CLARKSVILLE SENIOR CARE LLC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CLARKSVILLE SENIOR CARE LLC (EIN 54-1957066)
- Tax period
- 2012-09-01 to 2013-08-31
- Filed
- 2014-07-15
- IRS object ID
- 201431969349301423
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-07-15T15:52:54-05:00 | Timestamp |
| Tax Period End Date | 2013-08-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-09-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 541957066 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARKSVILLE SENIOR CARE LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CLAR | NameControl |
| Phone | 4345173183 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2204 WILBORN AVENUE | AddressLine1 |
| City | SOUTH BOSTON | City |
| State | VA | State |
| ZIP Code | 24592 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEWART R NELSON | Name |
| Title | CFO | Title |
| Phone | 4345173183 | Phone |
| Date Signed | 2014-07-15 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHRIS A LUMSDEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2204 WILBORN AVENUE | AddressLine1 |
| City | SOUTH BOSTON | City |
| State | VA | State |
| ZIP Code | 24592 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 10213150 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MEADOWVIEWTERRACE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | VA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE THE HIGHEST QUALITY OF CARE TO THOSE INDIVIDUALS REQUIRING LONG-TERM CARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 188 | TotalNbrEmployees |
| Total Nbr Volunteers | 95 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 50014 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 46688 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9512641 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 10130042 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 8572 | InvestmentIncomePriorYear |
| Investment Income Current Year | -6160 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 39894 | OtherRevenuePriorYear |
| Other Revenue Current Year | 18433 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 9611121 | TotalRevenuePriorYear |
| Total Revenue Current Year | 10189003 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 750000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 665000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5806203 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 6231611 | 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 | 3215751 | OtherExpensePriorYear |
| Other Expenses Current Year | 3508095 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9771954 | TotalExpensesPriorYear |
| Total Expenses Current Year | 10404706 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -160833 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -215703 | RevenuesLessExpensesCY |
| Total Assets BOY | 9706215 | TotalAssetsBOY |
| Total Assets EOY | 13962260 | TotalAssetsEOY |
| Total Liabilities BOY | 5804527 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5500952 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3901688 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8461308 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CLARKSVILLE SENIOR CARE, LLC 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. FOR MORE INFORMATION SEE SCHEDULE O. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 9124259 | Expense |
| Grants | 665000 | Grants |
| Revenue | 10130042 | Revenue |
| Description | THIS ORGANIZATION, DOING BUSINESS AS MEADOWVIEW TERRACE, OPERATES A 150-BED, DUALLY CERTIFIED (MEDICAID AND MEDICARE) NURSING FACILITY, WHICH INCLUDES 42 BEDS FOR ALZHEIMER'S SPECIAL CARE RESIDENTS IN TWO DISTINCT HOUSEHOLD/NEIGHBORHOODS. MEADOWVIEW TERRACE IS LOCATED IN MECKLENBURG COUNTY IN CLARKSVILLE, VIRGINIA. THE NURSING FACILITY PROVIDES PERSONAL CARE, HEALTH CARE SERVICES AND REHABILITATION SERVICES FOR PERSONS NEEDING LONG-TERM CARE AND WHOSE SPECIAL NEEDS CANNOT BE MET IN INDEPENDENT LIVING ENVIRONMENTS. FOR MORE INFORMATION, SEE SCHEDULE O. | Description |
| Total Program Service Expense | 9124259 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | 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 | 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 | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 31 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 188 | 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 | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | 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 | 0 | 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 |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEWART R NELSON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4345173183 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2204 WILBORN AVENUE | AddressLine1 |
| City | SOUTH BOSTON | City |
| State | VA | State |
| ZIP Code | 24592 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (10 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| DAVID H WHITE JR | |||||||||
| CHAIRMAN | 1.00 | 5.00 | X | X | 0 | 0 | 0 | ||
| J AUBREY HOUGHTON | |||||||||
| TREASURER (THROUGH 6/30/13) | 1.00 | 5.00 | X | X | 0 | 0 | 0 | ||
| CAROL C THOMAS | |||||||||
| VICE CHAIRMAN | 1.00 | 5.00 | X | X | 0 | 0 | 0 | ||
| HABIB BASSIL MD | |||||||||
| SECRETARY (THROUGH 6/30/13) | 1.00 | 5.00 | X | X | 0 | 78750 | 0 | ||
| JAMES PRIEST DDS | |||||||||
| BOARD MEMBER | 1.00 | 5.00 | X | 0 | 0 | 0 | |||
| CHRIS A LUMSDEN | |||||||||
| CEO(THRU 6/30)/PRES/SEC(EFF 7/1/13) | 1.00 | 39.00 | X | X | 7046 | 386609 | 21110 | ||
| ROBERT A BROERMANN | |||||||||
| TREASURER (EFF 7/1/13) | 1.00 | 54.00 | X | X | 0 | 0 | 0 | ||
| STEWART R NELSON | |||||||||
| CHIEF FINANCIAL OFFICER | 1.00 | 39.00 | X | 4745 | 254658 | 4655 | |||
| THOMAS S KLUGE | |||||||||
| CHIEF OPERATING OFFICER | 1.00 | 39.00 | 4182 | 219588 | 14338 | X | |||
| JILL ALLEN | |||||||||
| MEDICAL DIRECTOR | 40.00 | 0.00 | 178738 | 0 | 7147 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 194711 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 939605 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 47250 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FUNCTIONAL PATHWAYS LLC | |||||
| 614 MABRY HOOD ROAD STE 301 | KNOXVILLE | TN | 37932 | CONTRACT LABOR | 533001 |
| PHARM SAVE INC | |||||
| 2545 JETPORT ROAD | KINSTON | NC | 28504 | CONSULTING | 184536 |
| VIRGINIA HOSPITAL LAUNDRY | |||||
| 1601 OLIVER HILL WAY | RICHMOND | VA | 232191233 | LAUNDRY SERVICES | 100852 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Government Grants | 46688 | GovernmentGrants |
| Total Contributions | 46688 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 623000 | 10093350 | 10093350 |
| BARBER AND BEAUTY SHOP REVENUE | 812900 | 36692 | 36692 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 10130042 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17987 | TotalRevenueColumn |
| Exclusion | $17,987 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 24147 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -24147 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -24147 | TotalRevenueColumn |
| Exclusion | -$24,147 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFE AND VENDING | 722210 | 13666 | $13,666 |
| MISCELLANEOUS | 900099 | 4767 | $4,767 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 18433 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10189003 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10130042 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $12,273 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 665000 | Total |
| Program Services | 665000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30118 | Total |
| Management And General | 30118 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4552996 | Total |
| Program Services | 3953384 | ProgramServices |
| Management And General | 599612 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 162859 | Total |
| Program Services | 141687 | ProgramServices |
| Management And General | 21172 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1147692 | Total |
| Program Services | 998492 | ProgramServices |
| Management And General | 149200 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 337946 | Total |
| Program Services | 292995 | ProgramServices |
| Management And General | 44951 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41895 | Total |
| Management And General | 41895 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23022 | Total |
| Management And General | 23022 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 937268 | Total |
| Program Services | 911335 | ProgramServices |
| Management And General | 25933 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5651 | Total |
| Management And General | 5651 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 352755 | Total |
| Program Services | 305513 | ProgramServices |
| Management And General | 47242 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 246887 | Total |
| Program Services | 246887 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6286 | Total |
| Program Services | 2303 | ProgramServices |
| Management And General | 3983 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134612 | Total |
| Program Services | 134612 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 653805 | Total |
| Program Services | 653805 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156204 | Total |
| Management And General | 156204 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SURGICAL SUPPLI | 699652 | 699652 | |
| MISCELLANEOUS | 135560 | 20605 | 114955 |
| BAD DEBTS | 79405 | 79405 | |
| EDUCATION | 23397 | 16493 | 6904 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11696 | Total |
| Program Services | 2091 | ProgramServices |
| Management And General | 9605 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10404706 | Total |
| Program Services | 9124259 | ProgramServices |
| Management And General | 1280447 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1708214 | BOY |
| EOY | 1707754 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 115271 | BOY |
| EOY | 133116 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 776079 | BOY |
| EOY | 712697 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35370 | BOY |
| EOY | 47816 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 126956 | BOY |
| EOY | 84041 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11045668 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 177783 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6493350 | BOY |
| EOY | 10867885 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 294031 | BOY |
| EOY | 311137 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156944 | BOY |
| EOY | 97814 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9706215 | BOY |
| EOY | 13962260 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 854629 | BOY |
| EOY | 871542 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 760869 | BOY |
| EOY | 714181 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3506926 | BOY |
| EOY | 3287394 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 81144 | BOY |
| EOY | 33148 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1457 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 599502 | BOY |
| EOY | 594687 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5804527 | BOY |
| EOY | 5500952 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3901688 | BOY |
| EOY | 8461308 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3901688 | BOY |
| EOY | 8461308 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9706215 | BOY |
| EOY | 13962260 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -215703 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -3777 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 4779100 | 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 |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL HOSPITAL INCORPORATED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540648699 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Amount | $0 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 0 | SumOfAmounts |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $995 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 995 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | OTHER LOBBYING ACTIVITIES A PORTION OF DUES PAID TO THE VIRGINIA HEALTH CARE ASSOCIATION IS ATTRIBUTABLE TO LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtc |
| Included On FS | 1 | IncludedOnFS |
| Explanation In Part XIII | X | ExplanationInPartXIII |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2746000 | OtherCostOrOtherBasis |
| Book Value | 2746000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6927709 | OtherCostOrOtherBasis |
| Depreciation | 141487 | Depreciation |
| Book Value | 6786222 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1104459 | OtherCostOrOtherBasis |
| Depreciation | 25467 | Depreciation |
| Book Value | 1078992 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 267500 | OtherCostOrOtherBasis |
| Depreciation | 10829 | Depreciation |
| Book Value | 256671 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10867885 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD PARTY PROGRAMS | $172,836 |
| DUE TO AFFILIATES | $202,146 |
| PATIENT SECURITY DEPOSITS | $133,198 |
| ACCRUED PENSION OBLIGATION | -$9,507 |
| OTHER LONG-TERM LIABILITIES | $96,014 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 594687 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 2B: | THE ORGANIZATION SERVES AS CUSTODIAN OVER PATIENT ACCOUNTS, AND THESE AMOUNTS HAVE BEEN INCLUDED ON THE AUDITED FINANCIAL STATEMENTS AS A LIABILITY. | |
| PART X, LINE 2: | THE COMPANY IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS AMENDED. THE COMPANY DOES NOT BELIEVE ITS FINANCIAL STATEMENTS INCLUDE (OR REFLECT) ANY UNCERTAIN TAX POSITIONS. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| HALIFAX REGIONAL LONG TERM CARE INC | |||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 546074529 | 501(C)(3) | 650000 | TO FUND OPERATING EXPENSES |
| HALIFAX REGIONAL DEVELOPMENT FOUNDATION INC | |||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541801459 | 501(C)(3) | 15000 | TO FUND COMMUNITY PARTNERSHIP |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: GRANTS FROM CLARKSVILLE SENIOR CARE, LLC ARE ONLY MADE TO AFFILIATES WHOSE FINANCIAL RECORDS ARE MAINTAINED BY HALIFAX REGIONAL HOSPITAL. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (4 entries)
| TitleTitle | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHRIS A LUMSDEN | ||||||||||||||
| CEO(THRU 6/30)/PRES/SEC(EFF 7/1/13) | 7046 | 313754 | 0 | 30000 | 0 | 42855 | 304 | 2197 | 2258 | 16351 | 9608 | 405157 | 0 | 0 |
| STEWART R NELSON | ||||||||||||||
| CHIEF FINANCIAL OFFICER | 4745 | 211317 | 0 | 20000 | 0 | 23341 | 340 | 2464 | 224 | 1627 | 5309 | 258749 | 0 | 0 |
| THOMAS S KLUGE | ||||||||||||||
| CHIEF OPERATING OFFICER | 4182 | 186247 | 0 | 10000 | 0 | 23341 | -490 | -3547 | 2230 | 16145 | 5922 | 232186 | 0 | 0 |
| JILL ALLEN | ||||||||||||||
| MEDICAL DIRECTOR | 178738 | 0 | 0 | 0 | 0 | 0 | 7147 | 0 | 0 | 0 | 185885 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 3 | ReturnReference |
| Explanation | THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE METHODS LISTED ON LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EDA OF THE TOWN OF CLARKSVILLE VA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 546001219 | IssuerEIN |
| Date Issued | 2010-04-01 | DateIssued |
| Issue Price | 4000000 | IssuePrice |
| Description Of Purpose | CURRENT REFUNDED SERIES 2000 | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 695756 | AmountRetired |
| Total Proceeds | 4000000 | TotalProceeds |
| Other Spent Proceeds | 4000000 | OtherSpentProceeds |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 1 | RebateNotDueYet |
| Exception To Rebate | 1 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)
| ExplanationExplanation |
|---|
| ISSUER A: SERIES 2010 (CLARKSVILLE SENIOR CARE, LLC) HOSPITAL FACILITIES AND DEBT NOW ACQUIRED AND OWNED BY SENTARA HEALTHCARE. PART II, 2 - AS PART OF ACQUISITION, SENTARA PAID OFF THE SERIES 2010 BONDS WITH EQUITY ON NOVEMBER 15, 2013. PART II, 3 - AMOUNT OF TOTAL PROCEEDS OF ISSUE INCLUDES ISSUE PRICE. NO INTEREST WAS EARNED. ALL PROCEEDS SPENT ON OR AROUND DATE OF CLOSING FOR REFUNDING PURPOSES. THE SERIES 2010 DID NOT RECEIVE ANY TRANSFERRED PROCEEDS FROM THE REFUNDED SERIES 2000 BONDS. PRIOR 2000 DSRF PROCEEDS WERE USED TOWARDS REFUNDING STRUCTURE. PART II, 7 - THE COST OF ISSUANCE EXPENSES FOR THE ISSUE WERE PAID WITH EQUITY AND NOT FROM BOND PROCEEDS. PART IV, 2B - THE SERIES 2010 CURRENT REFUNDED A SERIES 2000 ISSUE. ISSUE QUALIFIED FOR THE SIX-MONTH SPENDING EXCEPTION TO REBATE. ARBITRAGE COMPLIANCE REPORT PROVIDED TO CLARKSVILLE SENIOR CARE AND TO SENTARA AS OF THE 11/15/2013 FINAL REDEMPTION DATE. |
| PART IV, 7, AND PART V: CLARKSVILLE SENIOR CARE DID NOT HAVE WRITTEN POLICIES AND/OR PROCEDURES TO ADDRESS PRIVATE USE, ARBITRAGE COMPLIANCE, AND/OR POST ISSUANCE COMPLIANCE. HOWEVER, CLARKSVILLE SENIOR CARE HAD ENGAGED AN OUTSIDE COMPANY TO MONITOR ITS OUTSTANDING TAX-EXEMPT BONDS FOR ARBITRAGE COMPLIANCE PURPOSES WITH REPORTS COMPLETED ANNUALLY. SUBSEQUENT TO THE JULY 2013 ACQUISITION BY SENTARA, THE SERIES 2010 BONDS FELL UNDER THE WRITTEN POLICIES AND PROCEDURES ESTABLISHED SEPARATELY FOR SENTARA. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (16 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | CLARKSVILLE SENIOR CARE, LLC 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 ARE TO PROVIDE EXTENDED CARE, OUTPATIENT CARE, HOME CARE, ASSISTED LIVING CARE, SENIOR LIVING COMMUNITY OR HOME FOR THE AGED, AND RELATED MEDICAL SERVICES FOR HALIFAX REGIONAL LONG TERM CARE, INC. IN SUPPORT OF HALIFAX REGIONAL HOSPITAL, INC., AND TO CARRY OUT OTHER EXCLUSIVELY CHARITABLE, EDUCATIONAL, OR SCIENTIFIC PURPOSES OF HALIFAX REGIONAL HOSPITAL, INC. |
| PROGRAM SERVICE ACCOMPLISHMENTS | FORM 990, PART III, LINE 4A | THIS ORGANIZATION, DOING BUSINESS AS MEADOWVIEW TERRACE, OPERATES A 150-BED, DUALLY CERTIFIED (MEDICAID AND MEDICARE) NURSING FACILITY, WHICH INCLUDES 42 BEDS FOR ALZHEIMER'S SPECIAL CARE RESIDENTS IN TWO DISTINCT HOUSEHOLD/NEIGHBORHOODS. MEADOWVIEW TERRACE IS LOCATED IN MECKLENBURG COUNTY IN CLARKSVILLE, VIRGINIA. THE NURSING FACILITY PROVIDES PERSONAL CARE, HEALTH CARE SERVICES AND REHABILITATION SERVICES FOR PERSONS NEEDING LONG TERM CARE AND WHOSE SPECIAL NEEDS CANNOT BE MET IN INDEPENDENT LIVING ENVIRONMENTS. IN FY13, 60.9 PERCENT OF THE FACILITY'S REVENUES WERE REIMBURSABLE UNDER THE MEDICAID PROGRAM AND 18.1 PERCENT WERE REIMBURSABLE UNDER MEDICARE. MEADOWVIEW TERRACE UTILIZES EXCESS REVENUE OVER EXPENSES TO UPGRADE FACILITIES, TO PURCHASE NEW EQUIPMENT AND TO UPGRADE CLINICAL AND INFORMATION TECHNOLOGY IN ORDER TO IMPROVE QUALITY AND RESIDENT SAFETY. MEADOWVIEW TERRACE WORKS IN CONJUNCTION WITH HALIFAX REGIONAL HOSPITAL, INC. ("THE HOSPITAL") TO PROVIDE HEALTH INFORMATION TO THE COMMUNITY. WITH THE HIGH PREVALENCE OF ALZHEIMER'S DISEASE (5.3 MILLION AMERICANS) AND WITH A LARGE PERCENT OF NURSING HOME RESIDENTS HAVING ALZHEIMER'S DISEASE OR A RELATED DEMENTIA, MEADOWVIEW TERRACE DEVOTES RESOURCES TO ACTIVITIES THAT WILL HELP RAISE AWARENESS OF ALZHEIMER'S DISEASE AND THAT WILL HELP THOSE AFFECTED BY THE DISEASE TO LEARN AND UNDERSTAND MORE ABOUT IT. IN ADDITION, MEADOWVIEW TERRACE HELPS TO SUPPORT COMMUNITY ACTIVITIES BY PROVIDING STAFF EXPERTISE AND RESOURCES FOR A NUMBER OF ORGANIZATIONS. COMMUNITY HEALTH IMPROVEMENT SERVICES & EDUCATION ADVANCE DIRECTIVE DAY IN APRIL 2013, MEADOWVIEW TERRACE PARTICIPATED IN THE VIRGINIA ADVANCE DIRECTIVE DAY BY PROVIDING INFORMATION ON ADVANCE DIRECTIVES IN THE FACILITY'S FRONT LOBBY WITH STAFF AVAILABLE TO ANSWER QUESTIONS. HEALTHY LIVING EXPO AGAIN FY2013, MEADOWVIEW TERRACE PARTICIPATED IN HALIFAX REGIONAL HEALTH SYSTEM'S HEALTHY LIVING EXPO, AN ANNUAL COMMUNITY HEALTH FAIR THAT PROVIDES A MYRIAD OF FREE HEALTH SCREENINGS AND HEALTH AND WELLNESS EDUCATIONAL ACTIVITIES AND INFORMATION TO THE PUBLIC. IN ADDITION TO ASSISTING WITH PLANNING FOR THIS EVENT, MEADOWVIEW TERRACE PROVIDED LONG TERM CARE INFORMATION, NUTRITION COUNSELING AND INFORMATION RELATED TO EXERCISE FOR THE ELDERLY. MORE THAN 325 INDIVIDUALS WERE REACHED THROUGH THIS COMMUNITY HEALTH EVENT. TOWN MEETINGS, NATIONAL CELEBRATIONS/OBSERVANCES FOR PUBLIC MEADOWVIEW TERRACE PERIODICALLY HOSTS FREE FAMILY NIGHT PROGRAMS WHICH ARE OPEN TO AND PROMOTED TO THE PUBLIC. THESE MEETINGS ARE PROGRAMS OF INTEREST TO THE GENERAL PUBLIC AND FEATURE AN INVITED SPEAKER. DIABETES EDUCATION THE DIETITIAN AT MEADOWVIEW TERRACE WORKED IN CONJUNCTION WITH HALIFAX REGIONAL HOSPITAL STAFF TO TEACH DIABETES EDUCATION CLASSES THROUGHOUT THE YEAR. THESE CLASSES ARE FREE OF CHARGE AND OFFERED MONTHLY. WEIGHT WATCHERS SUPPORT GROUP WEIGHT WATCHERS MEETS WEEKLY AT MEADOWVIEW TERRACE TO WEIGH IN AND FOR EDUCATIONAL MEETINGS COVERING NUTRITION, FOOD BUYING AND PREPARATIONS, ETC. ALTHOUGH THIS IS A FRANCHISED PROGRAM, MEADOWVIEW TERRACE PROVIDED MEETING SPACE AT A REDUCED RATE. FINANCIAL AND IN-KIND CONTRIBUTIONS FOOD DRIVES IN FY13 MEADOWVIEW TERRACE COORDINATED A FOOD DRIVE AND COLLECTED 700 POUNDS OF CANS AND BOXES OF NON-PERISHABLE FOOD WHICH WERE DONATED TO THE CLARKSVILLE FOOD PANTRY DURING THEIR ANNUAL FOOD DRIVE TO HELP PUT FOOD ON THE TABLES OF THOSE HAVING DIFFICULTY PROVIDING FOR THEIR FAMILIES. NINE TURKEYS WERE ALSO DONATED TO MECKLENBURG SOCIAL SERVICES TO BE DISTRIBUTED DURING THE HOLIDAYS. ALZHEIMER'S ASSOCIATION THE MEADOWVIEW TERRACE STAFF AND VOLUNTEERS ORGANIZE, COORDINATE, ADVERTISE AND HOST FUNDRAISING EVENTS TO SUPPORT THE WORK OF THE SOUTHEASTERN VIRGINIA CHAPTER OF THE ALZHEIMER'S ASSOCIATION. THE MONEY RAISED IS USED LOCALLY TO SUPPORT ALZHEIMER'S RELATED PROGRAMS INCLUDING FAMILY ORIENTATIONS, THE 24-HOUR HELPLINE, EDUCATIONAL SEMINARS AND TRAINING SESSIONS FOR BOTH FAMILY AND PROFESSIONAL CAREGIVERS, THE SAFE RETURN PROGRAM, LOCAL SUPPORT GROUPS AND THE SPEAKER'S BUREAU, ALL OF WHICH ASSIST INDIVIDUALS AND FAMILIES AFFECTED BY THE DISEASE. NEARLY $3,500 WAS COLLECTED FROM THE FUND-RAISING EFFORTS THROUGHOUT THE YEAR AND DONATED TO THE ASSOCIATION. OTHER IN-KIND CONTRIBUTIONS MEADOWVIEW TERRACE HELD BAKE SALES TO RAISE MONEY FOR THE MECKLENBURG COUNTY DEPARTMENT OF SOCIAL SERVICES CHRISTMAS PROGRAM, (GIFTS FOR NEEDY CHILDREN). IN ADDITION, APPROXIMATELY 200 POUNDS OF DOG AND CAT FOOD WAS COLLECTED AND DONATED TO THE CLARKSVILLE SPCA. THE FACILITY ALSO COLLECTED NEWSPAPERS TO DONATE TO THE SPCA. THROUGH MAY 2013 MEADOWVIEW TERRACE SPONSORED THE BACKPACK BUDDIES PROGRAM AT CLARKSVILLE ELEMENTARY SCHOOL, PROVIDING STUDENTS WITH SCHOOL SUPPLIES. COMMUNITY BUILDING MEADOWVIEW TERRACE TAKES PRIDE IN BEING A CONTRIBUTING MEMBER OF THE CLARKSVILLE AND MECKLENBURG COUNTY COMMUNITY AND AS SUCH REACHES OUT INTO THE COMMUNITY IN A VARIETY OF WAYS. INTERGENERATIONAL PROGRAMS EACH YEAR, MEADOWVIEW TERRACE PLANS, COORDINATES AND HOSTS A COMMUNITY "SAFE TRICK OR TREAT" AT THE FACILITY ON HALLOWEEN. THIS EVENT PROVIDES A SAFE HAVEN FOR CHILDREN TO TRICK OR TREAT, GOING FROM NEIGHBORHOOD TO NEIGHBORHOOD IN THE FACILITY AND INCLUDES REFRESHMENTS FOR ALL PARTICIPANTS. THE FACILITY ALSO PLANS, COORDINATES AND HOSTS A BREAKFAST WITH SANTA AND AN EASTER EGG HUNT EACH YEAR FOR THE CHILDREN OF STAFF, AND RESIDENTS' GRANDCHILDREN, COMPLETE WITH REFRESHMENTS AND PRIZES FOR ALL. THE BOY SCOUT, GIRL SCOUT AND CUB SCOUT TROOPS CONTINUE TO VISIT AND INTERACT WITH RESIDENTS AS PART OF THEIR BADGE PROGRAM. PEOPLE OF ALL AGES FROM VARIOUS COMMUNITY GROUPS, CLUBS, CHURCHES AND SCHOOLS SHARE THEIR TALENTS WITH RESIDENTS, STAFF MEMBERS AND FAMILIES THROUGHOUT THE YEAR. IN FEBRUARY, MEADOWVIEW TERRACE EMPLOYEES PARTICIPATED IN READ ACROSS AMERICA DAY AND EMPLOYEES READ TO STUDENTS AT CLARKSVILLE ELEMENTARY. COMMUNITY INVOLVEMENT EMPLOYEES OF MEADOWVIEW TERRACE PARTICIPATE IN AND SHARE THEIR TALENTS AND EXPERTISE AS MEMBERS OF VARIOUS CIVIC AND RELIGIOUS ORGANIZATIONS IN THEIR RESPECTIVE COMMUNITIES. THEY PARTICIPATE IN THE CHAMBER OF COMMERCE, IN THE RURITAN CLUB AND THE AARP, AND THEY SERVE ON ADVISORY BOARDS SUCH AS THE VIRGINIA EMPLOYMENT COMMISSION, SOUTHSIDE VIRGINIA COMMUNITY COLLEGE AND OTHER COMMITTEES AND BOARDS INCLUDING THE MECKLENBURG COUNTY BUSINESS EDUCATION PARTNERSHIP. THIS YEAR THEY PARTICIPATED IN A SPELLING BEE TO RAISE MONEY FOR SCHOLARSHIPS. IN FY13 THE FACILITY PARTICIPATED IN THE DOWNTOWN CLARKSVILLE VETERANS PROGRAM, THE JULY 4TH PARADE AND THE CHRISTMAS PARADE IN BOTH CLARKSVILLE AND CHASE CITY. THE ACTIVITY DEPARTMENT ALSO ADOPTED FIVE CHILDREN FOR CHRISTMAS THROUGH MECKLENBURG SOCIAL SERVICES. OTHER VOLUNTEER SERVICES PROGRAM NEARLY 100 VOLUNTEERS FROM THE COMMUNITY, BOTH INDIVIDUALS AND GROUPS, HAVE DONATED THEIR TIME AT MEADOWVIEW TERRACE DURING FY13, PROVIDING COMPANIONSHIP, RECREATION AND SPIRITUAL ACTIVITIES FOR RESIDENTS. VOLUNTEERS COORDINATE BINGO GAMES, CRAFT ACTIVITIES, CHAPEL SERVICES, BIRTHDAY OBSERVANCES AND HOLIDAY CELEBRATIONS. THEY ALSO ACCOMPANY RESIDENTS ON PICNICS AND OUT-OF-RESIDENCE ACTIVITIES, INCLUDING BUS TRIPS TO COUNTY FAIRS, LAKEFEST, PARADES, BOYDTON DAY AND OTHER COMMUNITY EVENTS/FESTIVALS. THE VOLUNTEERS ASSIST WITH THE ANNUAL HALLOWEEN "SAFE TRICK-OR-TREAT NIGHT," "BREAKFAST WITH SANTA," EASTER EGG HUNTS AND COOKOUTS FOR RESIDENTS AND FAMILIES AND PROVIDE ONE ON ONE FRIENDLY VISITS TO RESIDENTS. MEADOWVIEW'S VOLUNTEERS ALSO ORGANIZE AND IMPLEMENT THE FACILITY'S FUNDRAISING EVENTS. HEALTHY DIRECTIONS EMPLOYEE PROGRAMS A VARIETY OF WELLNESS PROGRAMS ARE HELD ON A MONTHLY BASIS TO HELP EMPLOYEES AND THEIR FAMILY MEMBERS WITH WEIGHT LOSS, EXERCISE, AND NUTRITION TO LOWER BMI, CHOLESTEROL, GLUCOSE, BLOOD PRESSURE AND RISKS FOR HEART ATTACK, STROKE AND OTHER COMPLICATIONS OF CARDIOVASCULAR DISEASE. BY LOOKING BETTER AND FEELING BETTER, EMPLOYEES "SHOW" THE COMMUNITY THAT GOOD HEALTH IS ACHIEVABLE AND SET A GOOD EXAMPLE FOR THE HEALTHCARE ROLE THE ORGANIZATION PLAYS IN THE COMMUNITY. |
| SPECIAL OBSERVANCES IN ADDITION, RESIDENTS, FAMILY MEMBERS AND VISITORS HAD THE OPPORTUNITY TO PARTICIPATE IN A BLACK HISTORY CELEBRATION, AND CELEBRATIONS FOR VETERAN'S DAY, MOTHER'S DAY, FATHER'S DAY AND OTHER SPECIAL OBSERVANCES. DURING THANKSGIVING, A MEAL WAS PREPARED FOR RESIDENTS AND THEIR FAMILIES TO ENJOY. | ||
| 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 AND 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 MANAGERS ON THE BOARD WAS CHANGED FROM FIVE TO NOT LESS THAN THREE. MANAGERS ARE APPOINTED BY THE SOLE MEMBER, SUBJECT TO RATIFICATION BY SENTARA. -AS SOLE MEMBER OF HRH, SENTARA HAS THE EXCLUSIVE AUTHORITY TO DIRECT AND MANAGE THE OPERATIONS 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 | 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 BOARD OF MANAGERS 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 ANY 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 CONSOLIDATED 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. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 9: | ASU 2010-07 FMV ADJUSTMENTS 4,756,609. CHANGE IN PENSION LIABILITY 22,491. |
| 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HALIFAX REGIONAL HEALTH SYSTEM INC | |||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541801466 | HEALTHCARE | VA | 501(C)(3) | 11B TYPE II | N/A | 0 | |
| HALIFAX REGIONAL DEVELOPMENT FOUNDATION | |||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541801459 | HLTH/WELFARE | VA | 501(C)(3) | 11A TYPE I | 1 | HALIFAX REGIONAL HOSPITAL | |
| HALIFAX REGIONAL HOSPITAL INCORPORATED | |||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 540648699 | HEALTHCARE | VA | 501(C)(3) | 3 | 1 | SENTARA HEALTHCARE | |
| HALIFAX REGIONAL LONG TERM CARE INC | |||||||||||
| 103 ROSE HILL DRIVE | SOUTH BOSTON | VA | 24592 | 546074529 | SENIOR CARE | VA | 501(C)(3) | 11A TYPE I | 1 | HALIFAX REGIONAL HOSPITAL | |
| HALIFAX REGIONAL PROPERTIES INC | |||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541801463 | HLTH/WELFARE | VA | 501(C)(3) | 11A TYPE I | 1 | HALIFAX REGIONAL HOSPITAL | |
| SENTARA HEALTHCARE | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 521271901 | HEALTH CARE | VA | 501(C)(3) | LN7_NORMALGOVTSUPPOR | N/A | 0 | |
| SENTARA PRINCESS ANNE HOSPITAL | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 521277419 | HEALTH CARE | VA | 501(C)(3) | LN3_HOSPITALCOOPINSE | 1 | SENTARA HOSPITALS | |
| SENTARA HOSPITALS | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541547408 | HEALTH CARE | VA | 501(C)(3) | LN3_HOSPITALCOOPINSE | 1 | SENTARA HEALTHCARE | |
| SENTARA MEDICAL GROUP | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541217184 | HEALTH CARE | VA | 501(C)(3) | LN9_MORETHAN30PCTCON | 1 | SENTARA HEALTHCARE | |
| SENTARA ENTERPRISES | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541917649 | HEALTH CARE | VA | 501(C)(3) | LN9_MORETHAN30PCTCON | 1 | SENTARA HEALTHCARE | |
| SENTARA LIFE CARE CORP | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541217183 | HEALTH CARE | VA | 501(C)(3) | LN9_MORETHAN30PCTCON | 1 | SENTARA HEALTHCARE | |
| OPTIMA HEALTH PLAN | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541283337 | HMO | VA | 501(C)(3) | 11A - I | 1 | SENTARA HEALTHCARE | |
| POTOMAC HOSPITAL CORP OF PRINCE WILLIAM | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 540853898 | HEALTH CARE | VA | 501(C)(3) | LN3_HOSPITALCOOPINSE | 1 | SENTARA HEALTHCARE | |
| ROCKINGHAM MEMORIAL HOSPITAL | |||||||||||
| 2010 HEALTH CAMPUS DRIVE | HARRISONBURG | VA | 22801 | 540506331 | HEALTH CARE | VA | 501(C)(3) | LN3_HOSPITALCOOPINSE | 1 | SENTARA HEALTHCARE | |
| VALLEY WELLNESS CENTER | |||||||||||
| 501 STONE SPRING ROAD | HARRISONBURG | VA | 22801 | 521309257 | PREVENTATIVE HEALTH/REHAB | VA | 501(C)(3) | LN9_MORETHAN30PCTCON | 1 | ROCKINGHAM MEMORIAL HOSPITAL | |
| MJH FOUNDATION | |||||||||||
| 500 MARTHA JEFFERSON DRIVE | CHARLOTTESVILLE | VA | 22911 | 541401357 | INVEST/MGT SVCS FOR MARTHA JEFFERSON HOSPITAL | VA | 501(C)(3) | 11A - I | 1 | MARTHA JEFFERSON HOSPITAL | |
| MARTHA JEFFERSON HOSPITAL FOUNDATION | |||||||||||
| 500 MARTHA JEFFERSON DRIVE | CHARLOTTESVILLE | VA | 22911 | 300041113 | FUNDRAISING | VA | 501(C)(3) | 11A - I | 1 | MARTHA JEFFERSON HOSPITAL | |
| MARTHA JEFFERSON HOSPITAL | |||||||||||
| 500 MARTHA JEFFERSON DRIVE | CHARLOTTESVILLE | VA | 22911 | 540261840 | HEALTH CARE | VA | 501(C)(3) | LN3_HOSPITALCOOPINSE | 1 | SENTARA HEALTHCARE | |
| MPB INC | |||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541346393 | TITLE HOLDING COMPANY | VA | 501(C)(2) | 1 | SENTARA ENTERPRISES | ||
Form990 Schedule R Part III Form990ScheduleRPartIII (23 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| MANAGEMENT SERVICES LLC | |||||||
| 814 GREENBRIER CIRCLE | CHESAPEAKE | VA | 23320 | 541365012 | HLTH MGT SV | VA | N/A |
| OBICI REAL ESTATE HOLDINGS LLC | |||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 261749881 | RE RENTAL | VA | N/A |
| PRINCESS ANNE AMB SURG MGT LLC | |||||||
| 1975 GLENN MITCHELL STE 300 | VA BEACH | VA | 23456 | 204920880 | HEALTH CARE | VA | N/A |
| VA BEACH AMBULATORY SURGERY CENTER | |||||||
| 1700 WILL O WISP DRIVE | VA BEACH | VA | 23454 | 541448218 | HEALTH CARE | VA | N/A |
| AMER HEALTH EVAL CTR-WMSBG LLC | |||||||
| 739 THIMBLE SHOALS STE 105 | NEWPORT NEWS | VA | 23606 | 263761741 | HEALTH CARE | VA | N/A |
| CANCER CENTERS OF VA LLC | |||||||
| 5900 LAKE WRIGHT DRIVE | NORFOLK | VA | 23502 | 201338518 | HEALTH CARE | VA | N/A |
| HAMPTON ROADS LITHOTRIPSY LLC | |||||||
| 225 CLEARFIELD AVE | VIRGINIA BEACH | VA | 23462 | 200942600 | HEALTH CARE | VA | N/A |
| HEALTHCARE PERFORMANCE IMPROVEMENT LLC | |||||||
| 5041 CORPORATE WOODS DR STE 180 | VIRGINIA BEACH | VA | 23462 | 204024074 | CONSULTING | VA | N/A |
| RADIOLOGY SERVICES OF HAMPTON ROADS LC | |||||||
| 814 GREENBRIER CIRCLE STE L | CHESAPEAKE | VA | 23320 | 541774472 | HEALTH CARE | VA | N/A |
| SENTARA OBICI AMBULATORY SURGERY LLC | |||||||
| 2750 GODWIN BLVD | SUFFOLK | VA | 23434 | 260144898 | HEALTH CARE | VA | N/A |
| ST LUKES PROPERTIES LLC | |||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 272774684 | MOB RENTAL | VA | N/A |
| POTOMAC INOVA HEALTHCARE ALLIANCE LLC | |||||||
| 8110 GATEHOUSE RD STE 400W | FALLS CHURCH | VA | 22042 | 541802733 | HEALTHCARE | VA | N/A |
| CAREPLEX WEST LLC | |||||||
| 18000 W SARAH LANE STE 250 | BROOKFIELD | WI | 53045 | 202738977 | RENTAL RE | WI | N/A |
| PORT WARWICK II LLC | |||||||
| 18000 WEST SARAH LANE STE 250 | BROOKFIELD | WI | 53045 | 202739075 | RENTAL RE | WI | N/A |
| ORTHOPAEDIC HOSPITAL MANAGEMENT LLC | |||||||
| 3000 COLISEUM DRIVE | HAMPTON | VA | 23666 | 274185117 | MGT SVCS | VA | N/A |
| CAREPLEX ORTHOPAEDIC ASC LLC | |||||||
| 3000 COLISEUM DRIVE | HAMPTON | VA | 23666 | 271867311 | HEALTH CARE | VA | N/A |
| PORT WARWICK III LLC | |||||||
| 18000 WEST SARAH LANE STE 250 | BROOKFIELD | WI | 53045 | 611499371 | RENTAL RE | WI | N/A |
| MARTHA JEFFERSON OSC LLC | |||||||
| 595 MARTHA JEFFERSON DR | CHARLOTTESVILLE | VA | 22911 | 113656095 | HEALTH CARE | VA | N/A |
| VALIANCE HEALTH LLC | |||||||
| 3190 PEOPLES DRIVE | HARRISONBURG | VA | 22801 | 541866081 | HEALTH CARE | VA | N/A |
| PHYSICAL THERAPY ACACLLC | |||||||
| 501 ALBEMARLE SQUARE | CHARLOTTESVILLE | VA | 22901 | 260080717 | HEALTH CARE | VA | N/A |
| NORTHERN VIRGINIA HOME CARE LLC | |||||||
| 601 SOUTH CARLIN SPRINGS RD | ARLINGTON | VA | 22204 | 453940053 | HOME CARE | VA | N/A |
| MNS SUPPLY CHAIN NETWORK LLC | |||||||
| 2085 FRONTIS PLAZA BLVD | WINSTON SALEM | NC | 27103 | 454235238 | GPO | DE | N/A |
| LAKE RIDGE AMBULATORY SURGERY CENTER LLC | |||||||
| 12825 MINNIEVILLE RD STE 204 | WOODBRIDGE | VA | 22192 | 455347932 | HEALTH CARE | VA | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (15 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Postal CodeAddressForeign/PostalCode | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SOUTHSIDE HEALTH SERVICES INC | ||||||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541417772 | HEALTH SERVICES | VA | N/A | C | 1 | |||||
| DOMINION HEALTH MEDICAL ASSOCIATES LTD | ||||||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541060357 | PHYS PRACTICE | VA | N/A | C | 1 | |||||
| SENTARA HOLDINGS INC | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541555638 | HOLDING COMPANY | VA | N/A | C | 1 | |||||
| SENTARA HEALTH PLANS INC | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 522368125 | TPA | VA | N/A | C | 1 | |||||
| OPTIMA HEALTH GROUP | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541473382 | HMO | VA | N/A | C | 1 | |||||
| OPTIMA HEALTH INSURANCE COMPANY | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541642752 | HEALTH INSURANCE | VA | N/A | C | 1 | |||||
| OPTIMA BEHAVIORAL HEALTH SERVICES | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 621382666 | MENTAL HEALTH SVCS | VA | N/A | C | 1 | |||||
| SENTARA VENTURES INC | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541688615 | HOLDING COMPANY | VA | N/A | C | 1 | |||||
| SMG INNOVATIONS INC | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 203730331 | HEALTH CARE | VA | N/A | C | 1 | |||||
| SENTARA OBICI PROFESSIONAL CENTER | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541445865 | RE RENTAL | VA | N/A | C | 1 | |||||
| SENTARA STRATEGIC SOLUTIONS INC | ||||||||||||||
| 6015 POPLAR HALL DRIVE | NORFOLK | VA | 23502 | 541020941 | HEALTH CARE | VA | N/A | C | 1 | |||||
| POTOMAC VENTURES CORP | ||||||||||||||
| 2300 OPITZ BLVD | WOODBRIDGE | VA | 22191 | 541441420 | PHARMACY | VA | N/A | C | 1 | |||||
| ROCKINGHAM HEALTH SERVICES INC | ||||||||||||||
| 2010 HEALTH CAMPUS DRIVE | HARRISONBURG | VA | 22801 | 541721387 | CONTRACTING SVCS | VA | N/A | C | 1 | |||||
| MARTHA JEFFERSON MEDICAL ENTERPRISES INC | ||||||||||||||
| 500 MARTHA JEFFERSON DRIVE | CHARLOTTESVILLE | VA | 22911 | 541841528 | MEDICAL BILLING SVCS | VA | N/A | C | 1 | |||||
| BAY PRIMEX INSURANCE COMPANY LTD | ||||||||||||||
| 980704114 | INSURANCE | N/A | C | 1 | PO BOX 1051 | GRAND CAYMAN | CJ | KY1-1102 | CJ | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | 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 | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| 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 | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| HALIFAX REGIONAL LONG TERM CARE INC | ||
| B | 650000 | CORP BOOKS/REC |
| DOMINION HEALTH MEDICAL ASSOCIATES | ||
| L | 129797 | CORP BOOKS/REC |
| HALIFAX REGIONAL HOSPITAL INC | ||
| O | 473080 | CORP BOOKS/REC |
| HALIFAX REGIONAL HOSPITAL INC | ||
| P | 1561813 | CORP BOOKS/REC |
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