RANDOLPH HOSPITAL INC: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- RANDOLPH HOSPITAL INC (EIN 56-0530234)
- Tax period
- 2014-10-01 to 2015-09-30
- Filed
- 2016-08-12
- IRS object ID
- 201642259349300224
- Schema version
- 2014v6.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-08-12T07:48:57-05:00 | ReturnTs |
| Tax Period End | 2015-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 227 WEST TRADE STREET SUITE 800 | AddressLine1Txt |
| City | CHARLOTTE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560530234 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RAND | BusinessNameControlTxt |
| Phone | 3366255151 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27204 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MURRAY S MARSH JR | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3366255151 | PhoneNum |
| Signature | 2016-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN NORMAN | PreparerPersonNm |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | PhoneNum |
| Preparation | 2016-08-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-09-27 15:27:22Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVE E EBLIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27203 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $123,143,105 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RANDOLPHHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1928 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTH CARE AND FOSTER HEALTH AND WELLNESS IN OUR COMMUNITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 1229 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$93,884 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $363,532 | PYContributionsGrantsAmt |
| CY Contributions Grants | $136,607 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $126,266,296 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $120,207,163 | CYProgramServiceRevenueAmt |
| PY Investment Income | $944,155 | PYInvestmentIncomeAmt |
| CY Investment Income | $660,733 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$1,510,588 | PYOtherRevenueAmt |
| CY Other Revenue | $2,138,602 | CYOtherRevenueAmt |
| PY Total Revenue | $126,063,395 | PYTotalRevenueAmt |
| CY Total Revenue | $123,143,105 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $6,476 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $3,244,309 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $52,567,898 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $54,495,813 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $76,184 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $74,809,819 | PYOtherExpensesAmt |
| CY Other Expenses | $62,805,424 | CYOtherExpensesAmt |
| PY Total Expenses | $127,384,193 | PYTotalExpensesAmt |
| CY Total Expenses | $120,545,546 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,320,798 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,597,559 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $139,341,480 | TotalAssetsBOYAmt |
| Total Assets EOY | $136,127,228 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $72,205,409 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $72,909,548 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $67,136,071 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $63,217,680 | NetAssetsOrFundBalancesEOYAmt |
| Mission | RANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $109,417,712 | ExpenseAmt |
| Grant | $3,244,309 | GrantAmt |
| Revenue | $122,583,908 | RevenueAmt |
| Desc | RANDOLPH 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 | $109,417,712 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 191 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1229 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LORETTA LONG | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3363283443 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216A FOUST ST | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27203 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| SAMUEL D CRANFORD | |||||||||
| CHAIR | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| GLENN MAC PUGH | |||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 0.00 | ||
| SAMUEL A RANKIN JR | |||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | 0.00 | ||
| DIANE FROST | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | 0.00 | |||
| REYNOLDS LISK | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CRANFORD KNOTT | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| ELBERT J LASSITER | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| MICHAEL C MILLER | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CRIS R RICHARDSON | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| ROBERT S SHACKLEFORD JR | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| STEVE E EBLIN | |||||||||
| CEO | 40.00 | Yes (X) | $362,506 | $0 | $6,016 | 0.00 | |||
| MURRAY S MARSH | |||||||||
| CFO | 40.00 | Yes (X) | $217,148 | $0 | $3,932 | 0.00 | |||
| DEVIN L GRIFFITH | |||||||||
| VP | 40.00 | Yes (X) | $184,030 | $0 | $1,255 | ||||
| BARBARA E WOLFE | |||||||||
| VP | 40.00 | Yes (X) | $160,569 | $0 | $3,901 | ||||
| ROBERT S CLAUSER | |||||||||
| VP | 40.00 | Yes (X) | $184,316 | $0 | $7,274 | ||||
| ANGELA P ORTH | |||||||||
| VP | 40.00 | Yes (X) | $220,619 | $0 | $3,182 | 0.00 | |||
| TREMONTEO CRAWFORD | |||||||||
| CHIEF NURSING OFFICER | 40.00 | $151,326 | $0 | $2,604 | 0.00 | Yes (X) | |||
| LISA HAMPTON | |||||||||
| DIRECTOR | 40.00 | $152,140 | $0 | $1,128 | Yes (X) | ||||
| MICHELE LUTHER | |||||||||
| PHARMACIST | 40.00 | $144,487 | $0 | $2,653 | Yes (X) | ||||
| WILLIAM WARD | |||||||||
| PHARMACIST | 40.00 | $136,877 | $0 | $4,423 | Yes (X) | ||||
| ANGELA BURGESS | |||||||||
| DIRECTOR | 40.00 | $131,178 | $0 | $5,295 | Yes (X) | ||||
| SUE BELL | |||||||||
| DIRECTOR | 40.00 | $128,269 | $0 | $6,637 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,173,465 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $48,300 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 33 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GREENSBORO RADIOLOGY PA | |||||
| 1331 N ELM ST STE 200 | GREENSBORO | NC | 274016304 | PROFESSIONAL RADIOLOGY SERVICES | $3,260,679 |
| PINNACLE HEALTHCARE ADVISORS INC | |||||
| 4841 OAK RIDGE DRIVE | HERMANTOWN | MN | 55811 | CONSULTANTS | $1,615,997 |
| SODEXO INC & AFFLIATES | |||||
| PO BOX 536922 | ATLANTA | GA | 303536922 | FOOD MANAGEMENT SERVICES | $1,348,777 |
| ARAMARK CORPORATION | |||||
| 10510 TWIN LAKES PARKWAY | CHARLOTTE | NC | 282697658 | REPAIRS & MAINTENANCE | $1,342,812 |
| THE ADVISORY BOARD | |||||
| 600 NEW HAMPSHIRE AVE NW | WASHINGTON | DC | 20037 | CONSULTANTS | $631,673 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $21,766 | GovernmentGrantsAmt |
| All Other Contributions | $114,841 | AllOtherContributionsAmt |
| Total Contributions | $136,607 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $116,617,990 | $116,617,990 |
| CANCER CENTER REVENUES | 621400 | $511,807 | $511,807 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,077,366 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,077,366 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $120,207,163 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $660,733 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $660,733 | RelatedOrExemptFuncIncomeAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $422,590 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $422,590 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $422,590 | TotalRevenueColumnAmt |
| Exclusion | $422,590 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| GAIN ON INV IN AFFILIATES | 900009 | $1,626,544 | $1,626,544 |
| COFFEE/GIFT SHOP | 453220 | $89,468 | $89,468 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,716,012 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $123,143,105 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $122,583,908 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $422,590 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,244,309 | TotalAmt |
| Program Services | $3,244,309 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,616,668 | TotalAmt |
| Management And General | $2,616,668 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,917,761 | TotalAmt |
| Program Services | $35,221,197 | ProgramServicesAmt |
| Management And General | $3,655,030 | ManagementAndGeneralAmt |
| Fundraising | $41,534 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,332,245 | TotalAmt |
| Program Services | $1,129,744 | ProgramServicesAmt |
| Management And General | $201,169 | ManagementAndGeneralAmt |
| Fundraising | $1,332 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,551,854 | TotalAmt |
| Program Services | $7,251,972 | ProgramServicesAmt |
| Management And General | $1,291,330 | ManagementAndGeneralAmt |
| Fundraising | $8,552 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,077,285 | TotalAmt |
| Program Services | $2,609,538 | ProgramServicesAmt |
| Management And General | $464,670 | ManagementAndGeneralAmt |
| Fundraising | $3,077 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,715,004 | TotalAmt |
| Program Services | $1,137,048 | ProgramServicesAmt |
| Management And General | $577,956 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,329 | TotalAmt |
| Management And General | $156,329 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,036 | TotalAmt |
| Management And General | $64,036 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,853,268 | TotalAmt |
| Program Services | $7,837,561 | ProgramServicesAmt |
| Management And General | $14,136 | ManagementAndGeneralAmt |
| Fundraising | $1,571 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $427,053 | TotalAmt |
| Program Services | $307,478 | ProgramServicesAmt |
| Management And General | $109,753 | ManagementAndGeneralAmt |
| Fundraising | $9,822 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,637,309 | TotalAmt |
| Program Services | $6,636,822 | ProgramServicesAmt |
| Management And General | $992,850 | ManagementAndGeneralAmt |
| Fundraising | $7,637 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,572,810 | TotalAmt |
| Program Services | $1,516,189 | ProgramServicesAmt |
| Management And General | $56,621 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,651,864 | TotalAmt |
| Program Services | $3,461,967 | ProgramServicesAmt |
| Management And General | $189,897 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,963 | TotalAmt |
| Program Services | $307,768 | ProgramServicesAmt |
| Management And General | $50,755 | ManagementAndGeneralAmt |
| Fundraising | $1,440 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,976 | TotalAmt |
| Program Services | $46,976 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,746,448 | TotalAmt |
| Program Services | $1,746,448 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,407,132 | TotalAmt |
| Program Services | $6,407,132 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $458,497 | TotalAmt |
| Management And General | $458,497 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| BAD DEBTS | $17,938,736 | $17,938,736 | ||
| MEDICAL SUPPLIES | $12,009,254 | $12,009,254 | ||
| MISCELLANEOUS | $609,401 | $607,573 | $609 | $1,219 |
| RECRUITMENT | $151,344 | $151,344 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,545,546 | TotalAmt |
| Program Services | $109,417,712 | ProgramServicesAmt |
| Management And General | $11,051,650 | ManagementAndGeneralAmt |
| Fundraising | $76,184 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,294,427 | BOYAmt |
| EOY | $10,181,644 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,235,491 | BOYAmt |
| EOY | $6,215,186 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,163,098 | BOYAmt |
| EOY | $18,824,538 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,914,618 | BOYAmt |
| EOY | $2,734,484 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $702,949 | BOYAmt |
| EOY | $789,654 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $150,313,066 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $94,803,764 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,708,404 | BOYAmt |
| EOY | $55,509,302 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,592,295 | BOYAmt |
| EOY | $21,144,804 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,608,047 | BOYAmt |
| EOY | $6,119,855 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,122,151 | BOYAmt |
| EOY | $14,607,761 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,341,480 | BOYAmt |
| EOY | $136,127,228 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,760,219 | BOYAmt |
| EOY | $9,061,544 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,746,834 | BOYAmt |
| EOY | $43,170,434 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,698,356 | BOYAmt |
| EOY | $20,677,570 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,205,409 | BOYAmt |
| EOY | $72,909,548 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,759,963 | BOYAmt |
| EOY | $62,814,922 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $376,108 | BOYAmt |
| EOY | $402,758 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,136,071 | BOYAmt |
| EOY | $63,217,680 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,341,480 | BOYAmt |
| EOY | $136,127,228 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,597,559 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$783,778 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$5,732,171 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | Yes (1) | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $20,839 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $20,839 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE AMOUNT REFERENCED ABOVE REPRESENTS A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT IS ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,634,877 | BeginningYearBalanceAmt |
| End Year Balance | $1,634,877 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,634,877 | BeginningYearBalanceAmt |
| End Year Balance | $1,634,877 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,634,877 | BeginningYearBalanceAmt |
| End Year Balance | $1,634,877 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,634,877 | BeginningYearBalanceAmt |
| End Year Balance | $1,634,877 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,529,736 | BeginningYearBalanceAmt |
| Contributions | $105,141 | ContributionsAmt |
| End Year Balance | $1,634,877 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,232,061 | OtherCostOrOtherBasisAmt |
| Book Value | $3,232,061 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $80,930,973 | OtherCostOrOtherBasisAmt |
| Depreciation | $40,951,378 | DepreciationAmt |
| Book Value | $39,979,595 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,122,263 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,045,194 | DepreciationAmt |
| Book Value | $4,077,069 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $59,104,401 | OtherCostOrOtherBasisAmt |
| Depreciation | $48,514,034 | DepreciationAmt |
| Book Value | $10,590,367 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,923,368 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,293,158 | DepreciationAmt |
| Book Value | -$2,369,790 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $55,509,302 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (6 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $371,328 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | $43,924 |
| ASSETS LIMITED AS TO USE | $402,758 |
| INVESTMENT IN AFFILIATES | $778,989 |
| DUE FROM AFFILIATES | $12,633,255 |
| OTHER LONG-TERM ASSETS | $377,507 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $14,607,761 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| OTHER LONG-TERM LIABILITIES | $322,071 |
| MINIMUM PENSION LIABILITY | $7,974,333 |
| INTEREST RATE SWAP | $3,747,336 |
| DUE TO AFFILIATES | $8,633,830 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $20,677,570 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THIS IS A DONATION FROM ANNIS S. KEMP THAT IS RESTRICTED. |
| PART X, LINE 2: | THE HOSPITAL, RMA, RSG, 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, 2015. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,872,451 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,872,451 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09620 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,062,043 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,740,227 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $321,816 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00310 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $248,600 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $198,778 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $49,822 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,183,094 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $14,939,005 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,244,089 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09980 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $435,793 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $195,297 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $240,496 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $35,979 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $35,979 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,845 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,845 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $473,617 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $195,297 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $278,320 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,656,711 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,134,302 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,522,409 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10250 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,958,545 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $5,064,763 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $39,370,765 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $43,089,455 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,718,690 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 RANDOLPH NEWCO LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MEDICAL EQUIPMENT RENTAL | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.83030 | OrgProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INCORPORATED | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RANDOLPHHOSPITAL.ORG | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INCORPORATED | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.RANDOLPHHOSPITAL.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.RANDOLPHHOSPITAL.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | 0 | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.RANDOLPHHOSPITAL.ORG/PDFS/FINANCIALASSISTANCEPOLICY.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RANDOLPH HOSPITAL INCORPORATED | PART V, SECTION B, LINE 5: METHODOLOGY, DATA COLLECTION & ANALYSIS IN THE FALL OF 2012, 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 JANUARY - JULY 2013. PRIMARY DATA WAS COLLECTED FROM THE COMMUNITY IN THREE WAYS: DISTRIBUTION OF PAPER SURVEYS MAILED RANDOMLY TO RESIDENTS ACROSS THE COUNTY, AN INTERNET SURVEY AND A COMMUNITY LEADER QUESTIONNAIRE.PRIMARY DATA2013 RANDOLPH COUNTY HEALTH OPINION SURVEYTELEPHONE SURVEYS HAVE BEEN CONDUCTED IN YEARS PAST, HOWEVER, BECAUSE MANY PEOPLE NOW REPLACE LANDLINE PHONE SERVICE WITH CELL PHONES OR USE UNLISTED PHONE NUMBERS, IT WAS FELT THAT A PHONE SURVEY WOULD NOT BE REPRESENTATIVE OF THE COUNTY. WITH TECHNOLOGY CONTINUING TO ADVANCE, MORE OF AN EMPHASIS WAS PLACED ON ON-LINE SURVEYS, ALTHOUGH PAPER SURVEYS WERE STILL AN IMPORTANT TOOL. SURVEYS WERE MAILED TO RESIDENTS ACROSS THE COUNTY USING A RANDOM SAMPLE METHOD. THROUGH UTILIZATION OF RANDOLPH COUNTY'S ADDRESS DATABASE, EVERY FIFTIETH (50TH) ADDRESS WAS RANDOMLY SELECTED. OVER FIVE HUNDRED (525) SURVEYS, INCLUDING A SELF-ADDRESSED, STAMPED ENVELOPE WERE MAILED TO SELECTED ADDRESSES. IN ADDITION TO THE MAILED SURVEYS, THEY WERE ALSO DISTRIBUTED TO AGENCIES AND ORGANIZATIONS WITHIN THE COUNTY USING THE CONVENIENCE SAMPLE METHOD. SUCH AGENCIES INCLUDED: RANDOLPH COMMUNITY COLLEGE, RANDOLPH COUNTY SENIOR ADULTS ASSOCIATION, LIBERTY EARLY CHILDHOOD CENTER, RANDOLPH COUNTY PARTNERSHIP FOR CHILDREN, THE LATINO COALITION OF RANDOLPH COUNTY AND SEVERAL CHURCHES. ALL SURVEYS DISTRIBUTED WERE IN BOTH ENGLISH AND SPANISH. OF THE 3,500 TOTAL DISTRIBUTED SURVEYS, 1,570 WERE RETURNED FOR A RESPONSE RATE OF 45%. 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. INTERNET SURVEY 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. IN AN EFFORT TO PROMOTE THE INTERNET SURVEY, LAMINATED INFORMATION CARDS WERE DISPLAYED IN BOTH ENGLISH AND SPANISH AT VARIOUS BUSINESSES, WHICH INCLUDED CHURCH BULLETINS.COMMUNITY LEADER/SERVICE PROVIDER QUESTIONNAIRESTO ENSURE A SOLID REPRESENTATION FROM KEY SECTORS, THE STAKEHOLDER QUESTIONNAIRE WAS SENT TO DEPARTMENT HEADS AND DIRECTORS FROM VARIOUS AGENCIES OR REPRESENTATIVES WITHIN THE COUNTY. SURVEY RESULTS ARE INCLUDED IN THE APPENDIX SECTION OF THIS DOCUMENT. SECONDARY DATA THE MAJOR SOURCE FOR SECONDARY DATA IN THE 2013 RANDOLPH COUNTY COMMUNITY HEALTH ASSESSMENT INCLUDED:- NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS- NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES- LINC: LOG INTO NORTH CAROLINA- CECIL G. SHEPS CENTER FOR HEALTH SERVICES RESEARCH- US CENSUS DEPARTMENT- UNITED STATES CENSUS BUREAU- UNITED STATES DEPARTMENT OF COMMERCEAS APPLICABLE, RANDOLPH COUNTY STATISTICS HAVE BEEN COMPARED WITH STATE STATISTICS AS WELL AS FOUR PEER COUNTIES. THESE PEER COUNTIES WERE IDENTIFIED BASED UPON AGE, RACE AND POVERTY CHARACTERISTICS, AND ARE SELECTED FROM A GROUP OF COUNTIES WITHIN THE SAME POPULATION RANGE AS THE SUBJECT COUNTY. FOR RANDOLPH COUNTY, THE FOLLOWING FOUR PEER COUNTIES WERE IDENTIFIED: CRAVEN, DAVIDSON, HARNETT AND JOHNSTON. THEREFORE, IN ADDITION TO NORTH CAROLINA STATISTICS, THESE FOUR COUNTIES WERE USED FOR COMPARISON THROUGHOUT THE ASSESSMENT PROCESS. |
| RANDOLPH HOSPITAL INCORPORATED | PART 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 INCORPORATED | PART V, SECTION B, LINE 11: BASED ON PRIMARY DATA RESULTS, EMPLOYMENT OPPORTUNITIES, AFFORDABLE HOUSING, CRIME AND AVAILABILITY OF POSITIVE TEEN ACTIVITIES WERE MAJOR CONCERNS OF THE PUBLIC. HOWEVER, THE ADVISORY TEAM DECIDED THESE WERE NOT AREAS IN WHICH RANDOLPH HOSPITAL OR THE RANDOLPH COUNTY HEALTH DEPARTMENT COULD IMPACT. |
| RANDOLPH HOSPITAL INCORPORATED | PART 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. |
| RANDOLPH HOSPITAL INCORPORATED | PART V, SECTION B, LINE 22D: UNINSURED PATIENTS WILL RECEIVE A DISCOUNT AT THE TIME OF BILLING THAT IS EQUAL TO THE AVERAGE DISCOUNT GIVEN TO THE LARGEST MANAGED CARE PAYERS FOR THE PRIOR YEAR. |
| PART V, SECTION B, LINE 16 | FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY |
| RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 16A WEBSITE: | HTTP://WWW.RANDOLPHHOSPITAL.ORG/PDFS/FINANCIALASSISTANCEPOLICY.PDF |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| RANDOLPH MEDICAL ASSOCIATES | ||||
| 218-C FOUST STREET | ASHEBORO | NC | 27203 | WHOLLY OWNED PHYSICIAN PRACTICE (MULTIPLE LOCATIONS) |
| RANDOLPH SPECIALTY GROUP | ||||
| 138 DUBLIN SQUARE ROAD SUITE A | ASHEBORO | NC | 27203 | WHOLLY OWNED PHYSICIAN PRACTICE(MULTIPLE LOCATIONS) |
| RANDOLPH CANCER CENTER | ||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27203 | ONCOLOGY JOINT VENTURE |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. THE ORGANIZATION ESTIMATES FROM HISTORICAL PERSPECTIVE AND EXPERIENCE THAT APPROXIMATELY 85% OF BAD DEBT EXPENSE MAY BE ATTRIBUTABLE TO COMMUNITY BENEFIT. |
| 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 7, REPORTS FILED WITH STATES | NC |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | CHARITY CARE ASSISTANCE TO PATIENTS QUALIFYING UNDER RANDOLPH HOSPITAL'S CHARITY CARE POLICY. | GrantTypeTxt |
| Recipient | 1613 | RecipientCnt |
| Cash Grant | $3,244,309 | CashGrantAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVE E EBLIN | ||||||||||||||
| CEO | $362,506 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $6,016 | $0 | $368,522 | $0 | $0 | $0 |
| MURRAY S MARSH | ||||||||||||||
| CFO | $217,148 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $3,932 | $0 | $221,080 | $0 | $0 | $0 |
| DEVIN L GRIFFITH | ||||||||||||||
| VP | $184,030 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,255 | $0 | $185,285 | $0 | $0 | $0 |
| BARBARA E WOLFE | ||||||||||||||
| VP | $160,569 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $3,901 | $0 | $164,470 | $0 | $0 | $0 |
| ROBERT S CLAUSER | ||||||||||||||
| VP | $184,316 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,274 | $0 | $191,590 | $0 | $0 | $0 |
| ANGELA P ORTH | ||||||||||||||
| VP | $220,619 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $3,182 | $0 | $223,801 | $0 | $0 | $0 |
| TREMONTEO CRAWFORD | ||||||||||||||
| CHIEF NURSING OFFICER | $151,326 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $2,604 | $0 | $153,930 | $0 | $0 | $0 |
| LISA HAMPTON | ||||||||||||||
| DIRECTOR | $152,140 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $1,128 | $0 | $153,268 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | DURING THE YEAR, THE ORGANIZATION PAID FOR A TOTAL OF SEVENTEEN 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 4B | CERTAIN 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 (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THERE STANDS AN EXECUTIVE COMMITTEE CONSISTING OF THE CHAIRMAN, VICE CHAIRMAN, CHAIRMAN-ELECT, THE SECRETARY, THE 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 6 | THE 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 7A | THE DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS FROM NOMINATIONS RECEIVED BOTH FROM THE GOVERNANCE COMMITTEE AND FROM THE FLOOR AT THE ANNUAL MEETING OF THE MEMBERS. 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 7B | CHANGES TO THE BYLAWS, SALE OR MERGER OF THE HOSPITAL MUST BE APPROVED BY THE MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990, ALONG WITH A SUMMARY OF KEY ELEMENTS AND DISCLOSURES, ARE PROVIDED TO THE BOARD INVITING QUESTIONS AND COMMENTS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | RANDOLPH HOSPITAL HAS A 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 MONTHLY CORPORATE COMPLIANCE MEETING TO UPDATE KEY INDIVIDUALS ON NEW ISSUES AND NEW INFORMATION REGARDING CORPORATE COMPLIANCE. THE BOARD OF DIRECTORS IS 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 15 | THE COMPENSATION COMMITTEE OF THE BOARD ENGAGED EXTERNAL CONSULTANT TO ASSIST WITH NOT ONLY THE CEO'S COMPENSATION, BUT THE VP'S COMPENSATION, AS WELL. THE CONSULTANT USED THEIR MARKET DATABASE TO PROVIDE THE COMPENSATION COMMITTEE WITH SALARIES AT THE 25TH, 50TH, AND 75TH PERCENTILES FOR SIMILAR SIZED ORGANIZATIONS. ALL BASE SALARIES ARE APPROXIMATELY AT THE 30TH PERCENTILE. A PORTION OF EXECUTIVE SALARIES ARE AT RISK THROUGH AN INCENTIVE PROGRAM TIED TO ANNUAL GOALS. SHOULD ALL OF THE GOALS BE ACHIEVED IN A GIVEN YEAR, TOTAL COMPENSATION FOR EXECUTIVE LEADERS GOES TO APPROXIMATELY THE 50TH PERCENTILE. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINSTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF INTEREST RATE SWAP -767,592. CHANGE IN MINIMUM PENSION LIABILITY -2,666,827. EQUITY TRANSFER TO AFFILIATE -2,297,752. |
| PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | End Of Year AssetsEndOfYearAssetsAmt |
|---|---|---|---|---|---|---|---|---|---|
| PIEDMONT INTEGRATED HEALTH | |||||||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27204 | 472221211 | CLINICALLY INTEGRATED NETWORK | NC | -$103,159 | RANDOLPH HOSPITAL INC | |
| MRI OF ASHEBORO LLC | |||||||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27203 | 472221211 | IMAGING SERVICES | NC | -$163,084 | RANDOLPH HOSPITAL INC | $2,066,084 |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| RANDOLPH SPECIALTY GROUP | ||||||||||
| 364 WHITE OAK ST | ASHEBORO | NC | 27204 | 113827203 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | RANDOLPH HOSPITAL INC | Yes (1) |
| RANDOLPH CANCER CENTER | ||||||||||
| 373 N FAYETTEVILLE ST | ASHEBORO | NC | 27203 | 562181482 | HEALTHCARE | NC | 501(C)(3) | LINE 11A, I | RANDOLPH HOSPITAL INC | Yes (1) |
| RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION | ||||||||||
| 364 WHITE OAK ST | ASHEBORO | NC | 27203 | 582240755 | SUPPORT ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | RANDOLPH HOSPITAL INC | Yes (1) |
| STAYWELL SENIOR CARE | ||||||||||
| PO BOX 1048 | ASHEBORO | NC | 27204 | 461289922 | HEALTHCARE | NC | 501(C)(3) | LINE 11A, I | RANDOLPH HOSPITAL INC | Yes (1) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH NEWCO LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27203 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 471905523 | EIN |
| Primary Activities | MEDICAL EQUIPMENT RENTAL | PrimaryActivitiesTxt |
| Legal Domicile State | NC | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | UNRELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | $61,585 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $531,246 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | Yes (1) | GeneralOrManagingPartnerInd |
| Ownership | 0.83030 | OwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (12 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| RANDOLPH SPECIALTY GROUP - RENT | ||
| J | $125,730 | CASH |
| RANDOLPH MEDICAL ASSOCIATES - RENT | ||
| J | $20,310 | CASH |
| RANDOLPH SPECIALTY GROUP - PAYROLL | ||
| O | $202,563 | CASH |
| RANDOLPH SPECIALTY GROUP - PAYROLL | ||
| O | $140,350 | CASH |
| RANDOLPH MEDICAL ASSOCIATES - CASH TRANSFERS | ||
| R | $267,053 | CASH |
| RANDOLPH SPECIALTY GROUP - CASH TRANSFERS | ||
| R | $1,037,699 | CASH |
| RANDOLPH SPECIALTY GROUP | ||
| P | $757,553 | CASH |
| RANDOLPH MEDICAL ASSOCIATES - BENEFITS | ||
| Q | $142,258 | CASH |
| RANDOLPH SPECIALTY GROUP - BENEFITS | ||
| Q | $1,043,450 | CASH |
| INVESTMENT IN STAYWELL SENIOR CARE | ||
| D | $305,819 | CASH |
| INVESTMENT IN PIH | ||
| B | $710,460 | CASH |
| RANDOLPH CANCER CENTER | ||
| J | $249,000 | CASH |