2014-07-15T15:52:54-05:00 2013-08-31 990 2012-09-01 541957066 CLARKSVILLE SENIOR CARE LLC CLAR 4345173183 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 STEWART R NELSON 4345173183 2014-07-15 2012 2016-03-07 17:11:31Z CHRIS A LUMSDEN 2204 WILBORN AVENUE SOUTH BOSTON VA 24592 10213150 0 X WWW.MEADOWVIEWTERRACE.ORG X 1997 VA TO PROVIDE THE HIGHEST QUALITY OF CARE TO THOSE INDIVIDUALS REQUIRING LONG-TERM CARE SERVICES. 5 3 188 95 0 0 50014 46688 9512641 10130042 8572 -6160 39894 18433 9611121 10189003 750000 665000 0 0 5806203 6231611 0 0 0 3215751 3508095 9771954 10404706 -160833 -215703 9706215 13962260 5804527 5500952 3901688 8461308 X 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. 0 0 9124259 665000 10130042 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. 9124259 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 31 0 1 188 1 0 0 0 0 0 0 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 DAVID H WHITE JR 1.00 5.00 X X 0 0 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 HABIB BASSIL MD 1.00 5.00 X X 0 78750 0 JAMES PRIEST DDS 1.00 5.00 X 0 0 0 CHRIS A LUMSDEN 1.00 39.00 X X 7046 386609 21110 ROBERT A BROERMANN 1.00 54.00 X X 0 0 0 STEWART R NELSON 1.00 39.00 X 4745 254658 4655 THOMAS S KLUGE 1.00 39.00 X 4182 219588 14338 JILL ALLEN 40.00 0.00 X 178738 0 7147 194711 939605 47250 1 0 1 0 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 3 46688 46688 NET PATIENT SERVICE REVENUE 623000 10093350 10093350 BARBER AND BEAUTY SHOP REVENUE 812900 36692 36692 10130042 17987 17987 24147 -24147 -24147 -24147 CAFE AND VENDING 722210 13666 13666 MISCELLANEOUS 900099 4767 4767 18433 10189003 10130042 0 12273 665000 665000 30118 30118 4552996 3953384 599612 162859 141687 21172 1147692 998492 149200 337946 292995 44951 41895 41895 23022 23022 937268 911335 25933 5651 5651 352755 305513 47242 246887 246887 6286 2303 3983 134612 134612 653805 653805 156204 156204 MEDICAL SURGICAL SUPPLI 699652 699652 MISCELLANEOUS 135560 20605 114955 BAD DEBTS 79405 79405 EDUCATION 23397 16493 6904 11696 2091 9605 10404706 9124259 1280447 0 1708214 1707754 115271 133116 776079 712697 35370 47816 126956 84041 11045668 177783 6493350 10867885 294031 311137 156944 97814 9706215 13962260 854629 871542 760869 714181 3506926 3287394 81144 33148 1457 599502 594687 5804527 5500952 X 3901688 8461308 3901688 8461308 9706215 13962260 X -215703 -3777 4779100 X X 0 1 X 1 0 X X X 0 0 0 HALIFAX REGIONAL HOSPITAL INCORPORATED 540648699 3 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 995 995 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: OTHER LOBBYING ACTIVITIES A PORTION OF DUES PAID TO THE VIRGINIA HEALTH CARE ASSOCIATION IS ATTRIBUTABLE TO LOBBYING EXPENSES. 0 1 X 2746000 2746000 6927709 141487 6786222 1104459 25467 1078992 267500 10829 256671 10867885 DUE TO THIRD PARTY PROGRAMS 172836 DUE TO AFFILIATES 202146 PATIENT SECURITY DEPOSITS 133198 ACCRUED PENSION OBLIGATION -9507 OTHER LONG-TERM LIABILITIES 96014 594687 X 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 1 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 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. 0 0 0 0 0 0 0 0 0 CHRIS A LUMSDEN 7046 313754 0 30000 0 42855 304 2197 2258 16351 9608 405157 0 0 STEWART R NELSON 4745 211317 0 20000 0 23341 340 2464 224 1627 5309 258749 0 0 THOMAS S KLUGE 4182 186247 0 10000 0 23341 -490 -3547 2230 16145 5922 232186 0 0 JILL ALLEN 178738 0 0 0 0 0 7147 0 0 0 185885 0 0 0 PART I, LINE 3 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. A EDA OF THE TOWN OF CLARKSVILLE VA 546001219 2010-04-01 4000000 CURRENT REFUNDED SERIES 2000 0 0 0 A 695756 4000000 4000000 2010 1 0 1 1 A 0 1 1 0 0 0 0 0 0 A 0 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. 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. 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