CULPEPER WELLNESS FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CULPEPER WELLNESS FOUNDATION (EIN 52-1366700)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-14
- IRS object ID
- 201442269349300649
- 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 D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-14T15:20:47-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 FRANKLIN RD SE SUITE 501 | AddressLine1 |
| City | ROANOKE | City |
| State | VA | State |
| ZIP Code | 240112114 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 521366700 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CULP | NameControl |
| Phone | 5408298803 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 227010592 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | H LEE KIRK JR | Name |
| Title | PRESIDENT & CEO | Title |
| Phone | 5408298803 | Phone |
| Date Signed | 2014-08-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL P NORTON | Name |
| PTIN | P00430694 | PTIN |
| Phone | 5409896144 | Phone |
| Date Prepared | 2014-08-06 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | H LEE KIRK JR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4549913 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CULPEPERHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | VA | StateLegalDomicile |
| Activity Or Mission Description | THE ORGANIZATION'S MISSION IS TO SUPPORT THE MISSION OF CULPEPER REGIONAL HOSPITAL. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 390364 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 430790 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1645493 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 2556265 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 101106 | InvestmentIncomePriorYear |
| Investment Income Current Year | 338070 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 928976 | OtherRevenuePriorYear |
| Other Revenue Current Year | 710191 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3065939 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4035316 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 348023 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 539958 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1537972 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 2279077 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 16867 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1623992 | OtherExpensePriorYear |
| Other Expenses Current Year | 1865785 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3509987 | TotalExpensesPriorYear |
| Total Expenses Current Year | 4684820 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -444048 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -649504 | RevenuesLessExpensesCY |
| Total Assets BOY | 24212021 | TotalAssetsBOY |
| Total Assets EOY | 25679856 | TotalAssetsEOY |
| Total Liabilities BOY | 405694 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1105330 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 23806327 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 24574526 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF CULPEPER REGIONAL HEALTH SYSTEM IS TO SUPPORT THE ACTIVITIES THAT CARRY OUT THE CHARITABLE PURPOSES OF CULPEPER MEMORIAL HOSPITAL, DBA CULPEPER REGIONAL HOSPITAL. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1785747 | Expense |
| Revenue | 2000197 | Revenue |
| Description | POWELL WELLNESS CENTER, LLC, (PWC) A WHOLLY-OWNED SUBSIDIARY AND DISREGARDED ENTITY, BEGAN OPERATIONS IN AUGUST 2007 AND OPERATES A WELLNESS CENTER CONSISTENT WITH, AND IN SUPPORT OF, THE MISSION OF CULPEPER MEMORIAL HOSPITAL, DBA CULPEPER REGIONAL HOSPITAL. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 454877 | Expense |
| Grants | 454877 | Grants |
| Description | CRHS FOUNDATION WAS ORGANIZED AND IS OPERATED FOR THE PURPOSE OF SOLICITING, RECEIVING, AND ADMINISTERING GIFTS, GRANTS AND CONTRIBUTIONS FOR THE BENEFIT OF CULPEPER MEMORIAL HOSPITAL, DBA CULPEPER REGIONAL HOSPITAL. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1289870 | Expense |
| Grants | 85081 | Grants |
| Revenue | 1353296 | Revenue |
| Description | CRHS MANAGES REAL ESTATE PROPERTIES, AN AUXILIARY, A FREE CLINICAND PROVIDES SCHOLARSHIPS FOR THE PURPOSE OF PROMOTING THE VISION& MISSION OF CULPEPER MEMORIAL HOSPITAL, DBA CULPEPER REGIONALHOSPITAL. CULPEPER PHYSICIANS GROUP, LLC (DBA CULPEPER ENT), A WHOLLY-OWNED SUBSIDIARY AND DISREGARDED ENTITY, BEGAN OPERATIONS AS A PHYSICIAN PRACTICE, IN SEPTEMBER 2012. THE PRACTICE, WHICH SPECIALIZES IN THE MEDICAL AND SURGICAL TREATMENT OF EAR, NOSE AND THROAT CONDITIONS, WITH AUDIOLOGY AND HEARING DEVICE SERVICES, PROVIDES EXCELLENT PATIENT CARE IN A MANNER CONSISTENT WITH, AND IN SUPPORT OF, THE MISSION OF CULPEPER MEMORIAL HOSPITAL, DBA CULPEPER REGIONAL HOSPITAL. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 3530494 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 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 | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | H LEE KIRK JR | NamePerson |
| Telephone Number | 5408298803 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 227010592 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| CONSTANCE KINCHELOE | ||||||
| SECRETARY | 4.00 | X | 0 | 0 | 0 | |
| CHARLES CRIST | ||||||
| VICE CHAIR | 4.00 | X | 0 | 0 | 0 | |
| SHARON CLARK | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| CATHY ZIELINKSI | ||||||
| CHAIR, CHRS FOUNDATION | 2.00 | X | 0 | 0 | 0 | |
| HB SEDWICK | ||||||
| CHAIR, CRHS REAL ESTATE | 2.00 | X | 0 | 0 | 0 | |
| BREVARD WALLACE MD | ||||||
| CHAIR, POWELL WELLNESS CTR. | 2.00 | X | 0 | 0 | 0 | |
| DR ROBERT A ROSEN | ||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |
| NANCY CANNON | ||||||
| CHAIR, CRHS FREE CLINIC | 2.00 | X | 0 | 0 | 0 | |
| BARBARA WEBER | ||||||
| CHAIR, CRHS AUXILIARY | 2.00 | X | 0 | 0 | 0 | |
| MICHAEL ARMM | ||||||
| IMMEDIATE PAST CHAIR | 4.00 | X | 0 | 0 | 0 | |
| CHARLES BARRELL | ||||||
| TREASURER | 4.00 | X | 0 | 0 | 0 | |
| TOM REYNOLDS MD | ||||||
| CHAIR | 5.00 | X | 0 | 0 | 0 | |
| SAMUEL MORGAN | ||||||
| VICE PRESIDENT/CFO | 8.00 | 0 | 201189 | 10407 | X | |
| H LEE KIRK JR | ||||||
| PRESIDENT/CEO | 12.00 | 0 | 437300 | 33703 | X | |
| C GREG NAPPS | ||||||
| VICE PRESIDENT/COO | 8.00 | 0 | 195537 | 23780 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 834026 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 67890 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 13082 | FederatedCampaigns |
| Fundraising Events | 30072 | FundraisingEvents |
| Related Organizations | 28216 | RelatedOrganizations |
| All Other Contributions | 359420 | AllOtherContributions |
| Total Contributions | 430790 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PWC MEMBERSHIP DUES | 713940 | 1627788 | 1627788 |
| CULPEPER PHYSICIAN GRO | 900099 | 860156 | 860156 |
| PWC ASSESSMENT FEES | 713940 | 68321 | 68321 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 2556265 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 277013 | TotalRevenueColumn |
| Exclusion | $277,013 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 878682 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 464614 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 414068 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 414068 | TotalRevenueColumn |
| Related Or Exempt Function Income | 414068 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 61057 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 61057 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 61057 | TotalRevenueColumn |
| Related Or Exempt Function Income | 61057 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 24003 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 30072 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 49983 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -25980 | TotalRevenueColumn |
| Exclusion | -$25,980 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| OTHER REVENUE | 622110 | 254288 | 254288 |
| PWC CAFE | 722210 | 22948 | 22948 |
| MISC. REVENUE-RELATED- | 900099 | 18015 | 18015 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 26852 | TotalRevenueColumn |
| Related Or Exempt Function Income | 26852 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 322103 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4035316 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3353493 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $251,033 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 421695 | Total |
| Program Services | 421695 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118263 | Total |
| Program Services | 118263 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1934772 | Total |
| Program Services | 1516135 | ProgramServices |
| Management And General | 418637 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 321887 | Total |
| Program Services | 254365 | ProgramServices |
| Management And General | 67522 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22418 | Total |
| Program Services | 22418 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66675 | Total |
| Program Services | 66675 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19259 | Total |
| Management And General | 19259 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 67238 | Total |
| Management And General | 67238 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24650 | Total |
| Management And General | 24650 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305412 | Total |
| Program Services | 18962 | ProgramServices |
| Management And General | 286450 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 220728 | Total |
| Program Services | 195673 | ProgramServices |
| Management And General | 21442 | ManagementAndGeneral |
| Fundraising | 3613 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94475 | Total |
| Program Services | 83351 | ProgramServices |
| Management And General | 11124 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21808 | Total |
| Management And General | 21808 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 403993 | Total |
| Program Services | 398135 | ProgramServices |
| Management And General | 5858 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50299 | Total |
| Program Services | 47292 | ProgramServices |
| Management And General | 3007 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| UTILITIES | 117998 | 117998 | |
| REPAIRS AND MAINTENANCE | 70644 | 70608 | 36 |
| DUES & SUBSCRIPTIONS | 8713 | 8713 | |
| MINOR EQUIPMENT | 8623 | 8041 | 582 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 385270 | Total |
| Program Services | 190883 | ProgramServices |
| Management And General | 181133 | ManagementAndGeneral |
| Fundraising | 13254 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4684820 | Total |
| Program Services | 3530494 | ProgramServices |
| Management And General | 1137459 | ManagementAndGeneral |
| Fundraising | 16867 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 736900 | BOY |
| EOY | 831262 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44279 | BOY |
| EOY | 215824 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87054 | BOY |
| EOY | 64529 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9755 | BOY |
| EOY | 13640 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16871 | BOY |
| EOY | 14547 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 20345002 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5369917 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15371946 | BOY |
| EOY | 14975085 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6713755 | BOY |
| EOY | 7573986 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1188537 | BOY |
| EOY | 1800319 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 54034 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42924 | BOY |
| EOY | 136630 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24212021 | BOY |
| EOY | 25679856 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 229460 | BOY |
| EOY | 236279 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15628 | BOY |
| EOY | 14973 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 160606 | BOY |
| EOY | 854078 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 405694 | BOY |
| EOY | 1105330 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22806433 | BOY |
| EOY | 23421971 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 833880 | BOY |
| EOY | 986541 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 166014 | BOY |
| EOY | 166014 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23806327 | BOY |
| EOY | 24574526 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24212021 | BOY |
| EOY | 25679856 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -649504 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 557538 | ReconciliationUnrealizedInvest |
| Reconcilation Donated Services | 16913 | ReconcilationDonatedServices |
| Reconcilation Other Changes | 843252 | 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 Type3 Func Int | X | SupportingOrg509a3Type3FuncInt |
| Certification Checkbox | X | CertificationCheckbox |
| Written IRS Determination | X | WrittenIRSDetermination |
| 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 | CULPEPER MEMORIAL HOSPITAL DBA CULPEPPER REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540622371 | EIN |
| Type Of Organization | 03 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $278,992 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 278992 | 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 D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2378632 | OtherCostOrOtherBasis |
| Book Value | 2378632 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13302347 | OtherCostOrOtherBasis |
| Depreciation | 3565674 | Depreciation |
| Book Value | 9736673 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5939 | OtherCostOrOtherBasis |
| Depreciation | 1485 | Depreciation |
| Book Value | 4454 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3850792 | OtherCostOrOtherBasis |
| Depreciation | 1757019 | Depreciation |
| Book Value | 2093773 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 807292 | OtherCostOrOtherBasis |
| Depreciation | 45739 | Depreciation |
| Book Value | 761553 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14975085 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENTS IN AFFILIATES | 96176 | C |
| ASSETS WHOSE USE IS LIMITED | 1704143 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 1800319 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO CMH | $827,888 |
| ANNUITY PAYABLE | $26,190 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 854078 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | MANAGEMENT HAS RECEIVED A TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE INDICATING THAT CRHS AND THE HOSPITAL ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS ORGANIZATIONS OTHER THAN A PRIVATE FOUNDATION. FEDERAL TAX LAW REQUIRES THAT CRHS AND THE HOSPITAL BE OPERATED IN A MANNER CONSISTENT WITH ITS EXEMPTION APPLICATION IN ORDER TO MAINTAIN ITS EXEMPT STATUS. MANAGEMENT HAS ANALYZED THE OPERATIONS OF CRHS AND THE HOSPITAL AND CONCLUDED THAT THEY REMAIN IN COMPLIANCE WITH THE REQUIREMENTS FOR EXEMPTION. CRHS AND THE HOSPITAL ARE ALSO EXEMPT FROM STATE INCOME TAXES UNDER APPLICABLE STATE STATUTES. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFIT OR OBLIGATION AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GALA | NameOfEvent1 |
| Gross Receipts Event1 | 28875 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 12936 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 15939 | GrossRevenueEvent1 |
| Food And Beverage Event1 | 20129 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 6000 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 10203 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF | NameOfEvent2 |
| Gross Receipts Event2 | 25200 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 17136 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 8064 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 2266 | NonCashPrizesEvent2 |
| Food And Beverage Event2 | 4213 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 7172 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 54075 | GrossReceiptsTotal |
| Charitable Contributions Total | 30072 | CharitableContributionsTotal |
| Gross Revenue Total Events | 24003 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 2266 | NonCashPrizesTotalEvents |
| Food And Beverage Total Events | 24342 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 6000 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 17375 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 49983 | DirectExpenseSummaryEvents |
| Net Income Summary | -25980 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 540622371 | EINOfRecipient |
| Amount Of Cash Grant | 278992 | AmountOfCashGrant |
| Method Of Valuation | FMV | MethodOfValuation |
| Purpose Of Grant | DONATIONS FROM FOUNDATION FOR PROPERTY AND EQUIPMENT | PurposeOfGrant |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 43 | NumberOfRecipients |
| Amount Of Cash Grant | 118263 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, PART I, LINE 2: PART I LINE 2 LOCAL SCHOLARSHIPS TWO GRADUATING HIGH SCHOOL STUDENTS FROM EACH OF THE TWO CULPEPER HIGH SCHOOLS WHO ARE PURSUING A NURSING OR OTHER MEDICAL CAREER ARE ELIGIBLE TO APPLY FOR SCHOLARSHIPS AWARDED BY THE FOUNDATION. APPLICANTS MUST SUBMIT AN APPLICATION THAT INCLUDES AN ESSAY EXPLAINING THEIR DESIRE TO PURSUE THE DESIGNATED AREA OF STUDY. GUIDANCE STAFF AT THE RESPECTIVE HIGH SCHOOLS REVIEW APPLICATIONS AND SELECT THE WINNERS. |
| PART I, LINE 2 CRHS SCHOLARSHIPS: EMPLOYEES OF CRH & CRHS THAT ARE EMPLOYED FULL-TIME, PART-TIME OR LEASED AND HAVE BEEN ACCEPTED INTO A PROGRAM IDENTIFIED AS AN AREA OF NEED WITHIN THE ORGANIZATION ARE ELIGIBLE TO APPLY FOR ASSISTANCE FROM CRHS. APPLICANTS MUST: - APPLY PRIOR TO COMMENCEMENT OF THE COURSE OR PROGRAM OF STUDY - COMPLETE AN APPLICATION, INCUDING A 400-500 WORD ESSAY - PROVIDE COURSE REGISTRATION, TUITION BILL AND OTHER DOCUMENTATION SUPPORTING REQUEST - PROVIDE LETTER OF ACCEPTANCE INTO PROGRAM, AS APPLICABLE - PROVIDE TRANSCRIPTS AND MAINTAIN A MINIMUM GPA OF 3.0 THE EDUCATION ASSISTANCE COMMITTEE REVIEWS ALL APPLICATIONS AND APPROVES THE ASSISTANCE REQUEST BASED ON THE APPLICANT'S COURSE OF STUDY AND EDUCATION TRACK AS RELEVANT TO THE NEEDS OF CRHS. ASSISTANCE IS GRANTED ANNUALLY AND PAID BY SEMESTERS. APPROVALS ARE ONLY VALID FOR COURSES APPROVED EACH SEMESTER AND THE RECIPIENT MUST SUBMIT APPLICATIONS FOR RENEWAL EACH SEMESTER, ALONG WITH TRANSCRIPTS OF THE PREVIOUS SEMESTER'S GRADES TO ENSURE THE MINIMUM GPA OF 3.0 IS BEING MET. TUITION ASSISTANCE AMOUNTS ARE INTENDED TO COVER TUITION, FEES, BOOKS AND OTHER NECESSARY ITEMS NEEDED TO COMPLETE THE COURSES. DOCUMENTATION OF PROOF OF COST IS NECESSARY. |
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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMUEL MORGAN | ||||||||||||||
| VICE PRESIDENT/CFO | 0 | 182575 | 0 | 18614 | 0 | 0 | 0 | 7261 | 0 | 3146 | 0 | 211596 | 0 | 0 |
| H LEE KIRK JR | ||||||||||||||
| PRESIDENT/CEO | 0 | 321567 | 0 | 100733 | 0 | 15000 | 0 | 10000 | 0 | 23703 | 0 | 471003 | 0 | 0 |
| C GREG NAPPS | ||||||||||||||
| VICE PRESIDENT/COO | 0 | 181591 | 0 | 13946 | 0 | 0 | 0 | 2579 | 0 | 21201 | 0 | 219317 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | TOP MANAGEMENT COMPENSATION CRHS RELIES UPON CMH, DBA CULPEPER REGIONAL HOSPITAL, WHICH USES AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION STUDY OR SURVEY, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE ESTABLISH THE COMPENSATION OF THE CEO. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | REVIEWING THE 990 PART VI, LINE 11 THE FORM 990 IS PREPARED WITH ASSISTANCE FROM AN OUTSIDE ACCOUNTING FIRM, AND REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CONTROLLER OF THE HOSPITAL, AS WELL BY A SUBCOMMITTEE OF THE BOARD OF DIRECTORS, AS APPOINTED, OF THE ORGANIZATION. A COPY OF THE FORM 990 IS MADE AVAILABLE TO EACH OF THE ORGANIZATION'S BOARD MEMBERS FOR THEIR REVIEW AND COMMENT PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING CONFLICTS OF INTEREST PART VI, SECTION B, 12C THE ORGANIZATION HAS ADOPTED A CONFLICT OF INTEREST POLICY ADOPTED BY CULPEPER REGIONAL HOSPITAL. ANNUALLY, EACH BOARD MEMBER MUST DISCLOSE ANY CONFLICTS OF INTEREST WITH THE ORGANIZATION OR ANY OTHER BOARD MEMBERS. IN ADDITION TO THE ANNUAL DISCLOSURE, EACH MEETING OF THE BOARD BEGINS WITH A VOLUNTARY VERBAL SELF-DISCLOSURE OF ANY CONFLICTS WITH ANY ITEMS ON THE AGENDA. AS ADDITIONAL ISSUES ARISE DURING THE COURSE OF A MEETING, A SIMILAR SELF-DISCLOSURE IS EXPECTED TO BE MADE. IF SELF-DISCLOSURES ARE NOT FORTH-COMING, THE BOARD MEMBERS ARE ENCOURAGED TO RAISE THE POSSIBILITY OF POTENTIAL CONFLICTS WITH REGARD TO OTHER BOARD MEMBERS. DURING THE COURSE OF DOING BUSINESS, IF CONFLICTS ARE SUSPECTED BY ANYONE AFFILIATED WITH THE ORGANIZATAION WITH REGARD TO KEY EMPLOYEES, OFFICERS, OR BOARD MEMBERS, THEY ARE ENCOURAGED TO NOTIFY THE CHIEF EXECUTIVE OFFICER OF THEIR SUSPICIONS. THE CEO WILL INVESTIGATE, EMPLOYING LEGAL COUNSEL AS NECESSARY, AND WILL RESOLVE AS APPROPRIATE. ULTIMATELY IT IS THE RESPONSIBILITY OF THE CHIEF EXECUTIVE OFFICER AND THE CHAIRMAN OF THE BOARD TO ENFORCE THE POLICY. | |
| FORM 990, PART VI, SECTION B, LINE 15 | TOP MANAGEMENT COMPENSATION CRHS RELIES UPON CMH, DBA CULPEPER REGIONAL HOSPITAL, WHICH USES AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE CEO. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THIS ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 9: | K-1 PHYSICIANS OFFICE BUILDING -26,842. EQUITY TRANSFER FROM RELATED PARTY-CULPEPER HOSPITAL 860,488. BAD DEBT 9,606. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THE AUDIT COMMITTEE RESPONSIBILITY & OVERSIGHT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. | |
| FORM 990, PART V, LINE 2A | SALARIES INCURRED BY CULPEPER REGIONAL HOSPITAL, ON BEHALF OF THIS FILING ENTITY CULPEPER REGIONAL HEALTH SYSTEM & ITS SUBSIDIARIES, ARE ALLOCATED APPROPRIATELY. THE ALLOCATED WAGES & BENEFITS APPEAR AS EXPENSES ON THIS FORM 990, PART IX, LINES 7 & 9, HOWEVER, ALL WAGES ARE PAID BY, AND FORM W-2S ARE ISSUED THROUGH, THE HOSPITAL. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| POWELL WELLNESS CENTER | |||||||||
| 1005 GOLF DRIVE | CULPEPER | VA | 22701 | 204803079 | WELLNESS CENTER | VA | 2330197 | 9257040 | CRHS |
| CULPEPER PHYSICIANS GROUP LLC | |||||||||
| 501 SUNSET LANE | CULPEPER | VA | 22701 | 455590868 | PHYSICIAN PRACTICE | VA | 878171 | 322467 | CRHS |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540622371 | EIN |
| Primary Activities | COMMUNITY HOSPITAL | PrimaryActivities |
| Legal Domicile State | VA | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 170B1 (A) III | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRHS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER PHYSICIAN HOSPITAL ORGANIZATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 592 | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 541703526 | EIN |
| Primary Activity | MEMBERSHIP ORGANIZATION | PrimaryActivity |
| Legal Domicile State | VA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Controlled Org | 0 | ControlledOrg |
| 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 | 1 | 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 | 1 | 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
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | J | TransactionType |
| Amount Involved | 345798 | AmountInvolved |
| Method Of Amt Determination | FMV | MethodOfAmtDetermination |
Comments