EAST CAROLINA HEALTH: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- EAST CAROLINA HEALTH (EIN 56-0989789)
- Tax period
- 2018-10-01 to 2019-09-30
- Filed
- 2020-08-14
- IRS object ID
- 202032279349300018
- Schema version
- 2018v3.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-08-14T08:01:47-05:00 | ReturnTs |
| Tax Period End | 2019-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1Txt |
| City | ASHEVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560989789 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HALI | BusinessNameControlTxt |
| Phone | 2525358011 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1Txt |
| City | ROANOKE RAPIDS | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27870 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHERRY JENSEN | PersonNm |
| Person Title | VP OF FINANCE/CFO | PersonTitleTxt |
| Phone | 2525358011 | PhoneNum |
| Signature | 2020-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY BIBBY | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Preparation | 2020-08-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 99.47.28.203 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-08-14 | IPDt |
| IP Tm | 07:53:59 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 48FB394F9AA065459641371F168D9F2AFFFBB473 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-11-06 18:47:13Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VIDANT NORTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WILL MAHONE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1Txt |
| City | ROANOKE RAPIDS | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27870 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $102,047,420 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HALIFAXREGIONAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 986 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $8,975 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $5,304 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $197,545 | PYContributionsGrantsAmt |
| CY Contributions Grants | $174,864 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $109,770,592 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $101,745,912 | CYProgramServiceRevenueAmt |
| PY Investment Income | $427,364 | PYInvestmentIncomeAmt |
| CY Investment Income | -$256,734 | CYInvestmentIncomeAmt |
| PY Other Revenue | $49,385 | PYOtherRevenueAmt |
| CY Other Revenue | $11,060 | CYOtherRevenueAmt |
| PY Total Revenue | $110,444,886 | PYTotalRevenueAmt |
| CY Total Revenue | $101,675,102 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $43,754,228 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $44,758,646 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $60,934,007 | PYOtherExpensesAmt |
| CY Other Expenses | $59,832,019 | CYOtherExpensesAmt |
| PY Total Expenses | $104,688,235 | PYTotalExpensesAmt |
| CY Total Expenses | $104,590,665 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,756,651 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,915,563 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $96,800,365 | TotalAssetsBOYAmt |
| Total Assets EOY | $82,510,666 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $42,714,018 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $33,379,575 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $54,086,347 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $49,131,091 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO IMPROVE THE HEALTH AND WELL-BEING OF EASTERN NORTH CAROLINA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $93,741,374 | ExpenseAmt |
| Revenue | $101,745,912 | RevenueAmt |
| Desc | COMPLETED DUE DILIGENCE REQUIREMENTS AND TRANSACTIONS NECESSARY TO MERGE WITH VIDANT HEALTH AS OF JUNE 1, 2019.STROKE PROGRAM IMPLEMENTED.GENERAL SURGEON WAS RECRUITED.ALL COMPUTER SYSTEMS WERE EVALUATED FOR THE VIDANT MERGER AND IMPLEMENTATION OF THE EPIC SYSTEM.GENERATOR REPLACEMENT PROJECT STARTED.REDESIGN OF PSYCH BEHAVIORAL HEALTH UNIT.ACCREDITATION FOR SLEEP LAB AND HOME SLEEP TESTING.PHARMACY CERTIFIED FOR NEW USP 800 STANDARDS.JOINT CARE CENTER WAS RECERTIFIED BY THE JOINT COMMISSION FOR HIP AND KNEE REPLACEMENT PROGRAMS. RURAL HEALTH CENTER CONSTRUCTION WAS COMPLETED ON HRMC CAMPUS.IMPLEMENTED NEW PROCESS FOR USING EMT TRAINED STAFF FOR EMERGENCY PATIENT CARE.NURSE RESIDENCY PROGRAM WAS INITIATED WITH COMMUNITY COLLEGES.HRMC NURSE RECOGNIZED AS ONE OF THE STATE'S GREAT 100 NURSES.340B AUDIT WAS COMPLETED FOR PHARMACY. | Desc |
| Total Program Service Expenses | $93,741,374 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 154 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 986 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NC | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHERRY JENSEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 2525358005 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1Txt |
| City | ROANOKE RAPIDS | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27870 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| WILLIAM MAHONE | ||||||||
| CEO | 40.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| FANNIE GREENE | ||||||||
| CHAIRWOMAN | 1.00 | Yes (X) | $2,100 | $0 | $0 | |||
| DR NATARAJAN RAJAN | ||||||||
| MEMBER | 1.00 | Yes (X) | $1,450 | $0 | $0 | |||
| EVELYN DAWSON | ||||||||
| MEMBER | 1.00 | Yes (X) | $1,250 | $0 | $0 | |||
| TOM LYNCH | ||||||||
| MEMBER | 1.00 | Yes (X) | $2,100 | $0 | $0 | |||
| DR LORENZO SANTARINA | ||||||||
| MEMBER | 1.00 | Yes (X) | $100 | $0 | $0 | |||
| DR JOEY THOMAS | ||||||||
| MEMBER | 1.00 | Yes (X) | $10,760 | $0 | $0 | |||
| BOB PATTERSON | ||||||||
| MEMBER | 1.00 | Yes (X) | $1,700 | $0 | $0 | |||
| VERNON BRYANT | ||||||||
| MEMBER | 1.00 | Yes (X) | $700 | $0 | $0 | |||
| HUGH BAZEMORE | ||||||||
| MEMBER | 1.00 | Yes (X) | $1,650 | $0 | $0 | |||
| JOHNNY DRAPER | ||||||||
| MEMBER | 1.00 | Yes (X) | $700 | $0 | $0 | |||
| JAMES PIERCE | ||||||||
| MEMBER | 1.00 | Yes (X) | $650 | $0 | $0 | |||
| WILLIAM HODGE | ||||||||
| MEMBER | 1.00 | Yes (X) | $950 | $0 | $0 | |||
| REV RANDY MARTIN | ||||||||
| MEMBER | 1.00 | Yes (X) | $500 | $0 | $0 | |||
| SHERRY JENSEN | ||||||||
| CFO | 40.00 | Yes (X) | $286,286 | $0 | $86,000 | |||
| JASON HARRELL | ||||||||
| COO | 40.00 | Yes (X) | $0 | $0 | $0 | |||
| STEVEN HILL | ||||||||
| CRNA | 40.00 | $223,176 | $0 | $44,854 | Yes (X) | |||
| BRIAN SOMMER | ||||||||
| CRNA | 40.00 | $219,524 | $0 | $36,906 | Yes (X) | |||
| STEVEN ULSAS | ||||||||
| CRNA | 40.00 | $212,151 | $0 | $49,000 | Yes (X) | |||
| KENNETH HARTZ | ||||||||
| CRNA | 40.00 | $210,341 | $0 | $49,000 | Yes (X) | |||
| CLAUDE DIETTRICH | ||||||||
| CRNA | 40.00 | $206,607 | $0 | $46,584 | Yes (X) | |||
| KAREN DANIELS | ||||||||
| CNO | 40.00 | $126,366 | $0 | $30,926 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,509,061 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $343,270 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 29 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | Yes (1) | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NOVANT HEALTH SHARED SERVICES | |||||
| 108 PROVIDENCE RD | CHARLOTTE | NC | 28207 | MANAGEMENT | $2,134,079 |
| SODEXO | |||||
| PO BOX 360170 | PITTSBURGH | PA | 631502096 | DIETARY SERVICES | $1,687,220 |
| MEDICAL SOLUTIONS | |||||
| 1010 N 102ND ST SUITE 300 | OMAHA | NE | 68114 | CONTRACT NURSING | $1,295,245 |
| THEREX INC DBA REHABCARE | |||||
| PO BOX 502096 | ST LOUIS | MO | 631502096 | PT/ST/OT SERVICES | $1,106,191 |
| BIO-MEDICAL APPLICATIONS | |||||
| 16343 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | DIALYSIS SVCS | $452,093 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 41 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $57,274 | RelatedOrganizationsAmt |
| All Other Contributions | $117,590 | AllOtherContributionsAmt |
| Total Contributions | $174,864 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REV | 541380 | $101,557,295 | $101,557,295 |
| PURCHASE DISCOUNTS | 541900 | $123,965 | $123,965 |
| PHARMACY | 446110 | $35,515 | $35,515 |
| OTHER PATIENT SERVICES | 900099 | $29,137 | $29,137 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $101,745,912 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,292 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $8,975 | UnrelatedBusinessRevenueAmt |
| Exclusion | $31,317 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $51,139 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $75,292 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$24,153 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$24,153 | TotalRevenueColumnAmt |
| Exclusion | -$24,153 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $297,026 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$297,026 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$297,026 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$297,026 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| FOOD/VENDING REVENUE | 900099 | $22,187 | $22,187 |
| MISCELLANEOUS INCOME | 900099 | $13,026 | $13,026 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $35,213 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $101,675,102 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $101,448,886 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $8,975 | UnrelatedBusinessRevenueAmt |
| Exclusion | $42,377 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $437,262 | TotalAmt |
| Program Services | $150,976 | ProgramServicesAmt |
| Management And General | $286,286 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,653 | TotalAmt |
| Program Services | $115,653 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,849,479 | TotalAmt |
| Program Services | $28,960,216 | ProgramServicesAmt |
| Management And General | $5,889,263 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,229,886 | TotalAmt |
| Program Services | $1,015,346 | ProgramServicesAmt |
| Management And General | $214,540 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,316,115 | TotalAmt |
| Program Services | $4,388,779 | ProgramServicesAmt |
| Management And General | $927,336 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,810,251 | TotalAmt |
| Program Services | $2,320,034 | ProgramServicesAmt |
| Management And General | $490,217 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $635,955 | TotalAmt |
| Management And General | $635,955 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $554,635 | TotalAmt |
| Management And General | $554,635 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,979,246 | TotalAmt |
| Program Services | $14,177,309 | ProgramServicesAmt |
| Management And General | $801,937 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $228,501 | TotalAmt |
| Program Services | $228,501 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,910,565 | TotalAmt |
| Program Services | $3,168,812 | ProgramServicesAmt |
| Management And General | $741,753 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,331,243 | TotalAmt |
| Program Services | $1,307,886 | ProgramServicesAmt |
| Management And General | $23,357 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,087,481 | TotalAmt |
| Program Services | $1,087,481 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,079 | TotalAmt |
| Program Services | $56,233 | ProgramServicesAmt |
| Management And General | $20,846 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,083,526 | TotalAmt |
| Program Services | $4,083,526 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $646,714 | TotalAmt |
| Program Services | $442,187 | ProgramServicesAmt |
| Management And General | $204,527 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $17,287,024 | $17,287,024 | |
| MEDICAL SUPPLIES | $9,050,022 | $9,049,970 | $52 |
| DRUG EXPENSE | $2,740,327 | $2,740,327 | |
| MISCELLANEOUS EXPENSES | $2,721,787 | $2,685,434 | $36,353 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $497,914 | TotalAmt |
| Program Services | $475,680 | ProgramServicesAmt |
| Management And General | $22,234 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,590,665 | TotalAmt |
| Program Services | $93,741,374 | ProgramServicesAmt |
| Management And General | $10,849,291 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,110,440 | BOYAmt |
| EOY | $16,510,587 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,079,078 | BOYAmt |
| EOY | $10,629,557 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,612,688 | BOYAmt |
| EOY | $1,561,550 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,054,771 | BOYAmt |
| EOY | $1,429,687 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $91,275,094 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $61,215,899 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,180,980 | BOYAmt |
| EOY | $30,059,195 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,237,007 | BOYAmt |
| EOY | $11,361,377 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $9,001,592 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,139,454 | BOYAmt |
| EOY | $1,384,493 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,385,947 | BOYAmt |
| EOY | $572,628 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,800,365 | BOYAmt |
| EOY | $82,510,666 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,179,045 | BOYAmt |
| EOY | $15,501,580 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,875,911 | BOYAmt |
| EOY | $10,764,171 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,840,000 | BOYAmt |
| EOY | $5,520,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,819,062 | BOYAmt |
| EOY | $1,593,824 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,714,018 | BOYAmt |
| EOY | $33,379,575 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,959,066 | BOYAmt |
| EOY | $49,003,810 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,281 | BOYAmt |
| EOY | $127,281 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,086,347 | BOYAmt |
| EOY | $49,131,091 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,800,365 | BOYAmt |
| EOY | $82,510,666 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,915,563 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $360,307 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$2,400,000 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $867,707 | OtherCostOrOtherBasisAmt |
| Book Value | $867,707 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,977,365 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,943,801 | DepreciationAmt |
| Book Value | $9,033,564 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,339,040 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,417,578 | DepreciationAmt |
| Book Value | $5,921,462 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,435,081 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,024,843 | DepreciationAmt |
| Book Value | $12,410,238 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,655,901 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,829,677 | DepreciationAmt |
| Book Value | $1,826,224 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $30,059,195 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM OTHER ORGANIZATION | Desc |
| Book Value | $9,001,592 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $9,001,592 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO/FROM OTHER CORP | Desc |
| Amt | $1,593,824 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,593,824 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,776,698 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,776,698 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04330 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,751,897 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,255,663 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,496,234 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02860 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,528,595 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,255,663 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,272,932 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07190 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $676,324 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $533 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $675,791 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,150 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,150 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $677,474 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $533 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $676,941 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,206,069 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,256,196 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,949,873 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07960 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,194 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,194 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $604 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $604 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,798 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,798 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $17,287,024 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $548,172 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $30,571,887 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $34,411,280 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$3,839,393 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1Txt |
| City | ROANOKE RAPIDS | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27870 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DISPROPORTIONATE SHARE HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 18 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://VIDANTNORTHHOSPITAL.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 18 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://VIDANTNORTHHOSPITAL.COM | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://VIDANTNORTHHOSPITAL.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://VIDANTNORTHHOSPITAL.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://VIDANTNORTHHOSPITAL.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HALIFAX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 5: PRIMARY DATA WAS OBTAINED FROM COMMUNITY-WIDE HEALTH SURVEYS CONDUCTED BY HALIFAX AND NORTHAMPTON COUNTY HEALTH DEPARTMENTS. SURVEYS WERE DISTRIBUTED ACROSS THE COUNTIES IN AN EFFORT TO INCLUDE THE OPINIONS OF A DIVERSE POPULATION. |
| HALIFAX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 11: THE TOP PRIORITY ADDRESSED IN THIS CHNA WAS IDENTIFIED AS OVERWEIGHT/OBESITY. THE OBJECTIVES TO ADDRESSING THIS NEED INCLUDE: INCREASE AWARENESS OF THE OBESITY EPIDEMIC AND PROMOTE HEALTHY LIFESTYLES, BECOME A LEADING PARTNER WITH THE ROANOKE VALLEY COMMUNITY HEALTH INITIATIVE, AND CREATE A COMMUNITY RESOURCE DIRECTORY OF AVAILABLE RESOURCES TO HELP LEAD A HEALTHY LIFESTYLE. THE OTHER RISK FACTORS THAT WERE IDENTIFIED INCLUDE: DIET, PHYSICAL INACTIVITY, HIGH BLOOD CHOLESTEROL/HYPERTENSION, SUBSTANCE ABUSE, AND STRESS. THESE OTHER RISK FACTORS ARE BEING ADDRESSED BY OTHER AGENCIES IN THE AREA. ALSO, ADDRESSING THIS TOP PRIORITY OF OBESITY WILL ALSO HELP WITH THE OTHER FACTORS IDENTIFIED. |
| HALIFAX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 16J: ON THE BACK OF THE BILLING STATEMENT, THE ORGANIZATION LISTS THE CHARITY POLICY AND PROVIDES THE PATIENT WITH A FINANCIAL COUNSELOR TO DISCUSS THEIR ABILITY TO PAY THE INVOICE/RECEIVE CHARITY CARE. |
| HALIFAX REGIONAL MEDICAL CENTER | PART V, SECTION B, LINE 20E: SIGNAGE IS PLACED IN VARIOUS PLACES IN THE HOSPITAL INCLUDING ADMISSIONS AND EMERGENCY DEPT. |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE ORGANIZATION USED WORKSHEET 2 OF THE 2018 SCHEDULE H INSTRUCTIONS TO COMPUTE CHARITY CARE, UNREIMBURSED MEDICAID, AND SUBSIDIZED HEALTH SERVICES AT COST FOR PURPOSES OF PART I, LINE 7. |
| PART I, LN 7 COL(F): | THE TOTAL EXPENSE LISTED ON FORM 990, PART XI, LINE 25 CONTAINS BAD DEBT EXPENSE OF $17,287,024 WHICH HAS BEEN REMOVED FOR PURPOSES OF THE CALCULATION OF CHARITY CARE PERCENTAGE FOR PART I, LINE 7, COLUMN (F). |
| PART II, COMMUNITY BUILDING ACTIVITIES: | HOSPITAL EMPLOYEES ROUTINELY DEVOTE THEIR TIME TO SERVICE ON THE CITY COUNCIL AND THE LOCAL CHAMBER OF COMMERCE TO PROMOTE COMMUNITY ECONOMIC DEVELOPMENT. THE HOSPITAL SPONSORS NUMEROUS EDUCATIONAL PROGRAMS INCLUDING DIABETES AND CHILDHOOD OBESITY PROJECTS. OUR WEBSITE OFFERS HEALTHY LIFE STYLE TIPS AND TOOLS TO IMPROVE HEALTHY LIVING AS WELL AS SENDS OUT EMAILS FOR THIS PROMOTION. WE PROMOTE FAMILY FEST TO ENCOURAGE EXERCISE AND HEALTHY EATING FOR THE CHILDREN OF OUR COMMUNITY. |
| PART III, LINE 2: | THIS IS THE TOTAL NET BAD DEBT EXPENSE PER THE FY2019 FINANCIAL STMTS. |
| PART III, LINE 3: | IN OUR COMMUNITY, THE POPULATIONS OF PEOPLE WHO LIVE BELOW THE POVERTY LEVEL IS ABOUT 27%. PEOPLE WITHOUT HEALTH INSURANCE IS 13.7% IN THE AREA. BASED ON OUR PAST EXPERIENCE WITH CHARITY CARE AND BAD DEBT, ABOUT 10% OF THE PEOPLE THAT ARE CURRENTLY IN BAD DEBT WOULD QUALIFY FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 4: | THERE IS NOT A FOOTNOTE IN THE ORGANIZATION'S FINANCIAL STATEMENTS TO DISCUSS THE BAD DEBT EXPENSE.TOTAL BAD DEBT CONSISTS OF TOTAL CHARGES WRITTEN OFF TO BAD DEBT LESS ANY RECOVERIES AND PASS-THROUGH AMOUNTS FROM MEDICARE. IN OUR COMMUNITY, THE POPULATIONS OF PEOPLE WHO LIVE BELOW THE POVERTY LEVEL IS ABOUT 27%. PEOPLE WITHOUT HEALTH INSURANCE IS 13.7% IN THE AREA. BASED ON OUR PAST EXPERIENCE WITH CHARITY CARE AND BAD DEBT, ABOUT 10% OF THE PEOPLE THAT ARE CURRENTLY IN BAD DEBT WOULD QUALIFY FOR FINANCIAL ASSISTANCE. |
| PART III, LINE 8: | APPROXIMATELY 50% OF THE HOSPITAL'S TOTAL CHARGES ARE FROM MEDICARE. APPROXIMATELY 18% OF THE POPULATION OF HALIFAX COUNTY IS AGE 65 AND OVER. THE HOSPITAL HAS A RESPONSIBILITY TO THE COMMUNITY TO PROVIDE QUALITY CARE, AND A SHORTFALL WHEN APPLICABLE FOR OUR MEDICARE COST OF CARE SHOULD BE CONSIDERED A COMMUNITY BENEFIT. |
| PART III, LINE 9B: | HRMC DETERMINES IF PATIENTS QUALIFY UNDER OUR FINANCIAL ASSISTANCE POLICY BEFORE THEY ARE SEND TO AN OUTSIDE COLLECTION ACGENCY. THE COLLECTION AGENCIES AND OUTSOURCED BILLING COMPANIES FOR ED PHYSICIAN AND CRNAS ALSO FOLLOW THE HRMC FAP AND BILLING AND COLLECTIONS POLICIES. |
| PART VI, LINE 2: | THE COMMUNITY HEALTH NEEDS ASSESSMENT TEAM IS COMPRISED OF MANY PARTICIPANTS REPRESENTING AREA AGENCIES IN HALIFAX COUNTY, NORTH CAROLINA. MANY LOCAL ORGANIZATIONS ASSISTED HALIFAX REGIONAL, THE HALIFAX COUNTY HEALTH DEPARTMENT, AND HEALTHY HALIFAX PARTNERS, WITH THE CREATION OF THE ASSESSMENT. THESE PARTNERS INCLUDE ROANOKE VALLEY COMMUNITY HEALTH INITIATIVE, HALIFAX COUNTY COMMISSIONERS, HALIFAX COUNTY BOARD OF HEALTH, AND HALIFAX REGIONAL BOARD. THE 2019 HALIFAX COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED THROUGH A PARTNERSHIP BETWEEN THE HALIFAX COUNTY HEALTH DEPARTMENT, HALIFAX REGIONAL, HEALTH ENC AND CONDUENT HEALTHY COMMUNITIES INSTITUTE, WITH HALIFAX REGIONAL AND THE HALIFAX COUNTY HEALTH DEPARTMENT SERVING AS THE FISCAL SPONSORS. HEALTH ENC COMMISSIONED CONDUENT HEALTHY COMMUNITIES INSTITUTE (HCI) TO ASSIST WITH ITS COMMUNITY HEALTH NEEDS ASSESSMENT. CONDUENT HCI USES COLLABORATIVE APPROACHES TO IMPROVE COMMUNITY HEALTH AND PROVIDES WEB-BASED INFORMATION SYSTEMS TO PUBLIC HEALTH, HOSPITAL AND COMMUNITY DEVELOPMENT SECTORS, TO HELP THEM ASSESS POPULATION HEALTH. |
| PART VI, LINE 3: | OUR FINANCIAL ASSISTANCE POLICY IS ON OUR WEBSITE, AND SIGNAGE IS POSTED THROUGHOUT THE HOSPITAL TO INFORM PATIENTS ABOUT OUR POLICY. THE PROCESS AND PHONE NUMBERS TO CALL ARE ALSO NOTED ON OUR PATIENT STATEMENTS. WE HAVE STAFF FROM OUR COLLECTIONS DEPARTMENT AVAILABLE TO DISCUSS THE PROCESS WITH PATIENTS. THE COLLECTIONS DEPT APPLIES THE POLICY AS APPROPRIATE WHEN ASSISTING PATIENTS IN QUALIFYING FOR CHARITY CARE OR COLLECTING PAYMENTS FROM OUR PATIENTS. WE ALSO USE SOFTWARE TO HELP DETERMINE IF PATIENTS QUALIFY FOR CHARITY CARE. THIS MAKES IT EASIER FOR PATIENTS TO QUALIFY WITHOUT HAVING TO PRESENT A LOT OF PAPERWORK. |
| PART VI, LINE 4: | OUR PRIMARY SERVICE AREA CONSISTS OF HALIFAX, NORTHAMPTON, AND WARREN COUNTIES. THE PERCENTAGE OF THE HOSPITAL PATIENTS WITH MEDICARE AND MEDICAID IS 71.6% OF OUR TOTAL REVENUE. THE TOTAL POPULATION ESTIMATES JULY 2019 ARE 50,010 HALIFAX; 19,483 NORTHAMPTON; AND 19,731 WARREN. PERSONS AGE 65 AND OLDER JULY 2019 ARE 20.7% HALIFAX; 25.9% NORTHAMPTON; AND 25.4% WARREN. PEOPLE LIVING IN POVERTY ARE 22% HALIFAX; 21.4% NORTHAMPTON; AND 19.8% WARREN COMPARED TO THE NC RATE OF 14%. THE POPULATION UNDER AGE 65 LIVING WITH A DISABILITY ARE 13.9% HALIFAX; 14.9% NORTHAMPTON; AND 13.8% WARREN. PERSONS WITHOUT HEALTH INSURANCE ARE 13.5% HALIFAX; 11.5% NORTHAMPTON; AND 16.4% WARREN. |
| PART VI, LINE 5: | THE HOSPITAL SPONSORS NUMEROUS EDUCATIONAL PROGRAMS INCLUDING DIABETES AND CHILDHOOD OBESITY PROJECTS. WE HAVE RECEIVED GRANTS FOR DIABETES EDUCATION AND COMMUNITY HEALTH PROGRAMS. UNDER THESE GRANTS, WE ARE ABLE TO HAVE DEDICATED STAFF AND PROGRAMS TO IMPROVE THE HEALTH OF PEOPLE IN OUR COMMUNITY. WE PROMOTE FAMILY FEST TO ENCOURAGE EXERCISE AND HEALTH EATING FOR THE CHILDREN IN OUR COMMUNITY. OUR HOSPITAL WEBSITE OFFERS HEALTHY LIVING TIPS AND TOOLS TO IMPROVE HEALTH. |
| PART VI, LINE 6: | HALIFAX REGIONAL WAS UNDER A MANAGEMENT CONTRACT WITH NOVANT HEALTH THROUGH MAY 31, 2019. EFFECTIVE JUNE 1, 2019, HALIFAX REGIOANL MERGED WITH VIDANT HEALTH IN GREENVILLE, NC. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NC |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHERRY JENSEN | ||||||||||||||
| CFO | $243,088 | $0 | $43,198 | $0 | $0 | $0 | $43,000 | $0 | $43,000 | $0 | $372,286 | $0 | $0 | $0 |
| STEVEN HILL | ||||||||||||||
| CRNA | $222,426 | $0 | $750 | $0 | $0 | $0 | $22,427 | $0 | $22,427 | $0 | $268,030 | $0 | $0 | $0 |
| BRIAN SOMMER | ||||||||||||||
| CRNA | $219,524 | $0 | $0 | $0 | $0 | $0 | $18,453 | $0 | $18,453 | $0 | $256,430 | $0 | $0 | $0 |
| STEVEN ULSAS | ||||||||||||||
| CRNA | $212,151 | $0 | $0 | $0 | $0 | $0 | $24,500 | $0 | $24,500 | $0 | $261,151 | $0 | $0 | $0 |
| KENNETH HARTZ | ||||||||||||||
| CRNA | $210,341 | $0 | $0 | $0 | $0 | $0 | $24,500 | $0 | $24,500 | $0 | $259,341 | $0 | $0 | $0 |
| CLAUDE DIETTRICH | ||||||||||||||
| CRNA | $206,607 | $0 | $0 | $0 | $0 | $0 | $23,292 | $0 | $23,292 | $0 | $253,191 | $0 | $0 | $0 |
| KAREN DANIELS | ||||||||||||||
| CNO | $121,366 | $0 | $5,000 | $0 | $0 | $0 | $15,463 | $0 | $15,463 | $0 | $157,292 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 6 | INCENTIVE PAYMENTS FOR THE VPS ARE BASED ON MEETING CERTAIN GOALS ON THE ORGANIZATION'S BALANCED SCORECARD. PERCENTAGES ARE GIVEN FOR EACH GOAL MET. THIS AT RISK PAY IS USUALLY NOT GIVEN UNLESS THERE IS AN OPERATING MARGIN FOR THE ORGANIZATION. |
| PART II | WILLIAM MAHONE, CEO, AND JASON HARRELL, VP OF OPERATIONS, BOTH WERE EMPLOYEES OF NOVANT HEALTH THROUGH MAY 31, 2019. WE CONTRACTED WITH NOVANT FOR THESE EMPLOYEES AND PAID THEIR FEES QUARTERLY AS BILLED ON NOVANT INVOICES. JUNE 1, 2019, THESE EMPLOYEES BECAME PART OF VIDANT MEDICAL CORP. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||||
| A | 521309402 | NONEAVAIL | 2011-07-28 | $6,500,000 | CAPITAL ACQUISITION | 0 | 0 | 0 |
| NORTH CAROLINA MEDICAL CARE COMMISSION | ||||||||
| B | 521309402 | NONEAVAIL | 2016-09-27 | $8,845,000 | REFUNDING BONDS | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Other Spent ProceedsOtherSpentProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|
| A | $6,502,377 | $130,000 | $6,372,043 | 2013 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $8,845,135 | $145,064 | 0 | 0 | Yes (1) | Yes (1) | $8,699,936 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | Yes (1) | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, LINE 3: TOTAL PROCEEDS | FormAndLineReferenceDesc |
| Explanation | TOTAL PROCEEDS ON LINE 3 INCLUDE INVESTMENT EARNINGS TO DATE OF $ 2,488. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| AUDREY HARDY | |||
| RELATIVE OF BOARD MEMBER | $88,814 | COMPENSATION FOR SERVICES | 0 |
| BETTY ANDERSON | |||
| RELATIVE OF BOARD MEMBER | $26,839 | COMPENSATION FOR SERVICES | 0 |
| LYNCH'S OFFICE SUPPLY | |||
| BOARD MEMBER, TOM LYNCH | $138,211 | PURCHASE OF OFFICE SUPPLIES | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL SYSTEM HAD A MANAGEMENT SERVICES AGREEMENT WITH NOVANT HEALTH INC. THE BOARD OF HRMC CONTINUES TO OVERSEE THE OPERATIONS OF THE HEALTHCARE FACILITY AND RELATED EXEMPT ACTIVITIES. HRMC RECEIVES MANAGEMENT SERVICES AS WELL AS EXPENSE SAVINGS FOR AN ANNUAL MANAGEMENT FEE. NOVANT PROVIDES HRMC WITH A CEO AND COO AND HRMC PROVIDES REIMBURSEMENT FOR THOSE COSTS. DURING THE 2018 CALENDAR YEAR YEAR, NOVANT PAID COMPENSATION OF $369,835 TO THE ORGANIZATION'S CEO AND $216,187 TO THE ORGANIZATION'S COO. |
| FORM 990, PART VI, SECTION A, LINE 4 | MERGED WITH VIDANTH HEALTH JUNE 1, 2019. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. THE HOSPITAL PROVIDED EVERY VOTING BOARD MEMBER A COPY OF THE DRAFT 990 PRIOR TO A SCHEDULED MEETING. DETAILS OF THE RETURN WERE DISCUSSED WITH MANAGEMENT AND THE FINANCE COMMITTEE OF THE BOARD, WHO THEN DELIVERED A REPORT TO THE FULL BOARD PRIOR TO FILING THE RETURN WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | (BYLAWS, ARTICLE 2, SECTION 3) "ANY DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY GOVERNING BOARD MEMBER SHALL BE DISCLOSED TO THE OTHER MEMBERS OF THE BOARD OF DIRECTORS AND MADE A MATTER OF RECORD THROUGH AN ANNUAL PROCEDURE AND ALSO WHEN THE INTEREST BECOMES A MATTER OF BOARD ACTION. ANY GOVERNING BOARD MEMBER HAVING A DUALITY OF INTEREST OR POSSIBLE CONFLICT OF INTEREST ON ANY MATTER SHALL NOT VOTE OR USE PERSONAL INFLUENCE ON THAT MATTER, AND SHALL NOT BE COUNTED IN DETERMINING THE QUORUM FOR THE MEETING, EVEN WHERE PERMITTED BY LAW. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE QUORUM SITUATION. ANY EXISTING OR APPARENT CONFLICT OF INTEREST WILL BE REFERRED TO THE EXECUTIVE COMMITTEE OF THE BOARD FOR RESOLUTION." THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. BOARD MEMBERS AND HOSPITAL MANAGEMENT PERSONNEL ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE EACH YEAR. |
| FORM 990, PART VI, SECTION B, LINE 15 | AN OUTSIDE CONSULTANT IS USED TO DETERMINE THE APPROPRIATE COMPENSATION BASED ON COMPARABLE POSITIONS AND BENCHMARKS. THE CONSULTANT EVALUATES THE SALARIES FOR THE VP OF FINANCE. THE CEO APPROVES THE VP OF FINANCE SALARY. NOVANT DETERMINED THE COMPENSATION FOR THE CEO AND THE VP OF OPERATIONS BASED ON THE SAME PROCESS UNTIL WE MERGED WITH VIDANT JUNE 1, 2019. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| 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 WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,134,193. MANAGEMENT AND GENERAL EXPENSES 89,232. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,223,425. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 1,996,185. MANAGEMENT AND GENERAL EXPENSES 4,131. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,000,316. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 3,195,001. MANAGEMENT AND GENERAL EXPENSES 551,856. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,746,857. SUPPORT FEES: PROGRAM SERVICE EXPENSES 32,566. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,566. NURSING SERVICES: PROGRAM SERVICE EXPENSES 1,038,261. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,038,261. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,764,868. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,764,868. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 16,235. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,235. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 156,718. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156,718. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF DEFINED PENSION PLAN TRANSFER OF EQUITY -2,400,000. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL MEDICAL CENTER CRNA BILLING LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1Txt |
| City | ROANOKE RAPIDS | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27870 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 461929125 | EIN |
| Primary Activities | BILLING SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | NC | LegalDomicileStateCd |
| Total Income | $1,750,766 | TotalIncomeAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL MEDICAL CENTER INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (17 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | |
| VIDANT NORPUNGO DISTRICT HOSPITAL CORPORATION DBA VIDANT PUNGO HOSPITALTH | |||||||||||
| 2100 STANTONSBURG RD | GREENVILLE | NC | 27835 | 560518757 | HOSPITAL | NC | 501(C)(3) | LINE 3 | VIDANT HEALTH | 0 | |
| ROANOKE VALLEY HEALTH SERVICES | |||||||||||
| 2100 STANTONSBURG RD | GREENVILLE | NC | 27835 | 561925492 | HEALTHCARE | 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 | 0 | N/A | |
| 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 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ROANOKE VALLEY HEALTH SERVICES | ||
| B | $21,210,412 | CASH |
| HALIFAX REGIONAL MEDICAL CENTER FOUNDATION | ||
| C | $61,240 | CASH |
| ROANOKE VALLEY HEALTH SERVICES | ||
| R | $7,421,289 | CASH |
| ROANOKE VALLEY HEALTH SERVICES | ||
| S | $7,205,225 | CASH |
| HALIFAX REGIONAL MEDICAL CENTER FOUNDATION | ||
| M | $55,000 | CASH |