ROANOKE VALLEY HEALTH SERVICES INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ROANOKE VALLEY HEALTH SERVICES INC (EIN 56-1925492)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-03-07
- IRS object ID
- 201240679349300414
- Schema version
- 2010v3.4
- 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 | 2012-03-07T08:52:33-06:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 561925492 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROANOKE VALLEY HEALTH SERVICES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ROAN | NameControl |
| Phone | 2525358130 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1 |
| City | ROANOKE RAPIDS | City |
| State | NC | State |
| ZIP Code | 27870 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SHERRY JENSEN | Name |
| Title | CFO | Title |
| Phone | 2525358130 | Phone |
| Date Signed | 2012-03-07 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | SHERRY JENSEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1 |
| City | ROANOKE RAPIDS | City |
| State | NC | State |
| ZIP Code | 27870 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 3944412 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HALIFAXMEDICALCENTER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1994 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | OPERATION OF PRIMARY CARE MEDICAL OFFICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 25 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 51 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 57804 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 43989 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 3163247 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 3767033 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 310 | InvestmentIncomePriorYear |
| Investment Income Current Year | 84 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 523590 | OtherRevenuePriorYear |
| Other Revenue Current Year | 133306 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3744951 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3944412 | 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 | 4401890 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4821398 | 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 | 932283 | OtherExpensePriorYear |
| Other Expenses Current Year | 1760874 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 5334173 | TotalExpensesPriorYear |
| Total Expenses Current Year | 6582272 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1589222 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2637860 | RevenuesLessExpensesCY |
| Total Assets BOY | 1760796 | TotalAssetsBOY |
| Total Assets EOY | 1875506 | TotalAssetsEOY |
| Total Liabilities BOY | 12288981 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 14411520 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -10528185 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -12536014 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | ROANOKE VALLEY HEALTH SERVICES EXISTS TO MEET THE HEALTHCARE NEEDS OF OUR COMMUNITY BY PROVIDING EXCELLENT AND COMPASSIONATE SERVICES AND ALWAYS PLACING PATIENTS FIRST. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 5713639 | Expense |
| Revenue | 3767033 | Revenue |
| Description | ROANOKE VALLEY HEALTH SERVICES, INC. OPERATES NON-PROFIT PRIMARY CARE MEDICAL OFFICES. THE ORGANIZATION WORKS IN CLOSE TIES WITH HALIFAX REGIONAL MEDICAL CENTER, AND SHARES IN ITS GOALS AND ACHIEVEMENTS THROUGH A CONSTANT PARTNERSHIP OF FULFILLING THE HOSPITAL'S EXEMPT PURPOSE--PROVIDING EXCELLENT HEALTHCARE SERVICE TO THE COMMUNITY. IN THE CURRENT TAX YEAR, THE ORGANIZATION REACHED THE FOLLOWING MILESTONES: - RECRUITED SIX NEW PHYSICIANS: ONE GASTROENTEROLOGIST, TWO OB/GYN'S, TWO HOSPITALISTS, AND ONE FAMILY PHYSICIAN. - IMPLEMENTED ELECTRONIC MEDICAL RECORDS PROCESS AT ROANOKE AND WILDWOOD CLINICS. - SUCCESSFULLY IMPLEMENTED MARKETING AND ADVERTISING PROGRAMS FOR NEW PHYSICIAN PRACTICES FOR DRS. OCONNOR AND SORENSEN. | Description |
| Total Program Service Expense | 5713639 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| 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 | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | 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 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 51 | 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 | 25 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | 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 | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| 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 | SHERRY JENSEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2525358005 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 SMITH CHURCH ROAD | AddressLine1 |
| City | ROANOKE RAPIDS | City |
| State | NC | State |
| ZIP Code | 27870 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (30 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 |
|---|---|---|---|---|---|---|---|
| VERNON BRYANT | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 1100 | 0 | |
| BOB PATTERSON | |||||||
| VICE CHAIR | 1.00 | X | X | 0 | 1000 | 0 | |
| TOM LYNCH | |||||||
| TREASURER | 1.00 | X | X | 0 | 1050 | 0 | |
| JAMES PIERCE | |||||||
| SECRETARY | 1.00 | X | X | 0 | 800 | 0 | |
| WILL MAHONE | |||||||
| PRESIDENT | 1.00 | X | X | 0 | 327913 | 67358 | |
| JOHNNY DRAPER | |||||||
| PAST CHAIR | 1.00 | X | 0 | 1100 | 0 | ||
| DR NATARAJAN RAJAN | |||||||
| CHIEF OF STAFF | 1.00 | X | 0 | 0 | 0 | ||
| DR GERARDO MARADIAGA | |||||||
| PAST CHIEF OF STAFF | 1.00 | X | 0 | 100 | 0 | ||
| ERNEST L BARNER | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 700 | 0 | ||
| DREWERY BEALE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 900 | 0 | ||
| WILLIAM HODGE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 1100 | 0 | ||
| REV JOHN W SMITH | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 250 | 0 | ||
| EVELYN DAWSON | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 550 | 0 | ||
| FANNIE GREEN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 600 | 0 | ||
| J HUGH BAZEMORE | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 1100 | 0 | ||
| CARL FEREBEE | |||||||
| RVMM CHAIR | 1.00 | X | 0 | 92090 | 19511 | ||
| ME GILSTRAP | |||||||
| RVMM VICE CHAIR | 1.00 | X | 0 | 0 | 0 | ||
| BETTY COOK | |||||||
| RVMM BOARD MEMBER | 1.00 | X | 0 | 25612 | 291 | ||
| CONNIE HILL | |||||||
| RVMM BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| REV MARJORIE HOLM | |||||||
| RVMM BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RUBY PALMER | |||||||
| RVMM BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DR KENNETH ROBERT | |||||||
| RVMM BOARD MEMBER | 1.00 | X | 0 | 217063 | 32963 | ||
| CHRIS LEHMAN | |||||||
| RVMM BOARD MEMBER | 1.00 | X | 0 | 138389 | 43221 | ||
| SHERRY JENSEN | |||||||
| RVMM BOARD MEMBER | 1.00 | X | 0 | 217152 | 30925 | ||
| ROSE FLEMING | |||||||
| EXECUTIVE DIRECTOR | 40.00 | X | 0 | 0 | 0 | ||
| CHINEDU ONUORAH | |||||||
| HOSPITALIST | 40.00 | 355154 | 0 | 40341 | X | ||
| TOCHUKWU AGBATA | |||||||
| HOSPITALIST | 40.00 | 315723 | 0 | 40341 | X | ||
| SYED AHMED | |||||||
| HOSPITALIST | 40.00 | 281093 | 0 | 54567 | X | ||
| ASRA JAFFAR | |||||||
| HOSPITALIST | 40.00 | 250871 | 0 | 18951 | X | ||
| UMA AKKINENI | |||||||
| HOSPITALIST | 40.00 | 229809 | 0 | 26271 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1432650 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1028569 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 374740 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 13402 | FederatedCampaigns |
| All Other Contributions | 30587 | AllOtherContributions |
| Total Contributions | 43989 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 621610 | BusinessCode |
| Total Revenue Column | 3767033 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3767033 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 3767033 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 84 | TotalRevenueColumn |
| Exclusion | $84 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 133306 | TotalRevenueColumn |
| Exclusion | $133,306 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 133306 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3944412 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3767033 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $133,390 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4092321 | Total |
| Program Services | 3485276 | ProgramServices |
| Management And General | 607045 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 524719 | Total |
| Program Services | 446883 | ProgramServices |
| Management And General | 77836 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 204358 | Total |
| Program Services | 174044 | ProgramServices |
| Management And General | 30314 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27401 | Total |
| Management And General | 27401 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22020 | Total |
| Management And General | 22020 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 881176 | Total |
| Program Services | 881176 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29022 | Total |
| Program Services | 29022 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 283417 | Total |
| Program Services | 234634 | ProgramServices |
| Management And General | 48783 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46908 | Total |
| Program Services | 46908 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37393 | Total |
| Program Services | 37393 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37254 | Total |
| Program Services | 37254 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 122925 | Total |
| Program Services | 122925 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26800 | Total |
| Program Services | 26800 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 191324 | 191324 | |
| RECRUITMENT AND RELOCAT | 51917 | 51917 | |
| OTHER EXPENSES | 3317 | 3317 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6582272 | Total |
| Program Services | 5713639 | ProgramServices |
| Management And General | 868633 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 272144 | BOY |
| EOY | 212249 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 402195 | BOY |
| EOY | 556788 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1884 | BOY |
| EOY | 20057 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1772066 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 772520 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1064969 | BOY |
| EOY | 999546 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19604 | BOY |
| EOY | 86866 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1760796 | BOY |
| EOY | 1875506 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 142616 | BOY |
| EOY | 66578 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12146365 | BOY |
| EOY | 14344942 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12288981 | BOY |
| EOY | 14411520 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -10573070 | BOY |
| EOY | -12565188 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44885 | BOY |
| EOY | 29174 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -10528185 | BOY |
| EOY | -12536014 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1760796 | BOY |
| EOY | 1875506 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2637860 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 630031 | 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) |
|---|---|---|
| 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 D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1175431 | OtherCostOrOtherBasis |
| Depreciation | 512421 | Depreciation |
| Book Value | 663010 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 131202 | OtherCostOrOtherBasis |
| Depreciation | 57197 | Depreciation |
| Book Value | 74005 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 465433 | OtherCostOrOtherBasis |
| Depreciation | 202902 | Depreciation |
| Book Value | 262531 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 999546 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO HALIFAX REGIONAL MEDICAL CENTER | Description |
| Amount | $14,344,942 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 14344942 | TotalOfAmounts |
| Total Revenue | 3944412 | TotalRevenue |
| Total Expenses | 6582272 | TotalExpenses |
| Excess Or Deficit For Year | -2637860 | ExcessOrDeficitForYear |
| Other | $630,031 | OtherAmount |
| Total Adjustments | 630031 | TotalAdjustments |
| Excess Or Deficit Per FS | -2007829 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 4574443 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 630031 | OtherRevenues |
| Revenue Not Rptd F990 | 630031 | RevenueNotRptdF990 |
| Revenue Subtotal | 3944412 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 3944412 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 6582272 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 6582272 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 6582272 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | TRANSFER OF EQUITY FROM HOSPITAL 630,031. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | TRANSFER OF EQUITY FROM HOSPITAL 630,031. |
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 | 1 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WILL MAHONE | |||||||||||||
| 0 | 261320 | 0 | 52297 | 0 | 14296 | 0 | 38500 | 0 | 28858 | 0 | 395271 | 0 | 0 |
| DR KENNETH ROBERT | |||||||||||||
| 0 | 217063 | 0 | 0 | 0 | 0 | 0 | 11742 | 0 | 21221 | 0 | 250026 | 0 | 0 |
| CHRIS LEHMAN | |||||||||||||
| 0 | 138389 | 0 | 0 | 0 | 0 | 0 | 22000 | 0 | 21221 | 0 | 181610 | 0 | 0 |
| SHERRY JENSEN | |||||||||||||
| 0 | 186489 | 0 | 30663 | 0 | 0 | 0 | 15059 | 0 | 15866 | 0 | 248077 | 0 | 0 |
| CHINEDU ONUORAH | |||||||||||||
| 355154 | 0 | 0 | 0 | 0 | 0 | 18774 | 0 | 21567 | 0 | 395495 | 0 | 0 | 0 |
| TOCHUKWU AGBATA | |||||||||||||
| 315723 | 0 | 0 | 0 | 0 | 0 | 18774 | 0 | 21567 | 0 | 356064 | 0 | 0 | 0 |
| SYED AHMED | |||||||||||||
| 281093 | 0 | 0 | 0 | 0 | 0 | 33000 | 0 | 21567 | 0 | 335660 | 0 | 0 | 0 |
| ASRA JAFFAR | |||||||||||||
| 250871 | 0 | 0 | 0 | 0 | 0 | 16500 | 0 | 2451 | 0 | 269822 | 0 | 0 | 0 |
| UMA AKKINENI | |||||||||||||
| 229809 | 0 | 0 | 0 | 0 | 0 | 16500 | 0 | 9771 | 0 | 256080 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | HALIFAX REGIONAL MEDICAL CENTER, A RELATED ORGANIZATION, PROVIDES A SUPPLEMENTAL NON-QUALIFIED ANNUITY PLAN TO THE CEO. FOR 2010, WILL MAHONE ACCRUED $14,148 UNDER THIS PLAN. IT IS REPORTED ON SCHEDULE J, PART II, COLUMN B(III) AS OTHER REPORTABLE COMPENSATION. | |
| PART I, LINE 7 | THE OFFICERS LISTED BELOW ARE RECIPIENTS OF NON-FIXED PAYMENTS FROM A RELATED ORGANIZATION (HALIFAX REGIONAL MEDICAL CENTER, INC.). THE CEO AND VICE PRESIDENT RECEIVE AT-RISK SALARY PAYMENTS FROM THIS RELATED ORGANIZATION BASED ON REACHING BALANCED SCORECARD OBJECTIVES. THE AMOUNT AVAILABLE IS THE AT-RISK SALARY AVAILABLE FOR THE INDIVIDUAL POSITIONS. FOR 2010, THE FOLLOWING OFFICERS RECEIVED PAYMENTS UNDER THIS PLAN: WILL MAHONE $ 52,297 SHERRY JENSEN 30,663 | |
| PART III | PART I, LINE 3: INDEPENDENT REVIEW OF COMPENSATION: THE ORGANIZATION DOES NOT DIRECTLY COMPENSATE ANY OFFICER OR KEY EMPLOYEE. SOME OFFICERS AND BOARD MEMBERS OF THE ORGANIZATION ARE EMPLOYEES OF HALIFAX REGIONAL MEDICAL CENTER, INC., A RELATED ORGANIZATION. THE BOARD OF DIRECTORS OF THAT ORGANIZATION USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION AMOUNTS FOR ITS CEO AND OTHER KEY PERSONNEL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANTS - WRITTEN EMPLOYEMENT CONTRACTS - COMPENSATION STUDY OR SURVEY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE BOARD OF DIRECTORS AND OR THE EXECUTIVE COMMITTEE SHALL MANAGE THE BUSINESS AND AFFAIRS. IN THE ABSENCE OF A REGULAR OR CALLED MEETING OF THE BOARD, ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE REPORTED AT THE NEXT MEETING OF THE BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. THE ORGANIZATION PROVIDED EVERY VOTING BOARD MEMBER A COPY OF THE DRAFT 990 PRIOR TO A SCHEDULED MEETING. DETAILS OF THE RETURN WERE DISCUSSED WITH MANAGEMENT AND THE FINANCE COMMITTEE OF THE BOARD, WHO THEN DELIVERED A REPORT TO THE FULL BOARD PRIOR TO FILING THE RETURN WITH THE IRS. | |
| THE ORGANIZATION FOLLOWS THE SAME CONFLICT OF INTEREST POLICY AS ITS AFFILIATE, HALIFAX REGIONAL MEDICAL CENTER. THE POLICY IS REVIEWED ANNUALLY, AND BOARD MEMBERS AND MANAGEMENT ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE EVERY YEAR. | FORM 990, PART VI, SECTION B, LINE 12C | |
| PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON WRITTEN 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 18 | |
| PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | TRANSFER OF EQUITY FROM HOSPITAL 630,031. TOTAL TO FORM 990, PART XI, LINE 5: 630,031. | FORM 990, PART XI, LINE 5: |
| THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | FORM 990, PART XII, LINE 2C: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| HALIFAX REGIONAL MEDICAL CENTER | ||||||||||
| 250 SMITH CHURCH ROAD | ROANOKE RAPIDS | NC | 27870 | 560989789 | HEALTHCARE | NC | 501(C)(3) | 3 | 0 | |
| HALIFAX REGIONAL MEDICAL CENTER FOUNDATION | ||||||||||
| 250 SMITH CHURCH ROAD | ROANOKE RAPIDS | NC | 27870 | 561698825 | FUNDRAISING/OPERATIONAL SUPPORT | NC | 501(C)(3) | 7 | 0 | HALIFAX REGIONAL MEDICAL CENTER |
| 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 | 1 | 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 | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |