2014-07-15T08:07:19-05:00 2013-08-31 990 2012-09-01 541801459 HALIFAX REGIONAL DEVELOPMENT FOUNDATION INC HALI 4345173183 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 STEWART R NELSON 4345173183 2014-07-15 2012 2016-02-25 16:41:14Z CHRIS A LUMSDEN 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 764004 0 X WWW.HRHS.ORG X 1996 VA TO PROMOTE COMMUNITY HEALTH AND TO DEVELOP FUNDRAISING AND SUPPORT FOR HALIFAX REGIONAL HOSPITAL. 5 3 0 5 0 0 586236 715284 0 0 35381 37260 -7578 418 614039 752962 565883 731116 0 0 0 0 0 0 0 92 9 565975 731125 48064 21837 1418359 1315542 113731 41741 1304628 1273801 X HALIFAX REGIONAL DEVELOPMENT FOUNDATION, INC. IS ORGANIZED TO PROMOTE THE GENERAL HEALTH/WELFARE OF THE COMMUNITY, DEVELOP FUNDRAISING EFFORTS AND IMPROVE COMMUNITY SUPPORT FOR HALIFAX REGIONAL HOSPITAL. FOR MORE INFORMATION, SEE SCHEDULE O. 0 0 328403 328394 HALIFAX REGIONAL COMMUNITY PARTNERSHIP PROGRAMREFER TO SCHEDULE O. 139658 139658 HOSPICE FUNDREFER TO SCHEDULE O. 114067 114067 HALIFAX REGIONAL DENTAL CLINICREFER TO SCHEDULE O. 49559 49559 MEDICATION ASSISTANCE PROGRAMWITH FUNDING SUPPORT FROM THE VIRGINIA HEALTH CARE FOUNDATION, THE CHASTAIN HOME AND THE HALIFAX REGIONAL DEVELOPMENT FOUNDATION, MEDASSIST OF HALIFAX PROVIDES MEDICATION ASSISTANCE TO LOW INCOME, UNINSURED AND UNDERINSURED RESIDENTS IN HALIFAX AND MECKLENBURG COUNTIES. MEDASSIST OF HALIFAX COLLABORATES WITH OTHER HEALTHCARE PROVIDERS AND AGENCIES IN THE AREA TO IDENTIFY INDIVIDUALS WHO CAN BENEFIT FROM THIS SERVICE. THIS PROGRAM PROVIDES PARTICIPANTS A STABLE PROCESS FOR RECEIVING LIFE SUSTAINING AND/OR PREVENTIVE MEDICATIONS. HALIFAX COUNTY HAS A HIGHER INCIDENCE THAN THE STATE MEDIAN FOR HEALTH CONDITIONS FOR WHICH HOSPITALIZATIONS CAN BE PREVENTED WITH CONSISTENT, AVAILABLE AMBULATORY CARE AND GOOD PATIENT COMPLIANCE WITH TREATMENT/SELF PROTOCOLS, INCLUDING HYPERTENSION, ASTHMA AND DIABETES. COMPLIANCE WITH PRESCRIBED COURSES OF MEDICATION IMPROVES THE QUALITY OF LIFE FOR PATIENTS, WHILE DECREASING THE NUMBER OF HOSPITAL VISITS OF PATIENTS WHO RETURN DUE TO INABILITY TO COMPLY. EMERGENCY DEPARTMENT VISITS PRECIPITATED BY CONDITIONS WHICH COULD HAVE BEEN MANAGED WITH COMPLIANCE WITH THE PRESCRIBED MEDICATION REGIMEN ARE EXPECTED TO ALSO BE REDUCED. THIS PROGRAM IS ADMINISTERED THROUGH THE HALIFAX REGIONAL DEVELOPMENT FOUNDATION, INC. DURING FY13, 1,223 PATIENTS RECEIVED MEDICATIONS VALUED AT $5,611,020. 27000 27000 CANCER CARE FUNDTHE CANCER CARE FUND WAS ESTABLISHED TO PROVIDE ASSISTANCE TO UNINSURED AND UNDERINSURED PATIENTS WHO MEET THE MEDICAL CRITERIA FOR SCREENING FOR BREAST CANCER AND/OR COLON CANCER. IN FY13, THE CANCER CARE FUND PROVIDED $27,000 TO 27 INDIVIDUALS FOR SCREENINGS. THE PROGRAM IS ADMINISTERED AND PROMOTED BY HALIFAX REGIONAL HOSPITAL, INC. 67438 67438 PROJECT PRIMEPRIME (PUBLIC RALLY FOR INDIVIDUAL MEDICAL EDUCATION), WHICH BEGAN 28 YEARS AGO WITH CONTRIBUTIONS FROM INDIVIDUALS AND BUSINESSES IN THE AREA, PROVIDES FINANCIAL ASSISTANCE TO THOSE IN THE REGION WHO WANT TO PURSUE A CAREER IN A HEALTHCARE OR A HEALTHCARE-RELATED FIELD. IN FY13 APPROXIMATELY $67,000 IN SCHOLARSHIPS WAS AWARDED TO 53 INDIVIDUALS - 27 STUDENTS PURSUING NURSING EDUCATION AND 26 PEOPLE ENTERING CLINICAL AND/OR BUSINESS EDUCATION PROGRAMS. (SCHOLARSHIP APPLICATIONS ARE AVAILABLE ON THE HEALTH SYSTEM'S WEB SITE, BEGINNING IN JANUARY OF EACH YEAR, FOR THOSE IN THE REGION WHO HAVE BEEN ACCEPTED INTO ACCREDITED EDUCATIONAL PROGRAMS AND WHO DESIRE FINANCIAL ASSISTANCE TO PURSUE THEIR STUDIES.) PROJECT PRIME IS ADMINISTERED AND PROMOTED BY HALIFAX REGIONAL HOSPITAL, INC. 5000 5000 DR. JESSE J. BATES SCHOLARSHIP PROGRAMTHIS PROGRAM WAS STARTED IN 2002 IN HONOR OF DR. JESSE J. BATES, ONE OF TWELVE PHYSICIANS ON HALIFAX REGIONAL HOSPITAL'S MEDICAL STAFF WHEN THE HOSPITAL OPENED IN 1953. IN FY13, THE BATES SCHOLARSHIP PROVIDED $5,000 IN SCHOLARSHIP FUNDS TO SIX GRADUATING HIGH SCHOOL SENIORS FROM THE HALIFAX REGIONAL HEALTH SYSTEM SERVICE AREA. THE PURPOSE OF THE SCHOLARSHIP IS TO ENCOURAGE HIGH SCHOOL SENIORS TO SEEK EDUCATION TO FILL CRITICAL HEALTHCARE VACANCIES AND ACQUIRE SKILLS FOR USE WITH TECHNOLOGICALLY ADVANCED EQUIPMENT AND TREATMENT THERAPIES. THE SCHOLARSHIP ENDOWMENT FUND RECEIVES DONATIONS FROM THE COMMUNITY AND THE LATE DR. BATES' FAMILY. THIS SCHOLARSHIP IS ADMINISTERED AND PROMOTED BY HALIFAX REGIONAL HOSPITAL. 148997 148997 731125 1 1 0 0 0 0 0 0 0 1 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 5 3 1 0 1 0 1 1 1 1 1 0 0 1 1 0 1 1 1 0 0 0 X STEWART R NELSON 4345173183 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 X HABIB BASSIL MD 1.00 5.00 X X 0 78750 0 J AUBREY HOUGHTON 1.00 5.00 X X 0 0 0 CAROL C THOMAS 1.00 5.00 X X 0 0 0 DAVID H WHITE JR 1.00 5.00 X X 0 0 0 JAMES H PRIEST DDS 1.00 5.00 X 0 0 0 CHRIS A LUMSDEN 1.00 39.00 X X 0 393655 21110 ROBERT A BROERMANN 1.00 54.00 X X 0 0 0 STEWART R NELSON 1.00 39.00 X 0 259403 4655 THOMAS S KLUGE 1.00 39.00 X 0 223770 14338 0 955578 40103 0 0 1 0 0 26813 124525 563946 715284 37260 37260 11460 26813 11042 418 418 752962 0 0 37678 548020 548020 183096 183096 FEES 9 9 731125 731125 0 0 30357 37729 189285 638669 23375 80808 480546 1122683 52659 77790 1418359 1315542 -117257 82333 80808 31398 78190 113731 41741 X 371524 1304628 902277 1304628 1273801 1418359 1315542 21837 -52664 0 X X 0 1 X 1 0 X X X 0 0 0 HALIFAX REGIONAL HOSPITAL INC 540648699 3 1 56000 1 56000 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1304628 315911 -15404 702849 9 902277 1225984 614039 30580 565883 92 1304628 1214574 390056 36496 415057 85 1225984 1133467 280422 65015 264305 25 1214574 1143472 162263 46611 218833 46 1133467 1.00000 0 0 0 OTHER ASSETS 29116 DUE FROM AFFILIATES 48674 77790 DUE TO AFFILIATES 78190 78190 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE HALIFAX REGIONAL COMMUNITY PARTNERSHIP IS A CHARITABLE PROGRAM ESTABLISHED AS PART OF HALIFAX REGIONAL HEALTH SYSTEM TO PROMOTE ALL AREAS OF HEALTH AND WELLNESS IN THE COMMUNITIES WE SERVE, INCLUDING PHYSICAL, MENTAL, VOCATIONAL, EMOTIONAL, INTELLECTUAL AND SPIRITUAL WELL-BEING. THE CHARITABLE GIVING COMMITTEE CONSISTS OF NO LESS THAN THREE AND NO MORE THAN FIVE MEMBERS, WITH ONE MEMBER SERVING AS CHAIR AND ONE MEMBER SERVING AS THE COORDINATOR. CONTRIBUTIONS CAN ONLY BE GIVEN TO ORGANIZATIONS THAT: (1) TIE DIRECTLY WITH PROMOTING A HEALTHY LIFESTYLE AND AWARENESS OF HEALTH ISSUES, (2) PROMOTE KEY COMMUNITY GOALS AND FILL IMPORTANT UNMET NEEDS AS IDENTIFIED BY ELECTED OFFICIALS AND LEADERS IN THE COMMUNITY, (3) SUPPORT THE HRH PHILOSOPHY OF BEING AN EXCELLENT CORPORATE CITIZEN, (4) THAT ARE NON-PROFIT ENTITIES, AND (5) THAT INCLUDE HRHS EMPLOYEES, ESPECIALLY WHEN HRHS EMPLOYEES SERVE IN LEADERSHIP ROLES. ALL REQUESTS MUST BE IN WRITING AS NO VERBAL REQUESTS WILL BE REVIEWED OR FUNDED. THE REQUEST MUST STATE THE INTENDED USE OF THE FUNDS. THE PROCESS FOR REVIEWING REQUESTS IS AS FOLLOWS: (1) ALL REQUESTS FOR CONTRIBUTIONS SHOULD BE DIRECTED TO THE COORDINATOR. (2) THE COORDINATOR WILL CONSOLIDATE THE REQUESTS AND BE READY TO PROVIDE A SUMMARY FOR THE COMMITTEE DURING MEETINGS. (3) THE CHAIR WILL PRESENT RECOMMENDATIONS FOR GIVING. (4) THE COMMITTEE WILL REVIEW THE REQUESTS AND DECIDE ON THE AMOUNT OF FUNDING. (5) THE COORDINATOR WILL ISSUE THE CHECK REQUEST TO THE ACCOUNTING DEPARTMENT AND PROVIDE AN APPROVAL LETTER WITH THE CHECK WHEN IT IS MAILED OUT. THE PROJECT PRIME SCHOLARSHIP FUND IS ADMINISTERED BY HALIFAX REGIONAL HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE TO INDIVIDUALS WHO WISH TO PURSUE A CAREER IN HEALTHCARE OR A HEALTHCARE-RELATED FIELD. THE APPLICANTS MUST SUBMIT GRADES AND RECEIPTS UPON COMPLETION OF EACH SEMESTER TO VERIFY THAT THE GRANTS WERE USED AS INTENDED. THE RECIPIENT IS REQUIRED TO REPAY ANY FUNDS NOT USED OR IF THE RECIPIENT CANNOT PROVIDE RECEIPTS AND GRADES AT AN ACCEPTABLE LEVEL. THE JESSE J. BATES SCHOLARSHIP PROGRAM PROVIDES SCHOLARSHIPS TO GRADUATING HIGH SCHOOL SENIORS TO SEEK EDUCATION TO FILL CRITICAL HEALTHCARE VACANCIES. RECIPIENTS ARE REQUIRED TO PROVIDE DOCUMENTATION OF ACCEPTANCE INTO A PROGRAM AT THE TIME OF APPLICATION. THE FUNDS ARE MADE PAYABLE TO THE EDUCATIONAL INSTITUTIONS. THE THOMAS C. CROWELL, JR., MEMORIAL LIBRARY FUND PROVIDES EDUCATIONAL MATERIALS FOR THE LIBRARY OF HALIFAX REGIONAL HOSPITAL. THE MEDICATION ASSISTANCE PROGRAM (MEDASSIST) PROVIDES ASSISTANCE TO UNINSURED AND UNDERINSURED PATIENTS TO OBTAIN PRESCRIPTION MEDICATIONS AT REDUCED OR NO COST. THE PROGRAM IS ADMINISTERED THROUGH DOMINION HEALTH GROUP AND DOMINION HEALTH MEDICAL ASSOCIATES. APPLICANTS ARE REQUIRED TO SUBMIT FINANCIAL INFORMATION TO SUPPORT THE NEED FOR ASSISTANCE ON A PERIODIC BASIS. FUNDS ARE USED TO COVER THE EXPENSES OF THE PROGRAM. THE HOSPICE FUND WAS ESTABLISHED TO PROVIDE ASSISTANCE TO TERMINALLY ILL PATIENTS WHO ARE UNABLE TO AFFORD GOODS AND SERVICES NECESSARY FOR THE PROVISION OF END-OF-LIFE MEDICAL SERVICES. THE PROGRAM IS ADMINISTERED BY HALIFAX HOME HEALTH AND HOSPICE. THE CANCER CARE FUND WAS ESTABLISHED TO PROVIDE ASSISTANCE TO UNINSURED AND UNDERINSURED PATIENTS WHO MEET THE MEDICAL CRITERIA FOR SCREENING FOR BREAST CANCER AND/OR COLON CANCER. THE PROGRAM IS ADMINISTERED BY HALIFAX REGIONAL HOSPITAL. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HEALTH SYSTEM, THE HOSPITAL, THE FOUNDATION, PROPERTIES, THE WOODVIEW, AND MEADOWVIEW TERRACE ARE GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS AMENDED. HRPS IS DISREGARDED FOR FEDERAL AND STATE INCOME TAX PURPOSES AS ITS OPERATIONS ARE CONSIDERED PART OF THE HOSPITAL FOR INCOME TAX PURPOSES. DHMA AND SOUTHSIDE ARE FOR-PROFIT, TAXABLE ORGANIZATIONS. THE HEALTH SYSTEM DOES NOT BELIEVE ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDE (OR REFLECT) ANY UNCERTAIN TAX POSITIONS. GALA EVENT 38273 26813 11460 800 7084 1500 1658 38273 26813 11460 800 7084 1500 1658 11042 418 1 SOUTHERN VIRGINIA HIGHER EDUCATION CENTER 820 BRUCE STREET SOUTH BOSTON VA 24592 141931584 501(C)(3) 139194 GRANT FOR THE CENTER NURSING EXCELLENCE YMCA OF SOUTH BOSTONHALIFAX COUNTY 650 HAMILTON BLVD SOUTH BOSTON VA 24592 540951231 501(C)(3) 20250 FAMILY, YOUTH, & CHILDRENS SERVICES COMMUNITY ARTS CENTER FOUNDATION 700 BRUCE STREET SOUTH BOSTON VA 24592 541795927 501(C)(3) 30000 SPONSORSHIP SOUTHSIDE HEALTH SERVICES INC 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 541417772 51084 MEDICATION ASSISTANCE PROGRAM HALIFAX COUNTY CANCER ASSOCIATION 60 SOUTH MAIN STREET HALIFAX VA 24558 540848343 501(C)(3) 6000 ANNUAL WALK FOR HOPE AND ASSISTANCE WITH CANCER SUPPLIES HALIFAX COUNTY CHAMBER OF COMMERCE PO BOX 339 SOUTH BOSTON VA 24592 540641363 501(C)(6) 5500 SPONSORSHIP HALIFAX COUNTY PUBLIC SCHOOLS EDUCATION FOUNDATION PO BOX 1114 HALIFAX VA 24558 202098518 501(C)(3) 10300 DONATION FOR MINI-GRANT PROGRAM HALIFAX EDUCATIONAL FOUNDATION 820 BRUCE STREET SOUTH BOSTON VA 24592 541866278 501(C)(3) 50000 SUPPORT FOR STUDENT EDUCATION MENTOR ROLE MODEL PROGRAM PO BOX 1435 SOUTH BOSTON VA 24592 541812117 501(C)(3) 5250 GENERAL FINANCIAL SUPPORT OF PROGRAMS TRI-COUNTY CAA HEAD START PROGRAM 1176 HUELL MATTHEWS HIGHWAY SOUTH BOSTON VA 24592 540805926 501(C)(3) 15000 SUPPORT OF HEAD START PROGRAM TURBEVILLE FIRE DEPARTMENT 1020 MELON ROAD SOUTH BOSTON VA 24592 541249603 501(C)(3) 8719 GENERAL FINANCIAL SUPPORT DOMINION HEALTH MEDICAL ASSOCIATES 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 541060357 114067 FUNDING FOR HALIFAX REGIONAL DENTAL CLINIC HALIFAX REGIONAL HOSPITAL 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 540648699 501(C)(3) 56000 HOSPICE SUPPORT 10 3 HOSPICE FUND 6 28914 SCHOLARSHIPS 58 72438 CANCER CARE GRANT 27 27000 HOSPICE PATIENTS 256 54744 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALL REQUESTS MUST BE IN WRITING AS NO VERBAL REQUESTS WILL BE REVIEWED OR FUNDED. THE REQUEST MUST STATE THE INTENDED USE OF THE FUNDS. THE REQUESTS ARE REVIEWED BY THE RESPECTIVE COMMITTEES. ANY UNRELATED ORGANIZATION RECEIVING MORE THAN $5,000 IS REQUIRED TO PROVIDE A FORM W-9 AND AN INTERNAL REVENUE SERVICE DETERMINATION LETTER. ALL SCHOLARSHIP FUNDS MADE PAYABLE TO THE RECIPIENTS MUST BE SUBSTANTIATED AT THE COMPLETION OF THE COURSE BY SUBMISSION OF GRADES AND RECEIPTS FOR EXPENDITURES. IF ADEQUATE GRADES AND RECEIPTS ARE NOT RECEIVED, THE RECIPIENT IS REQUIRED TO REPAY THE GRANT. OTHER SCHOLARSHIP GRANTS ARE MADE PAYABLE TO THE EDUCATIONAL INSTITUTIONS. 0 0 0 0 0 0 0 0 0 CHRIS A LUMSDEN 0 320800 0 30000 0 42855 0 2501 0 18609 0 414765 0 0 STEWART R NELSON 0 216062 0 20000 0 23341 0 2804 0 1851 0 264058 0 0 THOMAS S KLUGE 0 190429 0 10000 0 23341 0 -4037 0 18375 0 238108 0 0 ORGANIZATION'S MISSION PART III, LINE 1 HALIFAX REGIONAL DEVELOPMENT FOUNDATION, INC. IS ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF HALIFAX REGIONAL HOSPITAL, INC. THE FUNCTIONS TO BE PERFORMED BY THE CORPORATION ARE TO SOLICIT, RECEIVE, AND ADMINISTER GIFTS, GRANTS, CONTRIBUTIONS AND DONATIONS FOR HALIFAX REGIONAL HOSPITAL, INC. OR PROVIDE SUCH OTHER SERVICES THAT ARE REQUESTED BY HALIFAX REGIONAL HOSPITAL, INC. AND TO CARRY OUT OTHER EXCLUSIVELY CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES OF HALIFAX REGIONAL HOSPITAL, INC. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A, 4B, 4C HALIFAX REGIONAL DEVELOPMENT FOUNDATION, INC. (FOUNDATION) IS ORGANIZED TO PROMOTE THE GENERAL HEALTH AND WELFARE OF THE COMMUNITY AND IS RESPONSIBLE FOR THE DEVELOPMENT OF FUNDRAISING EFFORTS AND IMPROVEMENT OF COMMUNITY SUPPORT FOR HALIFAX REGIONAL HOSPITAL, INC. ("THE HOSPITAL"), FOR ADMINISTERING GIFTS, GRANTS AND CONTRIBUTIONS FOR THE HOSPITAL AND ITS SUBSIDIARIES ("THE HEALTH SYSTEM") AND FOR PROVIDING OTHER SERVICES THAT ARE EXCLUSIVELY CHARITABLE, EDUCATIONAL OR SCIENTIFIC IN NATURE. THE FOUNDATION IS ALSO RESPONSIBLE FOR MANAGING THE INVESTMENT OF THE HOSPITAL'S ENDOWMENT FUNDS AND FOR MANAGEMENT OF THE HEALTH SYSTEM'S EDUCATIONAL ASSISTANCE PROGRAM. HALIFAX REGIONAL COMMUNITY PARTNERSHIP PROGRAM AS A CORNERSTONE ORGANIZATION IN OUR REGION, THE HEALTH SYSTEM TAKES SERIOUSLY ITS RESPONSIBILITY TO BE AN ACTIVE CORPORATE CITIZEN. THE HEALTH SYSTEM CONTRIBUTES TO VARIOUS ORGANIZATIONS THAT SHARE ITS MISSION TO PROMOTE GOOD HEALTH AND WELLNESS AND TO HELP IMPROVE THE QUALITY OF LIFE OF ALL AGES. AS PART OF THE HEALTH SYSTEM'S CONTINUED ACTIVE COMMUNITY INVOLVEMENT, THE HALIFAX REGIONAL COMMUNITY PARTNERSHIP PROGRAM WAS ESTABLISHED IN FY05 TO ENABLE THE HEALTH SYSTEM TO MAXIMIZE ITS RESOURCES TO PROVIDE THE GREATEST BENEFIT TO CITIZENS IN SOUTHSIDE VIRGINIA. GUIDELINES FOR REQUESTS HELP ANSWER IMPORTANT QUESTIONS THAT ENABLE THE PROGRAM TO DISPERSE RESOURCES IN THE MOST EFFECTIVE MANNER. IN FY13 $328,394 WAS DONATED TO SUPPORT COMMUNITY PROGRAMS IN OUR SERVICE AREA. ADDITIONALLY, HUNDREDS OF HEALTH EDUCATION BROCHURES AND GIVEAWAYS WERE PROVIDED TO COMMUNITY ORGANIZATIONS TO HELP SUPPORT THEIR EVENTS AND PROGRAMS. HOSPICE FUND HALIFAX REGIONAL HOSPICE IS THE RECIPIENT OF MANY GENEROUS DONATIONS FROM THE COMMUNITY MEMORIALIZING OR HONORING FAMILY AND FRIENDS. HOSPICE ALSO HOSTS AN ANNUAL GALA FUNDRAISING EVENT. FUNDS RAISED THROUGH DONATIONS AND THE GALA ARE USED TO SUPPORT UNFUNDED PATIENT CARE, THE VOLUNTEER AND R.I.S.E BEREAVEMENT PROGRAMS, STAFF, PATIENT AND FAMILY EDUCATION, MARKETING AND EDUCATIONAL MATERIALS, SPECIAL PROJECTS SUCH AS THE C.A.R.E. CHANNEL FOR HOSPITALIZED PATIENTS, AND ITEMS SUCH AS CDS AND DVDS USED IN MUSIC THERAPY. HOSPICE FUNDS ALSO PAY THE SALARIES OF A PART TIME CLERICAL SUPPORT PERSON, PART TIME CHAPLAIN AND A PART-TIME BEREAVEMENT COORDINATOR. HOSPICE DOES NOT DISCRIMINATE ON THE ABILITY TO PAY. IN FY13 HOSPICE RECEIVED CONTRIBUTIONS OF $97,140. DISBURSEMENTS IN FY13 TOTALED $150,700. HALIFAX REGIONAL DENTAL CLINIC HALIFAX REGIONAL DENTAL CLINIC (HRDC), WHICH OPENED IN FEBRUARY 2013, WAS BUILT TO GIVE CHILDREN A FUN, EASY EXPERIENCE AT THE DENTIST, WITH PLENTY TO KEEP THEM BUSY AS THEY HAVE THEIR APPOINTMENT. HRDC WAS BUILT AS A PARTNERSHIP WITH THE GENEROUS SUPPORT OF THE VIRGINIA DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT, THE VIRGINIA TOBACCO COMMISSION, AND OTHER PARTNERING ORGANIZATIONS. CONTINUE OPERATING SUPPORT IS PROVIDED BY THE VIRGINIA HEALTH CARE FOUNDATION, WHICH FUNDS SAFETY NET AND COMMUNITY MEDICAL AND DENTAL SERVICES THROUGHOUT THE COMMONWEALTH. HRDC IS ONE OF ONLY A FEW LOCAL PRACTICES THAT WILL ACCEPT MEDICAID PAYMENT FOR SERVICES. THE CLINIC HOPES TO REACH OUT TO MORE THAN 2,400 KIDS ANNUALLY WHEN IT IS RUNNING AT FULL CAPACITY. DURING THE FIRST YEAR OF SERVICE, MORE THAN 1,900 PEOPLE HAVE VISITED FOR CHECKUPS, FILLINGS, EXTRACTIONS OR OTHER DENTAL WORK. IN FACT, THE CLINIC HAS PROVIDED MORE THAN 4,400 APPOINTMENTS SINCE IT OPENED. IN FY13, FUNDS USED TO FUND THE CLINIC TOTALED $114,067. FORM 990, PART VI, SECTION A, LINE 2 DAVID H. WHITE, JR. AND CHRIS A. LUMSDEN HAVE A BUSINESS RELATIONSHIP. THE ORGANIZATION'S OFFICERS AND DIRECTORS SERVED TOGETHER ON THE BOARDS OF OTHER TAXABLE ORGANIZATIONS WITHIN THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), AS WELL AS JOINT VENTURES IN WHICH THE SYSTEM HAD AN OWNERSHIP INTEREST. SEE SCHEDULE R FOR A LISTING OF SUCH ENTITIES. FORM 990, PART VI, SECTION A, LINE 4 EFFECTIVE JULY 1, 2013, HALIFAX REGIONAL HOSPITAL, INC. ("HRH"), A 501(C)(3) AFFILIATE, REPLACED HALIFAX REGIONAL HEALTH SYSTEM, INC.("HRHS") AS SOLE MEMBER OF THE ORGANIZATION. THE MEMBER CHANGE OCCURRED IN ACCORDANCE WITH THE APRIL 23, 2013 AFFILIATION AGREEMENT AMONG HRHS, HRH, AND SENTARA HEALTHCARE ("SENTARA"), A 501(C)(3) ORGANIZATION, WHEREBY SENTARA REPLACED HRHS AS THE SOLE MEMBER OF HRH. AS A RESULT OF THE AFFILIATION, THE ORGANIZING AND GOVERNING DOCUMENTS OF THE ORGANIZATION WERE CHANGED IN THE FOLLOWING MANNER: -HRH REPLACED HRHS AS SOLE MEMBER OF THE ORGANIZATION. -THE NUMBER OF DIRECTORS ON THE BOARD WAS CHANGED FROM FIVE TO NO LESS THAN THREE. DIRECTORS ARE STILL APPOINTED BY THE SOLE MEMBER BUT NOW MUST BE RATIFIED BY SENTARA. -AS SOLE MEMBER OF HRH, SENTARA HAS THE EXCLUSIVE AUTHORITY TO DIRECT AND MANAGE THE OEPRATIONS AND AFFAIRS OF THE ORGANIZATION AND TO MAKE ALL DECISIONS REGARDING ITS BUSINESS, SUBJECT TO OVERSIGHT BY THE HRH BOARD AS AND TO THE EXTENT SET FORTH IN THE AFFILIATION AGREEMENT. SENTARA HAS ALSO BEEN GRANTED CERTAIN RESERVED POWERS, AS OUTLINED IN THE AFFILIATION AGREEMENT, WHEREBY HRH WILL NOT PERMIT THE ORGANIZATION TO TAKE OR ALLOW CERTAIN ACTIONS WITHOUT THE PRIOR WRITTEN CONSENT OF SENTARA . SEE PART VI SECTION A LINE 7B FOR FURTHER INFORMATION. -DURING THE COVENANT PERIOD, AS DEFINED IN THE AFFILIATION AGREEMENT, ANY ALTERATION, AMENDMENT, RESTATEMENT OR REPEAL OF ANY GOVERNING DOCUMENTS; THE ADOPTION OF ANY NEW GOVERNING DOCUMENTS; OR ANY ACTION TO BE TAKEN AS THE MEMBER UNDER THE GOVERNING DOCUMENTS REQUIRE THE APPROVAL OF A MAJORITY OF CLASS A DIRECTORS OF HRH, VOTING AS A SEPARATE CLASS, AND OF SENTARA. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAD ONE CLASS OF MEMBER. EFFECTIVE JULY 1, 2013, THE SOLE MEMBER WAS HALIFAX REGIONAL HOSPITAL, INC., A VIRGINIA NONSTOCK CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION'S SOLE MEMBER PRIOR TO JULY 1, 2013 WAS HALIFAX REGIONAL HEALTH SYSTEM, INC., A VIRGINIA NONSTOCK CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A PRIOR TO JULY 1, 2013, THE DATE OF AFFILIATION WITH THE SENTARA HEALTHCARE SYSTEM, MEMBERS OF THE GOVERNING BODY WERE ELECTED BY THE ORGANIZATION'S FORMER SOLE MEMBER, HALIFAX REGIONAL HEALTH SYSTEM, INC. EFFECTIVE JULY 1, 2013, HALIFAX REGIONAL HOSPITAL, INC. REPLACED HALIFAX REGIONAL HEALTH SYSTEM, INC. AS SOLE MEMBER OF THE ORGANIZATION AND APPOINTED MEMBERS OF THE GOVERNING BODY IN ACCORDANCE WITH THE APRIL 23, 2013 AFFILIATION AGREEMENT WITH SENTARA HEALTHCARE. FORM 990, PART VI, SECTION A, LINE 7B SENTARA HEALTHCARE ("SENTARA"), IN ITS CAPACITY AS THE 501(C)(3) SOLE MEMBER OF HALIFAX REGIONAL HOSPITAL, INC. ("HRH"), THE SOLE MEMBER OF THE ORGANIZATION, HAS RESERVED THE EXCLUSIVE RIGHT, POWER AND AUTHORITY TO MAKE DECISIONS FOR AND ON BEHALF OF THE ORGANIZATION WITH RESPECT TO THE APPROVAL OR ADOPTION OF ANY PLAN OF MERGER OR CONSOLIDATION; ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE ORGANIZATION; AND THE VOLUNTARY DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION, REVOCATION OF AN SUCH VOLUNTARY DISSOLUTION PROCEEDINGS, OR ANY DECISION TO FILE A PETITION REQUESTING OR CONSENTING TO AN ORDER FOR RELIEF UNDER THE FEDERAL BANKRUPTCY LAWS OR SIMILAR STATE LAWS FOR THE ORGANIZATION. ELECTION OF THE ORGANIZATION'S GOVERNING BODY IS ALSO SUBJECT TO RATIFICATION BY SENTARA. FINALLY, SPECIAL APPROVAL BY HRH'S GOVERNING BODY IS REQUIRED FOR CERTAIN OTHER ACTIONS OF THE ORGANIZATION. THESE INCLUDE A CHANGE IN THE ORGANIZATION'S MISSION; THE ESTABLISHMENT OF, AND APPOINTMENT OF MEMBERS TO, ANY COMMITTEES WHICH WILL HAVE ANY OF THE AUTHORITY OF THE HRH GOVERNING BODY; AND ANY ALTERATION, AMENDMENT, RESTATEMENT OR REPEAL OF ANY GOVERNING DOCUMENTS, THE ADOPTION OF ANY NEW GOVERNING DOCUMENTS; OR ANY ACTION TO BE TAKEN AS THE MEMBER UNDER THE GOVERNING DOCUMENTS. FINAL AUTHORITY FOR THE ESTABLISHMENT OF ALL POLICY PERTAINING TO THE ORGANIZATION FOR ITS OPERATION, MAINTENANCE AND DEVELOPMENT, AND FOR THE ATTAINMENT OF ITS OBJECTIVES, IS VESTED IN THE GOVERNING BODY OF HRH, AND SUBJECT TO RATIFICATION AND APPROVAL BY SENTARA. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS PREPARED BY ORGANIZATION'S CORPORATE TAX DEPARTMENT, BASED ON INFORMATION PROVIDED BY ORGANIZATION AND IN CONSULTATION WITH ORGANIZATION STAFF. THE DRAFT PREPARED BY CORPORATE IS THEN CAREFULLY REVIEWED BY ORGANIZATION MANAGEMENT AND STAFF. CHANGES ARE MADE AS APPROPRIATE. THE FINAL VERSION IS MADE AVAILABLE TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO EACH BOARD MEMBER IN JANUARY EVERY YEAR. THE QUESTIONNAIRE MUST BE COMPLETED BY ALL MEMBERS. A REPORT OF THE DISCLOSED POTENTIAL CONFLICTS IS PRESENTED BY THE SOLE MEMBER'S BOARD CHAIRMAN TO ITS BOARD IN EXECUTIVE SESSION ANNUALLY. IF IT IS DETERMINED BY THE SOLE MEMBER'S BOARD SECRETARY, BOARD PRESIDENT, AND MEDICAL STAFF PRESIDENT THAT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE CIRCUMSTANCES OF THE CONFLICT OF INTEREST SHALL BE SET FORTH IN DETAIL BY THE AFFECTED PARTY. SUBSEQUENTLY, WHEN A RESOLUTION CANNOT BE FOUND TO THE SATISFACTION OF THE SOLE MEMBER'S BOARD SECRETARY, BOARD PRESIDENT, AND MEDICAL STAFF PRESIDENT, THE MATTER WILL BE REVIEWED AND ADDRESSED BY THE SOLE MEMBER'S EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. A RECOMMENDATION WILL BE MADE TO THE AFFECTED PARTY ON HOW TO REMOVE THE CONFLICT. IF THE CONFLICT CANNOT BE RESOLVED TO THE SATISFACTION OF THE SOLE MEMBER'S EXECUTIVE COMMITTEE, A RECOMMENDATION WILL BE MADE TO REMOVE THE AFFECTED BOARD MEMBER FROM THE BOARD. IN SUCH CASE WHERE REMOVAL IS RECOMMENDED, SUCH REMOVAL PROCEDURES OUTLINED IN THE CORPORATE BYLAWS WILL BE FOLLOWED. THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE ARE RETAINED BY THE SOLE MEMBER'S BOARD SECRETARY. THE ORGANIZATION SEEKS TO PAY REASONABLE COMPENSATION UNDER IRC SECTION 4958 TO ATTRACT AND RETAIN THE APPROPRIATE CALIBER OF EMPLOYEES DEDICATED TO CARRYING OUT ITS TAX-EXEMPT MISSION. THE SOLE MEMBER OF THE ORGANIZATION PERIODICALLY CONDUCTS A REVIEW TO DETERMINE THE GOING FAIR MARKET COMPENSATION RANGES FOR COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE SOLE MEMBER SETS COMPENSATION WITHIN THE RANGE OF THE GOING MARKET RATE. NO INDIVIDUAL HAVING A CONFLICT OF INTEREST IS PERMITTED TO PARTICIPATE IN THE REVIEW OR DECISION. THE SOLE MEMBER MAINTAINS RECORDS REGARDING COMPENSATION. THE SOLE MEMBER'S BOARD CHAIRMAN ALSO SERVES AS THE CHAIRMAN OF ITS EXECUTIVE (COMPENSATION) COMMITTEE, COORDINATING WITH THE CHIEF EXECUTIVE OFFICER/PRESIDENT TO REVIEW ANNUAL PERFORMANCE AND COMPARATIVE MARKET INFORMATION FOR THE POSITION OF CHIEF EXECUTIVE OFFICER (CEO)/PRESIDENT, CHIEF OPERATING OFFICER (COO), AND CHIEF FINANCIAL OFFICER (CFO). A RECOMMENDATION IS PRESENTED TO THE EXECUTIVE COMMITTEE BY ITS CHAIRMAN. THE EXECUTIVE COMMITTEE TAKES ACTION ON THE RECOMMENDATION. THE SOLE MEMBER'S FULL BOARD OF DIRECTORS IS MADE AWARE THAT ITS EXECUTIVE COMMITTEE HAS TAKEN ACTION ON COMPENSATION FOR THE CEO/PRESIDENT, COO, AND CFO WITH DETAILS AVAILABLE FOR THEIR REVIEW UPON REQUEST. THIS PROCESS WAS LAST UNDERTAKEN DURING THE TAX YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION CURRENTLY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A THE EFFECTIVE DATE OF THE ORGANIZATION'S AFFILIATION WITH SENTARA HEALTHCARE, ITS NEW 501(C)(3) SOLE MEMBER, WAS JULY 1, 2013. SINCE THE COMPENSATION REQUIRED TO BE REPORTED IN PART VII SECTION A IS FROM THE 2012 CALENDAR YEAR, AND SENTARA HEALTHCARE WAS NOT RELATED TO THE ORGANIZATION AT ANY TIME DURING 2012, NO RELATED COMPENSATION HAS BEEN REPORTED IN PART VII SECTION FOR BOARD MEMBER AND TREASURER ROBERT BROERMANN, WHO IS AN EMPLOYED OFFICER OF SENTARA HEALTHCARE. CHANGE IN AFS OVERSIGHT PROCESS FORM 990, PART XII, LINE 2C DURING THE YEAR, THE ORGANIZATION AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM, WHO ASSUMED RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTED THE INDEPENDENT ACCOUNTANT. STATEMENT FILED PURSUANT TO TREASURY REGULATION SEC. 1.6038-2(J)(3): HALIFAX REGIONAL HOSPITAL, INC. ("HRH"), THE TAXPAYER'S 501(C)(3) SOLE MEMBER, OWNS A NON-CONTROLLING INTEREST IN VIRGINIA SOLUTIONS SPC, LTD., A CONTROLLED FOREIGN CORPORATION. ALL INFORMATION REQUIRED OF THE TAXPAYER BY IRC SECTION 6038 AND THE REGULATIONS THEREUNDER WITH RESPECT TO VIRGINIA SOLUTIONS SPC, LTD. IS FURNISHED BY HRH, EIN 54-0648699. THEREFORE, PURSUANT TO TREASURY REGULATION SEC. 1.6038-2(J)(2), THE TAXPAYER IS EXCEPTED FROM PROVIDING SUCH INFORMATION. THE REQUIRED INFORMATION IS E-FILED WITH HRH'S FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX. 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