2014-05-11T17:57:52-05:00 2013-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-10-01 561925492 ROANOKE VALLEY HEALTH SERVICES INC ROAN 2525358011 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 SHERRY JENSEN 2525358011 2014-05-11 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z SHERRY JENSEN 250 SMITH CHURCH ROAD ROANOKE RAPIDS NC 27870 5338462 0 X WWW.HALIFAXMEDICALCENTER.ORG X 1994 NC OPERATION OF PRIMARY CARE MEDICAL OFFICES 14 12 55 0 0 0 14707 1935 4810821 5124483 3156 -1777 291983 212015 5120667 5336656 0 0 0 0 5808011 4851992 0 0 0 2027652 3569230 7835663 8421222 -2714996 -3084566 2403602 1930373 15572838 16008095 -13169236 -14077722 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 1 7634350 5124483 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:-IMPLEMENTED THE ALLSCRIPTS PRACTICE MANAGEMENT SYSTEM IN ALL MEDICAL CENTER BASED CLINICS.-IMPLEMENTED EXERCISE STRESS TESTING AND EKG READINGS AT THE MEDICAL CENTER'S CARDIOLOGY CLINIC.-WORKED WITH THE ROANOKE VALLEY BREAST CANCER COALITION TO OFFER THE ANNUAL FREE BREAST CANCER SCREENING CLINIC HELD AT THE ROANOKE CLINIC.-ACHIEVED FEDERAL COMPLIANCE WITH THE MEANINGFUL USE PRACTICE REQUIREMENTS. -CONTINUED THE EXPANSION OF HOSPITALIST SERVICES BY RECRUITING TWO NEW HOSPITALISTS. THE EXPANSION EFFORTS WERE MADE TO MAINTAIN THE GOAL OF COVERING 90% OF ALL MEDICAL INPATIENTS, ALLOWING MORE OPENINGS FOR THE HALIFAX MEDICAL SPECIALISTS.-CONTINUED GROWTH OF THE NEWLY ACQUIRED CARDIOLOGY CLINIC WITH FULL TIME SERVICES OF DR. JOHN PUTHENVEETIL AND KIM DANG, PA TO MAINTAIN LOCAL CARDIOLOGY SERVICES. 7634350 1 0 0 0 0 0 0 0 0 0 1 0 0 0 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 1 55 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 1 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 BOB PATTERSON 1.00 1.00 X X 0 1300 0 TOM LYNCH 1.00 1.00 X X 0 1500 0 FANNIE GREEN 1.00 1.00 X X 0 1000 0 DREWERY BEALE 1.00 1.00 X X 0 950 0 VERNON BRYANT 1.00 1.00 X 0 1600 0 DR SOMASEKHARA BALLA 1.00 1.00 X 0 200 0 DR NATARAJAN RAJAN 1.00 1.00 X 0 1050 0 DR GERARDO MARADIAGA 1.00 1.00 X 0 500 0 JOHNNY DRAPER 1.00 1.00 X 0 1100 0 ERNEST L BARNER 1.00 1.00 X 0 250 0 WILLIAM HODGE 1.00 1.00 X 0 1350 0 JAMES PIERCE 1.00 1.00 X 0 850 0 EVELYN DAWSON 1.00 1.00 X 0 550 0 REV RANDY MARTIN 1.00 1.00 X 0 500 0 J HUGH BAZEMORE 1.00 1.00 X 0 1000 0 ALFRED W KWASKIKPUI 1.00 1.00 X 0 600 0 WILL MAHONE 1.00 40.00 X X 0 369708 47015 SHERRY JENSEN 1.00 40.00 X X 0 256037 21221 ME GILSTRAP 1.00 1.00 X 0 0 0 GEOFFREY HARDEE 1.00 40.00 X 0 38165 18883 BETTY COOK 1.00 40.00 X 0 27309 688 CARL FEREBEE 1.00 40.00 X 0 95901 17372 CONNIE HILL 1.00 X 0 0 0 REV MARJORIE HOLM 1.00 X 0 0 0 RUBY PALMER 1.00 X 0 0 0 DR KENNETH ROBERT 1.00 X 0 202186 24176 MICHAEL FELT 1.00 X 0 0 0 ROSE FLEMING 10.00 1.00 X 0 0 0 ROY O'CONNOR 42.00 X 448775 0 19483 CHINEDU ONUORAH 42.00 X 409994 0 25590 TOCHUKWU AGBATA 42.00 X 368058 0 25229 SAM SOOKSOOK 42.00 X 291310 0 19016 COURAGE EMOKPAE 42.00 X 288613 0 15763 1806750 1003606 234436 12 0 1 0 0 1935 1935 NET PATIENT SERVICE RE 621610 5124483 5124483 5124483 29 29 1806 -1806 -1806 -1806 OTHER REVENUE 900099 212015 212015 212015 5336656 5124483 0 210238 X 4071535 3479966 591569 561917 480274 81643 218540 186787 31753 1215 1215 19800 19800 2181741 2181741 4519 4519 150962 118696 32266 84557 84557 33861 33861 44198 44198 331345 331345 55873 55873 BAD DEBT EXPENSE 530067 530067 MEDICAL SUPPLIES 102466 102466 RECRUITMENT AND RELOCAT 26928 26928 OTHER EXPENSES 1698 1698 8421222 7634350 786872 0 139499 159151 640827 471302 6296 22389 2375861 1158266 1573195 1217595 43785 59936 2403602 1930373 360834 74019 15212004 15934076 15572838 16008095 X -13174203 -14083254 4967 5532 -13169236 -14077722 2403602 1930373 X -3084566 2176080 X X 0 1 X 1 0 X 1059192 538567 520625 111741 56817 54924 1107011 562882 544129 97917 97917 1217595 DUE TO HALIFAX REGIONAL MEDICAL CENTER 15934076 15934076 X 6982669 2176080 2176080 4806589 530067 530067 5336656 7891155 0 7891155 530067 530067 8421222 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013 AND 2012. THE MEDICAL CENTER BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO SEPTEMBER 30, 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: TRANSFER OF EQUITY FROM AFFILIATE 2,176,080. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET W/ REVENUES 530,067. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET W/ REVENUES 530,067. X X X X 0 0 0 0 0 0 0 0 0 WILL MAHONE 0 287393 0 60130 0 22185 0 23828 0 23187 0 416723 0 0 SHERRY JENSEN 0 209366 0 46671 0 0 0 5531 0 15690 0 277258 0 0 DR KENNETH ROBERT 0 202186 0 0 0 0 0 5231 0 18945 0 226362 0 0 ROY O'CONNOR 448775 0 0 0 0 0 4154 0 15329 0 468258 0 0 0 CHINEDU ONUORAH 409994 0 0 0 0 0 6516 0 19074 0 435584 0 0 0 TOCHUKWU AGBATA 368058 0 0 0 0 0 6155 0 19074 0 393287 0 0 0 SAM SOOKSOOK 291310 0 0 0 0 0 0 0 19016 0 310326 0 0 0 COURAGE EMOKPAE 288613 0 0 0 0 0 0 0 15763 0 304376 0 0 0 SUPPLEMENTAL INFORMATION PART III 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 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 THE ORGANIZATION COMPLETED THE TRANSITION FOR THE ROANOKE VALLEY MEDICAL MINISTRIES "FREE CLINIC"(RVMM). RVMM WAS ESTABLISHED YEARS AGO TO PROVIDE FREE SERVICES FOR INDIGENT PATIENTS INLCUDING PHYSICIAN VISITS AND ASSISTANCE WITH ORDERING MEDICATIONS THROUGH VARIOUS DRUG PROGRAMS. RVMM CEASED OPERATIONS IN THE CURRENT YEAR AFTER THE ORGANIZATION ASSISTED THE 100 PATIENTS TO NEW PRIMARY CARE MEDICAL HOMES. FORM 990, PART VI, SECTION A, LINE 7A PRIOR 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 11 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 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. OTHER FEES FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,071,238. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,071,238. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 14,257. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,257. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 92,588. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,588. COLLECTION FEES: PROGRAM SERVICE EXPENSES 3,658. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,658. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY FROM AFFILIATE 2,176,080. 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 1 0 0 0 0 0 0 1 1