2016-08-12T07:48:57-05:00 2015-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2014-10-01 560530234 RANDOLPH HOSPITAL INC RAND 3366255151 364 WHITE OAK STREET ASHEBORO NC 27204 MURRAY S MARSH JR CFO 3366255151 2016-08-11 1 JOHN NORMAN P01506766 7049985200 2016-08-10 2014 2016-09-27 15:27:22Z STEVE E EBLIN 364 WHITE OAK STREET ASHEBORO NC 27203 123143105 0 X WWW.RANDOLPHHOSPITAL.ORG X 1928 NC TO PROVIDE QUALITY HEALTH CARE AND FOSTER HEALTH AND WELLNESS IN OUR COMMUNITIES. 11 11 1229 0 0 -93884 363532 136607 126266296 120207163 944155 660733 -1510588 2138602 126063395 123143105 6476 3244309 0 0 52567898 54495813 0 0 76184 74809819 62805424 127384193 120545546 -1320798 2597559 139341480 136127228 72205409 72909548 67136071 63217680 RANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS. 0 0 109417712 3244309 122583908 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. 109417712 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 191 0 1 1229 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X LORETTA LONG 3363283443 216A FOUST ST ASHEBORO NC 27203 SAMUEL D CRANFORD CHAIR 4.00 X X 0 0 0 GLENN MAC PUGH VICE CHAIR 2.00 0.00 X X 0 0 0 SAMUEL A RANKIN JR SECRETARY 2.00 0.00 X X 0 0 0 DIANE FROST BOARD MEMBER 2.00 0.00 X 0 0 0 REYNOLDS LISK BOARD MEMBER 2.00 X 0 0 0 CRANFORD KNOTT BOARD MEMBER 2.00 X 0 0 0 ELBERT J LASSITER BOARD MEMBER 2.00 X 0 0 0 MICHAEL C MILLER BOARD MEMBER 2.00 X 0 0 0 CRIS R RICHARDSON BOARD MEMBER 2.00 X 0 0 0 ROBERT S SHACKLEFORD JR BOARD MEMBER 2.00 X 0 0 0 STEVE E EBLIN CEO 40.00 0.00 X 362506 0 6016 MURRAY S MARSH CFO 40.00 0.00 X 217148 0 3932 DEVIN L GRIFFITH VP 40.00 X 184030 0 1255 BARBARA E WOLFE VP 40.00 X 160569 0 3901 ROBERT S CLAUSER VP 40.00 X 184316 0 7274 ANGELA P ORTH VP 40.00 0.00 X 220619 0 3182 TREMONTEO CRAWFORD CHIEF NURSING OFFICER 40.00 0.00 X 151326 0 2604 LISA HAMPTON DIRECTOR 40.00 X 152140 0 1128 MICHELE LUTHER PHARMACIST 40.00 X 144487 0 2653 WILLIAM WARD PHARMACIST 40.00 X 136877 0 4423 ANGELA BURGESS DIRECTOR 40.00 X 131178 0 5295 SUE BELL DIRECTOR 40.00 X 128269 0 6637 2173465 0 48300 33 0 1 0 GREENSBORO RADIOLOGY PA 1331 N ELM ST STE 200 GREENSBORO NC 274016304 PROFESSIONAL RADIOLOGY SERVICES 3260679 PINNACLE HEALTHCARE ADVISORS INC 4841 OAK RIDGE DRIVE HERMANTOWN MN 55811 CONSULTANTS 1615997 SODEXO INC & AFFLIATES PO BOX 536922 ATLANTA GA 303536922 FOOD MANAGEMENT SERVICES 1348777 ARAMARK CORPORATION 10510 TWIN LAKES PARKWAY CHARLOTTE NC 282697658 REPAIRS & MAINTENANCE 1342812 THE ADVISORY BOARD 600 NEW HAMPSHIRE AVE NW WASHINGTON DC 20037 CONSULTANTS 631673 6 21766 114841 136607 PATIENT SERVICE REVENUE 621400 116617990 116617990 CANCER CENTER REVENUES 621400 511807 511807 3077366 3077366 120207163 660733 660733 422590 0 422590 422590 422590 GAIN ON INV IN AFFILIATES 900009 1626544 1626544 COFFEE/GIFT SHOP 453220 89468 89468 1716012 123143105 122583908 0 422590 3244309 3244309 2616668 2616668 38917761 35221197 3655030 41534 1332245 1129744 201169 1332 8551854 7251972 1291330 8552 3077285 2609538 464670 3077 1715004 1137048 577956 156329 156329 64036 64036 7853268 7837561 14136 1571 427053 307478 109753 9822 7637309 6636822 992850 7637 1572810 1516189 56621 3651864 3461967 189897 359963 307768 50755 1440 46976 46976 1746448 1746448 6407132 6407132 458497 458497 BAD DEBTS 17938736 17938736 MEDICAL SUPPLIES 12009254 12009254 MISCELLANEOUS 609401 607573 609 1219 RECRUITMENT 151344 151344 120545546 109417712 11051650 76184 7294427 10181644 7235491 6215186 19163098 18824538 2914618 2734484 702949 789654 150313066 94803764 58708404 55509302 21592295 21144804 5608047 6119855 16122151 14607761 139341480 136127228 10760219 9061544 43746834 43170434 17698356 20677570 72205409 72909548 X 66759963 62814922 376108 402758 67136071 63217680 139341480 136127228 X 2597559 -783778 -5732171 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 20839 20839 0 PART II-B, LINE 1: 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. 1634877 1634877 1634877 1634877 1634877 1634877 1634877 1634877 1529736 105141 1634877 0 0 3232061 3232061 80930973 40951378 39979595 5122263 1045194 4077069 59104401 48514034 10590367 1923368 4293158 -2369790 55509302 OTHER RECEIVABLES 371328 ESTIMATED THIRD-PARTY SETTLEMENTS 43924 ASSETS LIMITED AS TO USE 402758 INVESTMENT IN AFFILIATES 778989 DUE FROM AFFILIATES 12633255 OTHER LONG-TERM ASSETS 377507 14607761 OTHER LONG-TERM LIABILITIES 322071 MINIMUM PENSION LIABILITY 7974333 INTEREST RATE SWAP 3747336 DUE TO AFFILIATES 8633830 20677570 X 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. 1 1 X 1 X 1 X 1 0 1 1 9872451 9872451 0.09620 15062043 14740227 321816 0.00310 248600 198778 49822 0.00050 25183094 14939005 10244089 0.09980 435793 195297 240496 0.00230 35979 35979 0.00040 1845 1845 0.00000 473617 195297 278320 0.00270 25656711 15134302 10522409 0.10250 1 5958545 5064763 39370765 43089455 -3718690 X 1 1 1 RANDOLPH NEWCO LLC MEDICAL EQUIPMENT RENTAL 0.83030 1 1 RANDOLPH HOSPITAL INCORPORATED 364 WHITE OAK STREET ASHEBORO NC 27204 WWW.RANDOLPHHOSPITAL.ORG X X X RANDOLPH HOSPITAL INCORPORATED 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTP://WWW.RANDOLPHHOSPITAL.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML X X 1 13 1 HTTP://WWW.RANDOLPHHOSPITAL.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML 0 0 1 X 200.000000000000 300.000000000000 X X X 0 1 1 X HTTP://WWW.RANDOLPHHOSPITAL.ORG/PDFS/FINANCIALASSISTANCEPOLICY.PDF X 1 0 X X 1 X 0 0 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 3 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 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 1 CHARITY CARE ASSISTANCE TO PATIENTS QUALIFYING UNDER RANDOLPH HOSPITAL'S CHARITY CARE POLICY. 1613 3244309 X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 STEVE E EBLIN CEO 362506 0 0 0 0 0 0 0 6016 0 368522 0 0 0 MURRAY S MARSH CFO 217148 0 0 0 0 0 0 0 3932 0 221080 0 0 0 DEVIN L GRIFFITH VP 184030 0 0 0 0 0 0 0 1255 0 185285 0 0 0 BARBARA E WOLFE VP 160569 0 0 0 0 0 0 0 3901 0 164470 0 0 0 ROBERT S CLAUSER VP 184316 0 0 0 0 0 0 0 7274 0 191590 0 0 0 ANGELA P ORTH VP 220619 0 0 0 0 0 0 0 3182 0 223801 0 0 0 TREMONTEO CRAWFORD CHIEF NURSING OFFICER 151326 0 0 0 0 0 0 0 2604 0 153930 0 0 0 LISA HAMPTON DIRECTOR 152140 0 0 0 0 0 0 0 1128 0 153268 0 0 0 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. 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. PIEDMONT INTEGRATED HEALTH 364 WHITE OAK STREET ASHEBORO NC 27204 472221211 CLINICALLY INTEGRATED NETWORK NC -103159 RANDOLPH HOSPITAL INC MRI OF ASHEBORO LLC 364 WHITE OAK STREET ASHEBORO NC 27203 472221211 IMAGING SERVICES NC -163084 2066084 RANDOLPH HOSPITAL INC RANDOLPH SPECIALTY GROUP 364 WHITE OAK ST ASHEBORO NC 27204 113827203 HEALTHCARE NC 501(C)(3) LINE 9 RANDOLPH HOSPITAL INC 1 RANDOLPH CANCER CENTER 373 N FAYETTEVILLE ST ASHEBORO NC 27203 562181482 HEALTHCARE NC 501(C)(3) LINE 11A, I RANDOLPH HOSPITAL INC 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 1 STAYWELL SENIOR CARE PO BOX 1048 ASHEBORO NC 27204 461289922 HEALTHCARE NC 501(C)(3) LINE 11A, I RANDOLPH HOSPITAL INC 1 RANDOLPH NEWCO LLC 364 WHITE OAK STREET ASHEBORO NC 27203 471905523 MEDICAL EQUIPMENT RENTAL NC RANDOLPH HOSPITAL UNRELATED 61585 531246 0 1 0.83030 0 1 1 1 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 RANDOLPH SPECIALTY GROUP - RENT J 125730 CASH RANDOLPH MEDICAL ASSOCIATES - RENT J 20310 CASH RANDOLPH SPECIALTY GROUP - PAYROLL O 202563 CASH RANDOLPH SPECIALTY GROUP - PAYROLL O 140350 CASH RANDOLPH MEDICAL ASSOCIATES - CASH TRANSFERS R 267053 CASH RANDOLPH SPECIALTY GROUP - CASH TRANSFERS R 1037699 CASH RANDOLPH SPECIALTY GROUP P 757553 CASH RANDOLPH MEDICAL ASSOCIATES - BENEFITS Q 142258 CASH RANDOLPH SPECIALTY GROUP - BENEFITS Q 1043450 CASH INVESTMENT IN STAYWELL SENIOR CARE D 305819 CASH INVESTMENT IN PIH B 710460 CASH RANDOLPH CANCER CENTER J 249000 CASH