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ROANOKE VALLEY HEALTH SERVICES INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
ROANOKE VALLEY HEALTH SERVICES INC (EIN 56-1925492)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-06-27
IRS object ID
202241789349301004
Schema version
2020v4.2
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)
Return2022-06-27T09:24:17-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN440160260PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1FORVIS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1Txt
CityASHEVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28806ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN561925492EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ROANOKE VALLEY HEALTH SERVICES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlROANBusinessNameControlTxt
Phone2525358130PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1Txt
CityROANOKE RAPIDSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27870ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID HUGHESPersonNm
Person TitleTREASURERPersonTitleTxt
Phone2525358130PhoneNum
Signature2022-06-27SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDAVIDPersonFirstNm
Person LastHUGHESPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAMY BIBBYPreparerPersonNm
PTINP00445891PTIN
Phone8282542254PhoneNum
Preparation2022-06-27PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAVID HUGHESPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1Txt
CityROANOKE RAPIDSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27870ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$10,191,030GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.VIDANTHEALTH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1994FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionTO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$9,978,930PYProgramServiceRevenueAmt
CY Program Service Revenue$9,660,190CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$100CYInvestmentIncomeAmt
PY Other Revenue$374,322PYOtherRevenueAmt
CY Other Revenue$530,740CYOtherRevenueAmt
PY Total Revenue$10,353,252PYTotalRevenueAmt
CY Total Revenue$10,191,030CYTotalRevenueAmt
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$7,279,893PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,755,664CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,760,277PYOtherExpensesAmt
CY Other Expenses$8,539,319CYOtherExpensesAmt
PY Total Expenses$11,040,170PYTotalExpensesAmt
CY Total Expenses$15,294,983CYTotalExpensesAmt
PY Revenues Less Expenses-$686,918PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$5,103,953CYRevenuesLessExpensesAmt
Total Assets BOY$3,204,665TotalAssetsBOYAmt
Total Assets EOY$4,660,228TotalAssetsEOYAmt
Total Liabilities BOY$1,751,723TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,407,531TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,452,942NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$252,697NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant ChangeYes (1)SignificantChangeInd
Expense$14,838,015ExpenseAmt
Revenue$9,660,190RevenueAmt
DescVIDANT HEALTH PROFESSIONALS PROVIDED EVALUATIONS, CLINICAL CARE MANAGEMENT AND MEDICALLY NECESSARY PROCEDURES.Desc
Total Program Service Expenses$14,838,015TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNCStatesWhereCopyOfReturnIsFldCd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCHRIS TOWNSENDPersonNm
Phone2528470848PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12100 STANTONSBURG ROADAddressLine1Txt
CityGREENVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP27834ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
MICHAEL WALDRUM
CEO2.0050.00Yes (X)Yes (X)$0$1,236,677$236,036
JAY BRILEY
BOARD MEMBER2.0044.00Yes (X)$0$349,800$136,287
DAVID HUGHES
CFO2.0050.00Yes (X)Yes (X)$0$524,333$194,287
WILLIAM FLOYD
BOARD MEMBER2.0042.00Yes (X)$0$541,368$193,166
ANTHONY BARTHOLOMEW
BOARD MEMBER2.0040.00Yes (X)$0$233,833$53,221
DANIEL DRAKE
BOARD MEMBER2.0040.00Yes (X)$0$290,416$182,768
SHERRY JENSEN
CFO40.00$0$251,977$49,247Yes (X)
HAILE JONES
PHYSICIAN40.00$772,907$0$45,190Yes (X)
TOCHUKWU AGBATA
MEDICAL DIR. HOSPITALIST40.00$425,568$0$51,536Yes (X)
ELIZABETH BOND
PHYSICIAN40.00$353,256$0$29,001Yes (X)
HAZEL DUNCAN
HOSPITALIST40.00$374,836$0$47,133Yes (X)
RUDO GWANZURA
HOSPITALIST40.00$381,107$0$37,197Yes (X)
WILLIAM MAHONE
CEO40.00$0$227,671$48,363Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,307,674TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$3,656,075TotReportableCompRltdOrgAmt
Total Other Compensation$1,303,432TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K5IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
AXIA PHYSICIAN SOLUTIONS
101 N CHERRY ST STE 600WINSTONSALEMNC27101PHYSICIAN BILLING$473,321
SURAFEAL ABRAHA
5028 MYRTLE OAK DRCARYNC27519HOSPITALIST PHYS$456,686
JOSEPH AKANINYENE
113 ASPEN RIDGE DRHOLLY SPRINGSNC27540HOSPITALIST PHYS$283,623
PACE LOCUM TENENS
150 PROVIDENCE RD STE 100CHAPEL HILLNC27514LOCUMS PHYS$252,298
MOHINI PANDIRI
1135 GROGANSMILLS DRCARYNC27519HOSPITALIST PHYS$233,479
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K6CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNET PATIENT SERVICE REVDesc
Business621610BusinessCd
Total Revenue Column$9,660,190TotalRevenueColumnAmt
Related Or Exempt Func Income$9,660,190RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$9,660,190TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$100TotalRevenueColumnAmt
Exclusion$100ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business900099BusinessCd
Total Revenue Column$530,740TotalRevenueColumnAmt
Exclusion$530,740ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$530,740OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,191,030TotalRevenueColumnAmt
Related Or Exempt Func Income$9,660,190RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$530,840ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,206,975TotalAmt
Program Services$6,020,766ProgramServicesAmt
Management And General$186,209ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$144,713TotalAmt
Program Services$140,372ProgramServicesAmt
Management And General$4,341ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$24,372TotalAmt
Program Services$23,641ProgramServicesAmt
Management And General$731ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$379,604TotalAmt
Program Services$368,216ProgramServicesAmt
Management And General$11,388ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,824,378TotalAmt
Program Services$1,769,647ProgramServicesAmt
Management And General$54,731ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$5,000TotalAmt
Program Services$4,850ProgramServicesAmt
Management And General$150ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$4,490,401TotalAmt
Program Services$4,355,689ProgramServicesAmt
Management And General$134,712ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$17,459TotalAmt
Program Services$16,935ProgramServicesAmt
Management And General$524ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$40,442TotalAmt
Program Services$39,229ProgramServicesAmt
Management And General$1,213ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$26,559TotalAmt
Program Services$25,762ProgramServicesAmt
Management And General$797ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$35,499TotalAmt
Program Services$34,434ProgramServicesAmt
Management And General$1,065ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$4,467TotalAmt
Program Services$2,904ProgramServicesAmt
Management And General$1,563ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$81,722TotalAmt
Program Services$79,270ProgramServicesAmt
Management And General$2,452ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total-$11,871TotalAmt
Program Services-$5,342ProgramServicesAmt
Management And General-$6,529ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$1,730,626$1,730,626
MEDICAL SUPPLIES$232,385$225,413$6,972

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$62,252TotalAmt
Program Services$5,603ProgramServicesAmt
Management And General$56,649ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$15,294,983TotalAmt
Program Services$14,838,015ProgramServicesAmt
Management And General$456,968ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,132,272BOYAmt
EOY$3,938,943EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$747,612BOYAmt
EOY$207,833EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$77,755BOYAmt
EOY$74,173EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$58,556BOYAmt
EOY$2,700EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,178,535LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$765,553LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,143,898BOYAmt
EOY$412,982EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$44,572BOYAmt
EOY$23,597EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,204,665BOYAmt
EOY$4,660,228EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,751,723BOYAmt
EOY$4,407,531EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,751,723BOYAmt
EOY$4,407,531EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,452,942BOYAmt
EOY$252,697EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,452,942BOYAmt
EOY$252,697EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,204,665BOYAmt
EOY$4,660,228EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$5,103,953ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$3,903,708OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$111,490OtherCostOrOtherBasisAmt
Book Value$111,490BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$937,723OtherCostOrOtherBasisAmt
Depreciation$672,771DepreciationAmt
Book Value$264,952BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$129,322OtherCostOrOtherBasisAmt
Depreciation$92,782DepreciationAmt
Book Value$36,540BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$412,982TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationROANOKE VALLEY HEALTH SERVICES HAS BEEN DETERMINED TO QUALIFY AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ROANOKE VALLEY HEALTH SERVICES HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN YEARS AND HAS CONCLUDED THAT NO MATERIAL LIABILITIES EXIST AS OF SEPTEMBER 30, 2021 AND 2020. ROANOKE VALLEY HEALTH SERVICES FILES TAX RETURNS WITH THE U.S. FEDERAL JURISDICTION. WITH FEW EXCEPTIONS, ROANOKE VALLEY HEALTH SERVICES IS NO LONGER SUBJECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2018.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 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
MICHAEL WALDRUM
CEO$0$1,223,061$0$0$0$13,616$0$184,760$0$51,276$0$1,472,713$0$0
HAILE JONES
PHYSICIAN$772,907$0$0$0$0$0$0$0$45,190$0$818,097$0$0$0
WILLIAM FLOYD
BOARD MEMBER$0$540,617$0$0$0$751$0$148,988$0$44,178$0$734,534$0$0
DAVID HUGHES
CFO$0$521,847$0$0$0$2,486$0$152,504$0$41,783$0$718,620$0$0
JAY BRILEY
BOARD MEMBER$0$349,800$0$0$0$0$0$96,162$0$40,125$0$486,087$0$0
TOCHUKWU AGBATA
MEDICAL DIR. HOSPITALIST$425,568$0$0$0$0$0$0$0$51,536$0$477,104$0$0$0
DANIEL DRAKE
BOARD MEMBER$0$290,416$0$0$0$0$0$137,366$0$45,402$0$473,184$0$0
HAZEL DUNCAN
HOSPITALIST$374,836$0$0$0$0$0$0$0$47,133$0$421,969$0$0$0
RUDO GWANZURA
HOSPITALIST$381,107$0$0$0$0$0$0$0$37,197$0$418,304$0$0$0
ELIZABETH BOND
PHYSICIAN$353,256$0$0$0$0$0$0$0$29,001$0$382,257$0$0$0
SHERRY JENSEN
CFO$0$251,977$0$0$0$0$0$15,650$0$33,597$0$301,224$0$0
ANTHONY BARTHOLOMEW
BOARD MEMBER$0$233,833$0$0$0$0$0$23,824$0$29,397$0$287,054$0$0
WILLIAM MAHONE
CEO$0$227,671$0$0$0$0$0$17,757$0$30,606$0$276,034$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1AALL COMPENSATION AND REIMBURSEMENT LISTED FOR SUCH ITEMS ARE PAID AT THE VIDANT HEALTH ENTITY, AND THE WRITTEN POLICY AND ADHERENCE TO THE POLICY IS MAINTAINED AT VH.
PART I, LINE 3THE COMPENSATION IS DETERMINED BY THE COMPENSATION AND BENEFITS COMMITTEE OF THE VH BOARD USING COMPARATIVE DATA FROM LIKE ORGANIZATIONS AND INPUT FROM CONSULTANTS. ALL COMPENSATION DISCUSSIONS AND ACTIONS ARE DOCUMENTED AND APPROVED IN THE MINUTES OF THE COMMITTEE.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 3SOME OPERATINS OF ROANOKE VALLEY HEALTH SERVICES WERE MOVED TO VIDANT MEDICAL GROUP IN JUNE OF 2021.
FORM 990, PART VI, SECTION A, LINE 7AUNIVERSITY HEALTH SYSTEMS OF EASTERN CAROLINA, INC. (VIDANT HEALTH) SHALL HAVE THE RESPONSIBILITY TO ELECT OR APPOINT NO MORE THAN 7 INDIVIDUALS TO THE BOARD OF TRUSTEES OF ROANOKE VALLEY HEALTH SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7BTHE FOLLOWING RIGHTS ARE RESERVED BY UNIVERSITY HEALTH SYSTEMS OF EASTERN CAROLINA, INC.: A. AMENDING THE ARTICLES OF INCORPORATION OR THE BYLAWS; B. TAKING ANY ACTION THAT WOULD MAKE IT IMPOSSIBLE TO CARRY ON THE ORDINARY BUSINESS OF THE COMPANY; C. SELLING, LEASING OR OTHERWISE DISPOSING OF, OR AGREEING TO SELL, LEASE OR OTHERWISE DISPOSE OF, ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE COMPANY; D.WINDING UP, DISSOLVING, LIQUIDATING, REORGANIZING, OR OTHERWISE TERMINATING THE EXISTENCE OF THE COMPANY; OR E. MERGING OR CONSOLIDATING THE COMPANY WITH OR INTO ANY OTHER ENTITY OR CONVERTING THE COMPANY INTO ANY OTHER TYPE OF ENTITY.
FORM 990, PART VI, SECTION B, LINE 11BTHE BOARD MEMBER IS PROVIDED A COPY OF THE RETURN FOR REVIEW PRIOR TO FILING. THE RETURN IS ALSO REVIEWED BY THE CHIEF FINANCIAL OFFICER, CHIEF GENERAL COUNSEL, AND THE CHIEF AUDIT AND COMPLIANCE OFFICER OF UNIVERSITY HEALTH SYSTEMS OF EASTERN CAROLINA, INC. (D/B/A VIDANT HEALTH) PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12CAS DESCRIBED IN THE CONFLICT OF INTEREST POLICY MAINTAINED BY VH, ALL OFFICERS, BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A YEARLY COMPREHENSIVE CONFLICT OF INTEREST QUESTIONNAIRE. THESE ARE REVIEWED BY LEGAL COUNSEL AND ANY POTENTIAL OR ACTUAL CONFLICTS ARE BROUGHT TO THE BOARD FOR DISPOSITION. BOARD MEMBERS ARE INSTRUCTED TO REPORT ANY POTENTIAL CONFLICTS ARISING DURING THE YEAR FOR REVIEW. BOARD MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM VOTING ON ISSUES IN WHICH THEY ARE DEEMED TO HAVE A CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15THE COMPENSATION IS DETERMINED BY THE COMPENSATION AND BENEFITS COMMITTEE OF THE VH BOARD USING COMPARATIVE DATA FROM LIKE ORGANIZATIONS AND INPUT FROM CONSULTANTS. ALL COMPENSATION DISCUSSIONS AND ACTIONS ARE DOCUMENTED AND APPROVED IN THE MINUTES OF THE COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN IRC SECTION 6104(D).
FORM 990, PART IX, LINE 11GPHYSICIAN FEES: PROGRAM SERVICE EXPENSES 3,780,675. MANAGEMENT AND GENERAL EXPENSES 116,928. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,897,603. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 575,014. MANAGEMENT AND GENERAL EXPENSES 17,784. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 592,798.
FORM 990, PART XI, LINE 9:TRANSFER OF EQUITY FROM AFFILIATE 3,903,708.
FORM 990, PART XII, LINE 2C:THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
PITT COUNTY MEMORIAL HOSPITAL INC (DBA VIDANT MEDICAL CENTER)
2100 STANTONSBURG RDGREENVILLENC27835560585243HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
EAST CAROLINA HEALTH INC (DBA VIDANT COMMUNITY HOSPITALS - CENTRAL)
2100 STANTONSBURG RDGREENVILLENC27835562003393HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
PCMH MANAGEMENT INC (DBA VIDANT PROPERTIES)
2100 STANTONSBURG RDGREENVILLENC27835561690740MEDICAL PROPERTY MANAGEMENTNC501(C)(2)VIDANT HEALTH0
HEALTHACCESS INC
2100 STANTONSBURG RDGREENVILLENC27835561396133HEALTHCARENC501(C)(3)LINE 12B, IIVIDANT HEALTH0
VIDANT MEDICAL GROUP INC
2100 STANTONSBURG RDGREENVILLENC27835383740839HEALTHCARENC501(C)(3)LINE 12C, III-FIVIDANT HEALTH0
THE OUTER BANKS HOSPITAL INC
2100 STANTONSBURG RDGREENVILLENC27835562112733HOSPITALNC501(C)(3)LINE 3EAST CAROLINA HEALTH0
EAST CAROLINA HEALTH - BERTIE (DBA VIDANT BERTIE HOSPITAL)
2100 STANTONSBURG RDGREENVILLENC27835562072002HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
EAST CAROLINA HEALTH - CHOWAN (DBA VIDANT CHOWAN HOSPITAL)
2100 STANTONSBURG RDGREENVILLENC27835562101090HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
EAST CAROLINA HEALTH - HERITAGE (DBA VIDANT EDGECOMBE HOSPITAL)
2100 STANTONSBURG RDGREENVILLENC27835562093700HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
EAST CAROLINA HEALTH - BEAUFORT (DBA VIDANT BEAUFORT HOSPITAL)
2100 STANTONSBURG RDGREENVILLENC27835452436270HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
DUPLIN GENERAL HOSPITAL (DBA VIDANT DUPLIN HOSPITAL)
2100 STANTONSBURG RDGREENVILLENC27835566011594HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
EAST CAROLINA HEALTH INC (DBA VIDANT ROANOKE-CHOWAN HOSPITAL)
2100 STANTONSBURG RDGREENVILLENC27835264634725HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
HALIFAX REGIONAL MEDICAL CENTER DBA VIDANT NORTH
2100 STANTONSBURG RDGREENVILLENC27835560989789HOSPITALNC501(C)(3)LINE 3VIDANT HEALTH0
ACCESS EAST
2410 STATONSBURG RD STANTON SQUAREGREENVILLENC27834561949493HEALTHCARENC501(C)(3)LINE 10VIDANT HEALTH0
UNIVERSITY HEALTH SYSTEMS OF EASTERN CAROLINA INC
2100 STANTONSBURG RDGREENVILLENC27835562141073HEALTHCARENC501(C)(3)LINE 12A, I0N/A
HALIFAX REGIONAL MEDICAL CENTER FOUNDATION INC
250 SMITH CHURCH ROADROANOKE RAPIDSNC27870561698825SUPPORT/FUNDRAISINGNC501(C)(3)LINE 7VIDANT NORTH0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd