2019-08-14T11:00:17-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2017-10-01 560530234 RANDOLPH HOSPITAL INC RAND 3366255151 364 WHITE OAK STREET ASHEBORO NC 27203 LORETTA LONG CFO 3366255151 2019-08-13 1 JOHN NORMAN P01506766 7049985200 2019-08-13 67.137.57.251 2019-08-13 11:07:58 ED P E6B36A5AA947C5ABCF14DB2FEAA03B911CABFB79 7FA111DA1DF952C3932DE9B02872546115851591 2017 2019-02-21 02:37:17Z RANDOLPH HEALTH ANGELA P ORTH 364 WHITE OAK STREET ASHEBORO NC 27203 110456291 0 X WWW.RANDOLPHHEALTH.ORG X 1928 NC TO PROVIDE QUALITY HEALTH CARE AND FOSTER HEALTH AND WELLNESS IN OUR COMMUNITIES. 11 11 1068 237 100181 -73270 346956 672201 106955770 108487558 323584 723358 578276 573174 108204586 110456291 2864129 3577826 0 0 53143560 49258825 0 0 71586 62861334 64194812 118869023 117031463 -10664437 -6575172 125229349 114934410 74392554 66056502 50836795 48877908 RANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS. 0 0 106911429 3577826 108487558 RANDOLPH HOSPITAL, A NOT-FOR-PROFIT, 145-BED COMMUNITY HOSPITAL WAS ESTABLISHED IN 1928 WITH THE APPROVAL OF A COOPERATIVE PLAN WITH THE DUKE ENDOWMENT AT A JOINT MEETING OF THE ASHEBORO ROTARY CLUB, THE KIWANIS CLUB, THE CHAMBER OF COMMERCE, THE TOWN COUNCIL AND INTERESTED CITIZENS. THE PLAN CALLED FOR THE BUILDING OF A 40-BED HOSPITAL. 106911429 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 176 0 1068 1 1 1 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 X LORETTA LONG CFO 3366298810 364 WHITE OAK STREET ASHEBORO NC 27203 D CRANDFORD KNOTT BOARD MEMBER 2.00 X 0 0 0 ELBERT J LASSITER BOARD MEMBER 2.00 X 0 0 0 MICHAEL C MILLER SECRETARY 2.00 X X 0 0 0 GLENN MAC PUGH CHAIR 4.00 X X 0 0 0 SAMUEL A RANKIN JR VICE CHAIR 2.00 X X 0 0 0 DAVID BRYANT BOARD MEMBER 2.00 X 0 0 0 LINDA BROWN BOARD MEMBER 2.00 X 0 0 0 T REYNOLDS LISK BOARD MEMBER 2.00 X 0 0 0 CRIS R RICHARDSON MD BOARD MEMBER 2.00 X 0 0 0 ROBERT S SHACKLEFORD JR PHD BOARD MEMBER 2.00 X 0 0 0 THOMAS E LAWRENCE MD BOARD MEMBER 2.00 X 0 0 0 STEVE E EBLIN CEO 40.00 X 0 394088 48878 LORETTA M LONG CFO 40.00 X 128253 0 6460 CHARLES B WEST CMO 40.00 X 251284 0 3240 ANGELA BURGESS CIO 40.00 X 143513 0 1000 BARBARA E WOLFE VP 40.00 X 169246 0 4221 ROBERT S CLAUSER VP 40.00 X 206571 0 7841 ANGELA P ORTH VP 40.00 X 0 238384 33387 TREMONTEO CRAWFORD VP 40.00 X 176903 0 3177 LISA D HAMPTON DIRECTOR 40.00 X 156893 0 211 DAVID R BECKHAM PHYSICAL THERAPIST 40.00 X 140420 0 1418 WILLIAM T WARD PHARMACIST 40.00 X 133971 0 5824 AMY L TROY DIRECTOR 40.00 X 120739 0 1645 MURRAY S MARSH JR FORMER CFO 0.00 0.00 X 0 169296 32596 1627793 801768 149898 10 1 1 0 CONE HEALTH 1200 NORTH ELM STREET GREENSBORO NC 27401 CONSULTING, LAB, PHARM, MANAGEMENT FEE 3757658 ARAMARK CORPORATION 10510 TWIN LAKES PARKWAY CHARLOTTE NC 272697658 REPAIRS AND MAINT 1430120 MEDICUS HEALTHCARE SOLUTIONS LLC 22 ROULSTON ROAD WINDHAM NH 03087 PROFESSIONAL SERVICES 1166976 SODEXHO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 FOOD MANAGEMENT SERVICES 1045602 MEDSTREAM ANESTHESIA PLLC 82 PATTON AVE STE 510 ASHEVILLE NC 28801 PROFESSIONAL/ANESTHESIA SERVICES 549140 43 405000 265036 2165 672201 PATIENT SERVICE REVENU 621400 105106693 105106693 MRI OF ASHEBORO LLC 621400 1257429 1257429 CANCER CENTER REVENUES 621400 789823 789823 1333613 1333613 108487558 718214 718214 407994 0 407994 407994 407994 5144 0 5144 5144 5144 RANDOLPH NEWCO LLC 900009 96084 96084 COFFEE/GIFT SHOP 453220 64999 64999 PREMIER PARTNERSHIP 900009 4097 4097 165180 110456291 108487558 100181 1196351 3577826 3577826 1627793 1627793 35765359 33870167 1855608 39584 781871 663027 118063 781 8249816 7008867 1232786 8163 2833986 2403221 427932 2833 4513960 2992757 1521203 905002 905002 62810 62810 8880309 8862555 15979 1775 311181 224051 79973 7157 9270102 8055719 1205113 9270 1977728 1906531 71197 4054589 3843751 210838 288274 246475 40647 1152 5113 5113 1964603 1964603 5112421 5112421 391912 391912 BAD DEBT 14651841 14651841 MEDICAL SUPPLIES 11087711 11087711 MISCELLANEOUS 576702 434793 141038 871 RECRUITMENT 140554 140554 117031463 106911429 10048448 71586 7135928 2399182 2061364 489052 13366688 13141638 2555280 2495546 935109 1320013 156652777 108558593 52083109 48094184 18998690 15169491 7490371 8280194 20602810 23545110 125229349 114934410 11074650 13596342 40545909 31739048 22771995 20721112 74392554 66056502 X 50440662 48485178 396133 392730 50836795 48877908 125229349 114934410 X -6575172 2436 4613849 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 8456 8456 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION WERE ATTRIBUTABLE TO LOBBYING ACTIVITIES CARRIED OUT BY THOSE ORGANIZATIONS ON BEHALF OF THEIR MEMBERS. 1634877 1634877 1634877 1634877 1634877 1634877 1634877 1634877 1634877 1634877 0 0 2582897 2582897 83080268 46657142 36423126 5920149 1473995 4446154 63160245 59673257 3486988 1909218 754199 1155019 48094184 INVESTMENT IN RCC 6477040 C DUE FROM RCC JV 1803154 C 8280194 OTHER RECEIVABLES 631471 ASSETS LIMITED AS TO USE 397584 INVESTMENT IN AFFILIATES 2188901 DUE FROM AFFILIATES 20057073 OTHER LONG-TERM ASSETS 270081 23545110 MINIMUM PENSION LIABILITY 4621255 INTEREST RATE SWAP 1889802 DUE TO AFFILIATES 14020278 ESTIMATED THIRD PARTY SETTLEMENT 189777 20721112 X PART X, LINE 2: THE HOSPITAL, RHMG, PIH, STAYWELL, AND FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. NEWCO AND CPSC ARE LIMITED LIABILITY COMPANIES, WHICH DO NOT PRODUCE TAXABLE INCOME TO THEIR NOT-FOR-PROFIT OWNER. THE SYSTEM HAS DETERMINED IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2018. 1 1 1 X 1 X 1 0 1 1 7472940 7472940 0.07300 14045184 12862553 1182631 0.01160 183840 185493 0 0.00000 21701964 13048046 8655571 0.08460 21701964 13048046 8655571 0.08460 1 4740958 4029814 39852197 41759775 -1907578 X 1 1 1 RANDOLPH NEWCO LLC MEDICAL EQUIPMENT RENTAL 0.83030 0.16970 1 1 RANDOLPH HOSPITAL INCORPORATED 364 WHITE OAK STREET ASHEBORO NC 27204 WWW.RANDOLPHHOSPITAL.ORG X X X RANDOLPH HOSPITAL INCORPORATED 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X SEE PART VI X SEE PART VI X X 1 15 1 SEE PART VI 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X WWW.RANDOLPHHOSPITAL.ORG X WWW.RANDOLPHHOSPITAL.ORG X WWW.RANDOLPHHOSPITAL.ORG X X X X X X 1 0 X X X X X 1 X 0 0 RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 5: IN THE FALL OF 2015, THE RANDOLPH COUNTY HEALTH DEPARTMENT JOINED WITH RANDOLPH HOSPITAL, TO ESTABLISH THE ASSESSMENT FRAMEWORK AND A TIMELINE FOR DATA COLLECTION AND ANALYSIS, PRIORITIZATION OF HEALTH CONCERNS AND DEVELOPMENT OF ACTION PLANS. DATA COLLECTION AND ANALYSIS TOOK PLACE FROM SEPTEMBER 2015 - JULY 2016. PRIMARY DATA WAS COLLECTED FROM THE COMMUNITY IN TWO DIFFERENT WAYS: DISTRIBUTION OF PAPER SURVEYS AND AN INTERNET SURVEY. WITH TECHNOLOGY CONTINUING TO ADVANCE, RANDOLPH PLACED MORE OF AN EMPHASIS ON ON-LINE SURVEYS, ALTHOUGH RANDOLPLH CONTINUED TO USE PAPER SURVEYS AS AN IMPORTANT TOOL. IN ADDITION TO ON-LINE SURVEYS, RANDOLPH ALSO DISTRIBUTED PAPER SURVEYS TO AGENCIES AND ORGANIZATIONS WITHIN THE COUNTY USING THE CONVENIENCE SAMPLE METHOD. SUCH AGENCIES INCLUDED: RANDOLPH COMMUNITY COLLEGE, RANDOLPH COUNTY PARTNERSHIP FOR CHILDREN, EARLY CHILDHOOD CENTERS IN LIBERTY, RANDLEMAN AND RAMSEUR, MANY CHURCHES AND BOTH ASHEBORO CITY AND RANDOLPH COUNTY SCHOOLS. ALL SURVEYS DISTRIBUTED WERE IN BOTH ENGLISH AND SPANISH. OF THE 2,000 TOTAL DISTRIBUTED SURVEYS, 1,104 WERE RETURNED FOR A RESPONSE RATE OF 55%.SURVEY RESPONSES WERE ANALYZED FOR FREQUENCY OF RESPONSE USING SURVEY MONKEY. (IT SHOULD BE NOTED THAT NOT EVERY RESPONDENT ANSWERED EVERY QUESTION.) THE SURVEYS WERE NOT FULLY COMPLETED BY ALL INDIVIDUALS, RESULTING IN MISSING DATA ON VARIOUS QUESTIONS.IN COLLABORATION WITH THE RANDOLPH COUNTY GOVERNMENT IT, AN INTERNET SURVEY WAS DEVELOPED USING SURVEY MONKEY. THE INTERNET SURVEY WAS ACCESSIBLE THROUGH THE RANDOLPH COUNTY GOVERNMENT WEBSITE AS WELL AS THE RANDOLPH HOSPITAL WEBSITE. IN AN EFFORT TO PROMOTE THE INTERNET SURVEY, PRESS RELEASES RAN IN ALL AREA NEWSPAPERS, AS WELL AS PROMOTED VIA SOCIAL MEDIA.TO ENSURE A SOLID REPRESENTATION FROM KEY SECTORS, THE SURVEY WAS ALSO SENT TO DEPARTMENT HEADS AND DIRECTORS FROM VARIOUS AGENCIES OR REPRESENTATIVES WITHIN THE COUNTY. RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 6B: RANDOLPH COUNTY HEALTH DEPARTMENT RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 7D: BOTH RANDOLPH COUNTY AND RANDOLPH HOSPITAL WEBSITES HAVE POSTED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND EXECUTIVE SUMMARY. THE ASSESSMENT IS ALSO IN ALL SEVEN RANDOLPH COUNTY LIBRARIES. THIRTY DATA BOOKS AND 500 EXECUTIVE SUMMARIES WERE ORDERED AND PRINTED FOR DISTRIBUTION THROUGHOUT THE COMMUNITY. RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 11: IN JULY 2016, ADVISORY COMMITTEE MEMBERS MET TO IDENTIFY LEADING COMMUNITY HEALTH ISSUES IN RANDOLPH COUNTY. DURING THE MEETING, MEMBERS REVIEWED HEALTH CONCERNS IDENTIFIED THROUGH SURVEYS AS WELL AS THE INFORMATION GATHERED THROUGH SECONDARY RESEARCH. THROUGH NOMINAL GROUP TECHNIQUE THE COMMITTEE SELECTED EIGHT COMMUNITY HEALTH PROBLEMS: OBESITY, MENTAL HEALTH, SUBSTANCE ABUSE, ACCESS TO CARE, TOBACCO, SEXUALLY TRANSMITTED DISEASES, CHRONIC DISEASE MANAGEMENT AND INJURY PREVENTION. AFTER MUCH DISCUSSION, THE COMMITTEE AGREED TO FOCUS ON FOUR PRIORITY HEALTH CONCERNS: PHYSICAL ACTIVITY, NUTRITION, SUBSTANCE ABUSE, AND MENTAL HEALTH.IT IS IMPORTANT TO NOTE THAT ALTHOUGH THE ADVISORY COMMITTEE IDENTIFIED EIGHT HEALTH ISSUES, THE DECISION WAS MADE TO LIMIT THE FOCUS TO MAKE A LARGER IMPACT ON THE TOP FOUR AREAS THAT HAD THE OPPORTUNITY TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY. ADDRESSING OBESITY THROUGH PHYSICAL ACTIVITY AND NUTRITION CAN ALSO LEAD TO IMPACTING CHRONIC HEALTH DISEASES SUCH AS CANCER, HEART DISEASE AND DIABETES. ADDRESSING SUBSTANCE ABUSE THROUGH DRUG, ALCOHOL AND TOBACCO USE CAN ONCE AID IN IMPACTING CHRONIC HEALTH DISEASES. FINALLY, ADDRESSING MENTAL HEALTH ISSUES IMPACTS CHRONIC HEALTH DISEASES, OBESITY AND SUBSTANCE ABUSE. THE IDENTIFIED PRIORITY AREAS ARE ALSO IN LINE WITH THE AREAS IDENTIFIED DURING THE RANDOLPH COUNTY STRATEGIC PLANNING PROCESS. THE ENTIRE COUNTY IS NOW ALIGNED WITH FOCUSING ON THE SAME HEALTH PRIORITY AREAS--CREATING, FOR THE FIRST TIME, A COORDINATED AND UNITED COUNTY-WIDE EFFORT TO ADDRESS THE HEALTH OF OUR COMMUNITY. RANDOLPH HOSPITAL INCORPORATED PART V, SECTION B, LINE 20E: THE HOSPITAL ESTABLISHES DURING PRE-REGISTRATION WHETHER A PATIENT IS COVERED BY INSURANCE. IF THE PATIENT IS NOT COVERED BY INSURANCE, THE HOSPITAL MAKES THE PATIENT AWARE OF THE FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINES 7 AND 10 HTTPS://WWW.RANDOLPHHEALTH.ORG/HEALTH-RESOURCES/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 25 1 - RH STAYWELL SENIOR CARE 809 CURRY DRIVE ASHEBORO NC 27205 PACE CENTER 2 - RHMG ATHLETIC TRAINING 600 W SALISBURY ST STE A ASHEBORO NC 27203 ATHLETIC TRAINING 3 - RH CANCER CENTER 364 WHITE OAK ST ASHEBORO NC 27203 CANCER TREATMENT 4 - RHMG CHC BETTERCARE 600 W SALISBURY ST STE B ASHEBORO NC 27203 CORPORATE HEALTH & WELLNESS 5 - RHMG DEEP RIVER P T -ASHEBORO 600 W SALISBURY ST STE A ASHEBORO NC 27203 PHYSICAL THERAPY 6 - RHMG DEEP RIVER P T -RAMSEUR 701 LIBERTY ST RAMSEUR NC 27316 PHYSICAL THERAPY 7 - RHMG DEEP RIVER P T -RANDLEMAN 148 POINTE SOUTH DRIVE RANDLEMAN NC 27317 PHYSICAL THERAPY 8 - RH DIABETES CENTER 208-D FOUST ST ASHEBORO NC 27203 DIABETES TREATMENT 9 - RHMG EAR NOSE & THROAT 124 N PART ST ASHEBORO NC 27203 EAR NOSE AND THROAT 10 - RHMG ENDOSCOPY CENTER 700 SUNSET AVE ASHEBORO NC 27203 ENDOSCOPY 11 - RHMG FAMILY PRACTICE - LIBERTY 504 N GREENSBORO LIBERTY NC 27298 FAMILY MEDICINE 12 - RHMG FAMILY PRACTICE - RANDLEMAN 670 W ACADEMY ST RANDLEMAN NC 27317 FAMILY MEDICINE 13 - RHMG FAMILY PRACTICE - SEAGROVE 514 N BROAD ST SEAGROVE NC 27341 FAMILY MEDICINE 14 - RHMG FAMILY PRACTICE & WELLNESS 132-C W MILLER ST ASHEBORO NC 27203 FAMILY MEDICINE 15 - RHMG FITNESS CENTER 600 W SALISBURY ST STE A ASHEBORO NC 27203 FITNESS CENTER 16 - RHMG GASTROENTEROLOGY 700 SUNSET AVE ASHEBORO NC 27203 GASTROENTEROLOGY 17 - RHHOME HEALTH 341 N FAYETTEVILLE ST ASHEBORO NC 27203 HOME HEALTH 18 - RHMG INTERNAL MEDICINE 237-A N FAYETTEVILLE ST ASHEBORO NC 27203 INTERNAL MEDICINE 19 - RH MRI CENTER 237 N FAYETTEVILLE ST STE B ASHEBORO NC 27203 MRI 20 - RHMG ORTHOPEDICS & SPORTS MEDICINE 503 N FAYETTEVILLE ST ASHEBORO NC 27203 ORTHOPEDICS/SPORTS MEDICINE 21 - RHMGPEDIATRICS 713 S FAYETTEVILLE ST ASHEBORO NC 27203 PEDIATRICS 22 - RHMG P T & SPORTS MEDICINE 503 N FAYETTEVILLE ST ASHEBORO NC 27203 PHYSICAL THERAPY 23 - RH SURGERY CENTER 724 THOMAS ST ASHEBORO NC 27203 SURGICAL CENTER 24 - RHMG UROLOGY 132-C W MILLER ST ASHEBORO NC 27203 UROLOGY 25 - RH WOUND CARE & HYPERBARIC CENTER 212 FOUST ST ASHEBORO NC 27203 WOUND CARE PART I, LINE 6A: NORTH CAROLINA HOSPITAL ASSOCIATION PART I, LN 7 COL(F): UNINSURED PATIENTS NOT QUALIFYING FOR FINANCIAL ASSISTANCE OR STATE, FEDERAL, AND /OR GRANT FUND PROGRAMS ARE RESPONSIBLE FOR A DISCOUNTED PAYMENT AMOUNT IN ACCORDANCE WITH IRS SECTION 501(R). PAYMENT PLANS ARE OFFERED THROUGH RANDOLPH HOSPITAL WITH NO INCURRED INTEREST CHARGES. THE PATIENT FINANCIAL SERVICES DEPARTMENT OF RANDOLPH HOSPITAL PROVIDES A MONTHLY STATEMENT, MAKES TELEPHONE CONTACT, AND/OR SENDS COLLECTION LETTERS. UNCOLLECTED DELIQUENT ACCOUNTS MAY BE REFERRED TO AN EXTERNAL COLLECTION AGENCY OR ATTORNEY FOR CONTINUED COLLECTION. ALL INTERNAL AND EXTERNAL COLLECTIONS PROCESSES COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT (FDCPA). PART III, LINE 2: THE ORGANIZATION APPLIED THE COST-TO CHARGE RATIO TO ITS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT REPORTED ON PART III, LINE 2. PART III, LINE 3: THE ORGANIZATION ESTIMATES FROM HISTORICAL PERSPECTIVE AND EXPERIENCE THAT APPROXIMATELY 85% OF BAD DEBT EXPENSE MAY BE ATTRIBUTABLE TO COMMUNITY BENEFIT. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT EXPENSE WAS OBTAINED FROM AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL TRADITIONALLY INCURS A SHORTFALL IN PROVIDING MEDICARE SERVICES AND CONSIDERS THE ENTIRE SHORTFALL AS A COMMUNITY BENEFIT. MEDICARE DOES NOT REIMBURSE THE HOSPITAL ENOUGH TO COVER ITS COSTS ASSOCIATED WITH PROVIDING MEDICARE SERVICES, YET THE HOSPITAL CONTINUES TO FULFILL ITS MISSION OF PROVIDING SERVICES TO ITS COMMUNITY REGARDLESS OF THE REIMBURSEMENT LEVELS. AS SUCH, THE HOSPITAL BELIEVES THAT IT IS APPROPRIATE TO REPORT THIS SHORTFALL AS PART OF ITS COMMUNITY BENEFIT. THE BAD DEBT INCLUDED AS UNCOMPENSATED CARE REPRESENTS THE COST OF PROVIDING THOSE SERVICES, CALCULATED USING THE COST TO CHARGE RATIO OF THE CHARGES RECORDED IN THE FINANCIAL STATEMENTS AS BAD DEBT. PART III, LINE 9B: RANDOLPH HOSPITAL IS COMMITTED TO ASSISTING PATIENTS THAT DO NOT HAVE THE FINANCIAL RESOURCES TO PAY FOR THEIR HEALTH CARE SERVICES. THE HOSPITAL MAKES AVAILABLE FINANCIAL COUNSELING TO DETERMINE THE APPROPRIATE DISPOSITION OF THE PATIENT ACCOUNT. A MEDICAL ASSISTANCE COUNSELOR REVIEWS ACCOUNTS FOR POSSIBLE FINANCIAL ASSISTANCE FROM STATE, FEDERAL, AND/OR ENDOWMENT FUNDS PROGRAMS. RANDOLPH HOSPITAL PROVIDES CHARITY TO PATIENTS WHO MEET CRITERIA AS OUTLINED IN THE FINANCIAL ASSISTANCE POLICY. ANY PATIENT/GUARANTOR WHO REFUSES TO COMPLETE THE APPLICATION WILL BE CONSIDERED AS HAVING THE ABILITY TO PAY HIS ACCOUNT AND HANDLED ACCORDINGLY. PART VI, LINE 2: THE HOSPITAL WORKS WITH THE RANDOLPH COUNTY HEALTH DEPARTMENT ON AN ONGOING BASIS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. ADDITIONAL ASSISTANCE IS PROVIDED BY COMMUNITY INSTITUTIONS, BUSINESSES, AGENCIES AND INDIVIDUALS WITH AN INTEREST IN IMPROVING THE HEALTH STATUS OF RANDOLPH COUNTY RESIDENTS. PART VI, LINE 3: THE HOSPITAL HAS A DEDICATED PATIENT FINANCIAL TEAM THAT TAKES A PROACTIVE APPROACH TO COUNSELING AND EDUCATING PATIENTS ON THE HEALTHCARE BILLING PROCESS AND CREATING CUSTOMIZED PAYMENT OPTIONS TO HELP ALLEVIATE INITIAL FINANCIAL BURDENS. IF IT APPEARS THAT A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, OUR TEAM WILL HELP THE PATIENT DETERMINE WHICH ROUTE IS MOST APPROPRIATE FOR THEIR SITUATION. THE HOSPITAL ASSESSES AT THE TIME OF REGISTRATION AND DURING INTERVIEWS WITH FINANCIAL COUNSELORS WHETHER A PATIENT MIGHT QUALIFY FOR FINANCIAL ASSISTANCE AND PROVIDES LITERATURE TO THE PATIENT AT THAT TIME. THE HOSPITAL ALSO WIDELY COMMUNICATES THE AVAILABILITY OF THE FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE, BILLING STATEMENTS, AND SIGNS POSTED CONSPICUOUSLY THROUGH OUT ITS FACILITIES. PART VI, LINE 4: THE US CENSUS BUREAU REPORTED AN ESTIMATED POPULATION OF APPROXIMATELY 142,386 IN RANDOLPH COUNTY FOR THE YEAR 2013. THIS WAS AN INCREASE OF 8% FROM THE YEAR 2010 WHEN THE POPULATION WAS REPORTED TO BE APPROXIMATELY 141,144. THE ESTIMATED POPULATION IN NORTH CAROLINA IN 2013 WAS 9,749,266 WHICH WAS AN INCREASE OF 3.3% FROM 2010.SIMILAR TO NORTH CAROLINA AS A WHOLE, THE POPULATION OF RANDOLPH COUNTY IS DIVIDED ALMOST EQUALLY BETWEEN MALES (49.2%-RC, 48.7%-NC) AND FEMALES (50.8%-RC, 51.3%-NC). RESIDENTS OF RANDOLPH COUNTY ARE PREDOMINATELY WHITE (80.7%), FOLLOWED BY HISPANIC (10.8%) AND BLACK (5.6%). THE HISPANIC POPULATION IN RANDOLPH COUNTY (10.8%) IS HIGHER WHEN COMPARED TO NORTH CAROLINA (8.7%) AS A WHOLE.FROM AN ECONOMIC STANDPOINT, PERSONAL INCOME PER CAPITA FOR RANDOLPH COUNTY WAS AT $31,896 IN 2014, BELOW THE AVERAGE PER CAPITA INCOME FOR ALL RESIDENTS OF NORTH CAROLINA. THE PERCENTAGE OF MEDICAID ELIGIBLE PATIENTS IN RANDOLPH COUNTY CONTINUES TO RISE, EXCEEDING THE AVERAGE LEVEL IN NORTH CAROLINA. UNEMPLOYMENT RATES FOR RANDOLPH COUNTY IS AT APPROXIMATELY 5.5% OF THE WORKFORCE, SLIGHTLY BELOW THE NORTH CAROLINA RATE OF 5.7%. PART VI, LINE 7, REPORTS FILED WITH STATES NC 0 CHARITY CARE ASSISTANCE TO PATIENTS QUALIFYING UNDER RANDOLPH HOSPITAL'S CHARITY CARE POLICY. 2650 3577826 X X X X 0 1 0 0 0 0 0 0 0 STEVE E EBLIN CEO 0 321125 0 0 0 72963 0 43914 0 4964 0 442966 0 0 CHARLES B WEST CMO 250252 0 0 0 1032 0 0 0 3240 0 254524 0 0 0 BARBARA E WOLFE VP 168694 0 0 0 552 0 0 0 4221 0 173467 0 0 0 ROBERT S CLAUSER VP 206211 0 0 0 360 0 0 0 7841 0 214412 0 0 0 ANGELA P ORTH VP 0 210053 0 0 0 28331 0 25780 0 7607 0 271771 0 0 TREMONTEO CRAWFORD VP 175258 0 0 0 1645 0 0 0 3177 0 180080 0 0 0 LISA D HAMPTON DIRECTOR 156463 0 0 0 430 0 0 0 211 0 157104 0 0 0 MURRAY S MARSH JR FORMER CFO 0 138555 0 0 0 30741 0 30163 0 2433 0 201892 0 0 PART I, LINE 4B CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM PARTICIPATE IN THE RANDOLPH HOSPITAL, INC. DEFERRED COMPENSATION PLAN. UNDER THIS PLAN, AN ANNUAL CONTRIBUTION IS MADE INTO A TRUST FOR EACH PARTICIPANT BASED ON A PERCENTAGE (10% OR 15%) OF THEIR SALARY. EACH PARTICIPANT DIRECTS THE INVESTMENT OF HIS/HER ACCOUNT BALANCE. FORM 990, PART VI, SECTION A, LINE 1 THERE STANDS AN EXECUTIVE COMMITTEE CONSISTING OF THE CHAIRMAN, VICE CHAIRMAN, CHAIRMAN-ELECT, SECRETARY, CHAIRMAN OF THE FINANCE, AUDIT, INVESTMENT AND RETIREMENT COMMITTEE, AND UP TO TWO OTHER DIRECTORS AS DESIGNATED BY THE CHAIRMAN. THE COMMITTEE HAS AND MAY EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE ORGANIZATION, TO THE EXTENT PERMITTED BY LAW, DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION SHALL HAVE ONE CLASS OF MEMBERS CONSISTING OF AT LEAST 23 MEMBERS AND NEVER CONSISTING OF MORE THAN 30 MEMBERS. FOUR MEMBERS SHALL BE EX OFFICIO, AS INDICATED BELOW. THE REMAINDER SHALL BE ELECTED AS PROVIDED IN DETAIL IN THE BYLAWS. THE PRINCIPAL CRITERION FOR SELECTION OF CORPORATE MEMBERS SHALL BE THE PERSON'S QUALIFICATIONS TO EVENTUALLY SERVE AS A DIRECTOR OF RANDOLPH HOSPITAL, AS SET FORTH IN THE BYLAWS. AS CANDIDATES BECOME AVAILABLE, THE MEMBERS MAY EXPAND OR CONTRACT THEIR NUMBER, WITHIN THE LIMITS STATED ABOVE, IN ORDER TO PROVIDE AN ADEQUATE POOL OF MEMBERS WHO ARE QUALIFIED TO SERVE AS DIRECTORS. IN ADDITION TO THE ELECTED MEMBERS, THE MAYOR OF ASHEBORO, NORTH CAROLINA, THE CHAIRMAN OF THE BOARD OF COMMISSIONERS OF RANDOLPH COUNTY, NORTH CAROLINA, THE RANDOLPH COUNTY SUPERINTENDENT OF SCHOOLS, CITY OF ASHEBORO SUPERINTENDENT OF SCHOOLS, AND THE COUNTY HEALTH OFFICER OF RANDOLPH COUNTY, NORTH CAROLINA, SHALL BE EX OFFICIO MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE CORPORATE MEMBERS FROM NOMINATIONS RECEIVED BOTH FROM THE GOVERNANCE COMMITTEE AND FROM THE FLOOR AT THE ANNUAL MEETING. IF ANY DIRECTORS SHALL SERVE ONE-YEAR TERMS, AND SHALL CONTINUE TO SERVE UNTIL THEIR SUCCESSORS ARE ELECTED. DIRECTORS MAY BE RE-ELECTED. ANY DIRECTOR MAY BE REMOVED FROM OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE, BY A MAJORITY VOTE OF THE MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B CHANGES TO THE BYLAWS, SALE OR MERGER OF THE HOSPITAL MUST BE APPROVED BY THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED AT THE FAIR (FINANCE, AUDIT, INVESTMENT AND RETIREMENT) COMMITTEE PRIOR TO FILING WITH THE IRS. ALL OF THE BOARD MEMBERS ARE INVITED TO ATTEND. ANYONE NOT AT THE MEETING IS GIVEN A COPY OF THE 990 AND IS INVITED TO ASK QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C RANDOLPH HOSPITAL HAS A PART TIME CORPORATE COMPLIANCE OFFICER CHARGED WITH EDUCATING THE BOARD, OFFICERS, AND OTHER EMPLOYEES ON THE CONFLICT OF INTEREST POLICY. ALL NEW EMPLOYEES ARE GIVEN INFORMATION UPON ORIENTATION, AND ALL CURRENT EMPLOYEES ARE REQUIRED TO TAKE ANNUAL EDUCATION ON COMPLIANCE WITH THE POLICY. THERE IS A CORPORATE COMPLIANCE MEETING TO UPDATE KEY INDIVIDUALS ON NEW ISSUES AND NEW INFORMATION REGARDING CORPORATE COMPLIANCE. THE BOARD OF DIRECTORS ARE REQUIRED ANNUALLY TO READ, SIGN, AND REMIT A COPY OF THE POLICY TO THE BOARD CHAIR. ALL BOARD MEMBERS ARE AWARE OF THE POLICY AND IN CASE OF ANY CONFLICT OF INTEREST, THEY WILL RECUSE THEMSELVES. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD FOR RANDOLPH HOSPITAL REVIEWS AND FORMALLY APPROVES THE COMPENSATION PACKAGE OF THE CEO. HUMAN RESOURCES APPROVES THE COMPENSATION PACKAGES FOR ALL OTHER KEY EXECUTIVES. IN DETERMINING THE APPROPRIATE COMPENSATION LEVELS FOR THE CEO AND KEY EXECUTIVES, THE BOARD AND HUMAN RESOURCES REVIEWS MARKET DRIVEN DATA THAT TAKES INTO ACCOUNT SIMILAR EXECUTIVES AT ORGANIZATIONS OF SIMILAR SIZE AND STRUCTURE. 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 REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY 2,150,175. GAIN ON INVESTMENT IN AFFILIATES 1,501,544. CHANGE IN VALUE OF INTEREST RATE SWAP 1,063,379. CHANGE IN NET UNREALIZED GAINS ON OTHER THAN TRADING SECURITIES 99,296. NET ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL 379,883. TEMPORARILITY RESTRICTED NET ASSETS RELEASED FROM RESTRICTIONS -480,247. RANDOLPH NEWCO LLC (UBI INCLUSION) -96,084. PREMIER PARTNERSHIP (UBI INCLUSION) -4,097. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. MRI OF ASHEBORO LLC 237 N FAYETTEVILLE STREET B ASHEBORO NC 27203 472225445 IMAGING SERVICES NC -35396 1287465 RANDOLPH HOSPITAL INC PIEDMONT INTEGRATED HEALTH LLC 364 WHITE OAK STREET ASHEBORO NC 27203 472221211 CLINICALLY INTEGRATED NETWORK NC -200 0 RANDOLPH HOSPITAL INC RANDOLPH SPECIALTY GROUP 364 WHITE OAK STREET ASHEBORO NC 27204 113827203 HEALTHCARE NC 501(C)(3) LINE 10 RANDOLPH HOSPITAL INC 1 RANDOLPH CANCER CENTER 373 N FAYETTEVILLE STREET ASHEBORO NC 27203 562181482 HEALTHCARE NC 501(C)(3) LINE 12A, I RANDOLPH HOSPITAL INC 1 RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION 364 WHITE OAK STREET ASHEBORO NC 27204 582240755 SUPPORT ORGANIZATION NC 501(C)(3) LINE 12A, I RANDOLPH HOSPITAL INC 1 STAYWELL SENIOR CARE PO BOX 1048 ASHEBORO NC 27204 461289922 HEALTHCARE NC 501(C)(3) LINE 12A, I RANDOLPH HOSPITAL INC 1 RANDOLPH NEWCO LLC 364 WHITE OAK STREET ASHEBORO NC 27203 471905523 MEDICAL EQUIPMENT RENTAL NC UNRELATED 14337 179662 0 0 0 1 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 RANDOLPH SPECIALTY GROUP K 136000 CASH RANDOLPH SPECIALTY GROUP O 35259 CASH RANDOLPH SPECIALTY GROUP Q 1268544 CASH RANDOLPH SPECIALTY GROUP P 1563103 CASH RANDOLPH SPECIALTY GROUP S 3100000 CASH RANDOLPH CANCER CENTER J 249000 CASH STAYWELL SENIOR CARE L 577000 CASH STAYWELL SENIOR CARE O 33680 CASH STAYWELL SENIOR CARE Q 1097270 CASH