2022-06-27T09:24:17-05:00 2021-09-30 440160260 FORVIS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2020-10-01 561925492 ROANOKE VALLEY HEALTH SERVICES INC ROAN 2525358130 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 DAVID HUGHES TREASURER 2525358130 2022-06-27 1 DAVID HUGHES 999009999 AMY BIBBY P00445891 8282542254 2022-06-27 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAVID HUGHES 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 10191030 0 X WWW.VIDANTHEALTH.COM X 1994 NC TO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA. 5 0 0 0 0 0 0 0 9978930 9660190 0 100 374322 530740 10353252 10191030 0 0 0 0 7279893 6755664 0 0 0 3760277 8539319 11040170 15294983 -686918 -5103953 3204665 4660228 1751723 4407531 1452942 252697 X TO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA. 0 1 14838015 9660190 VIDANT HEALTH PROFESSIONALS PROVIDED EVALUATIONS, CLINICAL CARE MANAGEMENT AND MEDICALLY NECESSARY PROCEDURES. 14838015 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X CHRIS TOWNSEND 2528470848 2100 STANTONSBURG ROAD GREENVILLE NC 27834 MICHAEL WALDRUM CEO 2.00 50.00 X X 0 1236677 236036 JAY BRILEY BOARD MEMBER 2.00 44.00 X 0 349800 136287 DAVID HUGHES CFO 2.00 50.00 X X 0 524333 194287 WILLIAM FLOYD BOARD MEMBER 2.00 42.00 X 0 541368 193166 ANTHONY BARTHOLOMEW BOARD MEMBER 2.00 40.00 X 0 233833 53221 DANIEL DRAKE BOARD MEMBER 2.00 40.00 X 0 290416 182768 SHERRY JENSEN CFO 40.00 X 0 251977 49247 HAILE JONES PHYSICIAN 40.00 X 772907 0 45190 TOCHUKWU AGBATA MEDICAL DIR. HOSPITALIST 40.00 X 425568 0 51536 ELIZABETH BOND PHYSICIAN 40.00 X 353256 0 29001 HAZEL DUNCAN HOSPITALIST 40.00 X 374836 0 47133 RUDO GWANZURA HOSPITALIST 40.00 X 381107 0 37197 WILLIAM MAHONE CEO 40.00 X 0 227671 48363 2307674 3656075 1303432 5 1 1 0 AXIA PHYSICIAN SOLUTIONS 101 N CHERRY ST STE 600 WINSTONSALEM NC 27101 PHYSICIAN BILLING 473321 SURAFEAL ABRAHA 5028 MYRTLE OAK DR CARY NC 27519 HOSPITALIST PHYS 456686 JOSEPH AKANINYENE 113 ASPEN RIDGE DR HOLLY SPRINGS NC 27540 HOSPITALIST PHYS 283623 PACE LOCUM TENENS 150 PROVIDENCE RD STE 100 CHAPEL HILL NC 27514 LOCUMS PHYS 252298 MOHINI PANDIRI 1135 GROGANSMILLS DR CARY NC 27519 HOSPITALIST PHYS 233479 6 NET PATIENT SERVICE REV 621610 9660190 9660190 9660190 100 100 MISCELLANEOUS 900099 530740 530740 530740 10191030 9660190 0 530840 X 6206975 6020766 186209 144713 140372 4341 24372 23641 731 379604 368216 11388 1824378 1769647 54731 5000 4850 150 4490401 4355689 134712 17459 16935 524 40442 39229 1213 26559 25762 797 35499 34434 1065 4467 2904 1563 81722 79270 2452 -11871 -5342 -6529 BAD DEBT EXPENSE 1730626 1730626 MEDICAL SUPPLIES 232385 225413 6972 62252 5603 56649 15294983 14838015 456968 0 1132272 3938943 747612 207833 77755 74173 58556 2700 1178535 765553 1143898 412982 44572 23597 3204665 4660228 1751723 4407531 1751723 4407531 X 1452942 252697 1452942 252697 3204665 4660228 X -5103953 3903708 X X 0 1 X 1 0 X 111490 111490 937723 672771 264952 129322 92782 36540 412982 X PART X, LINE 2: ROANOKE 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. 0 0 0 0 0 0 0 0 0 MICHAEL WALDRUM CEO 0 1223061 0 0 0 13616 0 184760 0 51276 0 1472713 0 0 HAILE JONES PHYSICIAN 772907 0 0 0 0 0 0 0 45190 0 818097 0 0 0 WILLIAM FLOYD BOARD MEMBER 0 540617 0 0 0 751 0 148988 0 44178 0 734534 0 0 DAVID HUGHES CFO 0 521847 0 0 0 2486 0 152504 0 41783 0 718620 0 0 JAY BRILEY BOARD MEMBER 0 349800 0 0 0 0 0 96162 0 40125 0 486087 0 0 TOCHUKWU AGBATA MEDICAL DIR. HOSPITALIST 425568 0 0 0 0 0 0 0 51536 0 477104 0 0 0 DANIEL DRAKE BOARD MEMBER 0 290416 0 0 0 0 0 137366 0 45402 0 473184 0 0 HAZEL DUNCAN HOSPITALIST 374836 0 0 0 0 0 0 0 47133 0 421969 0 0 0 RUDO GWANZURA HOSPITALIST 381107 0 0 0 0 0 0 0 37197 0 418304 0 0 0 ELIZABETH BOND PHYSICIAN 353256 0 0 0 0 0 0 0 29001 0 382257 0 0 0 SHERRY JENSEN CFO 0 251977 0 0 0 0 0 15650 0 33597 0 301224 0 0 ANTHONY BARTHOLOMEW BOARD MEMBER 0 233833 0 0 0 0 0 23824 0 29397 0 287054 0 0 WILLIAM MAHONE CEO 0 227671 0 0 0 0 0 17757 0 30606 0 276034 0 0 PART I, LINE 1A ALL 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 3 THE 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 III, LINE 3 SOME OPERATINS OF ROANOKE VALLEY HEALTH SERVICES WERE MOVED TO VIDANT MEDICAL GROUP IN JUNE OF 2021. FORM 990, PART VI, SECTION A, LINE 7A UNIVERSITY 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 7B THE 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 11B THE 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 12C AS 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 15 THE 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 19 THE 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 11G PHYSICIAN 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. PITT COUNTY MEMORIAL HOSPITAL INC (DBA VIDANT MEDICAL CENTER) 2100 STANTONSBURG RD GREENVILLE NC 27835 560585243 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH INC (DBA VIDANT COMMUNITY HOSPITALS - CENTRAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562003393 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 PCMH MANAGEMENT INC (DBA VIDANT PROPERTIES) 2100 STANTONSBURG RD GREENVILLE NC 27835 561690740 MEDICAL PROPERTY MANAGEMENT NC 501(C)(2) VIDANT HEALTH 0 HEALTHACCESS INC 2100 STANTONSBURG RD GREENVILLE NC 27835 561396133 HEALTHCARE NC 501(C)(3) LINE 12B, II VIDANT HEALTH 0 VIDANT MEDICAL GROUP INC 2100 STANTONSBURG RD GREENVILLE NC 27835 383740839 HEALTHCARE NC 501(C)(3) LINE 12C, III-FI VIDANT HEALTH 0 THE OUTER BANKS HOSPITAL INC 2100 STANTONSBURG RD GREENVILLE NC 27835 562112733 HOSPITAL NC 501(C)(3) LINE 3 EAST CAROLINA HEALTH 0 EAST CAROLINA HEALTH - BERTIE (DBA VIDANT BERTIE HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562072002 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH - CHOWAN (DBA VIDANT CHOWAN HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562101090 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH - HERITAGE (DBA VIDANT EDGECOMBE HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 562093700 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH - BEAUFORT (DBA VIDANT BEAUFORT HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 452436270 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 DUPLIN GENERAL HOSPITAL (DBA VIDANT DUPLIN HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 566011594 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 EAST CAROLINA HEALTH INC (DBA VIDANT ROANOKE-CHOWAN HOSPITAL) 2100 STANTONSBURG RD GREENVILLE NC 27835 264634725 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 HALIFAX REGIONAL MEDICAL CENTER DBA VIDANT NORTH 2100 STANTONSBURG RD GREENVILLE NC 27835 560989789 HOSPITAL NC 501(C)(3) LINE 3 VIDANT HEALTH 0 ACCESS EAST 2410 STATONSBURG RD STANTON SQUARE GREENVILLE NC 27834 561949493 HEALTHCARE NC 501(C)(3) LINE 10 VIDANT HEALTH 0 UNIVERSITY HEALTH SYSTEMS OF EASTERN CAROLINA INC 2100 STANTONSBURG RD GREENVILLE NC 27835 562141073 HEALTHCARE NC 501(C)(3) LINE 12A, I N/A 0 HALIFAX REGIONAL MEDICAL CENTER FOUNDATION INC 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 561698825 SUPPORT/FUNDRAISING NC 501(C)(3) LINE 7 VIDANT NORTH 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0