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ROANOKE VALLEY HEALTH SERVICES INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
ROANOKE VALLEY HEALTH SERVICES INC (EIN 56-1925492)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-04-28
IRS object ID
201501189349300515
Schema version
2013v4.0
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)
Return2015-04-28T10:09:58-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN560747981PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN561925492EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1ROANOKE VALLEY HEALTH SERVICES INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlROANBusinessNameControlTxt
Phone2525358130PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1
CityROANOKE RAPIDSCity
StateNCState
ZIP Code27870ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSHERRY JENSENPersonNm
Person TitleCFOPersonTitleTxt
Phone2525358130PhoneNum
Signature2015-04-24SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAMY BIBBYPreparerPersonNm
PTINP00445891PTIN
Phone8282542254PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSHERRY JENSENPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1
CityROANOKE RAPIDSCity
StateNCState
ZIP Code27870ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$4,785,256GrossReceiptsAmt
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 Body14VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee51TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,935PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$5,124,483PYProgramServiceRevenueAmt
CY Program Service Revenue$4,679,092CYProgramServiceRevenueAmt
PY Investment Income-$1,777PYInvestmentIncomeAmt
CY Investment Income$12CYInvestmentIncomeAmt
PY Other Revenue$212,015PYOtherRevenueAmt
CY Other Revenue$106,152CYOtherRevenueAmt
PY Total Revenue$5,336,656PYTotalRevenueAmt
CY Total Revenue$4,785,256CYTotalRevenueAmt
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$4,851,992PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$5,186,665CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,569,230PYOtherExpensesAmt
CY Other Expenses$2,967,743CYOtherExpensesAmt
PY Total Expenses$8,421,222PYTotalExpensesAmt
CY Total Expenses$8,154,408CYTotalExpensesAmt
PY Revenues Less Expenses-$3,084,566PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$3,369,152CYRevenuesLessExpensesAmt
Total Assets BOY$1,930,373TotalAssetsBOYAmt
Total Assets EOY$1,592,304TotalAssetsEOYAmt
Total Liabilities BOY$16,008,095TotalLiabilitiesBOYAmt
Total Liabilities EOY$16,862,513TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$14,077,722NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$15,270,209NetAssetsOrFundBalancesEOYAmt
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$7,375,596ExpenseAmt
Revenue$4,679,092RevenueAmt
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 HOSPITALIST PHYSICIAN- RECEIVED HIGH-TECH STIMULUS FUNDS OF $1.6 MILLION FOR ROANOKE CLINIC AND $42,500 FOR OUR INTERNAL MEDICINE CLINIC- IMPLEMENTED THE FOLLOW-MY-HEALTH CLINICAL PATIENT INFORMATION PORTAL ALLOWING FOR ONLINE ACCESS TO PATIENTS' PERSONAL HEALTH RECORDS 24/7 SECURELY AND SAFELYDesc
Total Program Service Expenses$7,375,596TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
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
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee51EmployeeCnt
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 Members14GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
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 JENSENBusinessNameLine1
FieldValueIRS element (for citing)
Phone2525358005PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1250 SMITH CHURCH ROADAddressLine1
CityROANOKE RAPIDSCity
StateNCState
ZIP Code27870ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
BOB PATTERSON
CHAIRMAN1.001.00Yes (X)Yes (X)$0$2,150$0
TOM LYNCH
VICE CHAIR1.001.00Yes (X)Yes (X)$0$1,350$0
FANNIE GREEN
TREASURER1.001.00Yes (X)Yes (X)$0$1,450$0
DREWERY BEALE
SECRETARY1.001.00Yes (X)Yes (X)$0$1,400$0
VERNON BRYANT
PAST CHAIR1.001.00Yes (X)$0$1,700$0
DR SOMASEKHARA BALLA
CHIEF OF STAFF1.001.00Yes (X)$0$1,250$0
DR NATARAJAN RAJAN
PAST CHIEF OF STAFF1.001.00Yes (X)$0$1,000$0
HUGH BAZEMORE
BOARD MEMBER1.001.00Yes (X)$0$1,750$0
EVELYN DAWSON
BOARD MEMBER1.001.00Yes (X)$0$750$0
JOHNNY DRAPER
BOARD MEMBER1.001.00Yes (X)$0$750$0
WILLIAM HODGE
BOARD MEMBER1.001.00Yes (X)$0$1,750$0
REV RANDY MARTIN
BOARD MEMBER1.001.00Yes (X)$0$900$0
JAMES PIERCE
BOARD MEMBER1.001.00Yes (X)$0$700$0
WILL MAHONE
PRESIDENT/CEO1.0040.00Yes (X)Yes (X)$0$318,961$37,886
SHERRY JENSEN
VP FINANCE/CFO1.0040.00Yes (X)$0$220,520$14,105
TOCHUKWU AGBATA
PHYSICIAN60.00$388,833$0$16,610Yes (X)
ABRAHAN CHAPARRO
PHYSICIAN40.00$209,052$0$15,506Yes (X)
COURAGE EMOKPAE
PHYSICIAN40.00$266,728$0$14,956Yes (X)
CHINEDU ONUORAH
PHYSICIAN60.00$446,904$0$16,645Yes (X)
NKECHINYERE OBIEFUNA
PHYSICIAN60.00$395,998$0$10,667Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,707,515TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$556,381TotReportableCompRltdOrgAmt
Total Other Compensation$126,375TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K11IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1INTERIM PHYSICIANS LLCBusinessNameLine1

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line112140 WOODCRESTAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63141ZIPCode
FieldValueIRS element (for citing)
ServicesPHYSICIAN SERVICESServicesDesc
Compensation$402,956CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNET PATIENT SERVICE REDesc
Business621610BusinessCd
Total Revenue Column$4,679,092TotalRevenueColumnAmt
Related Or Exempt Func Income$4,679,092RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$4,679,092TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$12TotalRevenueColumnAmt
Exclusion$12ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business900099BusinessCd
Total Revenue Column$106,152TotalRevenueColumnAmt
Exclusion$106,152ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$106,152OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,785,256TotalRevenueColumnAmt
Related Or Exempt Func Income$4,679,092RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$106,164ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$4,265,932TotalAmt
Program Services$3,718,819ProgramServicesAmt
Management And General$547,113ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$685,968TotalAmt
Program Services$597,991ProgramServicesAmt
Management And General$87,977ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$234,765TotalAmt
Program Services$204,656ProgramServicesAmt
Management And General$30,109ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$4,121TotalAmt
Management And General$4,121ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$31,940TotalAmt
Management And General$31,940ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$16,800TotalAmt
Management And General$16,800ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,804,006TotalAmt
Program Services$1,804,006ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$3,009TotalAmt
Program Services$3,009ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$152,459TotalAmt
Program Services$121,168ProgramServicesAmt
Management And General$31,291ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$47,747TotalAmt
Program Services$47,747ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$31,175TotalAmt
Program Services$31,175ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$45,070TotalAmt
Program Services$45,070ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$270,043TotalAmt
Program Services$270,043ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$54,260TotalAmt
Program Services$54,260ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$386,718$386,718
MEDICAL SUPPLIES$90,934$90,934
RECRUITMENT AND RELOCAT$28,954$28,954
OTHER EXPENSES$507$507

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$8,154,408TotalAmt
Program Services$7,375,596ProgramServicesAmt
Management And General$778,812ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$159,151BOYAmt
EOY$197,808EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$471,302BOYAmt
EOY$286,641EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$22,389BOYAmt
EOY$14,198EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$2,401,221LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,415,566LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,217,595BOYAmt
EOY$985,655EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$59,936BOYAmt
EOY$108,002EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,930,373BOYAmt
EOY$1,592,304EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$74,019BOYAmt
EOY$104,030EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,934,076BOYAmt
EOY$16,758,483EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,008,095BOYAmt
EOY$16,862,513EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$14,083,254BOYAmt
EOY-$15,274,406EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,532BOYAmt
EOY$4,197EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$14,077,722BOYAmt
EOY-$15,270,209EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,930,373BOYAmt
EOY$1,592,304EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$3,369,152ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$2,176,665OtherChangesInNetAssetsAmt
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 D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,064,922OtherCostOrOtherBasisAmt
Depreciation$627,792DepreciationAmt
Book Value$437,130BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$111,741OtherCostOrOtherBasisAmt
Depreciation$65,873DepreciationAmt
Book Value$45,868BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,224,558OtherCostOrOtherBasisAmt
Depreciation$721,901DepreciationAmt
Book Value$502,657BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$985,655TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
OTHER RECEIVABLES$69,509
ESTIMATED THIRD PARTY SETTLEMENTS$38,493
FieldValueIRS element (for citing)
Total Book Value Other Assets$108,002TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO HALIFAX REGIONAL MEDICAL CENTERDesc
Amt$16,758,483Amt
FieldValueIRS element (for citing)
Total Liability$16,758,483TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$6,575,203TotalRevEtcAuditedFinclStmtAmt
Other Revenue$2,178,000OtherRevenueAmt
Revenue Not Reported$2,178,000RevenueNotReportedAmt
Revenue Subtotal$4,397,203RevenueSubtotalAmt
Other Revenues Not Included$388,053OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$388,053RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$4,785,256TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$7,767,690TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$7,767,690ExpensesSubtotalAmt
Other Expenses Not Included$386,718OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$386,718ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$8,154,408TotalExpensesPerForm990Amt

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, 2014 AND 2013. THE MEDICAL CENTER BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2011.
PART XI, LINE 2D - OTHER ADJUSTMENTS:TRANSFER OF EQUITY FROM AFFILIATE 2,178,000.
PART XI, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE NET W/ REVENUES 386,718. NET ASSETS RELEASED FROM RESTRICTION 1,335.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE NET W/ REVENUES 386,718.

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 (7 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
WILL MAHONE
PRESIDENT/CEO$0$295,212$0$0$0$23,749$0$18,839$0$19,047$0$356,847$0$0
SHERRY JENSEN
VP FINANCE/CFO$0$218,520$0$2,000$0$0$0$2,513$0$11,592$0$234,625$0$0
TOCHUKWU AGBATA
PHYSICIAN$378,333$0$10,500$0$0$0$3,039$0$13,571$0$405,443$0$0$0
ABRAHAN CHAPARRO
PHYSICIAN$204,756$0$4,296$0$0$0$2,229$0$13,277$0$224,558$0$0$0
COURAGE EMOKPAE
PHYSICIAN$260,728$0$6,000$0$0$0$3,278$0$11,678$0$281,684$0$0$0
CHINEDU ONUORAH
PHYSICIAN$436,404$0$10,500$0$0$0$3,074$0$13,571$0$463,549$0$0$0
NKECHINYERE OBIEFUNA
PHYSICIAN$385,498$0$10,500$0$0$0$0$0$10,667$0$406,665$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 DELEGATED MANAGEMENT DUTIES THROUGH NOVANT SHARED SERVICES UNDER A 3 YEAR CONTRACT BEGINNING IN MARCH OF 2014.
FORM 990, PART VI, SECTION A, LINE 7APRIOR TO THE ANNUAL MEETING, MEMBERS OF THE BOARD OF DIRECTORS SHALL BE SELECTED BY THE CURRENT BOARD AND RECOMMENDED TO THE BOARD OF DIRECTORS OF HALIFAX REGIONAL MEDICAL CENTER, A RELATED 501(C)(3) HEALTHCARE ORGANIZATION, FOR APPROVAL.
FORM 990, PART VI, SECTION B, LINE 11THE 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 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 1,675,435. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,675,435. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 4,778. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,778. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 120,969. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,969. COLLECTION FEES: PROGRAM SERVICE EXPENSES 2,824. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,824.
FORM 990, PART XI, LINE 9:TRANSFER OF EQUITY FROM AFFILIATE 2,178,000. NET ASSETS RELEASED FROM RESTRICTION -1,335.
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/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
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 OrgYes (1)RentalOfFcltsFromOthOrgInd
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