RANDOLPH MEDICAL ASSOCIATES: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- RANDOLPH MEDICAL ASSOCIATES (EIN 56-1853201)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-12
- IRS object ID
- 201342249349301674
- Schema version
- 2011v1.5
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-12T13:40:25-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561853201 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANDOLPH MEDICAL ASSOCIATES | 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 | 218C FOUST ST | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27203 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT S CLAUSER | Name |
| Title | PRESIDENT | Title |
| Phone | 3366255151 | Phone |
| Date Signed | 2013-08-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | ROBERT S CLAUSER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 218C FOUST ST | AddressLine1 |
| City | ASHEBORO | City |
| State | NC | State |
| ZIP Code | 27203 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8190901 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1993 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | OPERATING SIX HEALTHCARE PRACTICES IN RANDOLPH COUNTY, NC | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 88 | TotalNbrEmployees |
| Total Nbr Volunteers | 4 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7737614 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 7691618 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 225410 | OtherRevenuePriorYear |
| Other Revenue Current Year | 499283 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 7963024 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8190901 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5448878 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5926435 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2091679 | OtherExpensePriorYear |
| Other Expenses Current Year | 2062431 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7540557 | TotalExpensesPriorYear |
| Total Expenses Current Year | 7988866 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 422467 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 202035 | RevenuesLessExpensesCY |
| Total Assets BOY | 2297412 | TotalAssetsBOY |
| Total Assets EOY | 1953121 | TotalAssetsEOY |
| Total Liabilities BOY | 6065073 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4243108 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -3767661 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -2289987 | NetAssetsOrFundBalancesEOY |
| Mission Description | RANDOLPH MEDICAL ASSOCIATES WAS FORMED TO PROMOTE, IMPROVE AND ENHANCE THE QUALITY OF HEALTH CARE SERVICES IN RANDOLPH COUNTY, NC AND SURROUNDING COUNTIES BY PROVIDING PHYSICIANS AND OTHER MEDICAL SERVICES TO THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 7503628 | Expense |
| Revenue | 7691618 | Revenue |
| Description | RANDOLPH MEDICAL ASSOCIATES WAS ORGANIZED FOR THE PURPOSE OF PROMOTING COMMUNITY HEALTH THROUGH THE PROVISION OF HEALTH CARE SERVICES TO THE MEDICALLY UNDER-SERVED POPULATIONS OF RANDOLPH AND SURROUNDING COUNTIES. ITS ACTIVITIES INCLUDE PROMOTING AND CARRYING ON OF EDUCATIONAL ACTIVITIES RELATING TO THE CARE OF THE SICK, INJURED OR DISABLED. RANDOLPH MEDICAL ASSOCIATES PROVIDED CARE TO A TOTAL OF 69,531 PATIENTS DURING THE CALENDAR YEAR 2012 (68,346 OFFICE VISITS AND 1,185 HOSPITAL VISITS). | Description |
| Total Program Service Expense | 7503628 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | 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 | 0 | Hospital |
| 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 44 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 88 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | 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 | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| 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 | LINDA CROWSHAW | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3366255151 | TelephoneNumber |
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) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| GLENN MAC PUGH | ||||||||
| CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | ||
| SAM RANKIN JR | ||||||||
| VICE CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | ||
| STEVE EBLIN | ||||||||
| PRESIDENT | 2.00 | X | X | 0 | 187570 | 35406 | ||
| SAM CRANFORD JR | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| BETH RUSSELL | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| PATRICIA VINOCUR | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | X | 238305 | 0 | 33206 | |||
| ROBERT CLAUSER | ||||||||
| PRESIDENT | 20.00 | X | X | 144566 | 0 | 12340 | ||
| MURRAY S MARSH JR | ||||||||
| CFO | 2.00 | X | 0 | 0 | 0 | |||
| LYNWOOD R WHITE | ||||||||
| CFO | 2.00 | X | 0 | 266539 | 28491 | |||
| KEUNG LEE | ||||||||
| PHYSICIAN | 40.00 | 327310 | 0 | 42774 | X | |||
| JOHN GAGE | ||||||||
| PHYSICIAN | 40.00 | 334097 | 0 | 25666 | X | |||
| DOUGLAS SCHULTZ | ||||||||
| PHYSICIAN | 40.00 | 315116 | 0 | 24681 | X | |||
| MAURA HAMRICK | ||||||||
| PHYSICIAN | 40.00 | 190098 | 0 | 25352 | X | |||
| KATHLEEN RILEY | ||||||||
| PHYSICIAN | 40.00 | 173359 | 0 | 9489 | X | |||
| ROBERT E MORRISON | ||||||||
| SECRETARY/TREASURER | 2.00 | 0 | 1112524 | 182900 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1722851 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1566633 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 420305 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MISYS HEALTHCARE SYSTEMS LLC | |||||
| 8529 SIX FORKS ROAD | RALEIGH | NC | 27615 | COMPUTER MAINTENANCE, MISC. SERVICES | 289124 |
| QUEST DIAGNOSTICS INC | |||||
| PO BOX 740736 | ATLANTA | GA | 30374 | OUTSIDE LAB SERVICES | 109616 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 7691618 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7691618 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 7691618 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| OTHER REVENUE | 900099 | 445276 | $445,276 |
| AFFILIATE MGMT | 900099 | 54007 | $54,007 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 499283 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8190901 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7691618 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $499,283 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 353041 | Total |
| Program Services | 4527 | ProgramServices |
| Management And General | 348514 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4558496 | Total |
| Program Services | 4558496 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 701269 | Total |
| Program Services | 654845 | ProgramServices |
| Management And General | 46424 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 313629 | Total |
| Program Services | 292867 | ProgramServices |
| Management And General | 20762 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4432 | Total |
| Program Services | 4432 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7241 | Total |
| Management And General | 7241 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 245909 | Total |
| Program Services | 245909 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19732 | Total |
| Program Services | 19732 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 383183 | Total |
| Program Services | 320886 | ProgramServices |
| Management And General | 62297 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22283 | Total |
| Program Services | 22283 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 391255 | Total |
| Program Services | 391255 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28790 | Total |
| Program Services | 28790 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5242 | Total |
| Program Services | 5242 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 140467 | Total |
| Program Services | 140467 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38570 | Total |
| Program Services | 38570 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MEDICAL SUPPLIES | 620913 | 620913 |
| BAD DEBTS | 132729 | 132729 |
| MISCELLANEOUS | 21685 | 21685 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7988866 | Total |
| Program Services | 7503628 | ProgramServices |
| Management And General | 485238 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 786080 | BOY |
| EOY | 388386 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 769165 | BOY |
| EOY | 632849 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 177599 | BOY |
| EOY | 225600 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39597 | BOY |
| EOY | 15560 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2129563 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1599200 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 448588 | BOY |
| EOY | 530363 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76383 | BOY |
| EOY | 160363 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2297412 | BOY |
| EOY | 1953121 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2032698 | BOY |
| EOY | 566717 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 47632 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4032375 | BOY |
| EOY | 3628759 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6065073 | BOY |
| EOY | 4243108 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -3767661 | BOY |
| EOY | -2289987 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -3767661 | BOY |
| EOY | -2289987 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2297412 | BOY |
| EOY | 1953121 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 202035 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1275639 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6290477 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6833284 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6977456 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 7737614 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7691618 | CurrentTaxYear |
| Total | 35530449 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6290477 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6833284 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 6977456 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 7737614 | CurrentTaxYearMinus1Year |
| Current Tax Year | 7691618 | CurrentTaxYear |
| Total | 35530449 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 35530449 | PublicSupportTotal509 |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 35355 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 63301 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 58747 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 225410 | CurrentTaxYearMinus1Year |
| Current Tax Year | 499283 | CurrentTaxYear |
| Total | 882096 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6325832 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 6896585 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 7036203 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 7963024 | CurrentTaxYearMinus1Year |
| Current Tax Year | 8190901 | CurrentTaxYear |
| Total | 36412545 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.97580 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.98740 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00000 | InvestmentIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 86981 | OtherCostOrOtherBasis |
| Depreciation | 65273 | Depreciation |
| Book Value | 21708 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 403570 | OtherCostOrOtherBasis |
| Depreciation | 303071 | Depreciation |
| Book Value | 100499 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1639012 | OtherCostOrOtherBasis |
| Depreciation | 1230856 | Depreciation |
| Book Value | 408156 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 530363 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER RECEIVABLES | Description |
| Book Value | 160363 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 160363 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RANDOLPH HOSPITAL INC. | Description |
| Amount | $3,628,759 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3628759 | TotalOfAmounts |
| Total Revenue | 8190901 | TotalRevenue |
| Total Expenses | 7988866 | TotalExpenses |
| Excess Or Deficit For Year | 202035 | ExcessOrDeficitForYear |
| Other | $1,275,639 | OtherAmount |
| Total Adjustments | 1275639 | TotalAdjustments |
| Excess Or Deficit Per FS | 1477674 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 9466540 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 1275639 | OtherRevenues |
| Revenue Not Rptd F990 | 1275639 | RevenueNotRptdF990 |
| Revenue Subtotal | 8190901 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 8190901 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 7988866 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 7988866 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 7988866 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE. IT WAS DETERMINED THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | EQUITY TRANSFER TO RELATED PARTY 1,275,639. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | EQUITY TRANSFER TO RELATED PARTY 1,275,639. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (10 entries)
| 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 EBLIN | |||||||||||||
| 0 | 187210 | 0 | 0 | 0 | 360 | 0 | 30804 | 0 | 4602 | 0 | 222976 | 0 | 0 |
| PATRICIA VINOCUR | |||||||||||||
| 217721 | 0 | 20000 | 0 | 584 | 0 | 25934 | 0 | 7272 | 0 | 271511 | 0 | 0 | 0 |
| ROBERT CLAUSER | |||||||||||||
| 144386 | 0 | 0 | 0 | 180 | 0 | 5733 | 0 | 6607 | 0 | 156906 | 0 | 0 | 0 |
| LYNWOOD R WHITE | |||||||||||||
| 0 | 264955 | 0 | 0 | 0 | 1584 | 0 | 24296 | 0 | 4195 | 0 | 295030 | 0 | 0 |
| KEUNG LEE | |||||||||||||
| 310234 | 0 | 16818 | 0 | 258 | 0 | 33000 | 0 | 9774 | 0 | 370084 | 0 | 0 | 0 |
| JOHN GAGE | |||||||||||||
| 262481 | 0 | 70346 | 0 | 1270 | 0 | 22000 | 0 | 3666 | 0 | 359763 | 0 | 0 | 0 |
| DOUGLAS SCHULTZ | |||||||||||||
| 230546 | 0 | 83912 | 0 | 658 | 0 | 17807 | 0 | 6874 | 0 | 339797 | 0 | 0 | 0 |
| MAURA HAMRICK | |||||||||||||
| 122763 | 0 | 66892 | 0 | 443 | 0 | 16500 | 0 | 8852 | 0 | 215450 | 0 | 0 | 0 |
| KATHLEEN RILEY | |||||||||||||
| 155748 | 0 | 16974 | 0 | 637 | 0 | 0 | 0 | 9489 | 0 | 182848 | 0 | 0 | 0 |
| ROBERT E MORRISON | |||||||||||||
| 0 | 387202 | 0 | 0 | 0 | 725322 | 0 | 158990 | 0 | 23910 | 0 | 1295424 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | CERTAIN INDIVIDUALS ARE ALLOWED TO PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN. A DESCRIPTION OF THIS PLAN IS LISTED BELOW. THE AMOUNTS REPRESENTED AS DEFERRED COMPENSATION ON SCHEDULE J HAVE NOT BEEN PAID TO THE INDIVIDUALS. THE NUMBER 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, RANDOLPH HOSPITAL (A RELATED ORGANIZATION) ESTABLISHED SUPPLEMENTAL PLANS TO COVER HIGHLY COMPENSATED EMPLOYEES. THESE PLANS INCLUDED A NONQUALIFIED SUPPLEMENTAL RETIREMENT PLAN, A DEFERRED COMPENSATION PLAN, AND A SPLIT-DOLLAR LIFE INSURANCE PLAN. THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDES ADDITIONAL BENEFITS TO SUPPLEMENT BENEFITS EARNED UNDER THE 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. PREMIUMS PAID UNDER THE SPLIT-DOLLAR INSURANCE POLICY WERE $9,822 FOR THE FISCAL YEAR. ROBERT E. MORRISON RECEIVED A PAYAOUT OF PREVIOUSLY DEFERRED COMPENSATION FROM THE NONQUALIFIED SUPPLEMENTAL DEFERRED COMPENSATION PLAN IN 2012 IN THE AMOUNT OF $723,738. TOTAL CONTRIBUTIONS TO THIS PLAN FOR THE FISCAL YEAR TOTALED $927,287. THE BENEFIT OBLIGATION IS RECORDED IN OTHER LONG-TERM LIABILITIES. FOR THE YEAR, THE FOLLOWING INDIVIDUALS ACCRUED COMPENSATION UNDER THE SERP: STEVE EBLIN $9,470 ROBERT MORRISON $129,012 | |
| PART III | SCHEDULE J, PART I, LINE 1: SEVERAL OFFICERS OF RANDOLPH MEDICAL ASSOCIATES ARE COMPENSATED BY A RELATED TAX-EXEMPT ENTITY, RANDOLPH HOSPITAL, INC. SAID OFFICERS ARE ALLOWED REIMBURSEMENTS FOR HEALTH AND/OR SOCIAL CLUB DUES. RANDOLPH HOSPITAL, INC. HAS A WRITTEN REIMBURSEMENT POLICY AND REQUIRES SUBSTANTIATION BEFORE ISSUING ANY REIMBURSEMENTS. ADDITIONALLY, OFFICER COMPENSATION AMOUNTS ARE DETERMINED USING A VARIETY OF SOURCES INCLUDING: FORM 990 OF SIMILAR ORGANIZATIONS, COMPENSATION SURVEYS AND STATISTICS, AN INDEPENDENT CONSULTANT, AND A COMPENSATION COMMITTEE. ONCE A COMPENSATION PACKAGE IS APPROVED BY THE BOARD OF DIRECTORS, A WRITTEN EMPLOYMENT CONTRACT IS DRAFTED AND SIGNED BY THE APPLICABLE PARTIES. PART I, LINE 3: THE ORGANIZATION RELIES ON THE GOVERNING BODY OF RANDOLPH HOSPITAL, INC. TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR. RANDOLPH HOSPITAL USES THE FOLLOWING METHODS: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACTS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE SCHEDULE J, PART II: WE ARE REQUIRED TO REPORT COMPENSATION OF KEY INDIVIDUALS THAT WORK FOR AND ARE PAID BY A RELATED ORGANIZATION. COMPENSATION REPORTED ON THIS SCHEDULE DOES NOT NECESSARILY MEAN THAT THE COMPENSATION WAS PAID BY THIS ORGANIZATION. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS RANDOLPH HOSPITAL, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | DIRECTORS SHALL BE ELECTED BY THE AFFIRMATIVE VOTE OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER. ANY VACANCY OCCURRING ON THE BOARD MAY BE FILLED BY THE AFFIRMATIVE VOTE OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER. A DIRECTOR ELECTED TO FILL A VACANCY SHALL BE ELECTED FOR THE UNEXPIRED TERM OF HIS PREDECESSOR IN OFFICE. | |
| FORM 990, PART VI, SECTION A, LINE 7B | CERTAIN POWERS ARE RESERVED EXCLUSIVELY UNTO THE SOLE MEMBER OF THE ORGANIZATION, WHICH SHALL EXERCISE SUCH POWERS IN ACCORDANCE WITH LAW AND THE AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS OF ITS BOARD OF DIRECTORS, AS THEN CONSTITUTED; SUCH POWERS TO BE: (1) TO MERGE OR CONSOLIDATE THE ORGANIZATION WITH ANY OTHER NONPROFIT CORPORATION, (2) TO ACQUIRE OR CREATE ANOTHER CORPORATION, (3) TO MAKE A CAPITAL EXPENDITURE OVER A SPECIFIED DOLLAR LIMIT TO BE ESTABLISHED FROM TIME TO TIME BY THE SOLE MEMBER, (4) TO SELL CAPITAL ASSETS VALUED OVER A SPECIFIED DOLLAR LIMIT TO BE ESTABLISHED FROM TIME TO TIME BY THE SOLD MEMBER, (5) TO APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS PROPOSED BY THE ORGANIZATION, (6) PERMISSION TO DISSOLVE THE ORGANIZATION, AND (7) TO APPOINT THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AS PROVIDED IN ARTICLE III, SECTION 2 AND 4 OF THE BYLAWS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT FROM MANAGEMENT. THE 990 WAS REVIEWED BY THE ORGANIZATION'S BOARD OF DIRECTORS. ANYONE NOT IN ATTENDANCE DURING THE MEETING WAS PROVIDED A COPY AND INVITED TO SUBMIT QUESTIONS. FOLLOWING THE REVIEW, THE RETURN WAS FILED WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION SHARES WITH RANDOLPH HOSPITAL 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 15A | A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS ACQUIRES OUTSIDE INFORMATION USED TO DETERMINE EXECTUIVE SALARIES. | |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE 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, LINE 1A | ROBERT CLAUSER IS THE PRESIDENT 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 PARTNERSHIPS AND EMPLOYER HEALTH. | |
| FORM 990, PART XI, LINE 5: | EQUITY TRANSFER TO RELATED PARTY 1,275,639. TOTAL TO FORM 990, PART XI, LINE 5: 1,275,639. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| RANDOLPH HOSPITAL INC | |||||||||||
| PO BOX 1048 | ASHEBORO | NC | 27204 | 560530234 | HEALTHCARE | NC | 501(C)(3) | LINE 3 | N/A | 0 | |
| RANDOLPH HOSPITAL COMMUNITY HEALTH FOUNDATION | |||||||||||
| 346 WHITE OAK STREET | ASHEBORO | NC | 27204 | 582240755 | SUPPORTING ORGANIZATION | NC | 501(C)(3) | LINE 11A, I | 0 | RANDOLPH HOSPITAL INC | |
| RANDOLPH SPECIALTY GROUP PRACTICE | |||||||||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27204 | 113827203 | HEALTHCARE | NC | 501(C)(3) | LINE 9 | 0 | RANDOLPH HOSPITAL INC | |
| RANDOLPH CANCER CENTER LLC | |||||||||||
| 364 WHITE OAK STREET | ASHEBORO | NC | 27204 | 562181482 | HEALTHCARE | NC | 501(C)(3) | LINE 11A, I | 0 | RANDOLPH HOSPITAL INC | |
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 | 264317497 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | KS | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | LoansOrGuaranteesFromOtherOrg |
| 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 | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | 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 | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |