2011-11-15T09:51:49-06:00 2010-12-31 DAVENPORT MARVIN JOYCE & CO LLP 703 GREEN VALLEY ROAD SUITE 201 GREENSBORO NC 27408 990 2010-01-01 561376378 HOSPICE OF RANDOLPH COUNTY INC HOSP 3366729300 416 VISION DRIVE ASHEBORO NC 27203 RHONDA BURCH MOFFITT 3366729300 2011-11-15 1 SHIRLEY WEIGEL 3362759886 2010 2016-03-07 17:11:31Z RHONDA BURCH MOFFITT 416 VISION DRIVE ASHEBORO NC 27203 5312815 0 X WWW.HOSPICEOFRANDOLPH.ORG X 1981 NC MISSION: HOSPICE OF RANDOLPH COUNTY SERVES AS AN EDUCATION LEADER WHILE PROMOTING QUALITY OF LIFE AND SUPPORTING PATIENTS AND THEIR FAMILIES IN PREPARING FOR COMPLETION OF LIFE. ACTIVITIES: TO PROVIDE SYMPTOM CONTROL, REHABILITATION DURING EMOTIONAL CRISIS. SPECIAL THERAPIES, ACUTE CARE, CONTINOUS CARE, RESPITE AND ROUTINE HOME CARE ARE REIMBURSED BY REVENUE RESOURCES ALONG WITH SOME SUPPLIES, DURABLE MEDICAL EQUIPMENT, AND DRUGS. SERVICES ARE DELIVERED UNDER A HOLISTIC PLAN OF CARE. 14 13 100 80 0 0 299520 299770 5063680 4910735 48575 23975 70122 67914 5481897 5302394 337916 0 0 0 3069224 3150743 0 0 54794 1305013 1550582 4712153 4701325 769744 601069 6633570 8063691 413362 1241320 6220208 6822371 HOSPICE OF RANDOLPH COUNTY SERVES AS AN EDUCATIONAL LEADER WHILE PROMOTING QUALITY OF LIFE AND SUPPORTING PATIENTS AND THEIR FAMILIES IN PREPARING FOR COMPLETION OF LIFE. 0 0 2939435 0 4911138 PROVIDE SUPPORT AND EMOTIONAL ASSISTANCE TO PATIENTS AND THEIR FAMILIES WITH PAIN MANAGEMENT, SYMPTOM CONTROL, REHABILITATION AND EMOTIONAL CRISIS. SPECIAL THERAPIES, ACUTE CARE, CONTINOUS CARE, RESPITE AND ROUTINE HOME CARE ARE REIMBURSED BY THE ABOVE REVENUE RESOURCES ALONG WITH SOME SUPPLIES, DURABLE MEDICAL EQUIPMENT, AND DRUGS. SERVICES ARE DELIVERED UNDER HOLISTIC PLAN OF CARE. DURING 2010, HOSPICE OF RANDOLPH COUNTY PROVIDED HOSPICE CARE AND HOME HEALTH CARE TO 658 PATIENTS AND PROVIDED 50,023 DAYS OF CARE. 2939435 1 1 0 0 0 0 1 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 4 0 1 100 1 0 0 0 0 0 0 0 0 0 0 X 14 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X CAREY DURHAM 3366729300 416 VISION DRIVE ASHEBORO NC 27203 W EDWARD BUNCH 1.00 X 0 0 0 ROBIN COCKERHAM 1.00 X 0 0 0 ROBERT MORRISON 1.00 X 0 0 0 PATRICIA SHEVLIN MD 1.00 X 0 0 0 DAVID TOWNSEND III PE 1.00 X 0 0 0 BILLIE S VUNCANNON 1.00 X 0 0 0 RICK CRAWFORD 1.00 X 0 0 0 NEAL GRIFFIN III 1.00 X 0 0 0 CRANFORD KNOTT 1.00 X 0 0 0 PAM HILL 1.00 X 0 0 0 CHRISTINE MCCARTY MD 1.00 X 0 0 0 CAREY DURHAM 40.00 X 75700 0 12673 CANDICE GARRETT 1.00 X 0 0 0 ROBERT MASON 3.00 X 0 0 0 RHONDA BURCH MOFFITT 40.00 X 111937 0 11960 CINDY SCHRODER 1.00 X 0 0 0 187637 0 24633 1 0 0 0 ENGINEERED CONSTRUCTION CO 3227 WELLINGTON CT RALEIGH NC 27615 CONSTRUCTION 2233891 RANDOLPH HEALTH & REHAB CENTER 230 E PRESNELL ST ASHEBORO NC 27204 MEDICAL SERVICES 558311 RANDOLPH HOSPITAL 364 WHITE OAK ST ASHEBORO NC 27204 MEDICAL SERVICES 444153 HOSPICE PHARMACIA 1601 CHERRY ST SUITE 1700 PHILADELPHIA PA 19102 MEDICAL SERVICES 334527 SIGNATURE RESOURCE GROUP PO BOX 5501 WINSTONSALEM NC 27113 FURNITURE SALES 201347 11 10276 289494 26040 299770 MEDICARE PAYMENTS 621610 4560342 4560342 MEDICAID PAYMENTS 621610 227813 227813 PRIVATE INSURANCE 621610 122580 122580 4910735 23975 23975 77932 10421 67511 67511 403 403 403 5302394 4911138 0 91486 212270 212270 2404231 1593869 770430 39932 28691 21388 6767 536 316513 201041 110434 5038 189038 116071 70059 2908 24311 24311 59109 59109 156921 142052 14869 127737 127737 18792 18792 MEDICINE AND DRUGS 365591 365591 DURABLE MEDICAL EQUIPME 179480 179480 MEDICAL AND OFFICE SUPP 147380 127195 20185 THERAPY 64151 64151 LEASE/RENTAL 41273 41273 365837 128597 230860 6380 4701325 2939435 1707096 54794 720027 420477 2960323 2120331 304507 200209 776280 886211 77922 137534 5581362 1318578 1767901 4262784 26610 36145 6633570 8063691 413362 555320 686000 413362 1241320 X 4659368 6822371 1560840 0 6220208 6822371 6633570 8063691 X 601069 1094 X X 0 1 1 X 0 X 492524 1072956 435153 299520 299770 2599923 492524 1072956 435153 299520 299770 2599923 619286 1980637 55918 69722 34924 48575 23975 233114 1010 38509 507 40026 2873063 21473720 0.68940 0.69260 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 31535 X 0 490711 490711 4435441 782223 3653218 655210 536355 118855 4262784 5302394 4701325 601069 1094 1094 602163 5313909 1094 10421 11515 5302394 0 5302394 4711746 10421 10421 4701325 0 4701325 PART III, LINE 4: THE WORK OF ART CONSISTS OF PAINTINGS DONATED TO THE ORGANIZATION. THE WORKS OF ART ARE STATED AT THE ESTIMATED FAIR MARKET VALUE AT THE TIME OF DONATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, HAS NO PROVISION FOR INCOME TAXES. THE ORGANIZATION ACCOUNTS FOR UNCERTAIN INCOME TAX POSITIONS BY PRESCRIBING A MINIMUM PROBABILITY THRESHOLD A TAX POSITION MUST MEET BEFORE A FINANCIAL STATEMENT INCOME TAX BENEFIT IS RECOGNIZED. THE MINIMUM THRESHOLD IS DEFINED AS A TAX POSITION, BASED SOLELY ON ITS TECHNICAL MERITS, THAT WOULD MORE LIKELY THAN NOT BE SUSTAINED UPON EXAMINATION BY THE RELEVANT TAX AUTHORITY WITH KNOWLEDGE OF THE SAME FACTS. THE TAX BENEFIT TO BE RECOGNIZED IS MEASURED AS THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED UPON ULTIMATE RESOLUTION. BASED ON ALL KNOWN FACTS AND CIRCUMSTANCES AND CURRENT TAX LAW, THE ORGANIZATION BELIEVES THE TOTAL AMOUNT OF UNCERTAIN INCOME TAX POSITION LIABILITIES AND RELATED ACCRUED INTEREST ARE MATERIAL TO ITS FINANCIAL POSITION. PAGE 4, PART XII, LINE 2D DIRECT EXPENSES RELATED TO FUNDRAISING REVENUE IS NETTED AGAINST THE FUNDRAISING REVENUE ON PAGE 1, FORM 990. PAGE 4, PART XIII, LINE 2D DIRECT EXPENSES RELATED TO FUNDRAISING REVENUE IS NETTED AGAINST THE FUNDRAISING REVENUE ON PAGE 1, FORM 990. ANNUAL AUCTION BBQ 31784 31784 4953 GARDEN DELIGHT 11700 11700 2128 2 14538 14538 316 58022 58022 7397 7397 50625 RANDOLPH HOSPITAL BOARD MEMBER ROBERT MORRISON IS THE CEO OF RANDOLPH HOSPITAL 444153 HOSPICE OF RANDOLPH COUNTY PAID RANDOLPH HOSPITAL FOR INPATIENT ACUTE AND RESPITE CARE FOR HOSPICE PATIENTS. 0 X COMMUNICATION SYSTEM 1 26040 SELLING PRICE OF DONATED PROPERTY 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS NOT THE NUMBER OF ITEMS CONTRIBUTED. FORM 990, PART VI, SECTION A, LINE 2 SEVERAL OF THE BOARD MEMBERS DO BUSINESS WITH HOSPICE OF RANDOLPH COUNTY AND WITH EACH OTHER. FOR EXAMPLE, THERE ARE SEVERAL DOCTORS ON THE BOARD WHO MAY REFER THEIR PATIENTS FOR HOSPICE CARE WHEN APPROPRIATE. BOARD MEMBERS ARE PROHIBITED FROM VOTING ON ANY ISSUES WHERE A POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 11 BOARD MEMBERS REVIEW A DRAFT FORM OF THE 990 PRIOR TO FILING. THE REVIEW EITHER OCCURS DURING A BOARD MEETING OR THE RETURN IS SENT TO THE BOARD MEMBERS INDIVIDUALLY. FILING DOES NOT OCCUR UNTIL ALL BOARD MEMBERS HAVE INDICATED THEIR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C INDIVIDUALS IN CERTAIN SENSITIVE POSITIONS WHO MAKE SUBSTANTIAL AND FREQUENT DECISIONS AFFECTING THE INTERESTS OF HRC ARE REQUIRED TO COMPLETE AND SIGN AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE FORMS ARE DISTRIBUTED AND COLLECTED BY THE CORPORATE COMPLIANCE OFFICER (CCO). THE CCO REVIEWS WITH THE CEO/PRESIDENT ANY DISCLOSED CONFLICTS TO DETERMINE WHETHER DISQUALIFICATION FROM CERTAIN DECISIONS IS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 CEO'S COMPENSATION IS REVIEWED AND APPROVED ANNUALLY BY THE ASSESSMENT COMMITTEE WHICH CONSISTS OF THREE BOARD MEMBERS APPOINTED BY THE BOARD CHAIR. FOR DETERMINATION OF THESE EMPLOYEES' COMPENSATION AMOUNTS, HRC REFERS TO THE HOSPICE & HOME HEALTH SALARY & BENEFITS REPORT THAT IS PUBLISHED EVERY TWO YEARS BY THE HOSPITAL & HEALTHCARE COMPENSATION SERVICE (IN COOPERATION WITH THE NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE). IN ADDITION, A REVIEW IS MADE OF BENCHMARKING DATA FROM MULTI-VIEW INC.'S HOSPICE COMPENSATION SURVEY AS WELL AS COMPARABLE SALARIES ON PUBLICLY-ACCESSIBLE FORM 990S SUBMITTED BY HOSPICES OF OUR SIMILAR SIZE AND SCOPE. FORM 990, PART VI, SECTION C, LINE 19 CFO HAS A COPY OF THE AGENCY'S 990 TAX RETURN, COPY OF AUDITED FINANCIAL STATEMENTS, COPY OF CONFLICT OF INTEREST POLICY AT THE AGENCY'S OFFICE FOR ANYONE TO REVIEW PLUS THE 990 TAX RETURN CAN BE ACCESSED VIA GUIDESTAR AND THE FEDERAL GOVERNMENT'S WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,094. THE PROCESS FOR REVIEWING THE AUDIT AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED.