RANDOLPH HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- RANDOLPH HOSPITAL INC (EIN 56-0530234)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-12
- IRS object ID
- 201342249349301279
- Schema version
- 2011v1.5
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-12T13:40:25-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560530234 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RAND | NameControl |
| Phone | 3366255151 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27204 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MURRAY S MARSH JR | Name |
| Title | CFO | Title |
| Phone | 3366255151 | Phone |
| Date Signed | 2013-08-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STEVE E EBLIN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 123803216 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.RANDOLPHHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1931 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | OPERATION OF NONPROFIT HOSPITAL IN RANDOLPH COUNTY, NC | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1271 | TotalNbrEmployees |
| Total Nbr Volunteers | 233 | TotalNbrVolunteers |
| Total Gross UBI | 2949 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 82906 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 615714 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 115026675 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 120787025 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 825355 | InvestmentIncomePriorYear |
| Investment Income Current Year | -328915 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1135578 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1766752 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 117070514 | TotalRevenuePriorYear |
| Total Revenue Current Year | 122840576 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 9267 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2619 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 51867748 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 53127430 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 73284 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 63281689 | OtherExpensePriorYear |
| Other Expenses Current Year | 72186397 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 115158704 | TotalExpensesPriorYear |
| Total Expenses Current Year | 125316446 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1911810 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2475870 | RevenuesLessExpensesCY |
| Total Assets BOY | 155662010 | TotalAssetsBOY |
| Total Assets EOY | 152699418 | TotalAssetsEOY |
| Total Liabilities BOY | 76896374 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 75507546 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 78765636 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 77191872 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | RANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 113990678 | Expense |
| Grants | 2619 | Grants |
| Revenue | 117207481 | Revenue |
| Description | RANDOLPH HOSPITAL'S MISSION IS TO "PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS". RANDOLPH HOSPITAL PROVIDED QUALITY CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. RANDOLPH HOSPITAL PROVIDES A WIDE RANGE OF PROGRAMS FOR THE MEMBERS OF OUR COMMUNITY INCLUDING WELLNESS PROGRAMS, SUPPORT GROUPS AND COMMUNITY EDUCATION PROGRAMS FOR ALL CITIZENS FROM THE ELDERLY TO THE ELEMENTARY SCHOOL AGE.RANDOLPH HOSPITAL IS AN ACUTE-CARE HOSPITAL SERVING RANDOLPH COUNTY AND SURROUNDING COUNTIES. RANDOLPH HOSPITAL SERVED 6,722 INPATIENTS, HAD 39,076 EMERGENCY ROOM VISITS, 105,570 OTHER OUTPATIENT VISITS AND 43,903 HOME CARE VISITS DURING THE PERIOD OCTOBER 1, 2011 TO SEPTEMBER 30, 2012.RANDOLPH HOSPITAL PROVIDED CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW CHARGES. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES WERE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. TO THE EXTENT REIMBURSEMENT WAS BELOW CHARGES, RANDOLPH HOSPITAL RECOGNIZES THESE AMOUNTS AS UNDER REIMBURSED CARE IN MEETING ITS MISSION TO THE COMMUNITY. THE UNDER REIMBURSED VALUE ASSOCIATED WITH THESE SERVICES IS $86,565,360 FOR THE PERIOD OCTOBER 1, 2011 TO SEPTEMBER 30, 2012. CHARGES TO PRIVATE SECTOR PATIENTS COULD HAVE BEEN REDUCED BY THIS AMOUNT IF MEDICARE AND MEDICAID MATCHED THE RATES PAID BY PRIVATE SECTOR PATIENTS. IN ADDITION, RANDOLPH HOSPITAL WAS REIMBURSED BELOW CHARGES FOR OTHER PAYERS IN THE AMOUNT OF $57,458,600 FOR THE SAME PERIOD.RANDOLPH HOSPITAL PROVIDED CARE FOR URGENT AND EMERGENCY CASES AS WELL AS INPATIENT AND OUTPATIENT SERVICES FOR ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. 28.7 % OF EMERGENCY PATIENTS WERE UNINSURED. THE UNDER REIMBURSED VALUE ASSOCIATED WITH THIS CARE (CHARITY AND BAD DEBT) WAS $34,154,802 FOR THE PERIOD OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012.RANDOLPH HOSPITAL PROVIDES BENEFITS TO THE COMMUNITY OTHER THAN ITS TRADITIONAL HOSPITAL BASED SERVICES. SOME OF THESE SERVICES INCLUDE: - AN EDUCATIONAL OPPORTUNITY AT THE HOSPITAL WAS GIVEN FOR ALL COUNTY AND CITY SCHOOL 2ND GRADERS TO LEARN ABOUT SOME OF THE PROCEDURES THEY MIGHT ENCOUNTER IF THEY WERE PATIENTS. - HEALTH WATCH MONITORING SERVICES WERE PROVIDED FOR ALMOST 175 SUBSCRIBERS. - A HEALTH VAN WAS DEPLOYED TO OFFER FREE HEALTH SCREENINGS THROUGHOUT THE COMMUNITY. THE SERVICE PROVIDED APPROXIMATELY 500 FREE SCREENINGS FOR ABOUT 125 PEOPLE. - FORMAL EDUCATION PROGRAMS WERE OFFERED THAT INCLUDE CHILDBIRTH, SMOKING CESSATION, MATERNITY SUITES TOURS, CPR, BABYSITTER TRAINING AND OTHERS. - SUPPORT GROUPS WERE OFFERED THAT INCLUDED BUT WERE NOT LIMITED TO, CANCER SUPPORT, DIABETES, OSTOMY, STROKE, CAREGIVER AND HIV/AIDS. - FREE SCREENINGS WERE OFFERED THROUGHOUT THE YEAR FOR NUMEROUS THINGS SUCH AS VASCULAR DISEASE, OSTEOPOROSIS, PROSTATE CANCER, SKIN CANCER, ORAL CANCER, STROKE AND OTHERS. - FREE SEMINARS OFFERED INCLUDED SUCH TOPICS AS HEART DISEASE, CERVICAL HEALTH, CHILD SAFETY, BALANCE ISSUES AND DISEASE INTERVENTION. - HEALTH LINK, A HOSPITAL AND HEALTHCARE NEWSLETTER, WAS PUBLISHED QUARTERLY AND MAILED TO OVER 35,000 HOUSEHOLDS THROUGHOUT THE SURROUNDING COMMUNITY. - SCHOLARSHIPS WERE PROVIDED FOR STUDENTS STUDYING IN VARIOUS MEDICAL FIELDS INCLUDING REGISTERED NURSES AND RADIOLOGY TECHNICIANS. - RANDOLPH HOSPITAL EMPLOYEES CONTINUE TO GIVE BACK TO THE COMMUNITY BY SUPPORTING THE RANDOLPH COUNTY UNITED WAY AND THE RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION. THROUGH EMPLOYEE CAMPAIGNS, MORE THAN $54,000, AND $4,000 WERE GIVEN RESPECTIVELY. - THE RANDOLPH HEALTH IMPROVEMENT PARTNERSHIP WORKED TO IDENTIFY AND ADDRESS CRUCIAL HEALTH AND WELLNESS ISSUES COUNTYWIDE. - RANDOLPH HOSPITAL SERVED AS A MAJOR SPONSOR FOR THE ANNUAL RELAY FOR LIFE EVENT BY PREPARING OVER 1,000 FREE MEALS FOR CANCER SURVIVORS AND THEIR FAMILIES. - A FREE SPEAKERS BUREAU WAS PROVIDED TO THE COMMUNITY AND PROVIDED OVER 50 SPEAKERS ON A VARIETY OF HEALTHCARE RELATED TOPICS. | Description |
| Total Program Service Expense | 113990678 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 229 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1271 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LINDA CROWSHAW | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3366255151 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 346 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| SAMUEL D CRANFORD JR | |||||||
| CHAIRMAN | 4.00 | X | X | 0 | 0 | 0 | |
| ROBERT C SHAFFNER | |||||||
| VICE CHAIRMAN | 3.00 | X | X | 0 | 0 | 0 | |
| GLENN MAC PUGH | |||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |
| MARY COOPER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| ELBERT LASSITER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| DIANE FROST PHD | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| REYNOLDS LISK | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| CRANFORD KNOTT | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| MICHAEL C MILLER | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| SAMUEL A RANKIN JR | |||||||
| 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 | X | 187570 | 0 | 35406 | ||
| MURRAY S MARSH JR | |||||||
| CFO | 40.00 | X | 0 | 0 | 0 | ||
| SANDRA L ALLEN | |||||||
| VP OF CLINICAL SERVICES | 40.00 | X | 436291 | 0 | 62512 | ||
| DEVIN L GRIFFITH | |||||||
| VP OF COMMUNITY & STAFF SV | 40.00 | X | 168483 | 0 | 28699 | ||
| BARBARA E WOLFE | |||||||
| VP | 40.00 | X | 111245 | 0 | 14854 | ||
| ROB S CLAUSER | |||||||
| VP OF PHYS. PSHIP & EMP. HLTH | 0.00 | X | 0 | 144566 | 12340 | ||
| ROBERT E MORRISON | |||||||
| CEO THRU (3/1/12) | 40.00 | X | 1112524 | 0 | 182900 | ||
| LYNWOOD R WHITE | |||||||
| CFO THRU (9/4/12) | 40.00 | X | 266539 | 0 | 28491 | ||
| TREMONTEO CRAWFORD | |||||||
| CNO | 40.00 | 144070 | 0 | 13721 | X | ||
| LISA HAMPTON | |||||||
| DIR. PHARMACY | 40.00 | 139859 | 0 | 20063 | X | ||
| MICHELLE LUTHER | |||||||
| PHARMACIST | 40.00 | 134146 | 0 | 3625 | X | ||
| WILLIAM WARD | |||||||
| PHARMACIST | 40.00 | 126858 | 0 | 15360 | X | ||
| ANGELA BURGESS | |||||||
| CIO | 40.00 | 121304 | 0 | 24664 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2948889 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 144566 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 442635 | TotalOtherCompensation |
| Number Individuals GT100 K | 23 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| GREENSBORO RADIOLOGY | |||||
| 1317 NORTH ELM STREET SUITE 1B | GREENSBORO | NC | 27401 | PROFESSIONAL FEES | 3628988 |
| MCNEARY INSURANCE | |||||
| 6525 MORRISON BLVD | CHARLOTTE | NC | 28222 | INSURANCE SERVICES | 1550192 |
| EMPLOYEE BENEFITS SERVICE | |||||
| 534 RIVERCROSSING DR | FT MILL | SC | 29715 | EMPLOYEE BENEFIT SERVICES | 1350478 |
| SODEXHO INC | |||||
| 2803 SLATER ROAD | MORRISVILLE | NC | 27560 | FOOD SERVICE | 1204028 |
| ARAMARK CTS | |||||
| 12483 COLLECTION CCR DR | CHICAGO | IL | 60693 | BIOMEDICAL ENGINEERING | 948291 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 23 | NumberOfContractorsGT100K |
| Related Organizations | 7574 | RelatedOrganizations |
| Government Grants | 100000 | GovernmentGrants |
| All Other Contributions | 508140 | AllOtherContributions |
| Total Contributions | 615714 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| PATIENT SERVICE REVENU | 621400 | 117008632 | 117008632 | |
| PATIENT PHARMACY | 446110 | 3078086 | $3,078,086 | |
| MEALS/NUTRITION | 722210 | 501458 | $501,458 | |
| CANCER CENTER REVENUES | 621400 | 111199 | 111199 | |
| HEALTHWATCH REVENUE | 900099 | 87650 | 87650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 120787025 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 515721 | TotalRevenueColumn |
| Exclusion | $515,721 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 432511 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 118004 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 314507 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 314507 | TotalRevenueColumn |
| Exclusion | $314,507 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 844636 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -844636 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -844636 | TotalRevenueColumn |
| Exclusion | -$844,636 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| MISCELLANEOUS REVENUES | 900099 | 1094684 | $1,094,684 | |
| DISCOUNTS & REBATES | 900099 | 261098 | $258,149 | 2949 |
| COFFEE/GIFT SHOP | 453220 | 96463 | $96,463 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1452245 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 122840576 | TotalRevenueColumn |
| Related Or Exempt Function Income | 117207481 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 2949 | UnrelatedBusinessRevenue |
| Exclusion | $5,014,432 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2619 | Total |
| Program Services | 2619 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2653573 | Total |
| Management And General | 2653573 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39513334 | Total |
| Program Services | 35770500 | ProgramServices |
| Management And General | 3702593 | ManagementAndGeneral |
| Fundraising | 40241 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1359351 | Total |
| Program Services | 1153148 | ProgramServices |
| Management And General | 204906 | ManagementAndGeneral |
| Fundraising | 1297 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6217400 | Total |
| Program Services | 5274267 | ProgramServices |
| Management And General | 937200 | ManagementAndGeneral |
| Fundraising | 5933 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3383772 | Total |
| Program Services | 2870479 | ProgramServices |
| Management And General | 510064 | ManagementAndGeneral |
| Fundraising | 3229 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 583733 | Total |
| Program Services | 386727 | ProgramServices |
| Management And General | 197006 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 136393 | Total |
| Management And General | 135614 | ManagementAndGeneral |
| Fundraising | 779 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 68389 | Total |
| Management And General | 68389 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9474387 | Total |
| Program Services | 9455609 | ProgramServices |
| Management And General | 17935 | ManagementAndGeneral |
| Fundraising | 843 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 385168 | Total |
| Program Services | 277373 | ProgramServices |
| Management And General | 98836 | ManagementAndGeneral |
| Fundraising | 8959 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13958615 | Total |
| Program Services | 12131886 | ProgramServices |
| Management And General | 1817952 | ManagementAndGeneral |
| Fundraising | 8777 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1438065 | Total |
| Program Services | 1386521 | ProgramServices |
| Management And General | 51544 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2489327 | Total |
| Program Services | 2359405 | ProgramServices |
| Management And General | 129922 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 440326 | Total |
| Program Services | 376652 | ProgramServices |
| Management And General | 62125 | ManagementAndGeneral |
| Fundraising | 1549 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13978 | Total |
| Program Services | 13978 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 941324 | Total |
| Program Services | 941324 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6521918 | Total |
| Program Services | 6521918 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 526337 | Total |
| Management And General | 526337 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBTS | 26111179 | 26111179 | ||
| MEDICAL SUPPLIES | 8253417 | 8253417 | ||
| MISCELLANEOUS | 705508 | 703676 | 155 | 1677 |
| RECRUITMENT | 138333 | 138333 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 125316446 | Total |
| Program Services | 113990678 | ProgramServices |
| Management And General | 11252484 | ManagementAndGeneral |
| Fundraising | 73284 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2909826 | BOY |
| EOY | 4397436 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27272799 | BOY |
| EOY | 21613959 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 201282 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18864797 | BOY |
| EOY | 21785392 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2651497 | BOY |
| EOY | 2990893 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1281034 | BOY |
| EOY | 1295095 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 141521349 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 76464755 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68347346 | BOY |
| EOY | 65056594 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18330864 | BOY |
| EOY | 19804569 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1141256 | BOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4504439 | BOY |
| EOY | 4104513 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10156870 | BOY |
| EOY | 11650967 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 155662010 | BOY |
| EOY | 152699418 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6418679 | BOY |
| EOY | 9806813 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46080000 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4978937 | BOY |
| EOY | 47177798 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19418758 | BOY |
| EOY | 18522935 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76896374 | BOY |
| EOY | 75507546 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77067162 | BOY |
| EOY | 75983761 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1698474 | BOY |
| EOY | 1208111 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78765636 | BOY |
| EOY | 77191872 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 155662010 | BOY |
| EOY | 152699418 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2475870 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 902106 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $12,072 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 12072 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). BOTH ASSOCIATIONS PERFORM LOBBYING OF STATE AND LOCAL GOVERNMENTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND A PORTION OF THE DUES PAID TO EACH ASSOCIATION IS ATTRIBUTABLE TO THOSE LOBBYING EXPENDITURES. FOR THE FISCAL YEAR, THE PORTION OF DUES ATTRIBUTABLE TO LOBBYING WAS ESTIMATED AT $12,072. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3232061 | OtherCostOrOtherBasis |
| Book Value | 3232061 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 78479386 | OtherCostOrOtherBasis |
| Depreciation | 34229794 | Depreciation |
| Book Value | 44249592 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1923368 | OtherCostOrOtherBasis |
| Depreciation | 730529 | Depreciation |
| Book Value | 1192839 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 54554333 | OtherCostOrOtherBasis |
| Depreciation | 41504432 | Depreciation |
| Book Value | 13049901 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3332201 | OtherCostOrOtherBasis |
| Book Value | 3332201 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 65056594 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 1434189 |
| OTHER LONG-TERM ASSETS | 149515 |
| DEFERRED FINANCING COSTS, NET | 159504 |
| ASSETS LIMITED AS TO USE | 1238323 |
| DUE FROM AFFILIATES | 8669436 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 11650967 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | $1,164,105 |
| OTHER LONG-TERM LIABILITIES | $1,429,497 |
| PENSION PAYABLE | $7,163,692 |
| INTEREST RATE SWAP | $4,564,732 |
| DUE TO AFFILIATE | $4,200,909 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 18522935 | TotalOfAmounts |
| Total Revenue | 122840576 | TotalRevenue |
| Total Expenses | 125316446 | TotalExpenses |
| Excess Or Deficit For Year | -2475870 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 1538085 | NetUnrealizedGLOnInvestments |
| Other | -$635,979 | OtherAmount |
| Total Adjustments | 902106 | TotalAdjustments |
| Excess Or Deficit Per FS | -1573764 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 123860686 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1538085 | NetUnrealizedGainsInvestments |
| Other Revenues | -517975 | OtherRevenues |
| Revenue Not Rptd F990 | 1020110 | RevenueNotRptdF990 |
| Revenue Subtotal | 122840576 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 122840576 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 125434450 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 118004 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 118004 | ExpensesNotRptdF990 |
| Expenses Subtotal | 125316446 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 125316446 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL, RMA, RSG, AND FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AEC AND CPSC ARE LIMITED LIABILITY COMPANIES, WHICH DO NOT PRODUCE TAXABLE INCOME TO THEIR NOT-FOR-PROFIT OWNER. THE ORGANIZATIONS HAVE DETERMINED THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | CHANGE IN PENSION LIABILITY 99,914. CHANGE IN VALUE OF INTEREST RATE SWAP -246,791. OTHER CHANGES TO NET ASSETS -489,102. TOTAL TO SCHEDULE D, PART XI, LINE 8: -635,979. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENTAL EXPENSES 118,004. OTHER CHANGES TO NET ASSETS -489,102. CHANGE IN PENSION LIABILITY 99,914. CHANGE IN VALUE OF INTEREST RATE SWAP -246,791. | |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | DIRECT RENTAL EXPENSES 118,004. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4607444 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4607444 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04590 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14676541 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14643199 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 33342 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19283985 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14643199 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4640786 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04620 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 140508 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 140508 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 140508 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 140508 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19424493 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14643199 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4781294 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04760 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 24583 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 24583 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 24583 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 24583 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $26,088,402 | BadDebtExpenseAmount |
| Amount Attributable To | 22175142 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 24341178 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 26721256 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2380078 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 CENTRAL PIEDMONT SURGERY CENTER LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | AMBULATORY OUTPATIENT SURGICAL CENTER | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.68000 | OrganizationProfitOrOwnership |
| Physicans Profit Or Ownership | 0.21000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| HOME HEALTH OF RANDOLPH HOSPITAL | ||||
| 341 N FAYETTEVILLE STREET | ASHEBORO | NC | 27203 | HOME CARE |
| RANDOLPH HEALTH EDUCATION CENTER | ||||
| 200-A FOUST STREET | ASHEBORO | NC | 27203 | HEALTH EDUCATION CENTER |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: WORKSHEET 2 OF THE 2011 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. | ||
| PART I, L7 COL(F): THE AMOUNT OF TOTAL EXPENSE ON FORM 990, PART IX, LINE 25 HAS BEEN ADJUSTED TO REMOVE A BAD DEBT EXPENSE OF $26,111,179 AND TO INCLUDE ALLOCATED TOTAL EXPENSES OF A JOINT VENTURE OF $1,231,778 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). | ||
| PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT EXPENSE WAS OBTAINED FROM THE 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: COSTS AND TOTAL REVENUES RECEIVED FROM MEDICARE REPORTED ON LINES 5 AND 6 ARE CALCULATED FROM THE ORGANIZATION'S MEDICARE COST REPORT. | ||
| PART III, LINE 9B: THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. RANDOLPH HOSPITAL WILL IDENTIFY ANY PATIENT FINANCIAL RESPONSIBILITY PRIOR TO SERVICE AND REQUIRE THE PATIENT/GUARANTOR TO PAY OR MAKE ACCEPTABLE FINANCIAL ARRANGEMENTS FOR PAYMENT PRIOR TO SERVICE BEING RENDERED. A SLIDING FEE SCHEDULE WILL BE AVAILABLE FOR PATIENTS WHO HAVE THE ABILITY TO MAKE PARTIAL PAYMENT. FREE CARE WILL BE AVAILABLE TO THOSE WHO SUCCESSFULLY QUALIFY UNDER THE HOSPITAL'S CHARITY CARE POLICY FD-PA-007. IT IS THE APPLICANT'S RESPONSIBILITY TO DEMONSTRATE INABILITY TO PAY. | ||
| PART V, SECTION B, LINE 19D: THE HOSPITAL'S FAP PROVIDES A DISCOUNT FOR INDIVIDUALS THAT QUALIFY UNDER THE POLICY'S PROVISIONS. THE HOSPITAL HAS MADE PLANS TO IMPLEMENT A METHOD OF DETERMINING AMOUNTS GENERALLY BILLED (AGB) PER THE RECENTLY RELEASED PROPOSED REGULATIONS UNDER SECTION 1.501(R), HOWEVER GIVEN THE HIGH LEVEL OF DISCOUNT AVAILABLE UNDER THE CURRENT POLICY, THE ORGANIZATION IS CONFIDENT THAT ITS POLICIES ARE WELL WITHIN GUIDELINES. | RANDOLPH HOSPITAL | |
| PART VI, LINE 2: RANDOLPH HOSPITAL, IN COORDINATION WITH THE COUNTY HEALTH DEPARTMENT, COMMISSIONS A COMMUNITY NEEDS ASSESSMENT. THIS PROCEDURE INVOLVES COMMUNITY MEETINGS, FOCUS GROUPS, AND THE REVIEW OF HISTORICAL DATA. THE ORGANIZATION COMPLETES NEEDS ASSESSMENTS GENERALLY EVERY THREE YEARS, AND THE NEXT ASSESSMENT IS CURRENTLY IN PROCESS FOR COMPLETION IN 2012. | ||
| PART VI, LINE 3: RANDOLPH HOSPITAL EMPLOYS FINANCIAL COUNSELORS WHO WORK WITH ALL SCHEDULED PATIENTS IN ADVANCE OF THEIR SERVICES TO DETERMINE ELIGIBILITY FOR CHARITY CARE. EMERGENCY PATIENTS ARE COUNSELED AFTER THEIR TREATMENT IS COMPLETE. THE ORGAINIZATION ALSO PROVIDES FINANCIAL ASSISTANCE OPTIONS INFORMATION ON ITS WEBSITE AND CONTACTS THE SCHEDULED PATIENTS BY TELEPHONE TO PROVIDE THIS INFORMATION. | ||
| PART VI, LINE 4: RANDOLPH HOSPITAL IS A 145 BED ACUTE CARE HOSPITAL LOCATED IN ASHEBORO, NORTH CAROLINA. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF RANDOLPH COUNTY, NORTH CAROLINA AND SURROUNDING COUNTIES.FOR THE PERIOD OCTOBER 1, 2011 TO SEPTEMBER 30, 2012, RANDOLPH HOSPITAL SERVED 6,722 INPATIENTS, HAD 39,076 EMERGENCY ROOM VISITS, 105,570 OTHER OUTPATIENT VISITS AND 43,903 HOME CARE VISITS. RANDOLPH HOSPITAL PROVIDED THESE QUALITY SERVICES REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY.RANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS. THE HOSPITAL HAS PROVIDED QUALITY CARE TO ALL RESIDENTS IN AND AROUND ASHEBORO, NORTH CAROLINA. | ||
| PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. IN ADDITION, THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY TO MOST HOSPITAL DEPARTMENTS.ANY SURPLUS OF FUNDS IN A GIVEN YEAR IS USED TO FUND CAPITAL EXPENDITURES TO ACQUIRE EQUIPMENT NECESSARY TO PROVIDE QUALITY PATIENT CARE. | ||
| PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. | ||
| NC | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVE E EBLIN | |||||||||||||
| 187210 | 0 | 0 | 0 | 360 | 0 | 30804 | 0 | 4602 | 0 | 222976 | 0 | 0 | 0 |
| SANDRA L ALLEN | |||||||||||||
| 231158 | 0 | 0 | 0 | 205133 | 0 | 57062 | 0 | 5450 | 0 | 498803 | 0 | 0 | 0 |
| DEVIN L GRIFFITH | |||||||||||||
| 168296 | 0 | 0 | 0 | 187 | 0 | 27341 | 0 | 1358 | 0 | 197182 | 0 | 0 | 0 |
| ROB S CLAUSER | |||||||||||||
| 0 | 144386 | 0 | 0 | 0 | 180 | 0 | 5733 | 0 | 6607 | 0 | 156906 | 0 | 0 |
| ROBERT E MORRISON | |||||||||||||
| 387202 | 0 | 0 | 0 | 725322 | 0 | 158990 | 0 | 23910 | 0 | 1295424 | 0 | 0 | 0 |
| LYNWOOD R WHITE | |||||||||||||
| 264955 | 0 | 0 | 0 | 1584 | 0 | 24296 | 0 | 4195 | 0 | 295030 | 0 | 0 | 0 |
| TREMONTEO CRAWFORD | |||||||||||||
| 142296 | 0 | 0 | 0 | 1774 | 0 | 13490 | 0 | 231 | 0 | 157791 | 0 | 0 | 0 |
| LISA HAMPTON | |||||||||||||
| 139679 | 0 | 0 | 0 | 180 | 0 | 18903 | 0 | 1160 | 0 | 159922 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 1A | ||
| PART I, LINE 4B | THE AMOUNTS REPRESENTED AS DEFERRED COMPENSATION ON SCHEDULE J HAVE NOT BEEN PAID TO THE INDIVIDUALS. THE AMOUNT 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, THE HOSPITAL ESTABLISHED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO COVER HIGHLY COMPENSATED EMPLOYEES. THIS PLAN INCLUDED A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN, A NONQUALIFIED DEFERRED COMPENSATION PLAN (REVISED IN 2005), AND A SPLIT-DOLLAR LIFE INSURANCE PLAN. THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDES ADDITIONAL BENEFITS TO SUPPLEMENT BENEFITS EARNED UNDER THE ORGANIZATION'S BROADER 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, TOTAL CONTRIBUTIONS TO THIS PLAN FOR THE FISCAL YEAR TOTALED $1,143,000. THE SPLIT-DOLLAR LIFE INSURANCE AGREEMENT INVOLVES THE PAYMENT OF PREMIUMS BY THE HOSPITAL FOR A LIFE INSURANCE POLICY, THE BENEFITS OF WHICH ARE SPLIT BETWEEN THE EMPLOYEES' BENEFICIARIES AND THE HOSPITAL UP TO THE AMOUNT OF PREMIUMS PAID. PREMIUMS PAID UNDER THIS PLAN WILL CONTINUE UNTIL THE AGREEMENT IS TERMINATED OR UPON THE DEATH OF THE INSURED EMPLOYEES. PREMIUMS PAID UNDER THE SPLIT-DOLLAR INSURANCE POLICY WERE $9,822 FOR THE FISCAL YEAR. ROBERT E. MORRISON AND SANDRA ALLEN RECEIVED A PAYOUT OF PREVIOUSLY DEFERRED COMPENSATION FROM THE NONQUALIFIED SUPPLEMENTAL DEFERRED COMPENSATION PLAN IN 2011 IN THE AMOUNT OF $723,738 AND $203,549. NO OTHER PARTICIPANTS OF THE PLAN RECEIVED PAYOUTS DURING THE YEAR. FOR THE YEAR, THE FOLLOWING INDIVIDUALS ACCRUED COMPENSATION UNDER THE SERP: STEVE EBLIN $9,470 SANDRA ALLEN $9,513 DEVIN GRIFFITH $7,848 ROBERT MORRISON $129,012 LYNWOOD WHITE $10,273 | |
| PART III | SCHEDULE J, PART II: WE ARE REQUIRED TO REPORT COMPENSATION OF KEY INDIVIDUALS THAT WORK FOR AND ARE PAID BY A RELATED ORGANIZATION. COMPENSATION REPORTED ON THIS SCHEDULE DOES NOT NECESSARILY MEAN THAT THE COMPENSATION WAS PAID BY THIS ORGANIZATION. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 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 2.2 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 SERVE AS 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 AND QUALIFIED. 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 RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY THE FINANCE AND AUDIT COMMITTEE OF THE BOARD, FOLLOWED BY A PRESENTATION TO THE FULL BOARD AT A SCHEDULED MEETING. BOARD MEMBERS WERE PROVIDED WITH A COPY OF THE RETURN A WEEK PRIOR TO THE MEETING, AND A PERIOD OF TIME WAS ALLOWED FOR QUESTIONS AND COMMENTS BEFORE FILING THE RETURN WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION EMPLOYS A FULL TIME CORPORATE COMPLIANCE OFFICER CHARGED WITH EDUCATING THE BOARD, OFFICERS, AND OTHER EMPLOYEES ON THE CONFLICT OF INTEREST POLICY. ALL NEW EMPLOYEES ARE GIVEN INFORMATION UPON ORIENTATION, AND ALL CURRENT EMPLOYEES ARE REQUIRED TO TAKE ANNUAL EDUCATION ON COMPLIANCE WITH THE POLICY. THERE IS A 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 | RANDOLPH HOSPITAL CONTRACTS WITH AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE APPROPRIATE COMPENSATION LEVELS FOR EXECUTIVES THAT IS COMMENSURATE WITH ORGANIZATIONS OF SIMILAR SIZE AND STRUCTURE. A COMPENSATION COMMITTEE OF THE BOARD HAS FINAL DETERMINATION OF COMPENSATION LEVELS FOR TOP EXECUTIVES. | |
| FORM 990, PART VI, SECTION C, LINE 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 VII, LINE 1A | ROBERT CLAUSER IS THE EXECUTIVE DIRECTOR OF RANDOLPH MEDICAL ASSOCIATES AND RANDOLPH SPECIALTY GROUP PRACTICE AND SPLITS HIS TIME BETWEEN THESE TWO ENTITIES. HIS TITLE WITH THE HOSPITAL IS VP OF PHYSICIAN PRACTICE AND EMPLOYEE HEALTH. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 1,538,085. CHANGE IN PENSION LIABILITY 99,914. CHANGE IN VALUE OF INTEREST RATE SWAP -246,791. OTHER CHANGES TO NET ASSETS -489,102. TOTAL TO FORM 990, PART XI, LINE 5: 902,106. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ASHEBORO ENDOSCOPY CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 SUNSET AVENUE | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27203 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680530308 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Total Income | 452335 | TotalIncome |
| EOY Assets | 241391 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INC | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION | ||||||||||
| 346 WHITE OAK STREET | ASHEBORO | NC | 27204 | 582240755 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | RANDOLPH HOSPITAL INC | 1 |
| RANDOLPH MEDICAL ASSOCIATES | ||||||||||
| 132 WEST MILLER STREET | ASHEBORO | NC | 27204 | 561853201 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | RANDOLPH HOSPITAL INC | 1 |
| RANDOLPH SPECIALTY GROUP PRACTICE | ||||||||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27204 | 113827203 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | RANDOLPH HOSPITAL INC | 1 |
| RANDOLPH CANCER CENTER LLC | ||||||||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27204 | 562181482 | HEALTHCARE | NC | 501(C)(3) | LINE 11A, I | RANDOLPH HOSPITAL INC | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL PIEDMONT SURGERY CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11221 ROE AVE SUITE 320 | AddressLine1 |
| City | LEAWOOD | City |
| State | KS | State |
| ZIP Code | 66211 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 234317497 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | KS | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | -1231778 | ShareOfTotalIncome |
| Share Of EOY Assets | 129513 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
| Percentage Ownership | 0.68000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| RANDOLPH MEDICAL ASSOCIATES | ||
| I | 138154 | INTERCOMPANY |
| RANDOLPH SPECIALTY GROUP PRACTICE | ||
| D | 1220269 | A/R BALANCE |
| CENTRAL PIEDMONT SURGERY CENTER | ||
| D | 272000 | A/R BALANCE |
| RANDOLPH CANCER CENTER LLC | ||
| I | 249000 | A/R BALANCE |
Comments