HOSPICE OF SURRY COUNTY INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- HOSPICE OF SURRY COUNTY INC (EIN 56-1346589)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-06-12
- IRS object ID
- 201241649349300644
- 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 | 2012-06-12T10:40:28-05:00 | 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 | 561346589 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPICE OF SURRY COUNTY INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HOSP | NameControl |
| Phone | 3367892922 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 TECHNOLOGY LANE NO 200 | AddressLine1 |
| City | MOUNT AIRY | City |
| State | NC | State |
| ZIP Code | 27030 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DENISE WATSON | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 3367892922 | Phone |
| Date Signed | 2012-06-12 | 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
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOUNTAIN VALLEY HOSPICE AND PALLATIV | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DENISE WATSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 TECHNOLOGY LANE NO 200 | AddressLine1 |
| City | MOUNT AIRY | City |
| State | NC | State |
| ZIP Code | 27030 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19504715 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MTNVALLEYHOSPICE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1982 | YearFormation |
| State Legal Domicile | NC | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE THE QUALITY OF LIFE FOR THOSE WITH A LIMITED LIFE EXPECTANCY AND THEIR FAMILIES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 2 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 2 | NbrIndependentVotingMembers |
| Total Nbr Employees | 254 | TotalNbrEmployees |
| Total Nbr Volunteers | 405 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 174234 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 295363 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 16435540 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19163348 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 5880 | InvestmentIncomePriorYear |
| Investment Income Current Year | 9586 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 529 | OtherRevenuePriorYear |
| Other Revenue Current Year | 8299 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 16616183 | TotalRevenuePriorYear |
| Total Revenue Current Year | 19476596 | 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 | 8429015 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9444900 | 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 | 7378638 | OtherExpensePriorYear |
| Other Expenses Current Year | 8366969 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15807653 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17811869 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 808530 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1664727 | RevenuesLessExpensesCY |
| Total Assets BOY | 9400574 | TotalAssetsBOY |
| Total Assets EOY | 10168532 | TotalAssetsEOY |
| Total Liabilities BOY | 2987136 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2090367 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6413438 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8078165 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF HOSPICE OF SURRY COUNTY, INC. DBA MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE IS TO IMPROVE THE QUALITY OF LIFE TO THOSE WITH A LIMITED LIFE EXPECTANCY AND THEIR FAMILIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15777279 | Expense |
| Revenue | 19163348 | Revenue |
| Description | THE MISSION, VISION AND VALUES OF HOSPICE OF SURRY COUNTY, INC. ARE THE DRIVERS OF THE CARE AND SERVICES PROVIDED. HOSPICE OF SURRY IS A LEADER IN THE DELIVERY OF HOSPICE SERVICES AND IS DEDICATED TO DELIVERING THE VERY BEST CARE TO PATIENTS AND THEIR FAMILIES. HOSPICE OF SURRY IS CONTINUALLY ENHANCING ITS SERVICES, EXPANDING PROGRAMS AND EDUCATING THE COMMUNITIES WE SERVE. IN 2011, HOSPICE OF SURRY PROVIDED SERVICES IN 16 COUNTIES IN NORTH CAROLINA AND VIRGINIA. HOSPICE OF SURRY HAS GROWN INTO A REGIONAL PROVIDER WITH A STRONG PRESENCE IN EACH OF THE COMMUNITIES SERVED. IN 2011, THE FOLLOWING HIGHLIGHTS ARE NOTED: - ADMISSIONS INCREASED 18%, - DAYS OF CARE INCREASED 14%, - TOTAL PATIENT REVENUE EXCEEDED $15 MILLION, - ACHIEVED OPERATING INCOME OF 8.8% OF PATIENT REVENUE, - ACHIEVED NET INCOME OF 10.8% OF PATIENT REVENUE, - SIGNIFICANTLY DECREASED DEBT, - COLLECTED OVER $150K OF OUTSTANDING PLEDGES, - OPENED A NEW OFFICE IN PILOT MOUNTAIN, - STARTED A WE HONOR VETERANS PROGRAM, - STARTED A KIDS PATH PROGRAM, - STARTED A PET PEACE OF MIND PROGRAM, - PURCHASED A VEHICLE FOR EVENTS | Description |
| Total Program Service Expense | 15777279 | 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 | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | 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 | 0 | 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 | 103 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 254 | 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 |
| Form1098 C Filed | 1 | Form1098CFiled |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 2 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 2 | 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 | 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 | RON PARDUE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 3367892922 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 TECHNOLOGY LANE STE 200 | AddressLine1 |
| City | MOUNT AIRY | City |
| State | NC | State |
| ZIP Code | 27030 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (8 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|
| WILLIAM B JAMES | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| DON TRIPPEL | |||||||
| TREASURER (2/11-9/11) | 1.00 | X | X | 0 | 0 | 0 | |
| ROBERT HETRICK | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| DAVID LOVING | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| RANDOLPH F HARRISON | |||||||
| TREASURER (10/10-1/11) | 1.00 | X | X | 0 | 0 | 0 | |
| SYLVIA DENISE WATSON | |||||||
| EXECUTIVE DIRECTOR | 40.00 | X | 113357 | 0 | 16751 | ||
| RONNIE G PARDUE | |||||||
| CFO | 40.00 | X | 99846 | 0 | 2754 | ||
| GLENN D GOLASZEWSKI | |||||||
| MEDICAL DIRECTOR | 40.00 | 159379 | 0 | 14604 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 372582 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 34109 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | 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 |
|---|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD | |||||
| PO BOX 580017 | CHARLOTTE | NC | 28258 | INSURANCE | 1263087 |
| HUGH CHATHAM MEMORIAL HOSPITAL | |||||
| PO BOX 560 | ELKIN | NC | 28621 | HEALTH CARE | 733529 |
| NORTHERN HOSPITAL OF SURRY COUNTY | |||||
| PO BOX 1101 | MT AIRY | NC | 27030 | HEALTH CARE | 702642 |
| CENTRAL CONTINUING CARE | |||||
| 1287 NEWSOME STREET | MT AIRY | NC | 27030 | HEALTH CARE | 548953 |
| WISE HOSPICE OPTIONS | |||||
| 1733 NORMAL HILL | EDMOND | OK | 73034 | PHARMACY | 504634 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 16 | NumberOfContractorsGT100K |
| All Other Contributions | 295363 | AllOtherContributions |
| Total Contributions | 295363 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 19163348 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19163348 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19163348 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4599 | TotalRevenueColumn |
| Exclusion | $4,599 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 4987 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 4987 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4987 | TotalRevenueColumn |
| Exclusion | $4,987 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 36418 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 28119 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8299 | TotalRevenueColumn |
| Exclusion | $8,299 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19476596 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19163348 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $17,885 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 406691 | Total |
| Program Services | 130487 | ProgramServices |
| Management And General | 276204 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6794015 | Total |
| Program Services | 5680683 | ProgramServices |
| Management And General | 1113332 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62728 | Total |
| Program Services | 62728 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1654099 | Total |
| Program Services | 1654099 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 527367 | Total |
| Program Services | 527367 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7260 | Total |
| Management And General | 7260 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61790 | Total |
| Management And General | 61790 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 150 | Total |
| Management And General | 150 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2977566 | Total |
| Program Services | 2971781 | ProgramServices |
| Management And General | 5785 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139616 | Total |
| Program Services | 238 | ProgramServices |
| Management And General | 139378 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3240449 | Total |
| Program Services | 2996381 | ProgramServices |
| Management And General | 244068 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 91545 | Total |
| Program Services | 91545 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 393505 | Total |
| Program Services | 393505 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 596424 | Total |
| Program Services | 485867 | ProgramServices |
| Management And General | 110557 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 78367 | Total |
| Program Services | 70426 | ProgramServices |
| Management And General | 7941 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62830 | Total |
| Program Services | 6611 | ProgramServices |
| Management And General | 56219 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 458941 | Total |
| Program Services | 458941 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37660 | Total |
| Program Services | 37660 | ProgramServices |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 208960 | 208960 | |
| PROPERTY/SALES TAXES | 11906 | 11906 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17811869 | Total |
| Program Services | 15777279 | ProgramServices |
| Management And General | 2034590 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1945728 | BOY |
| EOY | 3202012 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 208969 | BOY |
| EOY | 52219 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2092544 | BOY |
| EOY | 1889282 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29386 | BOY |
| EOY | 37077 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 203523 | BOY |
| EOY | 248103 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 6292784 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1589463 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4914216 | BOY |
| EOY | 4703321 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 867 | BOY |
| EOY | 376 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5341 | BOY |
| EOY | 36142 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9400574 | BOY |
| EOY | 10168532 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1245242 | BOY |
| EOY | 1251463 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1600000 | BOY |
| EOY | 800000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 141894 | BOY |
| EOY | 38904 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2987136 | BOY |
| EOY | 2090367 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6204469 | BOY |
| EOY | 8025946 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 208969 | BOY |
| EOY | 52219 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6413438 | BOY |
| EOY | 8078165 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9400574 | BOY |
| EOY | 10168532 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1664727 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1109758 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 878613 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 761122 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 174234 | CurrentTaxYearMinus1Year |
| Current Tax Year | 295363 | CurrentTaxYear |
| Total | 3219090 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1109758 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 878613 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 761122 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 174234 | CurrentTaxYearMinus1Year |
| Current Tax Year | 295363 | CurrentTaxYear |
| Total | 3219090 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 329133 | AmountsSubstContributorsTotal |
| Public Support Total170 | 2889957 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 71818 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 42722 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 15330 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5880 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9586 | CurrentTaxYear |
| Total | 145336 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 3364426 | TotalSupport |
| Gross Receipts From Admissions Etc | 74398616 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.85900 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.76200 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 261343 | OtherCostOrOtherBasis |
| Book Value | 261343 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2468724 | OtherCostOrOtherBasis |
| Depreciation | 159216 | Depreciation |
| Book Value | 2309508 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3562717 | OtherCostOrOtherBasis |
| Depreciation | 1430247 | Depreciation |
| Book Value | 2132470 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 4703321 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CAPITAL LEASE OBLIGATION | Description |
| Amount | $38,904 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 38904 | TotalOfAmounts |
| Total Revenue | 19476596 | TotalRevenue |
| Total Expenses | 17811869 | TotalExpenses |
| Excess Or Deficit For Year | 1664727 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 1664727 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 19476596 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 19476596 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 19476596 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 17811869 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 17811869 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 17811869 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | INCOME TAXES- THE HOSPICE IS A NOT-FOR-PROFIT ORGANIZATION THAT HAS BEEN RECOGNIZED BY THE FEDERAL REVENUE SERVICE AS TAX-EXEMPT UNDER THE INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPICE FOLLOWS THE FINANCIAL ACCOUNTING STANDARDS BOARD'S ("FASB") AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVDUAL TAX POSITIONS IN THE FINANCIAL STATEMENTS. TAX POSITIONS MUST MEET A RECOGNITION THRESHOLD OF MORE-LIKELY -THAN-NOT IN ORDER FOR THE BENEFIT OF THOSE TAX POSITIONS TO BE RECOGNIZED IN THE HOSPICE'S FINANCIAL STATEMENTS. THE HOSPICE HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2011. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | BARBEQUE,ANNUAL YADKIN COUNTY | NameOfEvent1 |
| Gross Receipts Event1 | 6081 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 6081 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 3608 | OtherDirectExpensesEvent1 |
| Name Of Event2 | TOUR DE MAYBERRY | NameOfEvent2 |
| Gross Receipts Event2 | 8324 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 8324 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 4721 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 7 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 22013 | GrossReceiptsOtherEvents |
| Gross Revenue Other Events | 22013 | GrossRevenueOtherEvents |
| Other Direct Expenses Other Events | 19790 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 36418 | GrossReceiptsTotal |
| Gross Revenue Total Events | 36418 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 28119 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 28119 | DirectExpenseSummaryEvents |
| Net Income Summary | 8299 | NetIncomeSummary |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | GLENN D GOLASZEWSKI | NamePerson |
| Base Compensation Filing Org | 154579 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 4800 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 14604 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 173983 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DEBRA TRIPPEL | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SPOUSE OF CURRENT OFFICER | Relationship |
| Amount Of Transaction | 20760 | AmountOfTransaction |
| Description Of Transaction | COMPENSATION AS EMPLOYEE | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS TWO MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL, INC, AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE GOVERNING BODY CONSISTS OF REPRESENTATIVES APPOINTED BY THE ORGANIZATION'S MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE GOVERNING BODY CONSISTS OF REPRESENTATIVES APPOINTED BY THE ORGANIZATION'S MEMBERS, HUGH CHATHAM MEMORIAL HOSPITAL AND THE NORTHERN HOSPITAL DISTRICT OF SURRY COUNTY. DECISIONS OF THE REPRESENTATIVES ARE SUBJECT TO APPROVAL OF THE MEMBER ORGANIZATIONS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. UPON COMPLETION OF THE FORM 990, THE ORGANIZATION'S MANAGEMENT REVIEWED THE FORM 990. THE FORM 990 WAS THEN PROVIDED TO THE MEMBERS FOR THEIR REVIEW PRIOR TO SUBMISSION TO THE IRS. | |
| BOARD OF MEMBERS, ADVISORY BOARD AND HOSPICE STAFF SUBMIT A FORM TO DISCLOSE PERSONAL OR FINANCIAL INTERESTS THAT COULD POSSIBLY INTERFERE WITH THEIR DUTIES AND RESPONSIBILITIES TO THE ORGANIZATION. DISCLOSURE FORMS ARE SUBMITTED AT THE TIME OF HIRE OR BOARD APPOINTMENT, ANNUALLY AND/OR WHENEVER A POTENTIAL CONFLICT ARISES. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLOYMENT OR BOARD APPOINTMENT. | FORM 990, PART VI, SECTION B, LINE 12C | |
| SALARY RANGES ARE ESTABLISHED FOR EACH PAID POSITION IN THE ORGANIZATION. EACH SALARY RANGE HAS A MINIMUM AND MAXIMUM AMOUNT. THE MEMBERS DETERMINE THE SALARY FOR THE EXECUTIVE DIRECTOR, CFO AND MEDICAL DIRECTOR OF THE ORGANIZATION. THE EXCEUTIVE DIRECTOR AND CFO DETERMINE THE SALARY RANGES FOR OTHER PAID POSITIONS IN THE ORGANIZATION. SALARY RANGES ARE REVIEWED ANNUALLY AND BENCHMARKED AGAINST INDUSTRY DATA. | FORM 990, PART VI, SECTION B, LINE 15 | |
| RECENT FILINGS 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 18 | |
| PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | FORM 990, PART VI, SECTION C, LINE 19 |