2022-08-15T15:07:24-05:00 2021-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2020-10-01 560530234 RANDOLPH HOSPITAL INC RAND 3366255151 364 WHITE OAK STREET ASHEBORO NC 27203 LORETTA LONG CFO 3366255151 2022-08-15 1 LORETTA LONG 999009999 JOHN NORMAN P01506766 7049985200 2022-08-15 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z RANDOLPH HEALTH ANGELA P ORTH 364 WHITE OAK STREET ASHEBORO NC 27203 81442252 0 X WWW.RANDOLPHHEALTH.ORG X 1928 NC TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS. X 10 10 974 0 0 0 4208010 0 112515268 81442252 98899 0 24100 0 116846277 81442252 2769268 0 0 0 47180821 41827321 0 0 0 61713149 41156350 111663238 82983671 5183039 -1541419 118605955 0 68138216 0 50467739 0 X RANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO FOSTER HEALTH AND WELLNESS IN OUR COMMUNITIES. 0 1 71460954 81442252 RANDOLPH HOSPITAL, A NOT-FOR-PROFIT, 145-BED COMMUNITY HOSPITAL WAS ESTABLISHED IN 1928 WITH THE APPROVAL OF A COOPERATIVE PLAN WITH THE DUKE ENDOWMENT AT A JOINT MEETING OF THE ASHEBORO ROTARY CLUB, THE KIWANIS CLUB, THE CHAMBER OF COMMERCE, THE TOWN COUNCIL AND INTERESTED CITIZENS. THE PLAN CALLED FOR THE BUILDING OF A 40-BED HOSPITAL. 71460954 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 1 128 0 974 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X LORETTA LONG CFO 3366298810 364 WHITE OAK STREET ASHEBORO NC 27203 MICHAEL MILLER SECRETARY 0.50 X X 0 0 0 ELBERT LASSITER JR VICE CHAIR 0.50 X X 0 0 0 GLENN MAC PUGH CHAIRMAN 0.50 2.50 X X 0 0 0 LINDA BROWN BOARD MEMBER 0.50 X 0 0 0 DAVID BRYANT BOARD MEMBER 0.50 X 0 0 0 DR CRANFORD KNOTT BOARD MEMBER 0.50 X 0 0 0 THOMAS LAWRENCE MD BOARD MEMBER 0.50 X 0 0 0 T REYNOLDS LISK BOARD MEMBER 0.50 X 0 0 0 CHRIS RICHARDSON MD BOARD MEMBER 0.50 X 0 0 0 ROBERT SHACKLEFORD JR PHD BOARD MEMBER 0.50 X 0 0 0 BARBARA WOLFE VP 40.00 5.00 X 178543 0 7791 ROBERT CLAUSER VP 40.00 5.00 X 205409 0 15877 ANGELA ORTH CONE VP 40.00 5.00 X 0 0 0 TREMONTEO CRAWFORD VP 40.00 5.00 X 196238 0 7791 LORETTA LONG VP 40.00 5.00 X 156239 0 12722 DR CHARES WEST JR VP 40.00 5.00 X 321763 0 13814 LISA HAMPTON DIRECTOR 40.00 X 152861 0 7791 ANGELA BURGESS CIO 40.00 X 152657 0 7791 CHRISTOPHER PARRISH DIRECTOR 40.00 X 121280 0 15877 MARK MOORE DIRECTOR 40.00 X 117829 0 15877 MEGAN GODWIN PHARMACIST 40.00 X 120721 0 9568 1723540 0 114899 10 0 1 0 CONE HEALTH 1200 NORTH ELM STREET GREENSBORO NC 27401 HOSPITALIST,LAB,PHARM,MGT FEE 4507927 ANKURA CONSULTING GROUP 1220 19TH STREET NW STE 700 WASHINGTON DC 20036 CONSULTING 2228210 NELSON MULLINS RILEY SCARBOROUGH A07081 1320 MAIN STREET 17TH FLOOR COLUMBIA SC 29211 LEGAL SERVICES 2150310 TRIMEDX INC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS GA 303536922 REPAIRS AND MAINTENACE 1226103 HOULIHAN LOKEY CAPITAL INC 111 S WACKER DR 37TH FL CHICAGO IL 60606 CONSULTING 1104708 38 PATIENT SERVICE REVENU 621400 68465528 68465528 MRI OF ASHEBORO LLC 621400 743066 743066 CANCER CENTER REVENUE 621400 541579 541579 JOINT VENTURE 621400 116167 116167 11575912 11575912 81442252 81442252 81442252 0 0 31629540 30048063 1581477 10118967 8601122 1517845 78814 66992 11822 3557441 2358586 1198855 10245147 8913278 1331869 95897 90784 5113 194525 194525 3008746 3008746 395143 395143 MISCELLANEOUS 23502962 17627226 5875736 PROFESSIONAL FEES 156489 156489 82983671 71460954 11522717 0 5230096 0 9162508 0 2218063 0 930794 0 0 0 39850073 0 19994013 0 9365494 0 31854914 0 118605955 0 18377852 19500673 30259691 0 68138216 0 X 45647049 0 4820690 0 50467739 0 118605955 0 X -1541419 -3432033 -45494287 X 0 0 0 X 0 0 0 0 0 0 0 0 1 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES CARRIED OUT BY THOSE ORGANIZATIONS ON BEHALF OF THEIR MEMBERS. 1 1 1 X 1 X 1 0 1 1 5340126 5340126 0.06440 13786145 11675208 2110937 0.02540 19126271 11675208 7451063 0.08980 66105 66105 0.00080 22597 22597 0.00030 88702 88702 0.00110 19214973 11675208 7539765 0.09090 1 4473475 3802454 36125264 49399936 -13274672 X 1 1 1 RANDOLPH NEWCO LLC MEDICAL EQUIPMENT RENTAL 0.83030 0.16970 1 1 RANDOLPH HOSPITAL INCORPORATED 364 WHITE OAK STREET ASHEBORO NC 27203 WWW.RANDOLPHHEALTH.ORG X X X RANDOLPH HOSPITAL INCORPORATED 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE PART VI X SEE PART VI X X 1 18 1 SEE PART VI 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X WWW.RANDOLPHHOSPITAL.ORG X WWW.RANDOLPHHOSPITAL.ORG X WWW.RANDOLPHHOSPITAL.ORG X X X X X X 1 0 X X X X 1 X 0 0 RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 5: IN THE FALL OF 2018, RANDOLPH COUNTY PUBLIC HEALTH JOINED WITH RANDOLPH HEALTH, TO ESTABLISH THE ASSESSMENT FRAMEWORK AND A TIMELINE FOR DATA COLLECTION AND ANALYSIS, PRIORITIZATION OF HEALTH CONCERNS AND DEVELOPMENT OF COMMUNITY HEALTH IMPROVEMENT PLANS (CHIP). DATA COLLECTION AND ANALYSIS TOOK PLACE FROM SEPTEMBER 2018 - SEPTEMBER 2019. PRIMARY DATA WAS COLLECTED FROM THE COMMUNITY IN TWO DIFFERENT WAYS: DISTRIBUTION OF PAPER SURVEYS AND AN INTERNET SURVEY.WITH TECHNOLOGY CONTINUING TO ADVANCE, MORE OF AN EMPHASIS WAS PLACED ON ON-LINE SURVEYS ALTHOUGH, PAPER SURVEYS WERE STILL AN IMPORTANT TOOL. IN ADDITION TO ON-LINE SURVEYS, PAPER SURVEYS WERE DISTRIBUTED TO AGENCIES AND ORGANIZATIONS WITHIN THE COUNTY USING THE CONVENIENCE SAMPLE METHOD. ALL SURVEYS DISTRIBUTED WERE IN BOTH ENGLISH AND SPANISH. OF THE 1,500 TOTAL DISTRIBUTED SURVEYS, 927 WERE RETURNED FOR A RESPONSE RATE OF 62%. AN INTERNET SURVEY WAS DEVELOPED USING SURVEY MONKEY. THE INTERNET SURVEY WAS ACCESSIBLE THROUGH THE RANDOLPH COUNTY GOVERNMENT WEBSITE AS WELL AS THE RANDOLPH HEALTH WEBSITE. IN AN EFFORT TO PROMOTE THE INTERNET SURVEY, PRESS RELEASES RAN IN ALL AREA NEWSPAPERS, AS WELL AS PROMOTED VIA SOCIAL MEDIA.TO ENSURE A SOLID REPRESENTATION FROM KEY SECTORS, THE SURVEY WAS SENT TO RANDOLPH COUNTY GOVERNMENT DEPARTMENT HEADS AND DIRECTORS FROM VARIOUS AGENCIES OR REPRESENTATIVES WITHIN THE COUNTY. THE MAJOR SOURCE FOR SECONDARY DATA IN THE 2019 RANDOLPH COUNTY COMMUNITY HEALTH ASSESSMENT INCLUDED:- NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS- NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES- CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)- CECIL G. SHEPS CENTER FOR HEALTH SERVICES RESEARCH- US CENSUS DEPARTMENTAS APPLICABLE, RANDOLPH COUNTY STATISTICS HAVE BEEN COMPARED WITH STATE STATISTICS AS WELL AS FOUR PEER COUNTIES. THESE PEER COUNTIES WERE IDENTIFIED BASED UPON AGE, RACE AND POVERTY CHARACTERISTICS AND ARE SELECTED FROM A GROUP OF COUNTIES WITHIN THE SAME POPULATION RANGE AS THE SUBJECT COUNTY.FOR RANDOLPH COUNTY, THE FOLLOWING FOUR PEER COUNTIES WERE IDENTIFIED: CRAVEN, DAVIDSON, HARNETT AND JOHNSTON. THEREFORE, IN ADDITION TO NORTH CAROLINA STATISTICS, THESE FOUR COUNTIES WERE USED FOR COMPARISON THROUGHOUT THE ASSESSMENT PROCESS. RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 6B: RANDOLPH COUNTY HEALTH DEPARTMENT RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 7D: BOTH RANDOLPH COUNTY AND RANDOLPH HOSPITAL WEBSITES HAVE POSTED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND EXECUTIVE SUMMARY. THE ASSESSMENT IS ALSO IN ALL SEVEN RANDOLPH COUNTY LIBRARIES. TWENTY-FIVE DATA BOOKS AND 150 EXECUTIVE SUMMARIES WILL BE ORDERED AND PRINTED FOR DISTRIBUTION THROUGHOUT THE COMMUNITY. RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 11: IN AUGUST 2019, ADVISORY COMMITTEE MEMBERS MET TO IDENTIFY LEADING COMMUNITY HEALTH CONCERNS IN RANDOLPH COUNTY. DURING THE MEETING, MEMBERS REVIEWED HEALTH CONCERNS IDENTIFIED THROUGH SURVEYS AS WELL AS THE INFORMATION GATHERED THROUGH SECONDARY RESEARCH. THROUGH NOMINAL GROUP TECHNIQUE THE COMMITTEE SELECTED 15 COMMUNITY HEALTH CONCERNS SOME OF WHICH INCLUDE: OBESITY, MENTAL HEALTH, SUBSTANCE ABUSE, ACCESS TO CARE, TOBACCO, SEXUALLY TRANSMITTED DISEASES, CHRONIC DISEASE MANAGEMENT AND INJURY PREVENTION. AFTER MUCH DISCUSSION, THE COMMITTEE AGREED TO FOCUS ON THREE PRIORITY HEALTH CONCERNS:1. FOCUS AREA: EARLY AND MIDDLE CHILDHOOD A. INCREASE THE PROPORTION OF CHILDREN WHO ARE READY FOR SCHOOL IN ALL FIVE DOMAINS OF HEALTHY DEVELOPMENT: PHYSICAL DEVELOPMENT, SOCIAL-EMOTIONAL DEVELOPMENT, APPROACHES TO LEARNING, LANGUAGE AND COGNITIVE DEVELOPMENT B. INCREASE THE PROPORTION OF PARENTS WHO READ TO THEIR YOUNG CHILD2. FOCUS AREA: HEALTH-RELATED QUALITY OF LIFE AND WELL-BEING A. INCREASE THE PROPORTION OF ADULTS WHO SELF-REPORT GOOD OR BETTER PHYSICAL AND MENTAL HEALTH 3. FOCUS AREA: MENTAL HEALTH A. DECREASE THE AVERAGE NUMBER OF POOR MENTAL HEALTH DAYS AMONG ADULTS B. REDUCE THE RATE OF MENTAL HEALTH-RELATED VISITS TO THE EMERGENCY DEPARTMENT BY THE EXPANSION OF BEHAVIORAL HEALTH SERVICES WITHIN THE PRIMARY CARE SETTINGIT IS IMPORTANT TO NOTE THAT ALTHOUGH THE ADVISORY COMMITTEE IDENTIFIED FIFTEEN HEALTH ISSUES, THE DECISION WAS MADE TO LIMIT THE FOCUS TO MAKE A LARGER IMPACT ON THE TOP THREE AREAS THAT HAD THE OPPORTUNITY TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY. THE IDENTIFIED PRIORITY AREAS ARE ALSO IN LINE WITH THE AREAS IDENTIFIED DURING THE RANDOLPH COUNTY STRATEGIC PLANNING PROCESS. THE ENTIRE COUNTY IS NOW ALIGNED WITH FOCUSING ON THE SAME HEALTH PRIORITY AREAS--CREATING, A COORDINATED AND UNITED COUNTY-WIDE EFFORT TO ADDRESS THE HEALTH OF OUR COMMUNITY. RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 20E: THE HOSPITAL ESTABLISHES DURING PRE-REGISTRATION WHETHER A PATIENT IS COVERED BY INSURANCE. IF THE PATIENT IS NOT COVERED BY INSURANCE, THE HOSPITAL MAKES THE PATIENT AWARE OF THE FINANCIAL ASSISTANCE POLICY. 25 1 - RH STAYWELL SENIOR CARE 809 CURRY DRIVE ASHEBORO NC 27205 PACE CENTER 2 - RHMG ATHLETIC TRAINING 600 W SALISBURY ST STE A ASHEBORO NC 27203 ATHLETIC TRAINING 3 - RH CANCER CENTER 364 WHITE OAK ST ASHEBORO NC 27203 CANCER TREATMENT 4 - RHMG CHC BETTERCARE 600 W SALISBURY ST STE B ASHEBORO NC 27203 CORPORATE HEALTH & WELLNESS 5 - RHMG DEEP RIVER P T -ASHEBORO 600 W SALISBURY ST STE A ASHEBORO NC 27203 PHYSICAL THERAPY 6 - RHMG DEEP RIVER P T -RAMSEUR 701 LIBERTY ST RAMSEUR NC 27316 PHYSICAL THERAPY 7 - RHMG DEEP RIVER P T -RANDLEMAN 148 POINTE SOUTH DRIVE RANDLEMAN NC 27317 PHYSICAL THERAPY 8 - RH DIABETES CENTER 208-D FOUST ST ASHEBORO NC 27203 DIABETES TREATMENT 9 - RHMG EAR NOSE & THROAT 124 N PARK ST ASHEBORO NC 27203 EAR NOSE AND THROAT 10 - RHMG ENDOSCOPY CENTER 700 SUNSET AVE ASHEBORO NC 27203 ENDOSCOPY 11 - RHMG FAMILY PRACTICE - LIBERTY 504 N GREENSBORO LIBERTY NC 27298 FAMILY MEDICINE 12 - RHMG FAMILY PRACTICE - RANDLEMAN 670 W ACADEMY ST RANDLEMAN NC 27317 FAMILY MEDICINE 13 - RHMG FAMILY PRACTICE - SEAGROVE 514 N BROAD ST SEAGROVE NC 27341 FAMILY MEDICINE 14 - RHMG FAMILY PRACTICE & WELLNESS 132-C W MILLER ST ASHEBORO NC 27203 FAMILY MEDICINE 15 - RHMG FITNESS CENTER 600 W SALISBURY ST STE A ASHEBORO NC 27203 FITNESS CENTER 16 - RHMG GASTROENTEROLOGY 700 SUNSET AVE ASHEBORO NC 27203 GASTROENTEROLOGY 17 - RHHOME HEALTH 341 N FAYETTEVILLE ST ASHEBORO NC 27203 HOME HEALTH 18 - RHMG INTERNAL MEDICINE 237-A N FAYETTEVILLE ST ASHEBORO NC 27203 INTERNAL MEDICINE 19 - RH MRI CENTER 237 N FAYETTEVILLE ST STE B ASHEBORO NC 27203 MRI 20 - RHMG ORTHOPEDICS & SPORTS MEDICINE 503 N FAYETTEVILLE ST ASHEBORO NC 27203 ORTHOPEDICS/SPORTS MEDICINE 21 - RHMGPEDIATRICS 713 S FAYETTEVILLE ST ASHEBORO NC 27203 PEDIATRICS 22 - RHMG P T & SPORTS MEDICINE 503 N FAYETTEVILLE ST ASHEBORO NC 27203 PHYSICAL THERAPY 23 - RH SURGERY CENTER 724 THOMAS ST ASHEBORO NC 27203 SURGICAL CENTER 24 - RHMG UROLOGY 132-C W MILLER ST ASHEBORO NC 27203 UROLOGY 25 - RH WOUND CARE & HYPERBARIC CENTER 212 FOUST ST ASHEBORO NC 27203 WOUND CARE PART I, LINE 6A: NORTH CAROLINA HOSPITAL ASSOCIATION PART I, LN 7 COL(F): UNINSURED PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE OR STATE, FEDERAL, AND /OR GRANT FUND PROGRAMS ARE RESPONSIBLE FOR A DISCOUNTED PAYMENT AMOUNT IN ACCORDANCE WITH IRS SECTION 501(R). PAYMENT PLANS ARE OFFERED THROUGH RANDOLPH HOSPITAL WITH NO INCURRED INTEREST CHARGES. THE PATIENT FINANCIAL SERVICES DEPARTMENT OF RANDOLPH HOSPITAL PROVIDES A MONTHLY STATEMENT, MAKES TELEPHONE CONTACT, AND/OR SENDS COLLECTION LETTERS. UNCOLLECTED DELIQUENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY OR ATTORNEY FOR CONTINUED COLLECTION. ALL INTERNAL AND EXTERNAL COLLECTIONS PROCESSES COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT (FDCPA). PART III, LINE 2: THE ORGANIZATION APPLIED THE COST-TO CHARGE RATIO TO ITS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT REPORTED ON PART III, LINE 2. PART III, LINE 3: THE ORGANIZATION ESTIMATES FROM HISTORICAL PERSPECTIVE AND EXPERIENCE THAT APPROXIMATELY 85% OF BAD DEBT EXPENSE MAY BE ATTRIBUTABLE TO COMMUNITY BENEFIT. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT EXPENSE WAS OBTAINED FROM AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL TRADITIONALLY INCURS A SHORTFALL IN PROVIDING MEDICARE SERVICES AND CONSIDERS THE ENTIRE SHORTFALL AS A COMMUNITY BENEFIT. MEDICARE DOES NOT REIMBURSE THE HOSPITAL ENOUGH TO COVER ITS COSTS ASSOCIATED WITH PROVIDING MEDICARE SERVICES, YET THE HOSPITAL CONTINUES TO FULFILL ITS MISSION OF PROVIDING SERVICES TO ITS COMMUNITY REGARDLESS OF THE REIMBURSEMENT LEVELS. AS SUCH, THE HOSPITAL BELIEVES THAT IT IS APPROPRIATE TO REPORT THIS SHORTFALL AS PART OF ITS COMMUNITY BENEFIT. THE BAD DEBT INCLUDED AS UNCOMPENSATED CARE REPRESENTS THE COST OF PROVIDING THOSE SERVICES, CALCULATED USING THE COST TO CHARGE RATIO OF THE CHARGES RECORDED IN THE FINANCIAL STATEMENTS AS BAD DEBT. PART III, LINE 9B: RANDOLPH HOSPITAL IS COMMITTED TO ASSISTING PATIENTS THAT DO NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR THEIR HEALTH CARE SERVICES. THE HOSPITAL MAKES AVAILABLE FINANCIAL COUNSELING TO DETERMINE THE APPROPRIATE DISPOSITION OF THE PATIENT ACCOUNT. A MEDICAL ASSISTANCE COUNSELOR REVIEWS ACCOUNTS FOR POSSIBLE FINANCIAL ASSISTANCE FROM STATE, FEDERAL, AND/OR ENDOWMENT FUNDS PROGRAMS. RANDOLPH HOSPITAL PROVIDES CHARITY TO PATIENTS WHO MEET CRITERIA AS OUTLINED IN THE FINANCIAL ASSISTANCE POLICY. ANY PATIENT/GUARANTOR WHO REFUSES TO COMPLETE THE APPLICATION WILL BE CONSIDERED AS HAVING THE ABILITY TO PAY HIS ACCOUNT AND HANDLED ACCORDINGLY. PART VI, LINE 2: THE HOSPITAL WORKS WITH THE RANDOLPH COUNTY HEALTH DEPARTMENT ON AN ONGOING BASIS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. ADDITIONAL ASSISTANCE IS PROVIDED BY COMMUNITY INSTITUTIONS, BUSINESSES, AGENCIES AND INDIVIDUALS WITH AN INTEREST IN IMPROVING THE HEALTH STATUS OF RANDOLPH COUNTY RESIDENTS. PART VI, LINE 3: THE HOSPITAL HAS A DEDICATED PATIENT FINANCIAL TEAM THAT TAKES A PROACTIVE APPROACH TO COUNSELING AND EDUCATING PATIENTS ON THE HEALTHCARE BILLING PROCESS AND CREATING CUSTOMIZED PAYMENT OPTIONS TO HELP ALLEVIATE INITIAL FINANCIAL BURDENS. IF IT APPEARS THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, OUR TEAM WILL HELP THE PATIENT DETERMINE WHICH ROUTE IS MOST APPROPRIATE FOR THEIR SITUATION. THE HOSPITAL ASSESSES AT THE TIME OF REGISTRATION AND DURING INTERVIEWS WITH FINANCIAL COUNSELORS WHETHER A PATIENT MIGHT QUALIFY FOR FINANCIAL ASSISTANCE AND PROVIDES LITERATURE TO THE PATIENT AT THAT TIME. THE HOSPITAL ALSO WIDELY COMMUNICATES THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE, BILLING STATEMENTS, AND SIGNS POSTED CONSPICUOUSLY THROUGH OUT ITS FACILITIES. PART VI, LINE 4: THE US CENSUS BUREAU REPORTED AN ESTIMATED POPULATION OF APPROXIMATELY 143,149 IN RANDOLPH COUNTY FOR THE YEAR 2017. THIS WAS AN INCREASE OF ALMOST 1% FROM THE YEAR 2010 WHEN THE POPULATION WAS REPORTED TO BE APPROXIMATELY 141,752. THE ESTIMATED POPULATION IN NORTH CAROLINA IN 2017 WAS 10,052,564 WHICH WAS AN INCREASE OF 5.4% FROM 2010.SIMILAR TO NORTH CAROLINA AS A WHOLE, THE POPULATION OF RANDOLPH COUNTY IS DIVIDED ALMOST EQUALLY BETWEEN MALES (49.3%-RC, 48.7%-NC) AND FEMALES (50.7%-RC, 51.3%-NC). RESIDENTS OF RANDOLPH COUNTY ARE PREDOMINATELY WHITE (84.9%), FOLLOWED BY HISPANIC (11.1%) AND BLACK (6.3%). THE HISPANIC POPULATION IN RANDOLPH COUNTY (11.1%) IS HIGHER WHEN COMPARED TO NORTH CAROLINA (9.1%) AS A WHOLE. THE BLACK POPULATION IN RANDOLPH COUNTY (6.3%) IS LOWER WHEN COMPARED TO NORTH CAROLINA (21.5%).FROM AN ECONOMIC STANDPOINT, PERSONAL INCOME PER CAPITA FOR RANDOLPH COUNTY WAS AT $36,339 IN 2017, BELOW THE AVERAGE PER CAPITA INCOME FOR ALL RESIDENTS OF NORTH CAROLINA. THE PERCENTAGE OF MEDICAID ELIGIBLE PATIENTS IN RANDOLPH COUNTY IN 2017 IS 25.2%, EXCEEDING THE AVERAGE LEVEL IN NORTH CAROLINA. UNEMPLOYMENT RATES FOR RANDOLPH COUNTY IN 2018 IS APPROXIMATELY 3.7% OF THE WORKFORCE, SLIGHTLY ABOVE THE NORTH CAROLINA RATE OF 3.6%. PART VI, LINE 7, REPORTS FILED WITH STATES NC X X X X 0 1 0 0 0 0 0 0 0 DR CHARES WEST JR VP 294179 0 0 0 27584 0 0 0 13814 0 335577 0 0 0 ROBERT CLAUSER VP 196381 0 0 0 9028 0 0 0 15877 0 221286 0 0 0 TREMONTEO CRAWFORD VP 181103 0 0 0 15135 0 0 0 7791 0 204029 0 0 0 BARBARA WOLFE VP 152140 0 0 0 26403 0 0 0 7791 0 186334 0 0 0 LORETTA LONG VP 149520 0 0 0 6719 0 0 0 12722 0 168961 0 0 0 LISA HAMPTON DIRECTOR 126447 0 0 0 26414 0 0 0 7791 0 160652 0 0 0 ANGELA BURGESS CIO 146010 0 0 0 6647 0 0 0 7791 0 160448 0 0 0 PART I, LINE 4B CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM PARTICIPATE IN THE RANDOLPH HOSPITAL, INC. DEFERRED COMPENSATION PLAN. UNDER THIS PLAN, AN ANNUAL CONTRIBUTION IS MADE INTO A TRUST FOR EACH PARTICIPANT BASED ON A PERCENTAGE (10% OR 15%) OF THEIR SALARY. EACH PARTICIPANT DIRECTS THE INVESTMENT OF HIS/HER ACCOUNT BALANCE. DURING 2018, ROBERT CLAUSER, ANGELA ORTH, AND BARBARA WOLFE RECEIVED PAYOUTS FROM THE PLAN OF $58,682, $37,247, AND $48,101, RESPECTIVELY. REAL AND PERSONAL HOSPITAL PROPERTY PURCHASED AS PART OF A BANKRUPTCY PROCEEDING 2021-07-01 6996683 BANKRUPTCY AUCTION 854354835 AMERICAN HEALTHCARE SYSTEMS LLC 505 N BRAND BLVD STE 1110 GLENDALE CA 91203 C CORP/LLC 0 1 0 0 0 1 1 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: ALL OFFICERS AND KEY EMPLOYEES OF RANDOLPH HOSPITAL PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: AS A CONDITION TO THE PURCHASE AGREEMENT PURSUANT TO THE BANKRUPTCY PROCEEDING, THE PURCHASER MADE AN OFFER OF EMPLOYMENT TO ALL EMPLOYEES OF RANDOLPH HOSPITAL. PART I, LINE 3: UNABLE TO PARTNER WITH A SUITABLE TAX-EXEMPT PARTNER, THE ORGANIZATION WAS FORCED TO DECLARE BANKRUPTCY. THE ORGANIZATION SOLD ITS ASSETS TO AMERICAN HEALTHCARE SYSTEMS, A FOR-PROFIT ENTITY, AS DECIDED BY THE UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF NORTH CAROLINA GREENSBORO DIVISION IN BANKRUPTCY CASE NO. 20-10247. AS A RESULT, THE TAX-EXEMPT STATUS OF THE ORGANIZATION HAS TERMINATED. FORM 990, PART III, LINE 3 UNABLE TO PARTNER WITH A SUITABLE TAX-EXEMPT PARTNER, THE ORGANIZATION WAS FORCED TO DECLARE BANKRUPTCY. THE ORGANIZATION SOLD ITS ASSETS TO AMERICAN HEALTHCARE SYSTEMS, A FOR-PROFIT ENTITY, AS DECIDED BY THE UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF NORTH CAROLINA GREENSBORO DIVISION IN BANKRUPTCY CASE NO. 20-10247. AS A RESULT, THE TAX-EXEMPT STATUS OF THE ORGANIZATION HAS TERMINATED. FORM 990, PART VI, SECTION A, LINE 1 THERE STANDS AN EXECUTIVE COMMITTEE CONSISTING OF THE CHAIRMAN, VICE CHAIRMAN, CHAIRMAN-ELECT, SECRETARY, CHAIRMAN OF THE 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 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, CITY OF ASHEBORO SUPERINTENDENT OF SCHOOLS, AND THE COUNTY HEALTH OFFICER OF RANDOLPH COUNTY, NORTH CAROLINA, SHALL BE 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 CORPORATE MEMBERS FROM NOMINATIONS RECEIVED BOTH FROM THE GOVERNANCE COMMITTEE AND FROM THE FLOOR AT THE ANNUAL MEETING. IF ANY DIRECTORS SHALL SERVE ONE-YEAR TERMS, AND SHALL CONTINUE TO SERVE UNTIL THEIR SUCCESSORS ARE ELECTED. 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 11B THE 990 IS REVIEWED AT THE FAIR (FINANCE, AUDIT, INVESTMENT AND RETIREMENT) COMMITTEE PRIOR TO FILING WITH THE IRS. ALL OF THE BOARD MEMBERS ARE INVITED TO ATTEND. ANYONE NOT AT THE MEETING IS GIVEN A COPY OF THE 990 AND IS INVITED TO ASK QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C RANDOLPH HOSPITAL HAS A PART TIME CORPORATE COMPLIANCE OFFICER CHARGED WITH EDUCATING THE BOARD, OFFICERS, AND OTHER EMPLOYEES ON THE CONFLICT OF INTEREST POLICY. ALL NEW EMPLOYEES ARE GIVEN INFORMATION UPON ORIENTATION, AND ALL CURRENT EMPLOYEES ARE REQUIRED TO TAKE ANNUAL EDUCATION ON COMPLIANCE WITH THE POLICY. THERE IS A CORPORATE COMPLIANCE MEETING TO UPDATE KEY INDIVIDUALS ON NEW ISSUES AND NEW INFORMATION REGARDING CORPORATE COMPLIANCE. THE MEMBERS OF THE BOARD OF DIRECTORS ARE 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 USES COMPETITIVE MARKET SURVEYS, FROM SUCH ORGANIZATIONS AS NCHHRA AND VASHHRA, TO DETERMINE APPROPRIATE COMPENSATION LEVELS FOR EXECUTIVES THAT ARE COMMENSURATE WITH ORGANIZATIONS OF SIMILAR SIZE AND STRUCTURE. PERIODICALLY, AN EXTERNAL FIRM IS USED TO EVALUATE COMPENSATION. A COMPENSATION COMMITTEE OF THE BOARD HAS FINAL DETERMINATION OF COMPENSATION LEVELS FOR TOP EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART XI, LINE 9: TERMINATION OF EXEMPT STATUS -45,494,287. MRI OF ASHEBORO LLC 237 N FAYETTEVILLE STREET B ASHEBORO NC 27203 472225445 IMAGING SERVICES NC RANDOLPH HOSPITAL INC PIEDMONT INTEGRATED HEALTH LLC 364 WHITE OAK STREET ASHEBORO NC 27203 472221211 CLINICALLY INTEGRATED NETWORK NC RANDOLPH HOSPITAL INC RANDOLPH SPECIALTY GROUP 364 WHITE OAK STREET ASHEBORO NC 27203 113827203 HEALTHCARE NC 501(C)(3) LINE 10 RANDOLPH HOSPITAL INC 1 RANDOLPH CANCER CENTER 373 N FAYETTEVILLE STREET ASHEBORO NC 27203 562181482 HEALTHCARE NC 501(C)(3) LINE 12A, I RANDOLPH HOSPITAL INC 1 RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION 364 WHITE OAK STREET ASHEBORO NC 27203 582240755 SUPPORT ORGANIZATION NC 501(C)(3) LINE 12A, I RANDOLPH HOSPITAL INC 1 STAYWELL SENIOR CARE PO BOX 1048 ASHEBORO NC 27204 461289922 HEALTHCARE NC 501(C)(3) LINE 12A, I RANDOLPH HOSPITAL INC 1 RANDOLPH NEWCO LLC 364 WHITE OAK STREET ASHEBORO NC 27203 471905523 MEDICAL EQUIPMENT RENTAL NC RANDOLPH HOSPITAL UNRELATED 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 RANDOLPH SPECIALTY GROUP K 70290 CASH RANDOLPH SPECIALTY GROUP O 2380218 CASH RANDOLPH SPECIALTY GROUP Q 739984 CASH RANDOLPH CANCER CENTER J 186750 CASH STAYWELL SENIOR CARE L 395700 CASH STAYWELL SENIOR CARE O 188886 CASH STAYWELL SENIOR CARE Q 562230 CASH