2015-04-28T10:09:58-05:00 2014-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2013-10-01 561925492 ROANOKE VALLEY HEALTH SERVICES INC ROAN 2525358130 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 SHERRY JENSEN CFO 2525358130 2015-04-24 1 AMY BIBBY P00445891 8282542254 2013 2016-02-25 16:41:14Z SHERRY JENSEN 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 4785256 0 X WWW.HALIFAXMEDICALCENTER.ORG X 1994 NC OPERATION OF PRIMARY CARE MEDICAL OFFICES 14 12 51 0 0 0 1935 0 5124483 4679092 -1777 12 212015 106152 5336656 4785256 0 0 0 0 4851992 5186665 0 0 0 3569230 2967743 8421222 8154408 -3084566 -3369152 1930373 1592304 16008095 16862513 -14077722 -15270209 X ROANOKE VALLEY HEALTH SERVICES EXISTS TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY BY PROVIDING EXCELLENT AND COMPASSIONATE SERVICES AND ALWAYS PLACING PATIENTS FIRST. 0 0 7375596 4679092 ROANOKE VALLEY HEALTH SERVICES, INC. OPERATES NON-PROFIT PRIMARY CARE MEDICAL OFFICES. THE ORGANIZATION WORKS IN CLOSE TIES WITH HALIFAX REGIONAL MEDICAL CENTER, AND SHARES IN ITS GOALS AND ACHIEVEMENTS THROUGH A CONSTANT PARTNERSHIP OF FULFILLING THE HOSPITAL'S EXEMPT PURPOSE--PROVIDING EXCELLENT HEALTHCARE SERVICE TO THE COMMUNITY. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF THE PROGRAM SERVICE ACCOMPLISHMENTS.IN THE CURRENT TAX YEAR, THE ORGANIZATION REACHED THE FOLLOWING MILESTONES:- RECRUITED HOSPITALIST PHYSICIAN- RECEIVED HIGH-TECH STIMULUS FUNDS OF $1.6 MILLION FOR ROANOKE CLINIC AND $42,500 FOR OUR INTERNAL MEDICINE CLINIC- IMPLEMENTED THE FOLLOW-MY-HEALTH CLINICAL PATIENT INFORMATION PORTAL ALLOWING FOR ONLINE ACCESS TO PATIENTS' PERSONAL HEALTH RECORDS 24/7 SECURELY AND SAFELY 7375596 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 51 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NC X SHERRY JENSEN 2525358005 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 BOB PATTERSON CHAIRMAN 1.00 1.00 X X 0 2150 0 TOM LYNCH VICE CHAIR 1.00 1.00 X X 0 1350 0 FANNIE GREEN TREASURER 1.00 1.00 X X 0 1450 0 DREWERY BEALE SECRETARY 1.00 1.00 X X 0 1400 0 VERNON BRYANT PAST CHAIR 1.00 1.00 X 0 1700 0 DR SOMASEKHARA BALLA CHIEF OF STAFF 1.00 1.00 X 0 1250 0 DR NATARAJAN RAJAN PAST CHIEF OF STAFF 1.00 1.00 X 0 1000 0 HUGH BAZEMORE BOARD MEMBER 1.00 1.00 X 0 1750 0 EVELYN DAWSON BOARD MEMBER 1.00 1.00 X 0 750 0 JOHNNY DRAPER BOARD MEMBER 1.00 1.00 X 0 750 0 WILLIAM HODGE BOARD MEMBER 1.00 1.00 X 0 1750 0 REV RANDY MARTIN BOARD MEMBER 1.00 1.00 X 0 900 0 JAMES PIERCE BOARD MEMBER 1.00 1.00 X 0 700 0 WILL MAHONE PRESIDENT/CEO 1.00 40.00 X X 0 318961 37886 SHERRY JENSEN VP FINANCE/CFO 1.00 40.00 X 0 220520 14105 TOCHUKWU AGBATA PHYSICIAN 60.00 X 388833 0 16610 ABRAHAN CHAPARRO PHYSICIAN 40.00 X 209052 0 15506 COURAGE EMOKPAE PHYSICIAN 40.00 X 266728 0 14956 CHINEDU ONUORAH PHYSICIAN 60.00 X 446904 0 16645 NKECHINYERE OBIEFUNA PHYSICIAN 60.00 X 395998 0 10667 1707515 556381 126375 11 0 1 0 INTERIM PHYSICIANS LLC 12140 WOODCREST ST LOUIS MO 63141 PHYSICIAN SERVICES 402956 1 NET PATIENT SERVICE RE 621610 4679092 4679092 4679092 12 12 OTHER REVENUE 900099 106152 106152 106152 4785256 4679092 0 106164 X 4265932 3718819 547113 685968 597991 87977 234765 204656 30109 4121 4121 31940 31940 16800 16800 1804006 1804006 3009 3009 152459 121168 31291 47747 47747 31175 31175 45070 45070 270043 270043 54260 54260 BAD DEBT EXPENSE 386718 386718 MEDICAL SUPPLIES 90934 90934 RECRUITMENT AND RELOCAT 28954 28954 OTHER EXPENSES 507 507 8154408 7375596 778812 0 159151 197808 471302 286641 22389 14198 2401221 1415566 1217595 985655 59936 108002 1930373 1592304 74019 104030 15934076 16758483 16008095 16862513 X -14083254 -15274406 5532 4197 -14077722 -15270209 1930373 1592304 X -3369152 2176665 X X 0 1 X 1 0 X 1064922 627792 437130 111741 65873 45868 1224558 721901 502657 985655 OTHER RECEIVABLES 69509 ESTIMATED THIRD PARTY SETTLEMENTS 38493 108002 DUE TO HALIFAX REGIONAL MEDICAL CENTER 16758483 16758483 X 6575203 2178000 2178000 4397203 388053 388053 4785256 7767690 0 7767690 386718 386718 8154408 PART X, LINE 2: THE MEDICAL CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE MEDICAL CENTER HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2014 AND 2013. THE MEDICAL CENTER BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: TRANSFER OF EQUITY FROM AFFILIATE 2,178,000. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET W/ REVENUES 386,718. NET ASSETS RELEASED FROM RESTRICTION 1,335. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET W/ REVENUES 386,718. X X X X 0 0 0 0 0 0 0 0 0 WILL MAHONE PRESIDENT/CEO 0 295212 0 0 0 23749 0 18839 0 19047 0 356847 0 0 SHERRY JENSEN VP FINANCE/CFO 0 218520 0 2000 0 0 0 2513 0 11592 0 234625 0 0 TOCHUKWU AGBATA PHYSICIAN 378333 0 10500 0 0 0 3039 0 13571 0 405443 0 0 0 ABRAHAN CHAPARRO PHYSICIAN 204756 0 4296 0 0 0 2229 0 13277 0 224558 0 0 0 COURAGE EMOKPAE PHYSICIAN 260728 0 6000 0 0 0 3278 0 11678 0 281684 0 0 0 CHINEDU ONUORAH PHYSICIAN 436404 0 10500 0 0 0 3074 0 13571 0 463549 0 0 0 NKECHINYERE OBIEFUNA PHYSICIAN 385498 0 10500 0 0 0 0 0 10667 0 406665 0 0 0 PART I, LINE 3 INDEPENDENT REVIEW OF COMPENSATION: THE ORGANIZATION DOES NOT DIRECTLY COMPENSATE ANY OFFICER OR KEY EMPLOYEE. SOME OFFICERS AND BOARD MEMBERS OF THE ORGANIZATION ARE EMPLOYEES OF HALIFAX REGIONAL MEDICAL CENTER, INC., A RELATED ORGANIZATION. THE BOARD OF DIRECTORS OF THAT ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION AMOUNTS FOR ITS CEO AND OTHER KEY PERSONNEL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANTS - WRITTEN EMPLOYEMENT CONTRACTS - COMPENSATION STUDY OR SURVEY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED MANAGEMENT DUTIES THROUGH NOVANT SHARED SERVICES UNDER A 3 YEAR CONTRACT BEGINNING IN MARCH OF 2014. FORM 990, PART VI, SECTION A, LINE 7A PRIOR TO THE ANNUAL MEETING, MEMBERS OF THE BOARD OF DIRECTORS SHALL BE SELECTED BY THE CURRENT BOARD AND RECOMMENDED TO THE BOARD OF DIRECTORS OF HALIFAX REGIONAL MEDICAL CENTER, A RELATED 501(C)(3) HEALTHCARE ORGANIZATION, FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. THE ORGANIZATION PROVIDED EVERY VOTING BOARD MEMBER A COPY OF THE DRAFT 990 PRIOR TO A SCHEDULED MEETING. DETAILS OF THE RETURN WERE DISCUSSED WITH MANAGEMENT AND THE FINANCE COMMITTEE OF THE BOARD, WHO THEN DELIVERED A REPORT TO THE FULL BOARD PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION FOLLOWS THE SAME CONFLICT OF INTEREST POLICY AS ITS AFFILIATE, HALIFAX REGIONAL MEDICAL CENTER. THE POLICY IS REVIEWED ANNUALLY, AND BOARD MEMBERS AND MANAGEMENT ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE EVERY YEAR. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,675,435. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,675,435. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 4,778. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,778. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 120,969. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,969. COLLECTION FEES: PROGRAM SERVICE EXPENSES 2,824. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,824. FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY FROM AFFILIATE 2,178,000. NET ASSETS RELEASED FROM RESTRICTION -1,335. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HALIFAX REGIONAL MEDICAL CENTER 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 560989789 HEALTHCARE NC 501(C)(3) LINE 3 N/A 0 HALIFAX REGIONAL MEDICAL CENTER FOUNDATION 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 561698825 FUNDRAISING/OPERATIONAL SUPPORT NC 501(C)(3) LINE 7 HALIFAX REGIONAL MEDICAL CENTER 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1