2024-08-13T09:41:54-05:00 2023-09-30 440160260 FORVIS MAZARS LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2022-10-01 561346589 HOSPICE OF SURRY COUNTY INC HOSP 3367892922 401 TECHNOLOGY LANE 200 MOUNT AIRY NC 27030 BARRY S DOWELL CFO 3367892922 2024-08-13 1 0 AMY BIBBY P00445891 8282542254 2024-08-13 2022 2024-08-08 14:25:15Z MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE DENISE WATSON 401 TECHNOLOGY LANE 200 MOUNT AIRY NC 27030 38674075 0 X WWW.MTNVALLEYHOSPICE.ORG X 1982 NC OUR MISSION IS CREATING THE BEST EXPERIENCE FOR THOSE FACING SERIOUS ILLNESS - EVERY PATIENT, EVERY FAMILY, EVERY TIME. 2 2 481 49 0 0 2385944 809266 34721213 37580516 569941 66275 182589 182422 37859687 38638479 0 0 0 0 22202522 23808010 0 0 465337 14020972 15116101 36223494 38924111 1636193 -285632 19506734 22817283 5165679 8766883 14341055 14050400 X OUR MISSION IS CREATING THE BEST EXPERIENCE FOR THOSE FACING SERIOUS ILLNESS - EVERY PATIENT, EVERY FAMILY, EVERY TIME. 0 0 32866645 37726965 THE MISSION, VISION, AND VALUES OF MOUNTAIN VALLEY HOSPICE AND PALLIATIVE CARE (MHVPC) ARE THE MAIN DRIVERS OF CARE AND SERVICES PROVIDED TO OUR PATIENTS AND FAMILIES. OUR GOAL IS TO PROVIDE SERVICES BASED ON THE "MOUNTAIN VALLEY WAY" WHICH FOCUSES ON THE PATIENT AND FAMILY EXPERIENCE DURING CARE. OUR MISSION IS "CREATING THE BEST EXPERIENCE FOR THOSE FACING SERIOUS ILLNESSEVERY PATIENT, EVERY FAMILY, EVERY TIME". MVHPC HAS EXPANDED ITS REGIONAL FOOTPRINT IN BOTH NORTH CAROLINA AND VIRGINIA, SERVING PATIENTS FROM A 17-COUNTY SERVICE AREA. IN ADDITION, WE SERVE PATIENTS IN OUR TWO INPATIENT FACILITIES: THE JOAN AND HOWARD WOLTZ HOSPICE HOME AND THE SECU HOSPICE CARE CENTER. OUR OVERALL SUCCESS CAN BE ATTRIBUTED TO PROVIDING HIGH QUALITY CARE, ONGOING AWARENESS, AND MARKETING ACTIVITIES, OFFERING MULTIPLE PROGRAMS, FOSTERING RELATIONSHIPS AND ENGAGING THE COMMUNITY.IN FY 2023, MVHPC SERVED 2,798 TOTAL HOSPICE PATIENTS AND THEIR FAMILIES. THE ORGANIZATION SERVED AN AVERAGE DAILY CENSUS OF 464 PATIENTS AT HOME; IN LONG-TERM CARE FACILITIES, ASSISTED LIVING FACILITIES, HOSPITALS, AND HOSPICE INPATIENT UNITS. IN ADDITION TO HOSPICE SERVICES, MVHPC SERVED 546 PATIENTS IN OUR CONSULTATIVE PALLIATIVE CARE PROGRAM WHERE 195 EVENTUALLY TRANSITIONED TO HOSPICE. FOR OUR SPECIALTY POPULATIONS MVHPC OFFERS HOSPICE AND PALLIATIVE CARE SERVICES FOR PEDIATRIC PATIENTS THROUGH THE KIDS PATH PROGRAM; AND VETERANS THROUGH THE WE HONOR VETERANS PROGRAM; AND A PET PEACE OF MIND PROGRAM. PROGRAMS SUCH AS THESE MAKES OUR ORGANIZATION UNIQUE. FINALLY, WE ARE CONTINUALLY LOOKING FOR NEW AND INNOVATIVE OPPORTUNITIES TO MEET THE NEEDS OF OUR PATIENTS AND SUSTAIN OUR PROGRAMS. 32866645 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 34 0 1 481 1 0 0 0 0 0 0 0 0 0 0 0 0 X 2 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BARRY DOWELL 3367892922 401 TECHNOLOGY LANE STE 200 MOUNT AIRY NC 27030 PAUL HAMMES VICE CHAIRMAN 1.00 X X 0 0 0 CHRIS LUMSDEN CHAIRMAN 1.00 X X 0 0 0 ANDREA HICKLING TREASURER 1.00 X X 0 0 0 KENT THOMPSON SECRETARY 1.00 X X 0 0 0 TRACEY DOBSON CHIEF EXECUTIVE OFFICER/DI 40.00 X 233621 0 4340 BARRY S DOWELL CHIEF FINANCIAL OFFICER 40.00 X 163009 0 23444 GLENN D GOLASZEWSKI CHIEF MEDCIAL OFFICER 40.00 X 297020 0 26114 JENNA CAMPBELL CHIEF CLINICAL OPERATIONS OFFICER 40.00 X 157315 0 12169 ROHINI KANNIGANTI MEDICAL DIRECTOR 40.00 X 187673 0 3751 MICHAEL CAPRIOLA MEDICAL DIRECTOR 40.00 X 271186 0 18817 KRISTIE SZARPA SENIOR VP PRACTICE MANAGEMENT 40.00 X 182075 0 17323 1491899 0 105958 15 0 1 0 CMG CIT ACQUISITIONS INC 655 SOUTH WILLOW ST MANCHESTER NH 03103 CONTRACT LABOR 1298365 CCC OF MOUNT AIRY 1287 NEWSOME STREET MOUNT AIRY NC 27030 MEDICAL PAYMENT 729598 VILLAGE CARE OF KING 440 INGRAM ROAD KING NC 27021 MEDICAL PAYMENT 560891 HARBOURVIEW 542 ALLRED MILL RIOAD MOUNT AIRY NC 27030 MEDICAL PAYMENT 478692 TELEIOS COLLABORATIVE NETWORK 571 SOUTH ALLEN FLAT ROCK NC 28726 MANAGEMENT 425796 16 809266 809266 PATIENT SERVICE REVENUE 623000 34064937 34064937 NURSING HOME SUPPORT 623000 3515579 3515579 37580516 38226 38226 42994 14945 28049 28049 28049 56624 20651 35973 35973 146449 0 146449 146449 38638479 37726965 0 102248 X 396630 384949 11681 18335136 14536466 3522267 276403 233680 181343 48743 3594 3452702 2675057 724631 53014 1389862 1078579 289908 21375 20042 20042 66125 66125 957 957 6794969 6740484 54485 354076 354076 1152658 887085 238796 26777 492342 465615 26727 685628 685628 483752 245042 238310 400 98390 95474 2916 57296 57296 1252500 1252500 56591 56591 MEDICAL SUPPLIES 3212230 3212230 BAD DEBT 334541 334541 EVENT EXPENSES 45366 45366 MISCELLANEOUS EXPENSES 8638 8638 38924111 32866645 5592129 465337 6144734 6878239 3734191 3882289 243160 305661 561469 428942 18469277 8234640 8700520 10234637 74841 202862 47819 884653 19506734 22817283 3115099 2657873 247601 0 1802979 6109010 5165679 8766883 X 14341055 14050400 14341055 14050400 19506734 22817283 -285632 -5023 0 X X 0 1 X 1 0 X 1452630 1804836 989483 2549936 809266 7606151 1452630 1804836 989483 2549936 809266 7606151 102257 7503894 1045 240 146 12569 38226 52226 7658377 159829994 0.97980 0.93820 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 942487 942487 6920984 3251697 3669287 10605806 4982943 5622863 10234637 CAPITAL LEASE OBLIGATION 1488757 UNEARNED INCOME 3858159 RIGHT OF USE LIABILITY 762094 6109010 X 38458958 -5023 -174498 -179521 38638479 0 38638479 38749613 -174498 -174498 38924111 0 38924111 PART X, LINE 2: THE HOSPICE IS A NOT-FOR-PROFIT ORGANIZATION THAT HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS TAXEXEMPT UNDER INTERNAL REVENUE CODE SECTION 501 (C)(3). THE HOSPICE FOLLOWS THE FASB'S AUTHORITATIVE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR THE RECOGNITION AND MEASUREMENT OF THE BENEFITS OF INDIVIDUAL 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, 2023. PART XI, LINE 2D - OTHER ADJUSTMENTS: THRIFT SHOP GROSS RECEIPTS -157,680. THRIFT SHOP COST OF GOODS SOLD 11,231. GAIN ON SALE OF ASSET -28,049. PART XII, LINE 2D - OTHER ADJUSTMENTS: THRIFT SHOP GROSS RECEIPTS -157,680. THRIFT SHOP COST OF GOODS SOLD 11,231. GAIN ON SALE OF ASSET -28,049. X X X LUCKY DAYS IN MAY RAFFLE 23741 23741 1510 658 PORT-A-PIT FUNDRAISER 32883 32883 550 649 17284 56624 56624 1510 550 649 17942 20651 35973 X X 0 0 0 0 0 0 0 0 0 GLENN D GOLASZEWSKI CHIEF MEDCIAL OFFICER 287020 0 10000 0 0 0 6100 0 20014 0 323134 0 0 0 MICHAEL CAPRIOLA MEDICAL DIRECTOR 271186 0 0 0 0 0 5625 0 13192 0 290003 0 0 0 TRACEY DOBSON CHIEF EXECUTIVE OFFICER/DI 213621 0 20000 0 0 0 3894 0 446 0 237961 0 0 0 KRISTIE SZARPA SENIOR VP PRACTICE MANAGEMENT 172075 0 10000 0 0 0 3851 0 13472 0 199398 0 0 0 ROHINI KANNIGANTI MEDICAL DIRECTOR 187673 0 0 0 0 0 3751 0 0 0 191424 0 0 0 BARRY S DOWELL CHIEF FINANCIAL OFFICER 143009 0 20000 0 0 0 0 0 23444 0 186453 0 0 0 JENNA CAMPBELL CHIEF CLINICAL OPERATIONS OFFICER 137315 0 20000 0 0 0 3191 0 8978 0 169484 0 0 0 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 11B 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. FORM 990, PART VI, SECTION B, LINE 12C 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 15 THE BOARD DETERMINES THE CEO'S COMPENSATION. OTHER OFFICERS AND KEY FIGURES OF THE ORGANIZATION ARE DETERMINED BY A POSITION CONTROL COMMITTEE THAT REPRESENTS FINANCE, HUMAN RESOURCES, THE CEO AND MARKET COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 18 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 19 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 IX, LINE 11G ROOM AND BOARD FEES: PROGRAM SERVICE EXPENSES 3,687,422. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,687,422. MEDICAL FEES: PROGRAM SERVICE EXPENSES 2,152,224. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,152,224. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 900,838. MANAGEMENT AND GENERAL EXPENSES 54,485. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 955,323. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.