RANDOLPH HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- RANDOLPH HOSPITAL INC (EIN 56-0530234)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-14
- IRS object ID
- 201442269349302519
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-14T13:16:35-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 N TRYON STREET SUITE 1000 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560530234 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RAND | NameControl |
| Phone | 3366255151 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27204 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MURRAY S MARSH | Name |
| Title | CFO | Title |
| Phone | 3366255151 | Phone |
| Date Signed | 2014-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN NORMAN | Name |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STEVE E EBLIN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27203 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 119005674 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.RANDOLPHHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1928 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | OPERATION OF NONPROFIT HOSPITAL IN RANDOLPH COUNTY, NC | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1325 | TotalNbrEmployees |
| Total Nbr Volunteers | 234 | TotalNbrVolunteers |
| Total Gross UBI | 7525 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 615714 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 156000 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 120787025 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 117393265 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -328915 | InvestmentIncomePriorYear |
| Investment Income Current Year | -222620 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1766752 | OtherRevenuePriorYear |
| Other Revenue Current Year | 618106 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 122840576 | TotalRevenuePriorYear |
| Total Revenue Current Year | 117944751 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 2619 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 900 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 53127430 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 55508120 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 70897 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 72186397 | OtherExpensePriorYear |
| Other Expenses Current Year | 74008191 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 125316446 | TotalExpensesPriorYear |
| Total Expenses Current Year | 129517211 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2475870 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -11572460 | RevenuesLessExpensesCY |
| Total Assets BOY | 152699418 | TotalAssetsBOY |
| Total Assets EOY | 138073733 | TotalAssetsEOY |
| Total Liabilities BOY | 75507546 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 68482453 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 77191872 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 69591280 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | RANDOLPH HOSPITAL'S MISSION IS TO PROVIDE QUALITY HEALTH CARE AND TO PROMOTE HEALTH AND WELLNESS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 118615982 | Expense |
| Grants | 900 | Grants |
| Revenue | 117393265 | Revenue |
| Description | RANDOLPH HOSPITAL, A NOT-FOR-PROFIT, 145-BED COMMUNITY HOSPITAL WAS ESTABLISHED IN 1928 WITH THE APPROVAL OF A COOPERATIVE PLAN WITH THE DUKE ENDOWMENT AT A JOINT MEETING OF THE ASHEBORO ROTARY CLUB, THE KIWANIS CLUB, THE CHAMBER OF COMMERCE, THE TOWN COUNCIL AND INTERESTED CITIZENS. THE PLAN CALLED FOR THE BUILDING OF A 40-BED HOSPITAL. SEE SCHEDULE O FOR CONTINUATIONWITH A GRANT FROM THE DUKE ENDOWMENT AND CONTRIBUTIONS FROM THE COMMUNITY THAT EXCEEDED A $50,000 GOAL BY $10,000, RANDOLPH HOSPITAL WAS BUILT AND OPENED ON JULY 9, 1932. OVER THE NEXT 82 YEARS IT HAS GROWN TO 145 BEDS AND IS THE HEALTHCARE PROVIDER OF CHOICE FOR RANDOLPH COUNTY CITIZENS PROVIDING STATE-OF-THE-ART IMAGING SERVICES, ADVANCED SURGICAL PROCEDURES, COMPREHENSIVE CANCER SERVICES, MATERNITY CARE, HOME HEALTH AND MUCH MORE. WE ALSO OFFER COMMUNITY EDUCATION IN THE FORM OF SCREENINGS AND ON-SITE CLINICS FOR A VARIETY OF WELLNESS INITIATIVES AS WELL AS CAREGIVER SUPPORT SERVICES FOR THE COMMUNITIES WE SERVE. IN 2014, RANDOLPH HOSPITAL WAS RECOGNIZED BY PREMIER, INC. AS ONE OF ONLY 18 HOSPITALS IN THE UNITED STATES AND ONE OF ONLY TWO IN NORTH CAROLINA PROVIDING HIGH-VALUE HEALTHCARE AND ACHIEVING TOP PERFORMANCE IN ALL SIX OF THE AREAS MEASURED IN PREMIERS QUEST COLLABORATIVE: MORTALITY, HARM, READMISSIONS, COSTS, PATIENT EXPERIENCE AND EVIDENCE-BASED CARE. IN 2013, RANDOLPH CANCER CENTER RECEIVED THE OUTSTANDING ACHIEVEMENT AWARD FROM THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS -- ONE OF ONLY THREE CENTERS IN NORTH CAROLINA TO ACHIEVE THIS HONOR. IT RECOGNIZED THE OUTSTANDING EFFORT AND COMMITMENT BY THE ENTIRE RANDOLPH CANCER CENTER TEAM FOR PROVIDING HIGH QUALITY CANCER CARE TO OUR PATIENTS AND IN MEETING AND EXCEEDING THE STANDARDS SET BY THE COC ACCREDITATION PROGRAM. IN 2012, RANDOLPH CANCER CENTER WAS RECOGNIZED BY THE QUALITY ONCOLOGY PRACTICE INITIATIVE (QOPI) CERTIFICATION PROGRAM, AN AFFILIATE OF THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO). THE QOPI CERTIFICATION PROGRAM PROVIDES A THREE-YEAR CERTIFICATION FOR OUTPATIENT HEMATOLOGY-ONCOLOGY PRACTICES THAT MEET THE HIGHEST STANDARDS FOR QUALITY CANCER CARE. IN 2013, THE BREAST CENTER AT RANDOLPH HOSPITAL WAS GRANTED A THREE-YEAR FULL ACCREDITATION DESIGNATION BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC), MAKING IT ONE OF ONLY 17 BREAST CENTERS IN NORTH CAROLINA WITH THE ACCREDITATION. NAPBC IS A PROGRAM ADMINISTERED BY THE AMERICAN COLLEGE OF SURGEONS. ACCREDITATION BY THE NAPBC IS ONLY GIVEN TO THOSE CENTERS THAT HAVE VOLUNTARILY COMMITTED TO PROVIDE THE HIGHEST LEVEL OF QUALITY BREAST CARE AND THAT UNDERGO A RIGOROUS EVALUATION PROCESS AND REVIEW OF THEIR PERFORMANCE. IN 2012, THE HUMAN MOTION INSTITUTE AT RANDOLPH HOSPITAL EARNED THE JOINT COMMISSION'S GOLD SEAL OF APPROVAL FOR ITS ORTHOPEDIC JOINT REPLACEMENT PROGRAMS FOR HIPS AND KNEES BY DEMONSTRATING COMPLIANCE WITH THE JOINT COMMISSION'S NATIONAL STANDARDS FOR HEALTH CARE QUALITY AND SAFETY IN DISEASE-SPECIFIC CARE. THE CERTIFICATION AWARD RECOGNIZES RANDOLPH HOSPITAL'S DEDICATION TO CONTINUOUS COMPLIANCE WITH THE JOINT COMMISSION'S STATE-OF-THE-ART STANDARDS. | Description |
| Total Program Service Expense | 118615982 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 198 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1325 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | NC | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LORETTA LONG | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3363283443 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216A FOUST ST | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27203 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (24 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| SAMUEL D CRANFORD JR | |||||||||
| CHAIR | 4.00 | X | X | 0 | 0 | 0 | |||
| ROBERT C SHAFFNER | |||||||||
| VICE CHAIR | 3.00 | X | X | 0 | 0 | 0 | |||
| GLEN MAC PUGH | |||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |||
| MARY COOPER | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| ELBERT LASSITER | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| DIANE FROST | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| REYNOLDS LISK | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| CRANFORD KNOTT | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| MICHAEL C MILLER | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| SAMUEL A RANKIN JR | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| ROBERT S SHACKLEFORD JR | |||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||||
| STEVE E EBLIN | |||||||||
| CEO (3/1/12) | 38.00 | X | 280374 | 0 | 4505 | 2.00 | |||
| MURRAY S MARSH | |||||||||
| CFO (9/4/12) | 38.00 | X | 56975 | 0 | 982 | 2.00 | |||
| DEVIN L GRIFFITH | |||||||||
| VP | 40.00 | X | 176865 | 0 | 742 | ||||
| BARBARA E WOLFE | |||||||||
| VP (6/1/12) | 40.00 | X | 134802 | 0 | 1660 | ||||
| ROB S CLAUSER | |||||||||
| VP (6/1/12) | 38.00 | X | 100608 | 82805 | 3346 | 2.00 | |||
| TREMONTEO CRAWFORD | |||||||||
| CNO | 40.00 | 148953 | 0 | 4091 | X | ||||
| LISA HAMPTON | |||||||||
| DIR. PHARMACY | 40.00 | 146809 | 0 | 1196 | X | ||||
| MICHELLE LUTHER | |||||||||
| PHARMACIST | 40.00 | 136205 | 0 | 3320 | X | ||||
| WILLIAM WARD | |||||||||
| PHARMACIST | 40.00 | 134947 | 0 | 4991 | X | ||||
| ANGELA BURGESS | |||||||||
| CIO | 40.00 | 122242 | 0 | 8646 | X | ||||
| SANDRA L ALLEN | |||||||||
| FORMER VP | 40.00 | 463575 | 0 | 2459 | X | ||||
| ROBERT E MORRISON | |||||||||
| FORMER CEO | 0.00 | 904643 | 0 | 824 | X | ||||
| LYNWOOD R WHITE | |||||||||
| FORMER CFO | 0.00 | 450088 | 0 | 1592 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3257086 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 82805 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 38354 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| GREENSBORO RADIOLOGY PA | |||||
| 1331 N ELM ST SUITE 200 | GREENSBORO | NC | 274011023 | PROFESSIONAL RADIOLOGY SERVICES | 3801745 |
| EMPLOYEE BENEFITS SERVICES | |||||
| PO BOX 55210 | INDIANAPOLIS | IN | 462050210 | ADMINISTRATION OF EMPLOYEE BENEFITS | 1443466 |
| SODEXO INC & AFFILIATES | |||||
| PO BOX 536922 | ATLANTA | GA | 303536922 | FOOD MANAGEMENT SERVICES | 1208656 |
| MCNEARY INSURANCE CONSULTING DBA MCNEA | |||||
| 6525 MORRISON BLVD SUITE 200 | CHARLOTTE | NC | 28211 | INSURANCE CONSULTING | 1119932 |
| ARAMARK | |||||
| 12483 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | BIOMEDICAL ENGINEERING | 1068623 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 65 | NumberOfContractorsGT100K |
| All Other Contributions | 156000 | AllOtherContributions |
| Total Contributions | 156000 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | 114405392 | 114405392 |
| CANCER CENTER REVENUES | 621400 | 1014389 | 1014389 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1973484 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1973484 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 117393265 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 838303 | TotalRevenueColumn |
| Exclusion | $838,303 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 511490 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 511490 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 511490 | TotalRevenueColumn |
| Exclusion | $511,490 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1060923 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -1060923 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1060923 | TotalRevenueColumn |
| Exclusion | -$1,060,923 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| COFFEE/GIFT SHOP | 453220 | 99091 | $99,091 | |
| PREMIER PARTNERSHIP | 900009 | 7525 | 7525 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 106616 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 117944751 | TotalRevenueColumn |
| Related Or Exempt Function Income | 117393265 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 7525 | UnrelatedBusinessRevenue |
| Exclusion | $387,961 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 900 | Total |
| Program Services | 900 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2750398 | Total |
| Management And General | 2750398 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40955123 | Total |
| Program Services | 37075718 | ProgramServices |
| Management And General | 3837696 | ManagementAndGeneral |
| Fundraising | 41709 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 834332 | Total |
| Program Services | 707770 | ProgramServices |
| Management And General | 125766 | ManagementAndGeneral |
| Fundraising | 796 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7623419 | Total |
| Program Services | 6467003 | ProgramServices |
| Management And General | 1149141 | ManagementAndGeneral |
| Fundraising | 7275 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3344848 | Total |
| Program Services | 2837459 | ProgramServices |
| Management And General | 504197 | ManagementAndGeneral |
| Fundraising | 3192 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 566078 | Total |
| Program Services | 375030 | ProgramServices |
| Management And General | 191048 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 132887 | Total |
| Management And General | 131554 | ManagementAndGeneral |
| Fundraising | 1333 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59929 | Total |
| Management And General | 59929 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12072498 | Total |
| Program Services | 12048571 | ProgramServices |
| Management And General | 22853 | ManagementAndGeneral |
| Fundraising | 1074 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 325134 | Total |
| Program Services | 234140 | ProgramServices |
| Management And General | 83431 | ManagementAndGeneral |
| Fundraising | 7563 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7477803 | Total |
| Program Services | 6499203 | ProgramServices |
| Management And General | 973900 | ManagementAndGeneral |
| Fundraising | 4700 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1539936 | Total |
| Program Services | 1484741 | ProgramServices |
| Management And General | 55195 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3073812 | Total |
| Program Services | 2913385 | ProgramServices |
| Management And General | 160427 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 423672 | Total |
| Program Services | 362407 | ProgramServices |
| Management And General | 59775 | ManagementAndGeneral |
| Fundraising | 1490 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22692 | Total |
| Program Services | 22692 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1759640 | Total |
| Program Services | 1759640 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6818282 | Total |
| Program Services | 6818282 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 519923 | Total |
| Management And General | 519923 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBTS | 30195995 | 30195995 | ||
| MEDICAL SUPPLIES | 8072325 | 8072325 | ||
| MISCELLANEOUS | 742649 | 740721 | 163 | 1765 |
| RECRUITMENT | 204936 | 204936 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129517211 | Total |
| Program Services | 118615982 | ProgramServices |
| Management And General | 10830332 | ManagementAndGeneral |
| Fundraising | 70897 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4397436 | BOY |
| EOY | 5827649 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21613959 | BOY |
| EOY | 5798795 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21785392 | BOY |
| EOY | 15830200 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2990893 | BOY |
| EOY | 2847945 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1295095 | BOY |
| EOY | 805931 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 146555522 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 83277141 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65056594 | BOY |
| EOY | 63278381 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19804569 | BOY |
| EOY | 23417787 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4104513 | BOY |
| EOY | 4912015 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11650967 | BOY |
| EOY | 15355030 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 152699418 | BOY |
| EOY | 138073733 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9806813 | BOY |
| EOY | 9443463 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47177798 | BOY |
| EOY | 45080267 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18522935 | BOY |
| EOY | 13958723 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75507546 | BOY |
| EOY | 68482453 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75983761 | BOY |
| EOY | 68374953 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1208111 | BOY |
| EOY | 1216327 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77191872 | BOY |
| EOY | 69591280 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 152699418 | BOY |
| EOY | 138073733 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -11572460 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 356282 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 3615586 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $12,996 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 12996 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXPLANATION OF LOBBYING ACTIVITIES: | PART II-B, LINE 1: | THE AMOUNT REFERENCED ABOVE REPRESENTS A PORTION OF THE DUES PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION THAT IS ATTRIBUTABLE TO LOBBYING. |
| PART IV, SUPPLEMENTAL INFORMATION: | THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA). BOTH ASSOCIATIONS PERFORM LOBBYING OF STATE AND LOCAL GOVERNMENTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND A PORTION OF THE DUES PAID TO EACH ASSOCIATION IS ATTRIBUTABLE TO THOSE LOBBYING EXPENDITURES. FOR THE FISCAL YEAR, THE PORTION OF DUES ATTRIBUTABLE TO LOBBYING WAS ESTIMATED AT $______. |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1634877 | BeginningOfYearBalance |
| End Of Year Balance | 1634877 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1634877 | BeginningOfYearBalance |
| End Of Year Balance | 1634877 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1529736 | BeginningOfYearBalance |
| Contributions | 105141 | Contributions |
| End Of Year Balance | 1634877 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3232061 | OtherCostOrOtherBasis |
| Book Value | 3232061 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 79023373 | OtherCostOrOtherBasis |
| Depreciation | 36240782 | Depreciation |
| Book Value | 42782591 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 56595010 | OtherCostOrOtherBasis |
| Depreciation | 46202194 | Depreciation |
| Book Value | 10392816 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7705078 | OtherCostOrOtherBasis |
| Depreciation | 834165 | Depreciation |
| Book Value | 6870913 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 63278381 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| OTHER RECEIVABLES | 784747 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | 3583229 |
| ASSETS LIMITED AS TO USE | 1216327 |
| INVESTMENT IN AFFILIATES | 306541 |
| DUE FROM AFFILIATES | 9066080 |
| OTHER LONG-TERM ASSETS | 398106 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 15355030 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| OTHER LONG-TERM LIABILITIES | $282,136 |
| MINIMUM PENSION LIABILITY | $5,309,970 |
| INTEREST RATE SWAP | $2,711,912 |
| DUE TO AFFILIATES | $5,005,056 |
| INVESTMENT IN AFFILIATES | $649,649 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 13958723 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THIS IS A DONATION FROM ANNIS S. KEMP THAT IS RESTRICTED. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | THE HOSPITAL, RMA, RSG AND FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CPSC IS A LIMITED LIABILITY COMPANY THAT DOES NOT PRODUCE TAXABLE INCOME TO ITS NON-FOR-PROFIT OWNER. THE ORGANIZATIONS HAVE DETERMINED THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2802028 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2802028 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02820 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16834424 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11155059 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5679365 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05720 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19636452 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11155059 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8481393 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08540 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 30607 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 30607 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5619 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 619 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Direct Offsetting Revenue | 145000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -145000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 360259 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 360259 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00360 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 396485 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 150000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 246485 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00390 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20032937 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11305059 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8727878 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08930 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2563 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 5000 | DirectOffsettingRevenue |
| Net Community Building Expense | -2437 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2563 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 5000 | DirectOffsettingRevenue |
| Net Community Building Expense | -2437 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $30,195,995 | BadDebtExpenseAmount |
| Amount Attributable To | 25666596 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 23704303 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 28381488 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4677185 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership |
|---|---|
| 3 RANDOLPH CANCER CENTER LLC | |
| CANCER CENTER OUT PATIENT | 0.60000 |
| 5 CENTRAL PIEDMONT SURGERY CENTER LLC | |
| SURGERY CENTER | 0.73000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INCORPORATED | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RANDOLPHHOSPITAL.ORG | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 0 | CollectionActivities |
| Notified All Patients | X | NotifiedAllPatients |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| RANDOLPH MEDICAL ASSOCIATES | ||||
| 218-C FOUST STREET | ASHEBORO | NC | 27203 | WHOLLY OWNED PHYSICIAN PRACTICE (MULTIPLE LOCATIONS) |
| RANDOLPH SPECIALTY GROUP | ||||
| 138 DUBLIN SQUARE ROAD SUITE A | ASHEBORO | NC | 27203 | WHOLLY OWNED PRACTICE(MULTIPLE LOCATIONS) |
| RANDOLPH CANCER CENTER | ||||
| 373 N FAYETTEVILLE STREET | ASHEBORO | NC | 27203 | JOINT VENTURE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 30195995. | |
| PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT. BAD DEBT EXPENSE WAS OBTAINED FROM AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION ESTIMATES FROM HISTORICAL PERSPECTIVE AND EXPERIENCE THAT APPROXIMATELY 85% OF BAD DEBT EXPENSE MAY BE ATTRIBUTABLE TO COMMUNITY BENEFIT | |
| PART III, LINE 8: COSTS AND TOTAL REVENUES RECEIVED FROM MEDICARE REPORTED ON LINES 5 AND 6 ARE CALCULATED FROM THE ORGANIZATION'S MEDICARE COST REPORT. | |
| PART III, LINE 9B: OUR COLLECTION AGENCIES ARE TO OFFER TO ALL PATIENTS THE FINANCIAL ASSISTANCE APPLICATION TO BE COMPLETED AND RETURNED TO RH FOR PROCESSING; IF AWARDED FINANCIAL ASSISTANCE RH WILL NOTIFY THE COLLECTION VENDORS TO DISCONTINUE COLLECTION EFFORTS | |
| PART V, SECTION B, LINE 3: METHODOLOGY, DATA COLLECTION & ANALYSIS IN THE FALL OF 2012, THE RANDOLPH COUNTY HEALTH DEPARTMENT JOINED WITH RANDOLPH HOSPITAL, TO ESTABLISH THE ASSESSMENT FRAMEWORK AND A TIMELINE FOR DATA COLLECTION AND ANALYSIS, PRIORITIZATION OF HEALTH CONCERNS AND DEVELOPMENT OF ACTION PLANS. DATA COLLECTION AND ANALYSIS TOOK PLACE FROM JANUARY - JULY 2013. PRIMARY DATA WAS COLLECTED FROM THE COMMUNITY IN THREE WAYS: DISTRIBUTION OF PAPER SURVEYS MAILED RANDOMLY TO RESIDENTS ACROSS THE COUNTY, AN INTERNET SURVEY AND A COMMUNITY LEADER QUESTIONNAIRE.PRIMARY DATA2013 RANDOLPH COUNTY HEALTH OPINION SURVEYTELEPHONE SURVEYS HAVE BEEN CONDUCTED IN YEARS PAST, HOWEVER, BECAUSE MANY PEOPLE NOW REPLACE LANDLINE PHONE SERVICE WITH CELL PHONES OR USE UNLISTED PHONE NUMBERS, IT WAS FELT THAT A PHONE SURVEY WOULD NOT BE REPRESENTATIVE OF THE COUNTY. WITH TECHNOLOGY CONTINUING TO ADVANCE, MORE OF AN EMPHASIS WAS PLACED ON ON-LINE SURVEYS, ALTHOUGH PAPER SURVEYS WERE STILL AN IMPORTANT TOOL. SURVEYS WERE MAILED TO RESIDENTS ACROSS THE COUNTY USING A RANDOM SAMPLE METHOD. THROUGH UTILIZATION OF RANDOLPH COUNTY'S ADDRESS DATABASE, EVERY FIFTIETH (50TH) ADDRESS WAS RANDOMLY SELECTED. OVER FIVE HUNDRED (525) SURVEYS, INCLUDING A SELF-ADDRESSED, STAMPED ENVELOPE WERE MAILED TO SELECTED ADDRESSES. IN ADDITION TO THE MAILED SURVEYS, THEY WERE ALSO DISTRIBUTED TO AGENCIES AND ORGANIZATIONS WITHIN THE COUNTY USING THE CONVENIENCE SAMPLE METHOD. SUCH AGENCIES INCLUDED: RANDOLPH COMMUNITY COLLEGE, RANDOLPH COUNTY SENIOR ADULTS ASSOCIATION, LIBERTY EARLY CHILDHOOD CENTER, RANDOLPH COUNTY PARTNERSHIP FOR CHILDREN, THE LATINO COALITION OF RANDOLPH COUNTY AND SEVERAL CHURCHES. ALL SURVEYS DISTRIBUTED WERE IN BOTH ENGLISH AND SPANISH. OF THE 3,500 TOTAL DISTRIBUTED SURVEYS, 1,570 WERE RETURNED FOR A RESPONSE RATE OF 45%. SURVEY RESPONSES WERE ANALYZED FOR FREQUENCY OF RESPONSE USING SURVEY MONKEY. (IT SHOULD BE NOTED THAT NOT EVERY RESPONDENT ANSWERED EVERY QUESTION.) THE SURVEYS WERE NOT FULLY COMPLETED BY ALL INDIVIDUALS, RESULTING IN MISSING DATA ON VARIOUS QUESTIONS. INTERNET SURVEY IN COLLABORATION WITH THE RANDOLPH COUNTY GOVERNMENT IT, AN INTERNET SURVEY WAS DEVELOPED USING SURVEY MONKEY. THE INTERNET SURVEY WAS ACCESSIBLE THROUGH THE RANDOLPH COUNTY GOVERNMENT WEBSITE. IN AN EFFORT TO PROMOTE THE INTERNET SURVEY, LAMINATED INFORMATION CARDS WERE DISPLAYED IN BOTH ENGLISH AND SPANISH AT VARIOUS BUSINESSES, WHICH INCLUDED CHURCH BULLETINS.COMMUNITY LEADER/SERVICE PROVIDER QUESTIONNAIRESTO ENSURE A SOLID REPRESENTATION FROM KEY SECTORS, THE STAKEHOLDER QUESTIONNAIRE WAS SENT TO DEPARTMENT HEADS AND DIRECTORS FROM VARIOUS AGENCIES OR REPRESENTATIVES WITHIN THE COUNTY. SURVEY RESULTS ARE INCLUDED IN THE APPENDIX SECTION OF THIS DOCUMENT. SECONDARY DATA THE MAJOR SOURCE FOR SECONDARY DATA IN THE 2013 RANDOLPH COUNTY COMMUNITY HEALTH ASSESSMENT INCLUDED:- NORTH CAROLINA STATE CENTER FOR HEALTH STATISTICS- NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES- LINC: LOG INTO NORTH CAROLINA- CECIL G. SHEPS CENTER FOR HEALTH SERVICES RESEARCH- US CENSUS DEPARTMENT- UNITED STATES CENSUS BUREAU- UNITED STATES DEPARTMENT OF COMMERCEAS APPLICABLE, RANDOLPH COUNTY STATISTICS HAVE BEEN COMPARED WITH STATE STATISTICS AS WELL AS FOUR PEER COUNTIES. THESE PEER COUNTIES WERE IDENTIFIED BASED UPON AGE, RACE AND POVERTY CHARACTERISTICS, AND ARE SELECTED FROM A GROUP OF COUNTIES WITHIN THE SAME POPULATION RANGE AS THE SUBJECT COUNTY. FOR RANDOLPH COUNTY, THE FOLLOWING FOUR PEER COUNTIES WERE IDENTIFIED: CRAVEN, DAVIDSON, HARNETT AND JOHNSTON. THEREFORE, IN ADDITION TO NORTH CAROLINA STATISTICS, THESE FOUR COUNTIES WERE USED FOR COMPARISON THROUGHOUT THE ASSESSMENT PROCESS. | RANDOLPH HOSPITAL |
| PART V, SECTION B, LINE 5C: BOTH RANDOLPH COUNTY AND RANDOLPH HOSPITAL WEBSITES WILL POST THE COMMUNITY HEALTH NEEDS ASSESSMENT AND EXECUTIVE SUMMARY. THE ASSESSMENT WILL ALSO BE IN ALL SEVEN RANDOLPH COUNTY LIBRARIES. THIRTY DATA BOOKS AND 500 EXECUTIVE SUMMARIES WILL BE ORDERED AND PRINTED FOR DISTRIBUTION THROUGHOUT THE COMMUNITY. | RANDOLPH HOSPITAL |
| PART V, SECTION B, LINE 7: BASED ON PRIMARY DATA RESULTS, EMPLOYMENT OPPORTUNITIES, AFFORDABLE HOUSING, CRIME AND AVAILABILITY OF POSITIVE TEEN ACTIVITIES WERE MAJOR CONCERNS OF THE PUBLIC. HOWEVER, THE ADVISORY TEAM DECIDED THESE WERE NOT AREAS IN WHICH RANDOLPH HOSPITAL OR THE RANDOLPH COUNTY HEALTH DEPARTMENT COULD IMPACT. | RANDOLPH HOSPITAL |
| PART V, SECTION B, LINE 18E: THE HOSPITAL ESTABLISHES DURING PRE-REGISTRATION WHETHER A PATIENT IS COVERED BY INSURANCE. IF THE PATIENT IS NOT COVERED BY INSURANCE, THE HOSPITAL MAKES THE PATIENT AWARE OF THE FAP. | RANDOLPH HOSPITAL |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STEVE E EBLIN | ||||||||||||||
| CEO (3/1/12) | 280014 | 0 | 0 | 0 | 360 | 0 | 0 | 0 | 4505 | 0 | 284879 | 0 | 0 | 0 |
| DEVIN L GRIFFITH | ||||||||||||||
| VP | 176685 | 0 | 0 | 0 | 180 | 0 | 0 | 0 | 742 | 0 | 177607 | 0 | 0 | 0 |
| ROB S CLAUSER | ||||||||||||||
| VP (6/1/12) | 100488 | 64087 | 0 | 18628 | 120 | 90 | 0 | 0 | 3346 | 0 | 103954 | 82805 | 0 | 0 |
| TREMONTEO CRAWFORD | ||||||||||||||
| CNO | 148149 | 0 | 0 | 0 | 804 | 0 | 0 | 0 | 4091 | 0 | 153044 | 0 | 0 | 0 |
| SANDRA L ALLEN | ||||||||||||||
| FORMER VP | 193457 | 0 | 268313 | 0 | 1805 | 0 | 0 | 0 | 2459 | 0 | 466034 | 0 | 0 | 0 |
| ROBERT E MORRISON | ||||||||||||||
| FORMER CEO | 145882 | 0 | 756853 | 0 | 1908 | 0 | 0 | 0 | 824 | 0 | 905467 | 0 | 0 | 0 |
| LYNWOOD R WHITE | ||||||||||||||
| FORMER CFO | 169191 | 0 | 279618 | 0 | 1279 | 0 | 0 | 0 | 1592 | 0 | 451680 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | THE AMOUNTS REPRESENTED AS DEFERRED COMPENSATION ON SCHEDULE J HAVE BEEN ACCRUED AND/OR PAID TO THE INDIVIDUALS. THE AMOUNT REPRESENTS VESTED BENEFITS WHICH MAY BE PAID IN FUTURE YEARS, DEPENDING ON THE INDIVIDUAL'S LIFE SPAN AND OTHER FACTORS WHICH COULD RESULT IN FORFEITURE OF THE BENEFIT. DURING 1998, THE HOSPITAL ESTABLISHED A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TO COVER HIGHLY COMPENSATED EMPLOYEES. THIS PLAN INCLUDED A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN, A NONQUALIFIED DEFERRED COMPENSATION PLAN (REVISED IN 2005) AND A SPLIT-DOLLAR LIFE INSURANCE PLAN. THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDES ADDITIONAL BENEFITS TO SUPPLEMENT BENEFITS EARNED UNDER THE ORGANIZATIONS BROADER DEFINED BENEFIT PENSION PLAN. IN 2005, THE HOSPITAL INSTITUTED A NONQUALIFIED DEFERRED COMPENSATION PLAN. THE PURPOSE OF THIS PLAN IS TO PROVIDE ADDITIONAL RETENTION INCENTIVES AND RETIREMENT SECURITY FOR CERTAIN MEMBERS OF THE HOSPITAL'S SENIOR MANAGEMENT TEAM AND TO ALLOW FOR THE DEFERRAL OF COMPENSATION OF THOSE ELIGIBLE MEMBERS OF ITS SENIOR MANAGEMENT. THIS IS INTENDED TO BE A NONQUALIFIED PLAN. PARTICIPANTS ARE 100% VESTED AFTER 30 YEARS OF SERVICE OR AT AGE 67. THE SPLIT-DOLLAR LIFE INSURANCE AGREEMENT INVOLVES THE PAYMENT OF PREMIUMS BY THE HOSPITAL FOR A LIFE INSURANCE POLICY, THE BENEFITS OF WHICH ARE SPLIT BETWEEN THE EMPLOYEES' BENEFICIARIES AND THE HOSPITAL UP TO THE AMOUNT OF PREMIUMS PAID. PREMIUMS PAID UNDER THIS PLAN WILL CONTINUE UNTIL THE AGREEMENT IS TERMINATED OR UPON THE DEATH OF THE INSURED EMPLOYEES. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THERE STANDS AN EXECUTIVE COMMITTEE CONSISTING OF THE CHAIRMAN, VICE CHAIRMAN, CHAIRMAN-ELECT, THE SECRETARY, THE CHAIRMAN OF THE FINANCE, AUDIT, INVESTMENT AND RETIREMENT COMMITTEE, AND UP TO TWO OTHER DIRECTORS AS DESIGNATED BY THE CHAIRMAN. THE COMMITTEE HAS AND MAY EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE ORGANIZATION, TO THE EXTENT PERMITTED BY LAW, DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION SHALL HAVE ONE CLASS OF MEMBERS CONSISTING OF AT LEAST 23 MEMBERS AND NEVER CONSISTING OF MORE THAN 30 MEMBERS. FOUR MEMBERS SHALL BE EX OFFICIO, AS INDICATED BELOW. THE REMAINDER SHALL BE ELECTED AS PROVIDED IN DETAIL IN THE BYLAWS. THE PRINCIPAL CRITERION FOR SELECTION OF CORPORATE MEMBERS SHALL BE THE PERSON'S QUALIFICATIONS TO EVENTUALLY SERVE AS A DIRECTOR OF RANDOLPH HOSPITAL, AS SET FORTH IN SECTION 22 OF THE BYLAWS. AS CANDIDATES BECOME AVAILABLE, THE MEMBERS MAY EXPAND OR CONTRACT THEIR NUMBER, WITHIN THE LIMITS STATED ABOVE, IN ORDER TO PROVIDE AN ADEQUATE POOL OF MEMBERS WHO ARE QUALIFIED TO SERVE AS DIRECTORS. IN ADDITION TO THE ELECTED MEMBERS, THE MAYOR OF ASHEBORO, NORTH CAROLINA, THE CHAIRMAN OF THE BOARD OF COMMISSIONERS OF RANDOLPH COUNTY, NORTH CAROLINA, THE RANDOLPH COUNTY SUPERINTENDENT OF SCHOOLS AND THE COUNTY HEALTH OFFICER OF RANDOLPH COUNTY, NORTH CAROLINA, SHALL BE EX OFFICIO MEMBERS OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE DIRECTORS SHALL BE ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS FROM NOMINATIONS RECEIVED BOTH FROM THE GOVERNANCE COMMITTEE AND FROM THE FLOOR AT THE ANNUAL MEETING OF THE MEMBERS. IF ANY DIRECTORS SHALL SERVE ONE-YEAR TERMS, AND SHALL CONTINUE TO SERVE UNTIL THEIR SUCCESSORS ARE ELECTED. DIRECTORS MAY BE RE-ELECTED. ANY DIRECTOR MAY BE REMOVED FROM OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE, BY A MAJORITY VOTE OF THE MEMBERS OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 7B | CHANGES TO THE BYLAWS, SALE OR MERGER OF THE HOSPITAL MUST BE APPROVED BY THE MEMBERS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990, ALONG WITH A SUMMARY OF KEY ELEMENTS AND DISCLOSURES, IS PROVIDED TO THE BOARD INVITING QUESTIONS AND COMMENTS PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | RANDOLPH HOSPITAL HAS A FULL TIME CORPORATE COMPLIANCE OFFICER CHARGED WITH EDUCATING THE BOARD, OFFICERS, AND OTHER EMPLOYEES ON THE CONFLICT OF INTEREST POLICY. ALL NEW EMPLOYEES ARE GIVEN INFORMATION UPON ORIENTATION, AND ALL CURRENT EMPLOYEES ARE REQUIRED TO TAKE ANNUAL EDUCATION ON COMPLIANCE WITH THE POLICY. THERE IS A MONTHLY CORPORATE COMPLIANCE MEETING TO UPDATE KEY INDIVIDUALS ON NEW ISSUES AND NEW INFORMATION REGARDING CORPORATE COMPLIANCE. THE BOARD OF DIRECTORS IS REQUIRED ANNUALLY TO READ, SIGN, AND REMIT A COPY OF THE POLICY TO THE BOARD CHAIR. ALL BOARD MEMBERS ARE AWARE OF THE POLICY AND IN CASE OF ANY CONFLICT OF INTEREST, THEY WILL RECUSE THEMSELVES. | |
| FORM 990, PART VI, SECTION B, LINE 15 | RANDOLPH HOSPITAL CONTRACTS WITH AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE APPROPRIATE COMPENSATION LEVELS FOR EXECUTIVES THAT IS COMMENSURATE WITH ORGANIZATIONS OR SIMILAR SIZE AND STRUCTURE. A COMPENSATION COMMITTEE OF THE BOARD HAS FINAL DETERMINATION OF COMPENSATION LEVELS FOR TOP EXECUTIVES. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINSTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG | |
| 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 REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | |
| FORM 990, PART VII | ROBERT CLAUSER IS THE EXECUTIVE DIRECTOR OF RANDOLPH MEDICAL ASSOCIATES AND RANDOLPH SPECIALTY GROUP PRACTICE AND SPLITS HIS TIME BETWEEN THESE TWO ENTITIES. HIS TITLE WITH THE HOSPITAL IS VP OF PHYSICIAN PRACTICE AND EMPLOYEE HEALTH. | |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF INTEREST RATE SWAP 1,852,820. CHANGE IN PENSION LIABILITY 1,795,986. OTHER CHANGES IN NET ASSETS -25,695. PREMIER PARTNERSHIP -7,525. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH CANCER CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 364 WHITE OAK STREET | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27204 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 562181482 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | NC | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | LINE 11A, I | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL PIEDMONT SURGERY CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11221 ROE AVE SUITE 320 | AddressLine1 |
| City | LEAWOOD | City |
| State | KS | State |
| ZIP Code | 66211 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 234317497 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | KS | LegalDomicileState |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL PIEDMONT SURGERY CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | B | TransactionType |
| Amount Involved | 289460 | AmountInvolved |
| Method Of Amt Determination | CONTRIBUTION CALL | MethodOfAmtDetermination |