2016-11-14T07:57:50-06:00 2015-12-31 560570567 D M J & CO PLLC 703 GREEN VALLEY ROAD SUITE 201 GREENSBORO NC 27408 990 2015-01-01 561376378 HOSPICE OF RANDOLPH COUNTY INC HOSP 3366729300 416 VISION DRIVE ASHEBORO NC 27203 RHONDA BURCH MOFFITT CEO/PRESIDENT 3366729300 2016-11-11 1 ERIC DUTTON CPA P01218304 3362759886 2015 2017-02-10 21:41:12Z RHONDA BURCH MOFFITT 416 VISION DRIVE ASHEBORO NC 27203 7755745 0 X WWW.HOSPICEOFRANDOLPH.ORG X 1981 NC MISSION: HOSPICE OF RANDOLPH COUNTY SERVES AS AN EDUCATION LEADER WHILE PROMOTING QUALITY OF LIFE AND SUPPORTING PATIENTS AND THEIR FAMILIES IN PREPARING FOR COMPLETION OF LIFE. ACTIVITIES: TO PROVIDE SUPPORT AND EMOTIONAL ASSISTANCE TO PATIENTS AND THEIR FAMILIES WITH PAIN MANAGEMENT, SYMPTOM CONTROL, AND REHABILITATION DURING EMOTIONAL CRISIS RELATED TO END-OF-LIFE CARE. SPECIAL THERAPIES, ACUTE CARE, CONTINUOUS CARE, AND RESPITE AND ROUTINE HOME CARE ARE REIMBURSED BY REVENUE RESOURCES ALONG WITH SOME SUPPLIES, DURABLE MEDICAL EQUIPMENT, AND DRUGS. SERVICES ARE DELIVERED UNDER A HOLISTIC PLAN OF CARE. 15 13 122 70 0 0 248735 110449 6504556 7492726 3548 4423 105211 119026 6862050 7726624 0 0 0 0 4718629 4762957 0 0 65884 2133835 2228714 6852464 6991671 9586 734953 8586450 9264707 1637675 1581292 6948775 7683415 HOSPICE OF RANDOLPH COUNTY SERVES AS AN EDUCATIONAL LEADER WHILE PROMOTING QUALITY OF LIFE AND SUPPORTING PATIENTS AND THEIR FAMILIES IN PREPARING FOR COMPLETION OF LIFE. 0 0 4755840 7493920 PROVIDE SUPPORT AND EMOTIONAL ASSISTANCE TO PATIENTS AND THEIR FAMILIES WITH PAIN MANAGEMENT, SYMPTOM CONTROL, REHABILITATION AND EMOTIONAL CRISIS. SPECIAL THERAPIES, ACUTE CARE, CONTINUOUS CARE, RESPITE AND ROUTINE HOME CARE ARE REIMBURSED BY THE ABOVE REVENUE RESOURCES ALONG WITH SOME SUPPLIES, DURABLE MEDICAL EQUIPMENT, AND DRUGS. SERVICES ARE DELIVERED UNDER A HOLISTIC PLAN OF CARE. DURING 2015, HOSPICE OF RANDOLPH COUNTY PROVIDED 54,719 DAYS OF PATIENT CARE FOR ITS 838 HOSPICE, HOME HEALTH, AND KIDS PATH PATIENTS. 4755840 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 34 0 122 1 0 0 0 0 0 0 0 0 0 0 X 15 13 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X X CAREY DURHAM 3366729300 416 VISION DRIVE ASHEBORO NC 27203 SANDRA J ALLEN DIRECTOR 1.00 X 0 0 0 MARK HENSLEY DIRECTOR 1.00 X 0 0 0 NEAL GRIFFIN III DIRECTOR 1.00 X 0 0 0 MARK STRIDER DIRECTOR 1.00 X 0 0 0 DR MALKIAT DHATT DIRECTOR 1.00 X 0 0 0 STEVE EBLIN DIRECTOR 1.00 X 0 0 0 GLENN M PUGH DIRECTOR 1.00 X 0 0 0 ROXANNE TAYLOR DIRECTOR 1.00 X 0 0 0 CURT LORIMER DIRECTOR 1.00 X 0 0 0 BEN C MORGAN DIRECTOR 1.00 X 0 0 0 RHONDA TROLLINGER DIRECTOR 1.00 X 0 0 0 RHONDA BURCH MOFFITT CEO/PRESIDENT 40.00 X 136662 0 12956 CAREY M DURHAM CFO 40.00 X 88620 0 12248 JOHN S ROGERS SECRETARY 1.00 X 0 0 0 STUART FOUNTAIN TREASURER 1.00 X 0 0 0 CHRISTINE MCCARTY MD BOARD CHAIR 1.00 X 11850 0 0 SCOTT A MURKIN MD MEDICAL DIRECTOR 40.00 X 191688 0 22999 428820 0 48203 2 0 1 0 ENCLARA PHARMACIA 1601 CHERRY ST SUITE 1700 PHILADELPHIA PA 19102 PATIENT MEDICATIONS 546572 ADVANCED HOMECARE PO BOX 18049 GREENSBORO NC 27419 MEDICAL SUPPLIES 275878 WOODLAND HILL CARE AND REHAB 400 VISION DR ASHEBORO NC 27203 PATIENT CARE FACILITY 165388 UNIVERSAL HEALTHCARE 7166 JORDAN ROAD RAMSEUR NC 27316 PATIENT CARE FACILITY 116591 HOLLADAY SURGICAL SUPPLY 2551 LANDMARK DR WINSTONSALEM NC 27103 MEDICAL SUPPLIES 113466 6 7989 102460 110449 MEDICARE PAYMENTS 621610 6860135 6860135 MEDICAID PAYMENTS 621610 340969 340969 PRIVATE INSURANCE 621610 291622 291622 7492726 4423 4423 146954 29121 117833 117833 1193 1193 1193 7726624 7493919 0 122256 477024 477024 3537867 2868678 614543 54646 66564 56988 8490 1086 403383 301776 95797 5810 278119 189402 84375 4342 25262 25262 72729 72729 167848 154991 12857 65365 65365 251278 251278 35941 35941 MEDICINES AND DRUGS 515529 515529 DURABLE MEDICAL EQUIPME 273394 273394 MEDICAL AND OFFICE SUPP 154356 125009 29347 UTILITIES 75484 75484 591528 270073 321455 6991671 4755840 2169947 65884 1054068 1749960 1678899 1689236 1923 0 947096 1061101 94055 88493 7068923 2574530 4628885 4494393 181524 181524 8586450 9264707 505679 583256 1131996 998036 1637675 1581292 X 6948775 7683415 6948775 7683415 8586450 9264707 734953 -313 0 X X 0 1 X 1 0 X 111169 140949 119678 248735 110449 730980 111169 140949 119678 248735 110449 730980 138623 592357 11797 7245 23553 3398 4109 50102 781082 32717837 0.75840 0.79790 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 42964 X 0 500797 500797 5205928 1487506 3718422 1362198 1087024 275174 4494393 X 7755432 -313 29121 28808 7726624 0 7726624 7020792 29121 29121 6991671 0 6991671 PART III, LINE 4: THE ORGANIZATION HAS VARIOUS WORKS OF ART LOCATED AT ITS TWO LOCATIONS ON VISION DRIVE. THE ADMINISTRATIVE BUILDING HOUSES A FRAMED INK PRINT DONATED TO THE ORGANIZATION, AND ITS VALUE IS STATED AT $22,000 (WHICH WAS THE FAIR MARKET VALUE AT THE TIME OF THE DONATION). IN ADDITION, THE NEW INPATIENT FACILITY HOUSES SUCH PURCHASED WORKS OF ART AS FRAMED ORIGINAL PAINTINGS AND PHOTOGRAPHY, LARGE DECORATIVE POTTERY PIECES, MOUNTED MUSEUM-QUALITY HOMEMADE QUILTS, A METAL SCULPTURE, AND AN ORIGINAL HAND-PAINTED WALL MURAL. IN THE AGGREGATE, THESE PARTICULAR ITEMS ARE STATED AT THE $20,964 PRICE PAID BASED ON ARMS-LENGTH TRANSACTIONS. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, HAS NO PROVISION FOR INCOME TAXES. THE ORGANIZATION ACCOUNTS FOR UNCERTAIN INCOME TAX POSITIONS BY PRESCRIBING A MINIMUM PROBABILITY THRESHOLD A TAX POSITION MUST MEET BEFORE A FINANCIAL STATEMENT INCOME TAX BENEFIT IS RECOGNIZED. THE MINIMUM THRESHOLD IS DEFINED AS A TAX POSITION, BASED SOLELY ON ITS TECHNICAL MERITS, THAT WOULD MORE LIKELY THAN NOT BE SUSTAINED UPON EXAMINATION BY THE RELEVANT TAX AUTHORITY WITH KNOWLEDGE OF THE SAME FACTS. THE TAX BENEFIT TO BE RECOGNIZED IS MEASURED AS THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED UPON ULTIMATE RESOLUTION. BASED ON ALL KNOWN FACTS AND CIRCUMSTANCES AND CURRENT TAX LAW, THE ORGANIZATION BELIEVES THE TOTAL AMOUNT OF UNCERTAIN INCOME TAX POSITION LIABILITIES AND RELATED ACCRUED INTEREST ARE NOT MATERIAL TO ITS FINANCIAL POSITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED WITH REVENUE ON TAX RETURN 29,121. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES NETTED WITH REVENUE ON TAX RETURN 29,121. ANNUAL AUCTION BBQ 60334 60334 8318 HUMAN RACE 15868 15868 2 48615 48615 11832 124817 124817 20150 20150 104667 X X X 0 0 0 0 0 0 0 0 0 SCOTT A MURKIN MD MEDICAL DIRECTOR 191688 0 0 0 0 0 0 0 22999 0 214687 0 0 0 PART I, LINE 3 CEO/DIRECTOR COMPENSATION IS REVIEWED AND APPROVED ANNUALLY BY THE ASSESSMENT COMMITTEE WHICH CONSISTS OF THREE BOARD MEMBERS APPOINTED BY THE BOARD CHAIR. FOR DETERMINATION OF THESE EMPLOYEES' COMPENSATION AMOUNTS, HRC REFERS TO THE HOSPICE & HOME HEALTH SALARY & BENEFITS REPORT THAT IS PUBLISHED EVERY TWO YEARS BY THE HOSPITAL & HEALTHCARE COMPENSATION SERVICE (IN COOPERATION WITH THE NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE). IN ADDITION, A REVIEW IS MADE OF BENCHMARKING DATA FROM MULTI-VIEW INC.'S HOSPICE COMPENSATION SURVEY AS WELL AS COMPARABLE SALARIES ON PUBLICLY-ACCESSIBLE FORM 990S SUBMITTED BY HOSPICES OF OUR SIMILAR SIZE AND SCOPE. RANDOLPH HOSPITAL BOARD MEMBER STEVEN E. EBLIN IS THE CEO OF RANDOLPH HOSPITAL 50507 HOSPICE OF RANDOLPH COUNTY PAID RANDOLPH HOSPITAL FOR INPATIENT ACUTE AND RESPITE CARE FOR HOSPICE PATIENTS. 0 FORM 990, PART VI, SECTION A, LINE 2 SEVERAL OF THE BOARD MEMBERS DO BUSINESS WITH HOSPICE OF RANDOLPH COUNTY AND WITH EACH OTHER. FOR EXAMPLE, THERE IS ONE DOCTOR ON THE BOARD WHO MAY REFER HER PATIENTS FOR HOSPICE CARE WHEN APPROPRIATE. BOARD MEMBERS ARE PROHIBITED FROM VOTING ON ANY ISSUES WHERE A POTENTIAL CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 11 BOARD MEMBERS REVIEW A DRAFT FORM OF THE 990 PRIOR TO FILING. THE REVIEW EITHER OCCURS DURING A BOARD MEETING OR THE RETURN IS SENT TO THE BOARD MEMBERS INDIVIDUALLY. FILING DOES NOT OCCUR UNTIL ALL BOARD MEMBERS HAVE INDICATED THEIR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C INDIVIDUALS IN CERTAIN SENSITIVE POSITIONS WHO MAKE SUBSTANTIAL AND FREQUENT DECISIONS AFFECTING THE INTERESTS OF HRC ARE REQUIRED TO COMPLETE AND SIGN AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM. THE FORMS ARE DISTRIBUTED AND COLLECTED BY THE CORPORATE COMPLIANCE OFFICER (CCO). THE CCO REVIEWS WITH THE CEO/PRESIDENT ANY DISCLOSED CONFLICTS TO DETERMINE WHETHER DISQUALIFICATION FROM CERTAIN DECISIONS IS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 15 CEO/DIRECTOR COMPENSATION IS REVIEWED AND APPROVED ANNUALLY BY THE ASSESSMENT COMMITTEE WHICH CONSISTS OF THREE BOARD MEMBERS APPOINTED BY THE BOARD CHAIR. FOR DETERMINATION OF THESE EMPLOYEES' COMPENSATION AMOUNTS, HRC REFERS TO THE HOSPICE & HOME HEALTH SALARY & BENEFITS REPORT THAT IS PUBLISHED EVERY TWO YEARS BY THE HOSPITAL & HEALTHCARE COMPENSATION SERVICE (IN COOPERATION WITH THE NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE). IN ADDITION, A REVIEW IS MADE OF BENCHMARKING DATA FROM MULTI-VIEW INC.'S HOSPICE COMPENSATION SURVEY AS WELL AS COMPARABLE SALARIES ON PUBLICLY-ACCESSIBLE FORM 990S SUBMITTED BY HOSPICES OF OUR SIMILAR SIZE AND SCOPE. FORM 990, PART VI, SECTION C, LINE 19 CFO HAS A COPY OF THE AGENCY'S 990 TAX RETURN, COPY OF AUDITED FINANCIAL STATEMENTS, COPY OF CONFLICT OF INTEREST POLICY AT THE AGENCY'S OFFICE FOR ANYONE TO REVIEW PLUS THE 990 TAX RETURN CAN BE ACCESSED VIA GUIDESTAR AND THE FEDERAL GOVERNMENT'S WEBSITE. FORM 990, PART XII, LINE 2C: THE PROCESS FOR REVIEWING THE AUDIT AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED.