RANDOLPH MEDICAL ASSOCIATES: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- RANDOLPH MEDICAL ASSOCIATES (EIN 56-1853201)
- Tax period
- 2014-10-01 to 2014-12-31
- Filed
- 2015-11-16
- IRS object ID
- 201503209349300120
- Schema version
- 2014v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-16T08:35:35-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | 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 | 561853201 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH MEDICAL ASSOCIATES | 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 | 218C FOUST ST | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27203 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT S CLAUSER | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 3366255151 | PhoneNum |
| Signature | 2015-11-12 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | ROBERT S CLAUSER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 218C FOUST ST | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27203 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,360,254 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RANDOLPHMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF RANDOLPH MEDICAL ASSOCIATES IS TO PROVIDE TIMELY, CONVENIENT ACCESS TO A BROAD RANGE OF QUALITY MEDICAL SERVICES. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 110 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,611,426 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,360,254 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $188,393 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $9,799,819 | PYTotalRevenueAmt |
| CY Total Revenue | $2,360,254 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,146,659 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,607,332 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,924,122 | PYOtherExpensesAmt |
| CY Other Expenses | $853,643 | CYOtherExpensesAmt |
| PY Total Expenses | $9,070,781 | PYTotalExpensesAmt |
| CY Total Expenses | $2,460,975 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $729,038 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$100,721 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,711,233 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,093,033 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,381,800 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF RANDOLPH MEDICAL ASSOCIATES IS TO PROVIDE TIMELY, CONVENIENT ACCESS TO A BROAD RANGE OF QUALITY MEDICAL SERVICES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $2,361,705 | ExpenseAmt |
| Revenue | $2,360,254 | RevenueAmt |
| Desc | DURING THE THREE MONTHS ENDING DECEMBER 31, 2014, RANDOLPH MEDICAL ASSOCIATES PROVIDED INTERNAL MEDICINE, FAMILY PRACTICE, AND PEDIATRIC SERVICES TO THE COMMUNITY. EFFECTIVE DECEMBER 31, 2014, THE ORGANIZATION MERGED INTO RANDOLPH SPECIALTY GROUP PRACTICE AND CEASED OPERATIONS. | Desc |
| Total Program Service Expenses | $2,361,705 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | 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 | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 | Yes (1) | 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 | 52 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 110 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | 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 | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| 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 | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| 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 STREET | AddressLine1Txt |
| City | ASHEBORO | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27203 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MAC PUGH | ||||||||
| CHAIRMAN | 0.50 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| SAM RANKIN JR | ||||||||
| VICE CHAIRMAN | 0.50 | 2.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEVE EBLIN | ||||||||
| SECRETARY/TREASURER | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $361,940 | $58,662 | |
| SAM CRANFORD JR | ||||||||
| DIRECTOR/EX-OFFICIO | 0.50 | 5.50 | Yes (X) | $0 | $0 | $0 | ||
| BETH RUSSELL | ||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | |||
| PATRICIA VINOCUR | ||||||||
| PHYSICIAN/BOARD DIRECTOR | 40.00 | 0.50 | Yes (X) | $259,729 | $0 | $4,453 | ||
| ROBERT S CLAUSER | ||||||||
| PRESIDENT | 0.50 | 40.00 | Yes (X) | Yes (X) | $0 | $183,961 | $25,394 | |
| KEUNG W LEE | ||||||||
| PHYSICIAN/BOARD DIRECTOR | 40.00 | 0.50 | Yes (X) | $342,947 | $0 | $8,141 | ||
| MURRAY S MARSH JR | ||||||||
| CFO - RHI | 2.00 | 40.00 | Yes (X) | $0 | $216,596 | $25,030 | ||
| JOHN F GAGE | ||||||||
| PHYSICIAN | 40.00 | $293,428 | $0 | $2,379 | Yes (X) | |||
| DOUGLAS E SCHULTZ | ||||||||
| PHYSICIAN | 40.00 | $243,476 | $0 | $9,236 | Yes (X) | |||
| KATHLEEN RILEY | ||||||||
| PHYSICIAN | 40.00 | $205,104 | $0 | $8,280 | Yes (X) | |||
| STEPHEN D CAMPBELL | ||||||||
| PHYSICIAN | 40.00 | $195,558 | $0 | $0 | Yes (X) | |||
| MAURA L HAMRICK | ||||||||
| PHYSICIAN | 40.00 | $169,089 | $0 | $8,123 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,709,331 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $762,497 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $149,698 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MISYS HEALTHCARE SYSTEMS LLC | |||||
| 24630 NETWORK PLACE | CHICAGO | IL | 60673 | SOFTWARE MAINTENANCE | $297,864 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | CONTRACT LABOR | $185,041 |
| B&B CLEANING | |||||
| PO BOX 4640 | ASHEBORO | NC | 27204 | CLEANING SERVICES | $153,420 |
| LABORATORY CORPORATION OF AMERICA HOLDIN | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | LAB SERVICES | $127,555 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENU | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $2,360,254 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,360,254 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,360,254 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,360,254 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,360,254 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,502,261 | TotalAmt |
| Program Services | $1,431,570 | ProgramServicesAmt |
| Management And General | $70,691 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,763 | TotalAmt |
| Program Services | $16,587 | ProgramServicesAmt |
| Management And General | $1,176 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,308 | TotalAmt |
| Program Services | $81,528 | ProgramServicesAmt |
| Management And General | $5,780 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,099 | TotalAmt |
| Management And General | $3,099 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,767 | TotalAmt |
| Management And General | $1,767 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,395 | TotalAmt |
| Program Services | $14,395 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,716 | TotalAmt |
| Program Services | $4,716 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,066 | TotalAmt |
| Program Services | $86,309 | ProgramServicesAmt |
| Management And General | $16,757 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,999 | TotalAmt |
| Program Services | $18,999 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $184,236 | TotalAmt |
| Program Services | $184,236 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,198 | TotalAmt |
| Program Services | $7,198 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $669 | TotalAmt |
| Program Services | $669 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,672 | TotalAmt |
| Program Services | $42,672 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,599 | TotalAmt |
| Program Services | $10,599 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $442,921 | $442,921 |
| MISCELLANEOUS | $19,306 | $19,306 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,460,975 | TotalAmt |
| Program Services | $2,361,705 | ProgramServicesAmt |
| Management And General | $99,270 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,405 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $805,424 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $221,033 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,814 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $501,155 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,402 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,711,233 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $824,966 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,268,067 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,093,033 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,381,800 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,381,800 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,711,233 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$100,721 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $1,482,521 | 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) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| 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) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,737,614 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,691,618 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,171,918 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,611,426 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,360,254 | CurrentTaxYearAmt |
| Total | $35,572,830 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,737,614 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $7,691,618 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,171,918 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,611,426 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,360,254 | CurrentTaxYearAmt |
| Total | $35,572,830 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $35,572,830 | PublicSupportTotal509Amt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $225,410 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $499,283 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $454,487 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $188,393 | CurrentTaxYearMinus1YearAmt |
| Total | $1,367,573 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $7,963,024 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $8,190,901 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $8,626,405 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $9,799,819 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,360,254 | CurrentTaxYearAmt |
| Total | $36,940,403 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.96300 | PublicSupportCY509Pct |
| Public Support PY509 | 0.96570 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III | FormAndLineReferenceDesc |
| Explanation | THE SUPPORT TEST INCLUDES THE CURRENT YEAR, WHICH IS A SHORT PERIOD TAX YEAR FROM OCTOBER 1, 2014 THROUGH DECEMBER 31, 2014. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IT WAS DETERMINED THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2014. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (10 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 EBLIN | ||||||||||||||
| SECRETARY/TREASURER | $0 | $344,440 | $0 | $0 | $0 | $17,500 | $0 | $52,646 | $0 | $6,016 | $0 | $420,602 | $0 | $0 |
| PATRICIA VINOCUR | ||||||||||||||
| PHYSICIAN/BOARD DIRECTOR | $202,503 | $0 | $24,188 | $0 | $33,038 | $0 | $0 | $0 | $4,453 | $0 | $264,182 | $0 | $0 | $0 |
| ROBERT S CLAUSER | ||||||||||||||
| PRESIDENT | $0 | $176,692 | $0 | $0 | $0 | $7,269 | $0 | $18,120 | $0 | $7,274 | $0 | $209,355 | $0 | $0 |
| KEUNG W LEE | ||||||||||||||
| PHYSICIAN/BOARD DIRECTOR | $276,645 | $0 | $30,914 | $0 | $35,388 | $0 | $0 | $0 | $8,141 | $0 | $351,088 | $0 | $0 | $0 |
| MURRAY S MARSH JR | ||||||||||||||
| CFO - RHI | $0 | $170,596 | $0 | $0 | $0 | $46,000 | $0 | $21,098 | $0 | $3,932 | $0 | $241,626 | $0 | $0 |
| JOHN F GAGE | ||||||||||||||
| PHYSICIAN | $249,618 | $0 | $19,104 | $0 | $24,706 | $0 | $0 | $0 | $2,379 | $0 | $295,807 | $0 | $0 | $0 |
| DOUGLAS E SCHULTZ | ||||||||||||||
| PHYSICIAN | $223,568 | $0 | $0 | $0 | $19,908 | $0 | $0 | $0 | $9,236 | $0 | $252,712 | $0 | $0 | $0 |
| KATHLEEN RILEY | ||||||||||||||
| PHYSICIAN | $158,723 | $0 | $45,680 | $0 | $701 | $0 | $0 | $0 | $8,280 | $0 | $213,384 | $0 | $0 | $0 |
| STEPHEN D CAMPBELL | ||||||||||||||
| PHYSICIAN | $148,494 | $0 | $29,872 | $0 | $17,192 | $0 | $0 | $0 | $0 | $0 | $195,558 | $0 | $0 | $0 |
| MAURA L HAMRICK | ||||||||||||||
| PHYSICIAN | $127,665 | $0 | $32,784 | $0 | $8,640 | $0 | $0 | $0 | $8,123 | $0 | $177,212 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 4B | FormAndLineReferenceDesc |
| Explanation | CERTAIN INDIVIDUALS PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. A DESCRIPTION OF THIS PLAN IS LISTED BELOW. THE AMOUNTS REPRESENTED AS DEFERRED COMPENSATION ON SCHEDULE J HAVE NOT BEEN PAID TO THE INDIVIDUALS. THE NUMBER REPRESENTS VESTED BENEFITS WHICH MAY BE PAID IN FUTURE YEARS, DEPENDING ON THE INDIVIDUAL'S LIFE SPAN AND OTHER FACTORS WHICH COULD RESULT IN FORFEITURE OF THE BENEFIT. DURING 1998, RANDOLPH HOSPITAL (A RELATED ORGANIZATION) ESTABLISHED SUPPLEMENTAL PLANS TO COVER HIGHLY COMPENSATED EMPLOYEES. THESE PLANS INCLUDED A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN, A DEFERRED COMPENSATION PLAN, AND A SPLIT-DOLLAR LIFE INSURANCE PLAN (WHICH IS ONLY OFFERED TO CERTAIN EXECUTIVES PAID BY RANDOLPH HOSPITAL). THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDES ADDITIONAL BENEFITS TO SUPPLEMENT BENEFITS EARNED UNDER THE DEFINED BENEFIT PENSION PLAN. IN 2005, THE HOSPITAL INSTITUTED A NONQUALIFIED DEFERRED COMPENSATION PLAN. THE PURPOSE OF THIS PLAN IS TO PROVIDE ADDITIONAL RETENTION INCENTIVES AND RETIREMENT SECURITY FOR CERTAIN MEMBERS OF THE HOSPITAL'S SENIOR MANAGEMENT TEAM AND TO ALLOW FOR THE DEFERRAL OF COMPENSATION OF THOSE ELIGIBLE MEMBERS OF ITS SENIOR MANAGEMENT. THIS IS INTENDED TO BE A NONQUALIFIED PLAN. PARTICIPANTS ARE 100% VESTED AFTER 30 YEARS OF SERVICE OR AT AGE 67. ON OCTOBER 1, 2013, A NEW NON-QUALIFIED DEFERRED COMPENSATION PLAN WAS IMPLEMENTED WHICH REPLACED ALL PRIOR PLANS. | ExplanationTxt |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | MERGED WITH RANDOLPH SPECIALTY GROUP. | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2015-01-01 | DistributionDt |
| Fair Market Value Of Asset | $1,711,233 | FairMarketValueOfAssetAmt |
| EIN | 113827203 | EIN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | Yes (1) | DirectorOfSuccessorInd |
| Employee Of Successor | 0 | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2E: | PERSON(S) INVOLVED: BOARD OF DIRECTORS |
| PART I, LINE 2E: | EXPLANATION OF INVOLVEMENT: THE BOARDS OF RANDOLPH MEDICAL ASSOCIATES, AND RANDOLPH SPECIALY GROUP MERGED. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | EFFECTIVE 12/31/14, RANDOLPH MEDICAL ASSOCIATES MERGED INTO RANDOLPH SPECIALTY GROUP PRACTICE, A RELATED NORTH CAROLINA NONPROFIT ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS RANDOLPH HOSPITAL, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | DIRECTORS SHALL BE ELECTED BY THE AFFIRMATIVE VOTE OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER. ANY VACANCY OCCURING ON THE BOARD MAY BE FILLED BY THE AFFIRMATIVE VOTE OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER. A DIRECTOR ELECTED TO FILL A VACANCY SHALL BE ELECTED FOR THE UNEXPIRED TERM OF HIS PREDECESSOR IN OFFICE. |
| FORM 990, PART VI, SECTION A, LINE 7B | CERTAIN POWERS ARE RESERVED EXCLUSIVELY UNTO THE SOLE MEMBER OF THE ORGANIZATION, WHICH SHALL EXERCISE SUCH POWERS IN ACCORDANCE WITH LAW AND THE AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS OF ITS BOARD OF DIRECTORS, AS THEN CONSTITUTED, SUCH POWERS TO BE (1) TO MERGE OR CONSOLIDATE THE ORGANIZATION WITH ANY OTHER NONPROFIT CORPORATION, (2) TO ACQUIRE OR CREATE ANOTHER CORPORATION, (3) TO MAKE A CAPITAL EXPENDITURE OVER A SPECIFIED DOLLAR LIMIT TO BE ESTABLISHED FROM TIME TO TIME BY THE SOLE MEMBER, (4) TO SELL CAPITAL ASSETS VALUED OVER A SPECIFIED DOLLAR LIMIT TO BE ESTABLISHED FROM TIME TO TIME BY THE SOLE MEMBER, (5) TO APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BY LAWS PROPOSED BY THE ORGANIZATION, (6) PERMISSION TO DISSOLVE THE ORGANIZATION, AND (7) TO APPOINT THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AS PROVIDED IN ARTICLE III, SECTION 2 AND 4 OF THE BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990, ALONG WITH A SUMMARY OF KEY ELEMENTS AND DISCLOSURES, IS PROVIDED TO THE BOARD INVITING QUESTIONS AND COMMENTS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION SHARES WITH RANDOLPH HOSPITAL A PART TIME CORPORATE COMPLIANCE OFFICER CHARGED WITH EDUCATING THE BOARD, OFFICERS AND OTHER EMPLOYEES ON THE CONFLICT OF INTEREST POLICY. ALL NEW EMPLOYEES ARE GIVEN INFORMATION UPON ORIENTATION, AND CURRENT EMPLOYEES ARE REQUIRED TO TAKE ANNUAL EDUCATION ON COMPLIANCE WITH THE POLICY. REGULARLY SCHEDULED CORPORATE COMPLIANCE MEETINGS TO UPDATE KEY INDIVIDUALS ON NEW ISSUES AND NEW INFORMATION REGARDING CORPORATE COMPLIANCE. BOARD OF DIRECTORS ARE REQUIRED TO ANNUALLY READ, SIGN AND REMIT COPY OF THE POLICY TO THE BOARD CHAIR IN REGARDS TO THE CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS ARE AWARE OF POLICY AND IN CASE OF ANY CONFLICT OF INTEREST, THEY WILL RECUSE THEMSLEVES FROM THE VOTE. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE COMPENSATION COMMITTEE OF THE BOARD ENGAGED AN EXTERNAL CONSULTANT TO ASSIST WITH NOT ONLY THE CEO'S COMPENSATION, BUT THE VICE PRESIDENTS' COMPENSATION, AS WELL. THE EXTERNAL 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 ADMINISTRATIVE 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: | ADJUSTMENT DUE TO DISSOLUTION OF ENTITY 1,482,521. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAD NOT CHANGED SINCE PRIOR YEAR. |
Schedule R IRS990ScheduleR
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 | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| RANDOLPH HOSPITAL INC | |||||||||||
| PO BOX 1048 | ASHEBORO | NC | 27204 | 560530234 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | N/A | 0 | |
| RANDOLPH SPECIALTY GROUP | |||||||||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27204 | 113827203 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | 0 | RANDOLPH HOSPITAL INC | |
| RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION | |||||||||||
| 346 WHITE OAK STREET | ASHEBORO | NC | 27204 | 582240755 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | 0 | RANDOLPH HOSPITAL INC | |
| STAYWELL SENIOR CENTER | |||||||||||
| PO BOX 1048 | ASHEBORO | NC | 27204 | 461289922 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | 0 | RANDOLPH HOSPITAL INC | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | 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 | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | 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 | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| RANDOLPH HOSPITAL | ||
| K | $20,310 | COST |
| RANDOLPH HOSPITAL | ||
| S | $267,053 | CASH |
| RANDOLPH SPECIALTY GROUP | ||
| R | $255,000 | COST |
| RANDOLPH HOSPITAL | ||
| Q | $142,258 | COST |
Comments