HOSPICE OF SURRY COUNTY INC: Form 990, tax year 2024

View the entire original 990 at ProPublica ↗

Organization
HOSPICE OF SURRY COUNTY INC (EIN 56-1346589)
Tax period
2024-10-01 to 2025-09-30
Filed
2026-08-14
IRS object ID
202622269349300622
Schema version
2024v5.1
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

FieldValueIRS element (for citing)
Return2026-08-14T10:29:00+00:00ReturnTs
Tax Period End2025-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN440160260PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FORVIS MAZARS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1ONE OAK ST SUITE 300AddressLine1Txt
CityASHEVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28801ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2024-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN561346589EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF SURRY COUNTY INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlHOSPBusinessNameControlTxt
Phone3367892922PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1105 N CRUTCHFIELD ST 2 PO BOX 325AddressLine1Txt
CityDOBSONCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27017ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBARRY S DOWELLPersonNm
Person TitleCFOPersonTitleTxt
Phone3367892922PhoneNum
Signature2026-08-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAMY BIBBYPreparerPersonNm
PTINP00445891PTIN
Phone8282542254PhoneNum
Preparation2026-08-11PreparationDt
FieldValueIRS element (for citing)
Tax2024TaxYr
Build TS2025-03-06 01:10:19ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CAREBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1TRACEY DOBSONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1105 N CRUTCHFIELD ST 2 PO BOX 325AddressLine1Txt
CityDOBSONCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27017ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$45,305,586GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MTNVALLEYHOSPICE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1982FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionOUR MISSION IS CREATING THE BEST EXPERIENCE FOR THOSE FACING SERIOUS ILLNESS - EVERY PATIENT, EVERY FAMILY, EVERY TIME.ActivityOrMissionDesc
Voting Members Governing Body2VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee496TotalEmployeeCnt
Total Volunteers654TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$1,559,602PYContributionsGrantsAmt
CY Contributions Grants$647,403CYContributionsGrantsAmt
PY Program Service Revenue$40,842,883PYProgramServiceRevenueAmt
CY Program Service Revenue$44,250,530CYProgramServiceRevenueAmt
PY Investment Income$224,354PYInvestmentIncomeAmt
CY Investment Income$94,895CYInvestmentIncomeAmt
PY Other Revenue$259,610PYOtherRevenueAmt
CY Other Revenue$286,278CYOtherRevenueAmt
PY Total Revenue$42,886,449PYTotalRevenueAmt
CY Total Revenue$45,279,106CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$25,903,163PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$26,630,143CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$429,883CYTotalFundraisingExpenseAmt
PY Other Expenses$16,457,909PYOtherExpensesAmt
CY Other Expenses$18,235,080CYOtherExpensesAmt
PY Total Expenses$42,361,072PYTotalExpensesAmt
CY Total Expenses$44,865,223CYTotalExpensesAmt
PY Revenues Less Expenses$525,377PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$413,883CYRevenuesLessExpensesAmt
Total Assets BOY$22,182,367TotalAssetsBOYAmt
Total Assets EOY$19,808,205TotalAssetsEOYAmt
Total Liabilities BOY$8,590,819TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,803,254TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$13,591,548NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$14,004,951NetAssetsOrFundBalancesEOYAmt
MissionOUR MISSION IS CREATING THE BEST EXPERIENCE FOR THOSE FACING SERIOUS ILLNESS - EVERY PATIENT, EVERY FAMILY, EVERY TIME.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$37,978,474ExpenseAmt
Revenue$44,492,366RevenueAmt
DescTHE MISSION, VISION, AND VALUES OF MOUNTAIN VALLEY ARE THE DRIVING FORCE BEHIND THE CARE AND SERVICES PROVIDED TO OUR PATIENTS AND FAMILIES. OUR MISSION IS "CREATING THE BEST EXPERIENCE FOR THOSE FACING SERIOUS ILLNESS...EVERY PATIENT, EVERY FAMILY, EVERY TIME." THIS MISSION IS FULFILLED THROUGH THE MOUNTAIN VALLEY WAY, AN ORGANIZATIONAL PHILOSOPHY CENTERED ON DELIVERING AN EXCEPTIONAL PATIENT AND FAMILY EXPERIENCE. MOUNTAIN VALLEY PROVIDES HOSPICE, PALLIATIVE CARE, AND SERIOUS ILLNESS SERVICES THROUGHOUT AN 18-COUNTY SERVICE AREA IN NORTH CAROLINA AND VIRGINIA. IN ADDITION TO PROVIDING CARE IN PATIENTS' HOMES, NURSING FACILITIES, ASSISTED LIVING FACILITIES, AND HOSPITALS, MOUNTAIN VALLEY OPERATES TWO INPATIENT HOSPICE FACILITIES: THE JOAN AND HOWARD WOLTZ HOSPICE HOME AND THE SECU HOSPICE CARE CENTER. OUR CONTINUED SUCCESS IS DRIVEN BY A COMMITMENT TO HIGH-QUALITY CLINICAL CARE, STRONG COMMUNITY RELATIONSHIPS, ONGOING EDUCATION AND OUTREACH, INNOVATIVE PROGRAMS, AND A STEADFAST FOCUS ON MEETING THE EVOLVING NEEDS OF THOSE WE SERVE. DURING FISCAL YEAR 2025, MOUNTAIN VALLEY SERVED 2,686 HOSPICE PATIENTS AND THEIR FAMILIES, WITH AN AVERAGE DAILY CENSUS OF 498 PATIENTS. IN ADDITION TO HOSPICE CARE, MOUNTAIN VALLEY'S CONSULTATIVE PALLIATIVE CARE AND SERIOUS ILLNESS PROGRAM SERVED 519 PATIENTS, EXTENDING SUPPORTIVE CARE EARLIER IN THE COURSE OF SERIOUS ILLNESS AND HELPING MANY PATIENTS TRANSITION SEAMLESSLY TO HOSPICE SERVICES WHEN APPROPRIATE. MOUNTAIN VALLEY CONTINUES TO OFFER SPECIALIZED PROGRAMS THAT ADDRESS THE UNIQUE NEEDS OF OUR COMMUNITY, INCLUDING KIDS PATH FOR PEDIATRIC PATIENTS AND THE NATIONALLY RECOGNIZED WE HONOR VETERANS PROGRAM. THESE SPECIALIZED PROGRAMS ENHANCE THE QUALITY OF LIFE FOR PATIENTS AND FAMILIES WHILE DISTINGUISHING MOUNTAIN VALLEY AS A REGIONAL LEADER IN COMPASSIONATE, PATIENT-CENTERED CARE. MOUNTAIN VALLEY REMAINS COMMITTED TO IDENTIFYING INNOVATIVE OPPORTUNITIES TO EXPAND ACCESS TO CARE, IMPROVE THE PATIENT AND FAMILY EXPERIENCE, AND ENSURE THE LONG-TERM SUSTAINABILITY OF ITS MISSION.Desc
Total Program Service Expenses$37,978,474TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document112IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee496EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members2GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Policies Reference ChaptersfalsePoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Written Policy Or ProcedurefalseWrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BARRY DOWELLBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3367892922PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1105 N CRUTCHFIELD ST 2 PO BOX 325AddressLine1Txt
CityDOBSONCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27017ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
ANDREA HICKLING
TREASURER1.0Yes (X)Yes (X)$0$0$0
CHRIS LUMSDEN
VICE CHAIRMAN1.0Yes (X)Yes (X)$0$0$0
MARY BLACKBURN
SECRETARY1.0Yes (X)Yes (X)$0$0$0
PAUL HAMMES
CHAIRMAN1.0Yes (X)Yes (X)$0$0$0
ANGELA CAGLE
CHIEF HR OFFICER40.0Yes (X)$166,106$0$21,146
BARRY S DOWELL
CHIEF EXECUTIVE OFFICER40.0Yes (X)$190,883$0$30,642
GLENN D GOLASZEWSKI
CHIEF MEDICAL OFFICER40.0Yes (X)$292,923$0$29,232
JENNA CAMPBELL
CHIEF CLINICAL OPERATIONS OFFICER40.0Yes (X)$189,362$0$13,600
TRACEY DOBSON
CHIEF EXECUTIVE OFFICER40.0Yes (X)$239,010$0$5,126
ALEXANDER WAITE
MEDICAL DIRECTOR40.0$271,078$0$24,223Yes (X)
ANNA MARIA HAYES
SENIOR VICE PRESIDENT OF STRATEGY & INNOVATIO40.0$144,200$0$18,053Yes (X)
DON BIVENS
MEDICAL DIRECTOR40.0$289,101$0$3,947Yes (X)
MICHAEL CAPRIOLA
MEDICAL DIRECTOR40.0$296,923$0$22,557Yes (X)
VICTORIA MULLINS
NURSE PRACTITIONER40.0$142,047$0$20,387Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,221,633TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$188,913TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K23IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
THE CITADEL AT WINSTON-SALEM
1900 WEST 1ST STREETWINSTONSALEMNC27104MEDICAL PAYMENT$801,080
CMG CIT ACQUISITIONS INC
655 SOUTH WILLOWMANCHESTERNH03103CONTRACT LABOR$777,191
TELEIOS COLLABORATIVE NETWORK
571 SOUTH ALLENFLAT ROCKNC28726MANAGEMENT$755,326
HARBOURVIEW
542 ALLRED MILL RIOADMOUNT AIRYNC27030MEDICAL PAYMENT$751,680
CCC OF MOUNT AIRY
1287 NEWSOME STREETMOUNT AIRYNC27030MEDICAL PAYMENT$718,978
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K18CntrctRcvdGreaterThan100KCnt
All Other Contributions$647,403AllOtherContributionsAmt
Total Contributions$647,403TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE623000$38,720,520$38,720,520
NURSING HOME SUPPORT623000$5,530,010$5,530,010

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$44,250,530TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$72,083TotalRevenueColumnAmt
Exclusion$72,083ExclusionAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$22,812OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$22,812OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$22,812TotalRevenueColumnAmt
Exclusion$22,812ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$70,922FundraisingGrossIncomeAmt
Fundraising Direct Expenses$26,480FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$44,442TotalRevenueColumnAmt
Exclusion$44,442ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$241,836GrossSalesOfInventoryAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$241,836TotalRevenueColumnAmt
Related Or Exempt Func Income$241,836RelatedOrExemptFuncIncomeAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$45,279,106TotalRevenueColumnAmt
Related Or Exempt Func Income$44,492,366RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$139,337ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,078,282TotalAmt
Program Services$482,284ProgramServicesAmt
Management And General$584,048ManagementAndGeneralAmt
Fundraising$11,950FundraisingAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$19,964,176TotalAmt
Program Services$15,831,438ProgramServicesAmt
Management And General$3,877,834ManagementAndGeneralAmt
Fundraising$254,904FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$294,851TotalAmt
Program Services$228,591ProgramServicesAmt
Management And General$62,521ManagementAndGeneralAmt
Fundraising$3,739FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,738,260TotalAmt
Program Services$2,888,449ProgramServicesAmt
Management And General$802,563ManagementAndGeneralAmt
Fundraising$47,248FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,554,574TotalAmt
Program Services$1,205,224ProgramServicesAmt
Management And General$329,635ManagementAndGeneralAmt
Fundraising$19,715FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$66,890TotalAmt
Management And General$66,890ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$81,695TotalAmt
Management And General$81,695ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$7,936TotalAmt
Management And General$7,936ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,680,234TotalAmt
Program Services$8,613,194ProgramServicesAmt
Management And General$65,000ManagementAndGeneralAmt
Fundraising$2,040FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$423,514TotalAmt
Program Services$423,514ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,248,617TotalAmt
Program Services$931,545ProgramServicesAmt
Management And General$306,420ManagementAndGeneralAmt
Fundraising$10,652FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$557,008TotalAmt
Program Services$534,590ProgramServicesAmt
Fundraising$22,418FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$866,631TotalAmt
Program Services$866,631ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$631,699TotalAmt
Program Services$361,737ProgramServicesAmt
Management And General$269,789ManagementAndGeneralAmt
Fundraising$173FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$92,676TotalAmt
Program Services$90,141ProgramServicesAmt
Management And General$2,535ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$110,277TotalAmt
Program Services$110,277ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,307,418TotalAmt
Program Services$1,307,418ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$73,862TotalAmt
Program Services$73,862ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$3,834,058$3,834,058
BAD DEBT$195,521$195,521
MISCELLANEOUS EXPENSES$30,839$30,839
FUNDRAISING EXPENSES$26,205$26,205

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$44,865,223TotalAmt
Program Services$37,978,474ProgramServicesAmt
Management And General$6,456,866ManagementAndGeneralAmt
Fundraising$429,883FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,323,443BOYAmt
EOY$4,485,210EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$12,710BOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,275,565BOYAmt
EOY$4,157,618EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$299,786BOYAmt
EOY$278,305EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$310,841BOYAmt
EOY$636,595EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$20,067,288LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$10,534,969LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$10,559,073BOYAmt
EOY$9,532,319EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$140,022BOYAmt
EOY$144,772EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,260,927BOYAmt
EOY$573,386EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$22,182,367BOYAmt
EOY$19,808,205EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,449,095BOYAmt
EOY$3,123,998EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,141,724BOYAmt
EOY$2,679,256EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,590,819BOYAmt
EOY$5,803,254EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$13,591,548BOYAmt
EOY$14,004,951EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$13,591,548BOYAmt
EOY$14,004,951EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$22,182,367BOYAmt
EOY$19,808,205EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$413,883ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$480NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$989,483CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,549,936CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$809,266CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,559,602CurrentTaxYearMinus1YearAmt
Current Tax Year$647,403CurrentTaxYearAmt
Total$6,555,690TotalAmt

Tax Rev Levied Orgnztnl Bnft170 TaxRevLeviedOrgnztnlBnft170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl170 GovtFurnSrvcFcltsVl170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$989,483CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,549,936CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$809,266CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,559,602CurrentTaxYearMinus1YearAmt
Current Tax Year$647,403CurrentTaxYearAmt
Total$6,555,690TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$132,526SubstantialContributorsTotAmt
Public Support Total170$6,423,164PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$146CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$12,569CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$38,226CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$222,959CurrentTaxYearMinus1YearAmt
Current Tax Year$72,083CurrentTaxYearAmt
Total$345,983TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt
FieldValueIRS element (for citing)
Total Support$6,901,673TotalSupportAmt
Gross Receipts Rltd Activities$190,579,277GrossReceiptsRltdActivitiesAmt
Public Support CY1700.93067PublicSupportCY170Pct
Public Support PY1700.95452PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$942,487OtherCostOrOtherBasisAmt
Book Value$942,487BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,443,707OtherCostOrOtherBasisAmt
Depreciation$4,100,394DepreciationAmt
Book Value$3,343,313BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$62,976OtherCostOrOtherBasisAmt
Depreciation$34,691DepreciationAmt
Book Value$28,285BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,618,118OtherCostOrOtherBasisAmt
Depreciation$6,399,884DepreciationAmt
Book Value$5,218,234BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$9,532,319TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
FEDERAL INCOME TAXES
CAPITAL LEASE OBLIGATION$2,145,500
UNEARNED INCOME
RIGHT OF USE LIABILITY$533,756
FieldValueIRS element (for citing)
Total Liability$2,679,256TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$44,774,015TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$480NetUnrealizedGainsInvstAmt
Other Revenue-$504,611OtherRevenueAmt
Revenue Not Reported-$505,091RevenueNotReportedAmt
Revenue Subtotal$45,279,106RevenueSubtotalAmt
Other Revenues Not Included$0OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$45,279,106TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$44,360,612TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included-$504,611OtherExpensesIncludedAmt
Expenses Not Reported-$504,611ExpensesNotReportedAmt
Expenses Subtotal$44,865,223ExpensesSubtotalAmt
Other Expenses Not Included$0OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$44,865,223TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART X, LINE 2 FIN 48 (ASC 740) FOOTNOTETHE HOSPICE IS A NOT-FOR-PROFIT ORGANIZATION THAT HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAXEXEMPT UNDER INTERNAL REVENUE CODE SECTION 501 (C)(3). THE HOSPICE FOLLOWS THE FASB'S AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL TAX POSITIONS IN THE FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE HOSPICE'S FINANCIAL STATEMENTS. THE HOSPICE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2025.
SCHEDULE D, PART XI, LINE 2(D) OTHER REVENUES IN AUDITED FINANCIAL STATEMENTS NOT IN FORM 990GAIN ON SALE OF ASSET - -22812 FUNDRAISING INCOME - -44442 THRIFT SHOP GROSS RECEIPTS - -241836 BAD DEBT EXPENSE - -195521
SCHEDULE D, PART XII, LINE 2(D) OTHER EXPENSES IN AUDITED FINANCIAL STATEMENTS NOT IN FORM 990GAIN ON SALE OF ASSETS - -22812 FUNDRAISING INCOME - -44442 THRIFT SHOP GROSS RECEIPTS - -241836 BAD DEBT EXPENSE - -195521

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event140TH ANNIVERSARY GALAEvent1Nm
Gross Receipts Event1$53,080GrossReceiptsEvent1Amt
Gross Revenue Event1$53,080GrossRevenueEvent1Amt
Food And Beverage Event1$11,546FoodAndBeverageEvent1Amt
Entertainment Event1$2,000EntertainmentEvent1Amt
Other Direct Expenses Event1$2,739OtherDirectExpensesEvent1Amt
Event2PORT-A-PIT FUNDRAISEREvent2Nm
Gross Receipts Event2$17,842GrossReceiptsEvent2Amt
Gross Revenue Event2$17,842GrossRevenueEvent2Amt
Food And Beverage Event2$9,942FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$253OtherDirectExpensesEvent2Amt
Gross Revenue Other Events$0GrossRevenueOtherEventsAmt
Gross Receipts Total$70,922GrossReceiptsTotalAmt
Gross Revenue Total Events$70,922GrossRevenueTotalEventsAmt
Food And Beverage Total Events$21,488FoodAndBeverageTotalEventsAmt
Entertainment Total Events$2,000EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$2,992OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$26,480DirectExpenseSummaryEventsAmt
Net Income Summary$44,442NetIncomeSummaryAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
GLENN D GOLASZEWSKI
CHIEF MEDICAL OFFICER$282,923$0$10,000$0$0$0$6,066$0$23,166$0$322,155$0$0$0
TRACEY DOBSON
CHIEF EXECUTIVE OFFICER$214,010$0$25,000$0$0$0$4,292$0$834$0$244,136$0$0$0
BARRY S DOWELL
CHIEF EXECUTIVE OFFICER$165,883$0$25,000$0$0$0$3,835$0$26,807$0$221,525$0$0$0
JENNA CAMPBELL
CHIEF CLINICAL OPERATIONS OFFICER$164,362$0$25,000$0$0$0$3,825$0$9,775$0$202,962$0$0$0
ANGELA CAGLE
CHIEF HR OFFICER$141,106$0$25,000$0$0$0$3,443$0$17,703$0$187,252$0$0$0
MICHAEL CAPRIOLA
MEDICAL DIRECTOR$296,923$0$0$0$0$0$4,593$0$17,964$0$319,480$0$0$0
ALEXANDER WAITE
MEDICAL DIRECTOR$271,078$0$0$0$0$0$5,519$0$18,704$0$295,301$0$0$0
DON BIVENS
MEDICAL DIRECTOR$289,101$0$0$0$0$0$3,947$0$0$0$293,048$0$0$0
VICTORIA MULLINS
NURSE PRACTITIONER$142,047$0$0$0$0$0$2,984$0$17,403$0$162,434$0$0$0
ANNA MARIA HAYES
SENIOR VICE PRESIDENT OF STRATEGY & INNOVATIO$144,200$0$0$0$0$0$357$0$17,696$0$162,253$0$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, LINE 15THE BOARD DETERMINES THE CEO'S COMPENSATION. OTHER OFFICERS AND KEY FIGURES OF THE ORGANIZATION ARE DETERMINED BY A POSITION CONTROL COMMITTEE THAT REPRESENTS FINANCE, HUMAN RESOURCES, THE CEO AND MARKET COMPARABILITY DATA.
FORM 990, PART VI, LINE 18RECENT FILINGS 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, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERSTHE ORGANIZATION HAS TWO MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL, INC, AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY.
FORM 990, PART VI, LINE 7A MEMBERS OR STOCKHOLDERS ELECTING MEMBERS OF GOVERNING BODYTHE GOVERNING BODY CONSISTS OF REPRESENTATIVES APPOINTED BY THE ORGANIZATION'S MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY.
FORM 990, PART VI, LINE 7B DECISIONS REQUIRING APPROVAL BY MEMBERS OR STOCKHOLDERSTHE GOVERNING BODY CONSISTS OF REPRESENTATIVES APPOINTED BY THE ORGANIZATION'S MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY. DECISIONS OF THE REPRESENTATIVES ARE SUBJECT TO APPROVAL OF THE MEMBER ORGANIZATIONS.
FORM 990, PART VI, LINE 11B REVIEW OF FORM 990 BY GOVERNING BODYTHE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. UPON COMPLETION OF THE FORM 990, THE ORGANIZATION'S MANAGEMENT REVIEWED THE FORM 990. DUE TO THE TIMING OF THE QUARTERLY BOARD MEETINGS, THE COMPLETED AND FILED FORM 990 IS PROVIDED TO THE BOARD AT THE NEXT SCHEDULED MEETING.
FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICYBOARD OF MEMBERS, ADVISORY BOARD AND HOSPICE STAFF SUBMIT A FORM TO DISCLOSE PERSONAL OR FINANCIAL INTERESTS THAT COULD POSSIBLY INTERFERE WITH THEIR DUTIES AND RESPONSIBILITIES TO THE ORGANIZATION. DISCLOSURE FORMS ARE SUBMITTED AT THE TIME OF HIRE OR BOARD APPOINTMENT, ANNUALLY AND/OR WHENEVER A POTENTIAL CONFLICT ARISES. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLOYMENT OR BOARD APPOINTMENT.
FORM 990, PART VI, LINE 19 REQUIRED DOCUMENTS AVAILABLE TO THE PUBLICPHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART IX, LINE 11G OTHER FEESROOM & BOARD FEES - TOTAL EXPENSE: 5710235, PROGRAM SERVICE EXPENSE: 5710235, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; MEDICAL FEES - TOTAL EXPENSE: 1911514, PROGRAM SERVICE EXPENSE: 1911514, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; OTHER PROFESSIONAL FEES - TOTAL EXPENSE: 1058485, PROGRAM SERVICE EXPENSE: 991445, MANAGEMENT AND GENERAL EXPENSES: 65000, FUNDRAISING EXPENSES: 2040; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; - TOTAL EXPENSE: , PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ;
FORM 990, PART XII, LINE 2CTHIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

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