOSE ORGANIZATIONS ON BEHALF OF THEIR MEMBERS.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,634,877BeginningYearBalanceAmt
End Year Balance$1,634,877EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,634,877BeginningYearBalanceAmt
End Year Balance$1,634,877EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,634,877BeginningYearBalanceAmt
End Year Balance$1,634,877EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,634,877BeginningYearBalanceAmt
End Year Balance$1,634,877EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,634,877BeginningYearBalanceAmt
End Year Balance$1,634,877EndYearBalanceAmt
FieldValueIRS element (for citing)
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,582,897OtherCostOrOtherBasisAmt
Book Value$2,582,897BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$83,044,906OtherCostOrOtherBasisAmt
Depreciation$44,610,866DepreciationAmt
Book Value$38,434,040BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,920,149OtherCostOrOtherBasisAmt
Depreciation$1,323,133DepreciationAmt
Book Value$4,597,016BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$62,410,476OtherCostOrOtherBasisAmt
Depreciation$57,176,838DepreciationAmt
Book Value$5,233,638BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,909,218OtherCostOrOtherBasisAmt
Depreciation$673,700DepreciationAmt
Book Value$1,235,518BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$52,083,109TotalBookValueLandBuildingsAmt

Invst Program Related Org InvstProgramRelatedOrgGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
INVESTMENT IN RCC$6,477,040C
DUE FROM RCC JV$1,013,331C
FieldValueIRS element (for citing)
Total Book Value Program Rltd$7,490,371TotalBookValueProgramRltdAmt

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
OTHER RECEIVABLES$2,099,491
ESTIMATED THIRD-PARTY SETTLEMENTS$107,771
ASSETS LIMITED AS TO USE$399,326
INVESTMENT IN AFFILIATES$687,359
DUE FROM AFFILIATES$16,993,293
OTHER LONG-TERM ASSETS$315,570
FieldValueIRS element (for citing)
Total Book Value Other Assets$20,602,810TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
OTHER LONG-TERM LIABILITIES$214,213
MINIMUM PENSION LIABILITY$6,903,538
INTEREST RATE SWAP$2,953,181
DUE TO AFFILIATES$12,701,063
FieldValueIRS element (for citing)
Total Liability$22,771,995TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE HOSPITAL, RHMG, PIH, STAYWELL, AND FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NEWCO AND CPSC ARE LIMITED LIABILITY COMPANIES, WHICH DO NOT PRODUCE TAXABLE INCOME TO THEIR NOT-FOR-PROFIT OWNER. THE SYSTEM HAS DETERMINED IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2017.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance Budget0FinancialAssistanceBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,628,883TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$7,628,883NetCommunityBenefitExpnsAmt
Total Expense0.07230TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$15,530,312TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$13,976,443DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,553,869NetCommunityBenefitExpnsAmt
Total Expense0.01470TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$204,306TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$193,683DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,623NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$23,363,501TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$14,170,126DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,193,375NetCommunityBenefitExpnsAmt
Total Expense0.08710TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$284,651TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$284,651NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$18,675TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$18,675NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$422TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$422NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$303,748TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$303,748NetCommunityBenefitExpnsAmt
Total Expense0.00290TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$23,667,249TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$14,170,126DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,497,123NetCommunityBenefitExpnsAmt
Total Expense0.09000TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$4,632,467BadDebtExpenseAmt
Bad Debt Expense Attributable$3,937,597BadDebtExpenseAttributableAmt
Reimbursed By Medicare$41,011,433ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$43,546,210CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$2,534,777MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line11 RANDOLPH NEWCO LLCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesMEDICAL EQUIPMENT RENTALPrimaryActivitiesTxt
Org Profit Or Ownership0.83030OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.16970PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1RANDOLPH HOSPITAL INCORPORATEDBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1364 WHITE OAK STREETAddressLine1Txt
CityASHEBOROCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27204ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.RANDOLPHHOSPITAL.ORGWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1RANDOLPH HOSPITAL INCORPORATEDBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART VIOwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLSEE PART VIOtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLSEE PART VIStrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.RANDOLPHHOSPITAL.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.RANDOLPHHOSPITAL.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.RANDOLPHHOSPITAL.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
RANDOLPH HOSPITAL INCORPORATEDPART V, SECTION B, LINE 5: IN THE FALL OF 2015, THE RANDOLPH COUNTY HEALTH DEPARTMENT JOINED WITH RANDOLPH HOSPITAL, TO ESTABLISH THE ASSESSMENT FRAMEWORK AND A TIMELINE FOR DATA COLLECTION AND ANALYSIS, PRIORITIZATION OF HEALTH CONCERNS AND DEVELOPMENT OF ACTION PLANS. DATA COLLECTION AND ANALYSIS TOOK PLACE FROM SEPTEMBER 2015 - JULY 2016. PRIMARY DATA WAS COLLECTED FROM THE COMMUNITY IN TWO DIFFERENT WAYS: DISTRIBUTION OF PAPER SURVEYS AND AN INTERNET SURVEY. WITH TECHNOLOGY CONTINUING TO ADVANCE, MORE OF AN EMPHASIS WAS PLACED ON ON-LINE SURVEYS ALTHOUGH, PAPER SURVEYS WERE STILL AN IMPORTANT TOOL. IN ADDITION TO ON-LINE SURVEYS, PAPER SURVEYS WERE ALSO DISTRIBUTED TO AGENCIES AND ORGANIZATIONS WITHIN THE COUNTY USING THE CONVENIENCE SAMPLE METHOD. SUCH AGENCIES INCLUDED: RANDOLPH COMMUNITY COLLEGE, RANDOLPH COUNTY PARTNERSHIP FOR CHILDREN, EARLY CHILDHOOD CENTERS IN LIBERTY, RANDLEMAN AND RAMSEUR, MANY CHURCHES AND BOTH ASHEBORO CITY AND RANDOLPH COUNTY SCHOOLS. ALL SURVEYS DISTRIBUTED WERE IN BOTH ENGLISH AND SPANISH. OF THE 2,000 TOTAL DISTRIBUTED SURVEYS, 1,104 WERE RETURNED FOR A RESPONSE RATE OF 55%.SURVEY RESPONSES WERE ANALYZED FOR FREQUENCY OF RESPONSE USING SURVEY MONKEY. (IT SHOULD BE NOTED THAT NOT EVERY RESPONDENT ANSWERED EVERY QUESTION.) THE SURVEYS WERE NOT FULLY COMPLETED BY ALL INDIVIDUALS, RESULTING IN MISSING DATA ON VARIOUS QUESTIONS.IN COLLABORATION WITH THE RANDOLPH COUNTY GOVERNMENT IT, AN INTERNET SURVEY WAS DEVELOPED USING SURVEY MONKEY. THE INTERNET SURVEY WAS ACCESSIBLE THROUGH THE RANDOLPH COUNTY GOVERNMENT WEBSITE AS WELL AS THE RANDOLPH HOSPITAL WEBSITE. IN AN EFFORT TO PROMOTE THE INTERNET SURVEY, PRESS RELEASES RAN IN ALL AREA NEWSPAPERS, AS WELL AS PROMOTED VIA SOCIAL MEDIA.TO ENSURE A SOLID REPRESENTATION FROM KEY SECTORS, THE SURVEY WAS ALSO SENT TO DEPARTMENT HEADS AND DIRECTORS FROM VARIOUS AGENCIES OR REPRESENTATIVES WITHIN THE COUNTY.
RANDOLPH HOSPITAL INCORPORATEDPART V, SECTION B, LINE 6B: RANDOLPH COUNTY HEALTH DEPARTMENT
RANDOLPH HOSPITAL INCORPORATEDPART V, SECTION B, LINE 7D: BOTH RANDOLPH COUNTY AND RANDOLPH HOSPITAL WEBSITES WILL POST THE COMMUNITY HEALTH NEEDS ASSESSMENT AND EXECUTIVE SUMMARY. THE ASSESSMENT WILL ALSO BE IN ALL SEVEN RANDOLPH COUNTY LIBRARIES. THIRTY DATA BOOKS AND 500 EXECUTIVE SUMMARIES WILL BE ORDERED AND PRINTED FOR DISTRIBUTION THROUGHOUT THE COMMUNITY.
RANDOLPH HOSPITAL INCORPORATEDPART V, SECTION B, LINE 11: IN JULY 2016, ADVISORY COMMITTEE MEMBERS MET TO IDENTIFY LEADING COMMUNITY HEALTH ISSUES IN RANDOLPH COUNTY. DURING THE MEETING, MEMBERS REVIEWED HEALTH CONCERNS IDENTIFIED THROUGH SURVEYS AS WELL AS THE INFORMATION GATHERED THROUGH SECONDARY RESEARCH. THROUGH NOMINAL GROUP TECHNIQUE THE COMMITTEE SELECTED EIGHT COMMUNITY HEALTH PROBLEMS: OBESITY, MENTAL HEALTH, SUBSTANCE ABUSE, ACCESS TO CARE, TOBACCO, SEXUALLY TRANSMITTED DISEASES, CHRONIC DISEASE MANAGEMENT AND INJURY PREVENTION. AFTER MUCH DISCUSSION, THE COMMITTEE AGREED TO FOCUS ON FOUR PRIORITY HEALTH CONCERNS: PHYSICAL ACTIVITY, NUTRITION, SUBSTANCE ABUSE, AND MENTAL HEALTH.IT IS IMPORTANT TO NOTE THAT ALTHOUGH THE ADVISORY COMMITTEE IDENTIFIED EIGHT HEALTH ISSUES, THE DECISION WAS MADE TO LIMIT THE FOCUS TO MAKE A LARGER IMPACT ON THE TOP FOUR AREAS THAT HAD THE OPPORTUNITY TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY. ADDRESSING OBESITY THROUGH PHYSICAL ACTIVITY AND NUTRITION CAN ALSO LEAD TO IMPACTING CHRONIC HEALTH DISEASES SUCH AS CANCER, HEART DISEASE AND DIABETES. ADDRESSING SUBSTANCE ABUSE THROUGH DRUG, ALCOHOL AND TOBACCO USE CAN ONCE AID IN IMPACTING CHRONIC HEALTH DISEASES. FINALLY, ADDRESSING MENTAL HEALTH ISSUES IMPACTS CHRONIC HEALTH DISEASES, OBESITY AND SUBSTANCE ABUSE. THE IDENTIFIED PRIORITY AREAS ARE ALSO IN LINE WITH THE AREAS IDENTIFIED DURING THE RANDOLPH COUNTY STRATEGIC PLANNING PROCESS. THE ENTIRE COUNTY IS NOW ALIGNED WITH FOCUSING ON THE SAME HEALTH PRIORITY AREAS--CREATING, FOR THE FIRST TIME, A COORDINATED AND UNITED COUNTY-WIDE EFFORT TO ADDRESS THE HEALTH OF OUR COMMUNITY.
RANDOLPH HOSPITAL INCORPORATEDPART V, SECTION B, LINE 20E: THE HOSPITAL ESTABLISHES DURING PRE-REGISTRATION WHETHER A PATIENT IS COVERED BY INSURANCE. IF THE PATIENT IS NOT COVERED BY INSURANCE, THE HOSPITAL MAKES THE PATIENT AWARE OF THE FAP.
PART V, SECTION B, LINES 7 AND 10HTTPS://WWW.RANDOLPHHEALTH.ORG/HEALTH-RESOURCES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
FieldValueIRS element (for citing)
Facility25FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (25 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - STAYWELL SENIOR CARE
809 CURRY DRIVEASHEBORONC27205PACE CENTER
2 - ATHLETIC TRAINING
600 W SALISBURY ST STE AASHEBORONC27203ATHLETIC TRAINING
3 - CANCER CENTER
364 WHITE OAK STASHEBORONC27203CANCER TREATMENT
4 - CHC BETTERCARE
600 W SALISBURY ST STE BASHEBORONC27203CORPORATE HEALTH & WELLNESS
5 - DEEP RIVER P T -ASHEBORO
600 W SALISBURY ST STE AASHEBORONC27203PHYSICAL THERAPY
6 - DEEP RIVER P T -RAMSEUR
701 LIBERTY STRAMSEURNC27316PHYSICAL THERAPY
7 - DEEP RIVER P T -RANDLEMAN
148 POINTE SOUTH DRIVERANDLEMANNC27317PHYSICAL THERAPY
8 - DIABETES CENTER
208-D FOUST STASHEBORONC27203DIABETES TREATMENT
9 - EAR NOSE & THROAT
124 N PART STASHEBORONC27203EAR NOSE AND THROAT
10 - ENDOSCOPY CENTER
700 SUNSET AVEASHEBORONC27203ENDOSCOPY
11 - FAMILY PRACTICE - LIBERTY
504 N GREENSBOROLIBERTYNC27298FAMILY MEDICINE
12 - FAMILY PRACTICE - RANDLEMAN
670 W ACADEMY STRANDLEMANNC27317FAMILY MEDICINE
13 - FAMILY PRACTICE - SEAGROVE
514 N BROAD STSEAGROVENC27341FAMILY MEDICINE
14 - FAMILY PRACTICE & WELLNESS
132-C W MILLER STASHEBORONC27203FAMILY MEDICINE
15 - FITNESS CENTER
600 W SALISBURY ST STE AASHEBORONC27203FITNESS CENTER
16 - GASTROENTEROLOGY
700 SUNSET AVEASHEBORONC27203GASTROENTEROLOGY
17 - HOME HEALTH
341 N FAYETTEVILLE STASHEBORONC27203HOME HEALTH
18 - INTERNAL MEDICINE
237-A N FAYETTEVILLE STASHEBORONC27203INTERNAL MEDICINE
19 - MRI CENTER
237 N FAYETTEVILLE ST STE BASHEBORONC27203MRI
20 - ORTHOPEDICS & SPORTS MEDICINE
138-A DUBLIN SQUARE ROADASHEBORONC27203ORTHOPEDICS/SPORTS MEDICINE
21 - PEDIATRICS
713 S FAYETTEVILLE STASHEBORONC27203PEDIATRICS
22 - P T & SPORTS MEDICINE
138-A DUBLIN SQUARE ROADASHEBORONC27203PHYSICAL THERAPY
23 - SURGERY CENTER
724 THOMAS STASHEBORONC27203SURGICAL CENTER
24 - UROLOGY
132-C W MILLER STASHEBORONC27203UROLOGY
25 - WOUND CARE & HYPERBARIC CENTER
212 FOUST STASHEBORONC27203WOUND CARE

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 6A:NORTH CAROLINA HOSPITAL ASSOCIATION
PART I, LN 7 COL(F):UNINSURED PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE OR STATE, FEDERAL, AND /OR GRANT FUND PROGRAMS ARE RESPONSIBLE FOR A DISCOUNTED PAYMENT AMOUNT IN ACCORDANCE WITH IRS SECTION 501(R). PAYMENT PLANS ARE OFFERED THROUGH RANDOLPH HOSPITAL WITH NO INCURRED INTEREST CHARGES. THE PATIENT FINANCIAL SERVICES DEPARTMENT OF RANDOLPH HOSPITAL PROVIDES A MONTHLY STATEMENT, MAKES TELEPHONE CONTACT, AND/OR SENDS COLLECTION LETTERS. UNCOLLECTED DELIQUENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY OR ATTORNEY FOR CONTINUED COLLECTION. ALL INTERNAL AND EXTERNAL COLLECTIONS PROCESSES COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT (FDCPA).
PART III, LINE 2:THE ORGANIZATION APPLIED THE COST-TO CHARGE RATIO TO ITS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT REPORTED ON PART III, LINE 2.
PART III, LINE 3:THE ORGANIZATION ESTIMATES FROM HISTORICAL PERSPECTIVE AND EXPERIENCE THAT APPROXIMATELY 85% OF BAD DEBT EXPENSE MAY BE ATTRIBUTABLE TO COMMUNITY BENEFIT.
PART III, LINE 4:THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT EXPENSE WAS OBTAINED FROM AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8:THE HOSPITAL TRADITIONALLY INCURS A SHORTFALL IN PROVIDING MEDICARE SERVICES AND CONSIDERS THE ENTIRE SHORTFALL AS A COMMUNITY BENEFIT. MEDICARE DOES NOT REIMBURSE THE HOSPITAL ENOUGH TO COVER ITS COSTS ASSOCIATED WITH PROVIDING MEDICARE SERVICES, YET THE HOSPITAL CONTINUES TO FULFILL ITS MISSION OF PROVIDING SERVICES TO ITS COMMUNITY REGARDLESS OF THE REIMBURSEMENT LEVELS. AS SUCH, THE HOSPITAL BELIEVES THAT IT IS APPROPRIATE TO REPORT THIS SHORTFALL AS PART OF ITS COMMUNITY BENEFIT. THE BAD DEBT INCLUDED AS UNCOMPENSATED CARE REPRESENTS THE COST OF PROVIDING THOSE SERVICES, CALCULATED USING THE COST TO CHARGE RATIO OF THE CHARGES RECORDED IN THE FINANCIAL STATEMENTS AS BAD DEBT.
PART III, LINE 9B:RANDOLPH HOSPITAL IS COMMITTED TO ASSISTING PATIENTS THAT DO NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR THEIR HEALTH CARE SERVICES. THE HOSPITAL MAKES AVAILABLE FINANCIAL COUNSELING TO DETERMINE THE APPROPRIATE DISPOSITION OF THE PATIENT ACCOUNT. A MEDICAL ASSISTANCE COUNSELOR REVIEWS ALL SUCH ACCOUNTS FOR POSSIBLE FINANCIAL ASSISTANCE FROM STATE, FEDERAL, AND/OR ENDOWMENT FUNDS PROGRAMS. RANDOLPH HOSPITAL PROVIDES CHARITY TO PATIENTS WHO MEET CRITERIA AS OUTLINED IN THE FINANCIAL ASSISTANCE POLICY. ANY PATIENT/GUARANTOR WHO REFUSES TO COMPLETE THE APPLICATION WILL BE CONSIDERED AS HAVING THE ABILITY TO PAY HIS ACCOUNT AND HANDLED ACCORDINGLY.
PART VI, LINE 2:THE HOSPITAL WORKS WITH THE RANDOLPH COUNTY HEALTH DEPARTMENT ON AN ONGOING BASIS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. ADDITIONAL ASSISTANCE IS PROVIDED BY COMMUNITY INSTITUTIONS, BUSINESSES, AGENCIES AND INDIVIDUALS WITH AN INTEREST IN IMPROVING THE HEALTH STATUS OF RANDOLPH COUNTY RESIDENTS.
PART VI, LINE 3:THE HOSPITAL HAS A DEDICATED PATIENT FINANCIAL TEAM THAT TAKES A PROACTIVE APPROACH TO COUNSELING AND EDUCATING PATIENTS ON THE HEALTHCARE BILLING PROCESS AND CREATING CUSTOMIZED PAYMENT OPTIONS TO HELP ALLEVIATE INITIAL FINANCIAL BURDENS. IF IT APPEARS THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, OUR TEAM WILL HELP THE PATIENT DETERMINE WHICH ROUTE IS MOST APPROPRIATE FOR THEIR SITUATION. THE HOSPITAL ASSESSES AT THE TIME OF REGISTRATION AND DURING INTERVIEWS WITH FINANCIAL COUNSELORS WHETHER A PATIENT MIGHT QUALIFY FOR FINANCIAL ASSISTANCE AND PROVIDES LITERATURE TO THE PATIENT AT THAT TIME. THE HOSPITAL ALSO WIDELY COMMUNITES THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE, BILLING STATEMENTS, AND SIGNS POSTED CONSPICUOUSLY THROUGHT ITS FACILITIES.
PART VI, LINE 4:THE US CENSUS BUREAU REPORTED AN ESTIMATED POPULATION OF APPROXIMATELY 142,386 IN RANDOLPH COUNTY FOR THE YEAR 2013. THIS WAS AN INCREASE OF 8% FROM THE YEAR 2010 WHEN THE POPULATION WAS REPORTED TO BE APPROXIMATELY 141,144. THE ESTIMATED POPULATION IN NORTH CAROLINA IN 2013 WAS 9,749,266 WHICH WAS AN INCREASE OF 3.3% FROM 2010.SIMILAR TO NORTH CAROLINA AS A WHOLE, THE POPULATION OF RANDOLPH COUNTY IS DIVIDED ALMOST EQUALLY BETWEEN MALES (49.2%-RC, 48.7%-NC) AND FEMALES (50.8%-RC, 51.3%-NC). RESIDENTS OF RANDOLPH COUNTY ARE PREDOMINATELY WHITE (80.7%), FOLLOWED BY HISPANIC (10.8%) AND BLACK (5.6%). THE HISPANIC POPULATION IN RANDOLPH COUNTY (10.8%) IS HIGHER WHEN COMPARED TO NORTH CAROLINA (8.7%) AS A WHOLE.FROM AN ECONOMIC STANDPOINT, PERSONAL INCOME PER CAPITA FOR RANDOLPH COUNTY WAS AT $31,896 IN 2014, BELOW THE AVERAGE PER CAPITA INCOME FOR ALL RESIDENTS OF NORTH CAROLINA. THE PERCENTAGE OF MEDICAID ELIGIBLE PATIENTS IN RANDOLPH COUNTY CONTINUES TO RISE, EXCEEDING THE AVERAGE LEVEL IN NORTH CAROLINA. UNEMPLOYMENT RATES FOR RANDOLPH COUNTY IS AT APPROXIMATELY 5.5% OF THE WORKFORCE, SLIGHTLY BELOW THE NORTH CAROLINA RATE OF 5.7%.
PART VI, LINE 7, REPORTS FILED WITH STATESNC

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeCHARITY CARE ASSISTANCE TO PATIENTS QUALIFYING UNDER RANDOLPH HOSPITAL'S CHARITY CARE POLICY.GrantTypeTxt
Cash Grant$2,864,129CashGrantAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
STEVE E EBLIN
CEO$152,785$0$0$0$42,540$0$27,000$0$2,295$0$224,620$0$0$0
MURRAY S MARSH JR
CFO$72,907$0$0$0$115,218$0$23,226$0$1,675$0$213,026$0$0$0
BARBARA E WOLFE
VP$161,315$0$0$0$6,652$0$16,400$0$2,672$0$187,039$0$0$0
ROBERT S CLAUSER
VP$201,297$0$0$0$5,392$0$20,000$0$7,709$0$234,398$0$0$0
CHARLES B WEST
CMO$54,553$182,315$0$0$7,038$794$12,193$0$1,722$0$75,506$183,109$0$0
TREMONTEO CRAWFORD
VP$151,371$0$0$0$25,676$0$24,197$0$2,735$0$203,979$0$0$0
LISA D HAMPTON
PHARMACY DIRECTOR$154,802$0$0$0$291$0$0$0$695$0$155,788$0$0$0
MICHELLE C LUTHER
PHARMACIST$135,970$0$0$0$18,048$0$0$0$2,767$0$156,785$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1ADURING THE YEAR, THE ORGANIZATION PAID FOR A TOTAL OF SEVEN OF THE COMPANIONS OF BOARD MEMBERS TO TRAVEL WITH THEM TO THE ANNUAL BOARD MEETING. THE AMOUNT PAID BY THE ORGANIZATION TO EACH OF THE BOARD MEMBERS FOR COMPANION TRAVEL WAS TREATED AS TAXABLE INCOME AND FORMS 1099 WERE ISSUED.
PART I, LINE 4BCERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM PARTICIPATE IN THE RANDOLPH HOSPITAL, INC. DEFERRED COMPENSATION PLAN. UNDER THIS PLAN, AN ANNUAL CONTRIBUTION IS MADE INTO A TRUST FOR EACH PARTICIPANT BASED ON A PERCENTAGE (10% OR 15%) OF THEIR SALARY. EACH PARTICIPANT DIRECTS THE INVESTMENT OF HIS/HER ACCOUNT BALANCE.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1THERE STANDS AN EXECUTIVE COMMITTEE CONSISTING OF THE CHAIRMAN, VICE CHAIRMAN, CHAIRMAN-ELECT, SECRETARY, CHAIRMAN OF THE FINANCE, AUDIT, INVESTMENT AND RETIREMENT COMMITTEE, AND UP TO TWO OTHER DIRECTORS AS DESIGNATED BY THE CHAIRMAN. THE COMMITTEE HAS AND MAY EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE ORGANIZATION, TO THE EXTENT PERMITTED BY LAW, DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 6THE CORPORATION SHALL HAVE ONE CLASS OF MEMBERS CONSISTING OF AT LEAST 23 MEMBERS AND NEVER CONSISTING OF MORE THAN 30 MEMBERS. FOUR MEMBERS SHALL BE EX OFFICIO, AS INDICATED BELOW. THE REMAINDER SHALL BE ELECTED AS PROVIDED IN DETAIL IN THE BYLAWS. THE PRINCIPAL CRITERION FOR SELECTION OF CORPORATE MEMBERS SHALL BE THE PERSON'S QUALIFICATIONS TO EVENTUALLY SERVE AS A DIRECTOR OF RANDOLPH HOSPITAL, AS SET FORTH IN SECTION 22 OF THE BYLAWS. AS CANDIDATES BECOME AVAILABLE, THE MEMBERS MAY EXPAND OR CONTRACT THEIR NUMBER, WITHIN THE LIMITS STATED ABOVE, IN ORDER TO PROVIDE AN ADEQUATE POOL OF MEMBERS WHO ARE QUALIFIED TO SERVE AS DIRECTORS. IN ADDITION TO THE ELECTED MEMBERS, THE MAYOR OF ASHEBORO, NORTH CAROLINA, THE CHAIRMAN OF THE BOARD OF COMMISSIONERS OF RANDOLPH COUNTY, NORTH CAROLINA, THE RANDOLPH COUNTY SUPERINTENDENT OF SCHOOLS AND THE COUNTY HEALTH OFFICER OF RANDOLPH COUNTY, NORTH CAROLINA, SHALL BE EX OFFICIO MEMBERS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE CORPORATE MEMBERS FROM NOMINATIONS RECEIVED BOTH FROM THE GOVERNANCE COMMITTEE AND FROM THE FLOOR AT THE ANNUAL MEETING. IF ANY DIRECTORS SHALL SERVE ONE-YEAR TERMS, AND SHALL CONTINUE TO SERVE UNTIL THEIR SUCCESSORS ARE ELECTED. DIRECTORS MAY BE RE-ELECTED. ANY DIRECTOR MAY BE REMOVED FROM OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE, BY A MAJORITY VOTE OF THE MEMBERS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7BCHANGES TO THE BYLAWS, SALE OR MERGER OF THE HOSPITAL MUST BE APPROVED BY THE MEMBERS.
FORM 990, PART VI, SECTION B, LINE 11BTHE 990 IS REVIEWED AT THE FAIR (FINANCE, AUDIT, INVESTMENT AND RETIREMENT) COMMITTEE. ALL OF THE BOARD MEMBERS ARE INVITED TO ATTEND. ANYONE NOT AT THE MEETING IS GIVEN A COPY OF THE 990 AND IS INVITED TO ASK QUESTIONS.
FORM 990, PART VI, SECTION B, LINE 12CRANDOLPH HOSPITAL HAS A PART TIME CORPORATE COMPLIANCE OFFICER CHARGED WITH EDUCATING THE BOARD, OFFICERS, AND OTHER EMPLOYEES ON THE CONFLICT OF INTEREST POLICY. ALL NEW EMPLOYEES ARE GIVEN INFORMATION UPON ORIENTATION, AND ALL CURRENT EMPLOYEES ARE REQUIRED TO TAKE ANNUAL EDUCATION ON COMPLIANCE WITH THE POLICY. THERE IS A CORPORATE COMPLIANCE MEETING TO UPDATE KEY INDIVIDUALS ON NEW ISSUES AND NEW INFORMATION REGARDING CORPORATE COMPLIANCE. THE BOARD OF DIRECTORS ARE REQUIRED ANNUALLY TO READ, SIGN, AND REMIT A COPY OF THE POLICY TO THE BOARD CHAIR. ALL BOARD MEMBERS ARE AWARE OF THE POLICY AND IN CASE OF ANY CONFLICT OF INTEREST, THEY WILL RECUSE THEMSELVES.
FORM 990, PART VI, SECTION B, LINE 15RANDOLPH HOSPITAL CONTRACTS WITH AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE APPROPRIATE COMPENSATION LEVELS FOR EXECUTIVES THAT IS COMMENSURATE WITH ORGANIZATIONS OF SIMILAR SIZE AND STRUCTURE. A COMPENSATION COMMITTEE OF THE BOARD HAS FINAL DETERMINATION OF COMPENSATION LEVELS FOR TOP EXECUTIVES.
FORM 990, PART VI, SECTION C, LINE 18PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART VI, SECTION C, LINE 19PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART XI, LINE 9:CHANGE IN MINIMUM PENSION LIABILITY 2,242,110. LOSS ON INVESTMENT IN AFFILIATES 168,634. CHANGE IN VALUE OF INTEREST RATE SWAP 1,404,454. CHANGE IN NET UNREALIZED GAINS ON OTHER THAN TRADING SECURITIES 881,242. TEMP RESTRICTED GRANT FORFEITURE -400,000. PARTNERSHIP REVENUE NOT REPORTED ON AUDIT REPORT -85,309.
FORM 990, PART XII, LINE 2CNO CHANGE FROM PRIOR YEAR
RANDOLPH HEALTHAS OF JANUARY 2017 RANDOLPH HOSPITAL IS NOW RANDOLPH HEALTH RANDOLPH HOSPITAL, A COMPREHENSIVE PROVIDER OF HEALTHCARE TO THE PEOPLE OF RANDOLPH COUNTY AND SURROUNDING COMMUNITIES HAS BECOME RANDOLPH HEALTH. THE NEW NAME, RANDOLPH HEALTH, BETTER REFLECTS THE EVOLUTION THAT HAS BEEN TAKING PLACE THROUGHOUT THE RANDOLPH SYSTEM OVER THE PAST SEVERAL YEARS. THERE ARE THREE MAIN DRIVERS THAT LED TO THE CHANGE. FIRST, HEALTHCARE IS CHANGING FASTER THAN EVER BEFORE. TECHNOLOGICAL ADVANCEMENTS HAVE CREATED A HIGHER STANDARD OF CARE. SECONDLY, THE COMMUNITY SERVED IS CHANGING. THE COMMUNITY IS MORE KNOWLEDGEABLE AND DIVERSE THAN EVER, WHICH MEANS THE NEEDS AND EXPECTATIONS OF THE COMMUNITY HAS EVOLVED. THE THIRD REASON IS AS THE RANDOLPH HEALTH SYSTEM HAS EVOLVED OVER THE LAST 20 YEARS, IT HAS BECOME APPARENT THAT THE COMMUNITIES SERVED MIGHT NOT FULLY BE AWARE OF THE EXTENT OF OUR CHANGE. WE HAVE 26 DISTINCT CARE LOCATIONS IN RANDOLPH COUNTY IN ADDITION TO THE SERVICES WE PROVIDE IN HOMES. OUR COMMITMENT IS TO MAKING SURE YOU HAVE THE RIGHT CARE, WHEN YOU NEED IT AND WHERE YOU NEED IT.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdTotal IncomeTotalIncomeAmtEnd Of Year AssetsEndOfYearAssetsAmtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
MRI OF ASHEBORO LLC
237 N FAYETTEVILLE STREET BASHEBORONC27203472225445IMAGING SERVICESNC$1,165,348$1,716,800RANDOLPH HOSPITAL INC
PIEDMONT INTEGRATED HEALTH LLC
364 WHITE OAK STREETASHEBORONC27203472221211CLINICALLY INTEGRATED NETWORKNC$0$0RANDOLPH HOSPITAL INC

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
RANDOLPH SPECIALTY GROUP
364 WHITE OAK STREETASHEBORONC27204113827203HEALTHCARENC501(C)(3)LINE 10RANDOLPH HOSPITAL INCYes (1)
RANDOLPH CANCER CENTER
373 N FAYETTEVILLE STREETASHEBORONC27203562181482HEALTHCARENC501(C)(3)LINE 12A, IRANDOLPH HOSPITAL INCYes (1)
RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION
364 WHITE OAK STREETASHEBORONC27204582240755SUPPORT ORGANIZATIONNC501(C)(3)LINE 12A, IRANDOLPH HOSPITAL INCYes (1)
STAYWELL SENIOR CARE
PO BOX 1048ASHEBORONC27204461289922HEALTHCARENC501(C)(3)LINE 12A, IRANDOLPH HOSPITAL INCYes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1RANDOLPH NEWCO LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1364 WHITE OAK STREETAddressLine1Txt
CityASHEBOROCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27203ZIPCd
FieldValueIRS element (for citing)
EIN471905523EIN
Primary ActivitiesMEDICAL EQUIPMENT RENTALPrimaryActivitiesTxt
Legal Domicile StateNCLegalDomicileStateCd
Predominant Income TypeUNRELATEDPredominantIncomeTypeTxt
Disproportionate Allocations0DisproportionateAllocationsInd
General Or Managing Partner0GeneralOrManagingPartnerInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (8 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
RANDOLPH SPECIALTY GROUPRANDOLPH SPECIALTY GROUPRANDOLPH SPECIALTY GROU
K$146,040CASH
RANDOLPH SPECIALTY GROUP
O$1,420,810CASH
RANDOLPH SPECIALTY GROUP
Q$1,268,544CASH
RANDOLPH SPECIALTY GROUP
P$215,520CASH
RANDOLPH SPECIALTY GROUP
S$2,192,002CASH
RANDOLPH CANCER CENTER
J$249,000CASH
(no name)
CASH
(no name)
CASH