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ROANOKE VALLEY HEALTH SERVICES INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
ROANOKE VALLEY HEALTH SERVICES INC (EIN 56-1925492)
Tax period
2016-10-01 to 2017-09-30
Filed
2018-06-22
IRS object ID
201831739349300953
Schema version
2016v3.0
Note
A later return for the same period supersedes this one.
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 ReturnHeader

FieldValueIRS element (for citing)
Return2018-06-22T14:44:36-05:00ReturnTs
Tax Period End2017-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN560747981PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1Txt
CityASHEVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28806ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN561925492EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ROANOKE VALLEY HEALTH SERVICES INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlROANBusinessNameControlTxt
Phone2525358130PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1Txt
CityROANOKE RAPIDSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27870ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSHERRY JENSENPersonNm
Person TitleCFOPersonTitleTxt
Phone2525358130PhoneNum
Signature2018-06-22SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAmy BibbyPreparerPersonNm
PTINP00445891PTIN
Phone8282542254PhoneNum
Preparation2018-06-06PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSHERRY JENSENPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1Txt
CityROANOKE RAPIDSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27870ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$7,012,890GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.HALIFAXMEDICALCENTER.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1994FormationYr
Legal Domicile StateNCLegalDomicileStateCd
Activity Or MissionOPERATION OF PRIMARY CARE MEDICAL OFFICESActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee68TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$216,658CYContributionsGrantsAmt
PY Program Service Revenue$5,279,467PYProgramServiceRevenueAmt
CY Program Service Revenue$6,750,144CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$95,769PYOtherRevenueAmt
CY Other Revenue$46,088CYOtherRevenueAmt
PY Total Revenue$5,375,236PYTotalRevenueAmt
CY Total Revenue$7,012,890CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,068,155PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,867,241CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,345,556PYOtherExpensesAmt
CY Other Expenses$3,864,487CYOtherExpensesAmt
PY Total Expenses$9,413,711PYTotalExpensesAmt
CY Total Expenses$11,731,728CYTotalExpensesAmt
PY Revenues Less Expenses-$4,038,475PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$4,718,838CYRevenuesLessExpensesAmt
Total Assets BOY$1,465,651TotalAssetsBOYAmt
Total Assets EOY$1,921,677TotalAssetsEOYAmt
Total Liabilities BOY$17,107,863TotalLiabilitiesBOYAmt
Total Liabilities EOY$18,682,727TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$15,642,212NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$16,761,050NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionROANOKE VALLEY HEALTH SERVICES EXISTS TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY BY PROVIDING EXCELLENT AND COMPASSIONATE SERVICES AND ALWAYS PLACING PATIENTS FIRST.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$10,652,671ExpenseAmt
Revenue$6,796,232RevenueAmt
DescROANOKE 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.Desc
Total Program Service Expenses$10,652,671TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee68EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldNCStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SHERRY JENSENBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2525358005PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1Txt
CityROANOKE RAPIDSCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27870ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
William Mahone
President/CEO1.0040.00Yes (X)Yes (X)$0$0$0
Tom Lynch
Chairman1.001.00Yes (X)$0$1,800$0
Fannie Greene
Vice Chairwoman1.001.00Yes (X)$0$1,200$0
Drewery Beale
Treasurer1.001.00Yes (X)$0$1,500$0
Dr Natarajan Rajan
Secretary1.001.00Yes (X)$0$1,150$0
Bob Patterson
Past Chairman1.001.00Yes (X)$0$1,350$0
Dr Joey Thomas
Chief of Staff1.0010.00Yes (X)$0$250$0
Dr Sandeep Tiwari
Past Chief of Staff1.001.00Yes (X)$0$1,800$0
Hugh Bazemore
Board Member1.001.00Yes (X)$0$950$0
James Pierce
Board Member1.001.00Yes (X)$0$650$0
Johnny Draper
Board Member1.001.00Yes (X)$0$500$0
Vernon Bryant
Board Member1.001.00Yes (X)$0$800$0
William Hodge
Board Member1.001.00Yes (X)$0$1,400$0
Evelyn Dawson
Board Member1.00Yes (X)$0$450$0
Rev Randy Martin
Board Member1.00Yes (X)$0$550$0
Sherry Jensen
VP of Finance/CFO1.0040.00Yes (X)$0$279,598$15,487
Hailie Jones
Cardiologist40.00$414,688$0$17,451Yes (X)
Nkechinyere Obiefuna
Hospitalist40.00$379,769$0$13,477Yes (X)
Tochukwu Agbata
Hospitalist40.00$374,967$0$18,810Yes (X)
Michael Anigbogu
Cardiologist40.00$348,426$0$17,331Yes (X)
Hazel Duncan-Guy
Hospitalist40.00$309,095$0$19,818Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,826,945TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$293,948TotReportableCompRltdOrgAmt
Total Other Compensation$102,374TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K11IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Salary & Associates
334 Lumyer RdRockinghamNC28379HOSPITALIST PHYSICIAN$422,926
JO Medicals PC
824 Bentbury WayCaryNC275188809HOSPITALIST PHYSICIAN$383,065
Surafeal Abraha MD
5028 Myrtle Oak DrCaryNC27519HOSPITALIST PHYSICIAN$340,211
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Government Grants$216,658GovernmentGrantsAmt
Total Contributions$216,658TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNET PATIENT SERVICE REDesc
Business621610BusinessCd
Total Revenue Column$6,750,144TotalRevenueColumnAmt
Related Or Exempt Func Income$6,750,144RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$6,750,144TotalProgramServiceRevenueAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOther RevenueDesc
Business900099BusinessCd
Total Revenue Column$46,088TotalRevenueColumnAmt
Related Or Exempt Func Income$46,088RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$46,088OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,012,890TotalRevenueColumnAmt
Related Or Exempt Func Income$6,796,232RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,568,804TotalAmt
Program Services$5,722,000ProgramServicesAmt
Management And General$846,804ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$955,318TotalAmt
Program Services$832,165ProgramServicesAmt
Management And General$123,153ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$343,119TotalAmt
Program Services$298,887ProgramServicesAmt
Management And General$44,232ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$9,974TotalAmt
Management And General$9,974ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$17,800TotalAmt
Management And General$17,800ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,576,626TotalAmt
Program Services$2,576,626ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,494TotalAmt
Program Services$1,494ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$182,374TotalAmt
Program Services$145,280ProgramServicesAmt
Management And General$37,094ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$60,797TotalAmt
Program Services$60,797ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$30,124TotalAmt
Program Services$30,124ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$55,424TotalAmt
Program Services$55,424ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$8,468TotalAmt
Program Services$8,468ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$143,185TotalAmt
Program Services$143,185ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$69,755TotalAmt
Program Services$69,755ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
BAD DEBT EXPENSE$515,277$515,277
MEDICAL SUPPLIES$158,075$158,075
RECRUITMENT AND RELOCAT$25,000$25,000
OTHER EXPENSES$10,114$10,114

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$11,731,728TotalAmt
Program Services$10,652,671ProgramServicesAmt
Management And General$1,079,057ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$173,275BOYAmt
EOY-$87,975EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$399,980BOYAmt
EOY$464,732EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$28,300BOYAmt
EOY$531EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,823,519LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,498,242LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$755,449BOYAmt
EOY$1,325,277EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$108,647BOYAmt
EOY$219,112EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,465,651BOYAmt
EOY$1,921,677EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$92,364BOYAmt
EOY$421,718EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,015,499BOYAmt
EOY$18,261,009EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,107,863BOYAmt
EOY$18,682,727EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$15,645,059BOYAmt
EOY-$16,763,695EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,847BOYAmt
EOY$2,645EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$15,642,212BOYAmt
EOY-$16,761,050EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,465,651BOYAmt
EOY$1,921,677EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$4,718,838ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$3,600,000OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,141,112OtherCostOrOtherBasisAmt
Depreciation$646,509DepreciationAmt
Book Value$494,603BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$222,469OtherCostOrOtherBasisAmt
Depreciation$126,042DepreciationAmt
Book Value$96,427BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,171,871OtherCostOrOtherBasisAmt
Depreciation$663,936DepreciationAmt
Book Value$507,935BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$288,067OtherCostOrOtherBasisAmt
Depreciation$61,755DepreciationAmt
Book Value$226,312BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,325,277TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
OTHER RECEIVABLES$109,607
ESTIMATED THIRD PARTY SETTLEMENTS$109,505
FieldValueIRS element (for citing)
Total Book Value Other Assets$219,112TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO HALIFAX REGIONAL MEDICAL CENTERDesc
Amt$18,261,009Amt
FieldValueIRS element (for citing)
Total Liability$18,261,009TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$10,097,613TotalRevEtcAuditedFinclStmtAmt
Other Revenue$3,600,000OtherRevenueAmt
Revenue Not Reported$3,600,000RevenueNotReportedAmt
Revenue Subtotal$6,497,613RevenueSubtotalAmt
Other Revenues Not Included$515,277OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$515,277RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$7,012,890TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$11,216,451TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$11,216,451ExpensesSubtotalAmt
Other Expenses Not Included$515,277OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$515,277ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$11,731,728TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Sherry Jensen
VP of Finance/CFO$0$231,366$0$48,232$0$0$0$1,639$0$13,848$0$295,085$0$0
Hailie Jones
Cardiologist$409,473$0$5,215$0$0$0$120$0$17,331$0$432,139$0$0$0
Nkechinyere Obiefuna
Hospitalist$370,164$0$9,605$0$0$0$1,708$0$11,769$0$393,246$0$0$0
Tochukwu Agbata
Hospitalist$362,722$0$12,245$0$0$0$1,479$0$17,331$0$393,777$0$0$0
Michael Anigbogu
Cardiologist$348,211$0$215$0$0$0$0$0$17,331$0$365,757$0$0$0
Hazel Duncan-Guy
Hospitalist$297,375$0$11,720$0$0$0$1,818$0$18,000$0$328,913$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 3FormAndLineReferenceDesc
ExplanationINDEPENDENT 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 COMMITTEEExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 3THE 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 11bTHE 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 12cTHE 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 15An 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 18PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
Form 990, Part VI, Section C, line 19PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
Form 990, Part IX, line 11gPHYSICIAN 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
HALIFAX REGIONAL MEDICAL CENTER
250 SMITH CHURCH ROADROANOKE RAPIDSNC27870560989789HEALTHCARENC501(c)(3)Line 3N/A0
HALIFAX REGIONAL MEDICAL CENTER FOUNDATION
250 SMITH CHURCH ROADROANOKE RAPIDSNC27870561698825FUNDRAISING/OPERATIONAL SUPPORTNC501(c)(3)Line 70HALIFAX REGIONAL MEDICAL CENTER
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd