2021-08-13T10:16:49-05:00 2020-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2019-10-01 261694368 ONSLOW RADIATION ONCOLOGY LLC ATTN DANIEL WALLER MANAGER ONSL 9105774703 241 NEW RIVER DRIVE JACKSONVILLE NC 28540 CARL BIBER CHIEF FINANCIAL OFFICER 9105774703 2021-08-12 1 JOHN NORMAN P01506766 7049985200 2021-08-12 2019 2022-09-23 18:48:47Z CARL BIBER 241 NEW RIVER DRIVE JACKSONVILLE NC 28540 2220234 0 X WWW.ONSLOW.ORG X LLC 2006 NC TO PROVIDE QUALITY AND CONVENIENT CANCER TREATMENT TO THE SURROUNDING COMMUNITY WHILE PROVIDING THE AFOREMENTIONED CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY PURSUANT TO THE ORGANIZATION'S CHARITY CARE POLICY. 1 1 0 0 0 0 250000 431998 1710755 1788073 220 163 0 0 1960975 2220234 0 0 0 0 476090 508199 0 0 0 1750384 1722951 2226474 2231150 -265499 -10916 4340497 4392121 2689147 2051435 1651350 2340686 X SEE SCHEDULE OTHE PRIMARY MISSION OF ONSLOW RADIATION ONCOLOGY, LLC IS TWO-FOLD. THE FIRST MISSION IS TO ESTABLISH AN ONCOLOGY CENTER IN ONSLOW COUNTY TO ALLEVIATE THE BURDEN OF CANCER PATIENTS IN THE SURROUNDING COMMUNITY TO RECEIVE THEIR CURRENT CANCER TREATMENTS. THE SECOND PURPOSE AND FOCUS IS TO PROVIDE CANCER TREATMENT TO MEMBERS OF THE SURROUNDING AREA WITH THE LEAST AMOUNT OF NEGATIVE IMPACT ON THE PATIENTS AND THEIR FAMILIES. THIS INCLUDES PROVIDING CARE TO PATIENTS IN NEED, REGARDLESS OF THEIR ABILITY TO PAY PURSUANT TO ONSLOW RADIATION ONCOLOGY, LLC'S CHARITY CARE POLICY WITH THE CONSISTENT GOAL OF IMPROVING THE HEALTH IN THE COMMUNITY WE SERVE. 0 1 2231150 1788073 THE ONCOLOGY CENTER ACCOMPLISHED BOTH GOALS OF 1) PROVIDING CONVENIENT LOCAL CANCER TREATMENT SO THAT PATIENTS DO NOT HAVE TO TRAVEL LONG DISTANCES AND 2) PROVIDING CANCER TREATMENT TO MEMBERS OF THE SURROUNDING AREA WITH THE LEAST AMOUNT OF NEGATIVE IMPACT ON THE PATIENTS AND THEIR FAMILIES. IN DOING SO, THE CENTER PROVIDED CARE TO PATIENTS IN NEED, REGARDLESS OF THEIR ABILITY TO PAY, PURSUANT TO ONSLOW RADIATION ONCOLOGY, LLC'S CHARITY CARE POLICY, AND WITH THE CONSISTENT GOAL OF IMPROVING THE HEALTH IN THE COMMUNITY THE ONCOLOGY CENTER SERVES. 2231150 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 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 1 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 0 1 1 0 0 0 X DANIEL WALLER 9105772734 241 NEW RIVER DRIVE JACKSONVILLE NC 28540 DANIEL THOMAS WALLER MANAGER (OMH) 1.00 X 0 183628 19473 THOMAS JENKINS MANAGER (OMH) 1.00 X 0 126269 24594 CARL BIBER MANAGER (OMH) 1.00 X 0 71875 603 ONSLOW MEMORIAL HOSPITAL INSTITUTIONAL TRUSTEE 1.00 X 0 0 0 PITT COUNTY MEMORIAL HOSPITAL INSTITUTIONAL TRUSTEE THROUGH 7/31/20 1.00 X 0 0 0 PHYLLIS DEANTONIO MANAGER (PCMH) THROUGH 7/31/20 1.00 X 0 0 0 DAVID HUGHES MANAGER (PCMH) THROUGH 7/31/20 1.00 X 0 0 0 TODD HICKEY MANAGER (PCMH) THROUGH 7/31/20 1.00 X 0 0 0 0 381772 44670 0 0 1 0 VIDANT MEDICAL GROUP PO BOX 6028 GREENVILLE NC 27835 PHYSICIAN SERVICES 686684 SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DEPT 0733 DALLAS TX 75312 MAINTENANCE CONTRACT 311947 ONSLOW MEMORIAL HOSPITAL 317 WESTERN BOULEVARD JACKSONVILLE NC 28546 MEDICAL SERVICES 277752 3 431998 431998 NET OUTPATIENT REVENUE 621400 1788073 1788073 1788073 163 163 2220234 1788073 0 163 X 405372 405372 75951 75951 26876 26876 18000 18000 40104 40104 934455 934455 10212 10212 7221 7221 192 192 89554 89554 210461 210461 36522 36522 MAINTENANCE CONTRACT 361255 361255 SUPPLIES 13973 13973 EQUIPMENT RENTAL 1002 1002 2231150 2231150 0 0 94670 330334 141945 140879 8834 964 6466274 2546652 4095048 3919622 0 322 4340497 4392121 99593 171928 2541399 1879507 48155 0 2689147 2051435 X 1651350 2340686 1651350 2340686 4340497 4392121 X -10916 700252 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5045729 1257872 3787857 1420545 1288780 131765 3919622 0 0 0 0 0 0 0 0 0 DANIEL THOMAS WALLER MANAGER (OMH) 0 183628 0 0 0 0 0 5357 0 14116 0 203101 0 0 THOMAS JENKINS MANAGER (OMH) 0 126269 0 0 0 0 0 4127 0 20467 0 150863 0 0 FORM 990, PART III, LINE 3 EFFECTIVE JULY 31, 2020, THE AUTHORITY ENTERED INTO A MEMBERSHIP INTEREST REDEMPTION AGREEMENT AND BILL OF SALE WITH VIDANT, WHEREBY THE HOSPITAL ACQUIRED VIDANT'S 50% INTEREST IN ORO, MAKING THE HOSPITAL THE SOLE MEMBER OF ORO. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS AN LLC AND HAS ONLY ONE MEMBER, ONSLOW MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF TRUSTEES ARE APPOINTED FROM THE MEMBER HOSPITAL. A TOTAL OF THREE BOARD MEMBERS ARE APPOINTED THAT REPRESENTS THE MEMBER/HOSPITAL IN ALL MATTERS AND TO VOTE THE HOSPITAL'S INTEREST. THE BOARD OF TRUSTEES MAY ALSO SELECT AN ALTERNATE TO SERVE IN THE REPRESENTATIVE'S PLACE IF FOR ANY REASON IS UNABLE TO ATTEND A MEETING OR OTHERWISE FULFILL THEIR DUTIES. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN ACTIONS REQUIRE MEMBER APPROVAL AS LISTED IN THE ARTICLES OF ORGANIZATION. EXAMPLES OF SUCH ACTIONS ARE: 1) AMENDING THE ARTICLES OF ORGANIZATION, 2) MERGING OR CONSOLIDATING THE "COMPANY" INTO ANOTHER ENTITY, 3) SELLING, ASSIGNING OR TRANSFERRING THE "COMPANY'S" ASSETS, 4) DISSOLVING, LIQUIDATING OR REORGANIZING THE "COMPANY", 5) ADMITTING OTHER MEMBERS TO THE "COMPANY", 6) APPROVING THE ANNUAL BUDGET OR A CALL FOR ADDITIONAL CAPITAL TO BE CONTRIBUTED, 7) APPROVING PURCHASES, CONTRACTS OR ANY BUSINESS DECISIONS REQUIRING EXPENDITURES OF $100,000 OR MORE, OR 8) APPROVING ANY LOAN OR CAPITAL LEASE WHOSE TERM IS OVER 3 YEARS OR WHOSE AMOUNT IS GREATER THAN $50,000. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION HAS ONE MEMBER/OWNER. THE MEMBER/OWNER APPOINTS 3 INDIVIDUALS (MANAGERS) TO MANAGER THE ORGANIZATIONS DAY-TO-DAY OPERATIONS. THE MANAGERS IN TURN ELECT A CHAIRMAN. THE CHAIRMAN REVIEWS THE FORM 990. AFTER THE CHAIRMAN COMPLETES THE REVIEW, A COPY IS SUBMITTED TO THE ORGANIZATION'S APPOINTED REPRESENTATIVES. THE FORM 990 IS FILED AFTER THE REPRESENTATIVES HAVE REVIEWED THE FORM AND ALL QUESTIONS OR CORRECTIONS HAVE BEEN ADDRESSED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN 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 477,290. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 477,290. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 457,165. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 457,165. FORM 990, PART XI, LINE 9: ACQUISITION OF NET ASSETS OF AFFILIATE 700,252. ONSLOW MEMORIAL HOSPITAL 241 NEW RIVER DRIVE JACKSONVILLE NC 28540 562014989 HOSPITAL NC 501(C)(3) LINE 3 N/A 0 ONSLOW AMBULATORY SERVICES 241 NEW RIVER DRIVE JACKSONVILLE NC 28540 561880357 OUTPATIENT MEDICAL SERVICES NC 501(C)(3) LINE 12C, III-FI ONSLOW MEMORIAL HOSPITAL 0 ONSLOW MEMORIAL HOSPITAL FOUNDATION INC 241 NEW RIVER DRIVE JACKSONVILLE NC 28540 581943240 PROMOTE AND SUPPORT ONSLOW MEMORIAL HOSPITAL NC 501(C)(3) LINE 12A, I ONSLOW MEMORIAL HOSPITAL 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 1 0 0 0 0