2018-11-15T13:01:55-06:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-10-01 561925492 ROANOKE VALLEY HEALTH SERVICES INC ROAN 2525358130 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 SHERRY JENSEN CFO 2525358130 2018-11-14 1 Amy Bibby P00445891 8282542254 2018-11-14 12.25.12.224 2018-11-14 13:26:17 ES 13071720181730341e02 2018-06-22 P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D80274681E9CC1823A2CB70D0FAA557DD4368EAD 2016 2019-02-21 02:37:17Z X SHERRY JENSEN 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 7012890 0 X WWW.HALIFAXMEDICALCENTER.ORG X 1994 NC OPERATION OF PRIMARY AND SPECIALTY CARE MEDICAL OFFICES 2 0 68 0 0 0 0 216658 5279467 6750144 0 0 95769 46088 5375236 7012890 0 0 0 0 6068155 7867241 0 0 0 3345556 3864487 9413711 11731728 -4038475 -4718838 1465651 1921677 17107863 18682727 -15642212 -16761050 X ROANOKE VALLEY HEALTH SERVICES EXISTS TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY BY PROVIDING EXCELLENT AND COMPASSIONATE SERVICES AND ALWAYS PLACING PATIENTS FIRST. 0 0 10652671 6796232 ROANOKE VALLEY HEALTH SERVICES, INC. OPERATES NON-PROFIT PRIMARY CARE MEDICAL OFFICES. THE ORGANIZATION WORKS IN CLOSE TIES WITH HALIFAX REGIONAL MEDICAL CENTER, AND SHARES IN ITS GOALS AND ACHIEVEMENTS THROUGH A CONSTANT PARTNERSHIP OF FULFILLING THE HOSPITAL'S EXEMPT PURPOSE--PROVIDING EXCELLENT HEALTHCARE SERVICE TO THE COMMUNITY. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF THE PROGRAM SERVICE ACCOMPLISHMENTS.IN THE CURRENT TAX YEAR, THE ORGANIZATION REACHED THE FOLLOWING MILESTONES:- Recruited 3 providers: 1 Pulmonologist, 1 General Surgeon, and 1 Hospitalist- Began operating Roanoke Valley surgical Associates, formerly owned by Dr Fred Wier, and installed Athena Health practice management software and recruited Dr Jacqueline Thompson to this practice to replace Dr Rao following his retirement.- Opened Halifax Pulmonology Clinic with Dr Todd Duggan on the Medical Center campus and converted practice management software to Athena Health.- Provided free annual breast cancer screening at Roanoke Clinics in conjunction with Roanoke Valley Breast Cancer Coalition (RVBCC).- Installed Athena Health Clinic practice management system for scheduling, billing, EMR best capable of capturing and reporting data for quality, compliance, and regulatory programs.- The Hospital based clinic achieved certification by Medicare and Blue Cross as a Patient Centered Medical Home to create effective primary care relationships with patients.- Planned and implemented new cosmetic service line with Dr Rupe at Roanoke Clinic.- Implemented Medicare Million Hearts Cardiovascular Diseases and Risk Reduction Model to improve cardiac health in patients with 1 of 11 Medicare grants in the US.- Applied and received the Health Resources & Services Administration (HRSA) Grant for $200,000. 10652671 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 68 1 0 0 0 0 0 0 0 0 0 0 X 2 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NC X SHERRY JENSEN 2525358005 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 William Mahone President/CEO 1.00 40.00 X X 0 0 0 Sherry Jensen VP of Finance/CFO 1.00 40.00 X X 0 279598 15487 0 279598 15487 11 0 1 0 Salary & Associates 334 Lumyer Rd Rockingham NC 28379 HOSPITALIST PHYSICIAN 422926 JO Medicals PC 824 Bentbury Way Cary NC 275188809 HOSPITALIST PHYSICIAN 383065 Surafeal Abraha MD 5028 Myrtle Oak Dr Cary NC 27519 HOSPITALIST PHYSICIAN 340211 3 216658 216658 NET PATIENT SERVICE RE 621610 6750144 6750144 6750144 Other Revenue 900099 46088 46088 46088 7012890 6796232 0 0 X 6568804 5722000 846804 955318 832165 123153 343119 298887 44232 9974 9974 17800 17800 2576626 2576626 1494 1494 182374 145280 37094 60797 60797 30124 30124 55424 55424 8468 8468 143185 143185 69755 69755 BAD DEBT EXPENSE 515277 515277 MEDICAL SUPPLIES 158075 158075 RECRUITMENT AND RELOCAT 25000 25000 OTHER EXPENSES 10114 10114 11731728 10652671 1079057 0 173275 -87975 399980 464732 28300 531 2823519 1498242 755449 1325277 108647 219112 1465651 1921677 92364 421718 17015499 18261009 17107863 18682727 X -15645059 -16763695 2847 2645 -15642212 -16761050 1465651 1921677 X -4718838 3600000 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1141112 646509 494603 222469 126042 96427 1171871 663936 507935 288067 61755 226312 1325277 OTHER RECEIVABLES 109607 ESTIMATED THIRD PARTY SETTLEMENTS 109505 219112 DUE TO HALIFAX REGIONAL MEDICAL CENTER 18261009 18261009 X 10097613 3600000 3600000 6497613 515277 515277 7012890 11216451 0 11216451 515277 515277 11731728 Part X, Line 2: THE MEDICAL CENTER IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE MEDICAL CENTER HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2017. Part XI, Line 2d - Other Adjustments: TRANSFER OF EQUITY FROM AFFILIATE 3,600,000. Part XI, Line 4b - Other Adjustments: BAD DEBT EXPENSE NET W/ REVENUES 515,277. Part XII, Line 4b - Other Adjustments: BAD DEBT EXPENSE NET W/ REVENUES 515,277. X X X X 0 0 0 0 0 0 0 0 0 Sherry Jensen VP of Finance/CFO 0 231366 0 48232 0 0 0 1639 0 13848 0 295085 0 0 Part I, Line 3 INDEPENDENT REVIEW OF COMPENSATION: THE ORGANIZATION DOES NOT DIRECTLY COMPENSATE ANY OFFICER OR KEY EMPLOYEE. SOME OFFICERS AND BOARD MEMBERS OF THE ORGANIZATION ARE EMPLOYEES OF HALIFAX REGIONAL MEDICAL CENTER, INC., A RELATED ORGANIZATION. THE BOARD OF DIRECTORS OF THAT ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION AMOUNTS FOR ITS CEO AND OTHER KEY PERSONNEL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANTS - WRITTEN EMPLOYEMENT CONTRACTS - COMPENSATION STUDY OR SURVEY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE Header: REASON FOR AMENDMENT THE RETURN HAS BEEN AMENDED TO UPDATE PART VI AND PART VII OF THE RETURN TO ALIGN WITH THE ORGANIZATION'S GOVERNING DOCUMENTS. Form 990, Part VI, Section A, line 3 THE ORGANIZATION SHARES ITS MANAGEMENT OVERSIGHT WITH HALIFAX REGIONAL MEDICAL CENTER (HRMC), THE PARENT ORGANIZATION. DURING MARCH OF 2014 THE HOSPITAL SYSTEM ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH NOVANT HEALTH INC. THAT CONTINUES THROUGH FEBRUARY 2017. 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 HRMC PROVIDES REIMBURSEMENT FOR THOSE COSTS. DURING THE YEAR, NOVANT PAID COMPENSATION OF $486,665 TO THE ORGANIZATION'S CEO. 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 ORGANIZATION 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 THE ORGANIZATION FOLLOWS THE SAME CONFLICT OF INTEREST POLICY AS ITS AFFILIATE, HALIFAX REGIONAL MEDICAL CENTER. THE POLICY IS REVIEWED ANNUALLY, AND BOARD MEMBERS AND MANAGEMENT ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE EVERY 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 VPs. The CEO approves the VP Salaries. Novant determines the compensation for the CEO. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON WRITTEN 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 WRITEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. Part VI LN 1: BOARD INDEPENDENCE THE ORGANIZATION'S BOARD OF DIRECTORS CONSISTS OF TOP MANAGEMENT OFFICIALS OF HALIFAX REGIONAL MEDICAL CENTER, INC A RELATED ORGANIZATION. THESE INDIVIDUALS ARE OVERSEEN AND GOVERNED BY THE MEDICAL CENTER'S INDEPENDENT BOARD OF DIRECTORS. Form 990, Part IX, line 11g PHYSICIAN FEES: Program service expenses 2,066,739. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,066,739. CONTRACT SERVICES: Program service expenses 21,351. Management and general expenses 0. Fundraising expenses 0. Total expenses 21,351. PURCHASED SERVICES: Program service expenses 485,966. Management and general expenses 0. Fundraising expenses 0. Total expenses 485,966. COLLECTION FEES: Program service expenses 2,570. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,570. Form 990, Part XI, line 9: TRANSFER OF EQUITY FROM AFFILIATE 3,600,000. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HALIFAX REGIONAL MEDICAL CENTER 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 560989789 HEALTHCARE NC 501(c)(3) Line 3 N/A 0 HALIFAX REGIONAL MEDICAL CENTER FOUNDATION 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 561698825 FUNDRAISING/OPERATIONAL SUPPORT NC 501(c)(3) Line 7 HALIFAX REGIONAL MEDICAL CENTER 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1