WILLIAMSBURG REGIONAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- WILLIAMSBURG REGIONAL HOSPITAL (EIN 57-0468486)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-14
- IRS object ID
- 201322269349300417
- Schema version
- 2011v1.5
- 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 H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-14T07:29:07-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410746749 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 N TRYON STREET SUITE 1000 | AddressLine1 |
| City | CHARLOTTE | City |
| State | NC | State |
| ZIP Code | 28246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 570468486 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAMSBURG REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WILL | NameControl |
| Phone | 8433558888 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO DRAWER 568 | AddressLine1 |
| City | KINGSTREE | City |
| State | SC | State |
| ZIP Code | 29556 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID KLINE | Name |
| Title | CFO | Title |
| Phone | 8433558888 | Phone |
| Date Signed | 2013-08-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN NORMAN | Name |
| PTIN | P01506766 | PTIN |
| Phone | 7049985200 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID KLINE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO DRAWER 568 | AddressLine1 |
| City | KINGSTREE | City |
| State | SC | State |
| ZIP Code | 29556 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 17405826 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.WMBGRH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | SC | StateLegalDomicile |
| Activity Or Mission Description | OPERATION OF AN ACUTE CARE HOSPITAL. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 266 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 105386 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 852456 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 14193961 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16497274 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 608863 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1784 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14908210 | TotalRevenuePriorYear |
| Total Revenue Current Year | 17351514 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7425764 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9451365 | 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 | 7594967 | OtherExpensePriorYear |
| Other Expenses Current Year | 8359346 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15020731 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17810711 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -112521 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -459197 | RevenuesLessExpensesCY |
| Total Assets BOY | 6506682 | TotalAssetsBOY |
| Total Assets EOY | 6821728 | TotalAssetsEOY |
| Total Liabilities BOY | 7858526 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8632769 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -1351844 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -1811041 | NetAssetsOrFundBalancesEOY |
| Mission Description | WILLIAMSBURG REGIONAL HOSPITAL IS A NOT FOR PROFIT ACUTE CARE HOSPITAL WITH 25 LICENSED BEDS, PROVIDING EXCELLENCE IN PATIENT CARE IN AN ENVIRONMENT THAT IS RESPECTFUL OF OTHERS, ADAPTIVE TO CHANGE, ACCOUNTABLE FOR OUTCOMES, AND ATTENTIVE TO THE NEEDS OF THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15343722 | Expense |
| Revenue | 16497274 | Revenue |
| Description | IN FISCAL YEAR 2012, THERE WERE 2,070 TOTAL ACUTE CARE PATIENT DAYS ALONG WITH SWING BED SERVICE PATIENT DAYS OF 2,069. OUTPATIENT VOLUMES WERE AS FOLLOWS : 11,037 ER VISITS, 25,399 PHYSICAL THERAPY PROCEDURES, 7,227 OCCUPATIONAL THERAPY PROCEDURES, 821 SPEECH THERAPY PROCEDURES, 47,451 RESPIRATORY PROCEDURES, 82,080 PHARMACY PRESCRIPTIONS, 49,325 LABORATORY PROCEDURES, AND 11,094 RADIOLOGY PROCEDURES, 216 SLEEP LAB VISITS. | Description |
| Total Program Service Expense | 15343722 | 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 | 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 | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | 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 | 1 | 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 | 0 | 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 | 69 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 266 | 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| 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 |
| States Where Copy Of Return Is Filed | SC | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONNA L KENYON CONTROLLER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8433550172 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO DRAWER 568 | AddressLine1 |
| City | KINGSTREE | City |
| State | SC | State |
| ZIP Code | 29556 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (22 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JOHN MARTIN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JIM CHERRY | |||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | ||
| HARRY FLOYD MD | |||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM JENKINSON III | |||||||
| EX-OFFICIO | 1.00 | X | 0 | 0 | 0 | ||
| JAMES KIRBY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LEE MCCLARY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| STANLEY PASLEY | |||||||
| EX-OFFICIO | 1.00 | X | 0 | 0 | 0 | ||
| FRANK TREFNY MD | |||||||
| CHIEF OF MEDICAL STAFF | 1.00 | X | 0 | 0 | 0 | ||
| JULIE FLOYD | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| STANLEY MYERS | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MITCHELL D MONSOUR | |||||||
| FORMER CEO | 40.00 | 132200 | 0 | 0 | X | ||
| DAN HARRINGTON | |||||||
| COO | 40.00 | 58692 | 0 | 5082 | X | ||
| SHERI SEIGLER | |||||||
| FORMER CNO | 40.00 | 44734 | 0 | 1318 | X | ||
| SHARON POSTON | |||||||
| CEO | 40.00 | 105282 | 0 | 8381 | X | ||
| DAVID KLINE | |||||||
| CFO | 40.00 | 83870 | 0 | 6884 | X | ||
| BAMBIE N FLOYD | |||||||
| CNO | 40.00 | 44372 | 0 | 3394 | X | ||
| DR TROY GAMBLE | |||||||
| CMO | 40.00 | 112774 | 0 | 8461 | X | ||
| MARK D FIELDER MD | |||||||
| SURGEON | 21.00 | 190175 | 0 | 11463 | X | ||
| TONNY HARMON | |||||||
| PHARMACIST | 40.00 | 101678 | 0 | 8809 | X | ||
| CATHERINE C POSTON | |||||||
| PHARMACIST | 40.00 | 101773 | 0 | 8875 | X | ||
| LIDIA M BURROUGHS | |||||||
| THERAPIST | 40.00 | 102634 | 0 | 8915 | X | ||
| NAGASUMANTH VEMULA MD | |||||||
| HOSPITALIST | 40.00 | 257832 | 0 | 12567 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1336016 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 84149 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PEE DEE EMERGENCY | |||||
| PO BOX 246 | MANNING | SC | 29102 | ER PHYSICIANS | 1215718 |
| SLEEP MANAGEMENT LLC | |||||
| 6100 DUTCHMANS LN | LOUISVILLE | KY | 40205 | SLEEP LAB | 198350 |
| MCLEOD PHYSICIAN ASSOCIATES | |||||
| 901 E CHEVES ST | FLORENCE | SC | 29506 | PHYSICIAN SERVICES | 172800 |
| MERCATOR HEALTH ADVISORS | |||||
| PO BOX 16171 | JACKSON | MS | 39236 | CEO | 132200 |
| CLIFTONLARSONALLEN | |||||
| 101 NORTH TRYON STREET | CHARLOTTE | NC | 28246 | AUDITING SERVICES | 122242 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 2166 | RelatedOrganizations |
| Government Grants | 606300 | GovernmentGrants |
| All Other Contributions | 243990 | AllOtherContributions |
| Total Contributions | 852456 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 16244794 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16244794 | RelatedOrExemptFunctionIncome |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 252480 | TotalRevenueColumn |
| Related Or Exempt Function Income | 252480 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16497274 | TotalProgramServiceRevenue |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 56096 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 54312 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1784 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1784 | TotalRevenueColumn |
| Exclusion | $1,784 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17351514 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16497274 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,784 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 437192 | Total |
| Program Services | 437192 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6787640 | Total |
| Program Services | 5944594 | ProgramServices |
| Management And General | 843046 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58428 | Total |
| Program Services | 58428 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1646623 | Total |
| Program Services | 1460281 | ProgramServices |
| Management And General | 186342 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 521482 | Total |
| Program Services | 462468 | ProgramServices |
| Management And General | 59014 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17413 | Total |
| Management And General | 17413 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3660927 | Total |
| Program Services | 3147568 | ProgramServices |
| Management And General | 513359 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21172 | Total |
| Program Services | 629 | ProgramServices |
| Management And General | 20543 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209745 | Total |
| Program Services | 64191 | ProgramServices |
| Management And General | 145554 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 694405 | Total |
| Program Services | 651971 | ProgramServices |
| Management And General | 42434 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33071 | Total |
| Program Services | 32004 | ProgramServices |
| Management And General | 1067 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9354 | Total |
| Program Services | 5526 | ProgramServices |
| Management And General | 3828 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 279547 | Total |
| Program Services | 279547 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 235129 | Total |
| Program Services | 235129 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 151132 | Total |
| Program Services | 151132 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PATIENT SUPPLIES | 1967320 | 1890625 | 76695 |
| LICENSE AND PERMIT | 404350 | 404350 | |
| REPAIRS AND MAINTENANCE | 342892 | 273493 | 69399 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 332889 | Total |
| Program Services | 248944 | ProgramServices |
| Management And General | 83945 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17810711 | Total |
| Program Services | 15343722 | ProgramServices |
| Management And General | 2466989 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 139062 | BOY |
| EOY | 147264 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 339057 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3150506 | BOY |
| EOY | 3782513 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 409453 | BOY |
| EOY | 428312 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78499 | BOY |
| EOY | 78546 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 11722433 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9460975 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2328909 | BOY |
| EOY | 2261458 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15000 | BOY |
| EOY | 15000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46196 | BOY |
| EOY | 108635 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6506682 | BOY |
| EOY | 6821728 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3806155 | BOY |
| EOY | 4616514 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2128441 | BOY |
| EOY | 1751039 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1923930 | BOY |
| EOY | 2265216 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7858526 | BOY |
| EOY | 8632769 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1351844 | BOY |
| EOY | -1811041 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -1351844 | BOY |
| EOY | -1811041 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6506682 | BOY |
| EOY | 6821728 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -459197 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | 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 |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 | 445790 | OtherCostOrOtherBasis |
| Book Value | 445790 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4003777 | OtherCostOrOtherBasis |
| Depreciation | 2805379 | Depreciation |
| Book Value | 1198398 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1456126 | OtherCostOrOtherBasis |
| Depreciation | 1427559 | Depreciation |
| Book Value | 28567 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5816740 | OtherCostOrOtherBasis |
| Depreciation | 5228037 | Depreciation |
| Book Value | 588703 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2261458 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD PARTY | $2,243,643 |
| OTHER LIABILITIES | $21,573 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2265216 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION AS DEFINED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND AS SUCH IS EXEMPT FROM FEDERAL INCOME TAXES. IN ADDITION, THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES. THE HOSPITAL FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THIS STATUS BE CHALLENGED IN THE FUTURE, THE 2009, 2010, AND 2011 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. MANAGEMENT IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 232155 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 232155 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01810 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1130127 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1892934 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -762807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1362282 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1892934 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -530652 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01810 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1362282 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1892934 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -530652 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01810 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,262,231 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 5887386 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7436438 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1549052 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 SELECT LABORATORIES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | INDEPENDENT LAB OWNED BY MULTIPLE PHYSICIANS, ETC. | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.00008 | OrganizationProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAMSBURG REGIONAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 NELSON BOULEVARD | AddressLine1 |
| City | KINGSTREE | City |
| State | SC | State |
| ZIP Code | 29556 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAMSBURG REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Other Actions | X | OtherActions |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 7: THE ORGANIZATION USED THE IRS WORKSHEETS TO CALCULATE THE AMOUNTS REPORTED ON SCHEDULE H. | |
| PART I, LINE 7G: N/A. NO SUBSIDIZED HEALTH SERVICES PROVIDED. | |
| PART I, L7 COL(F): THE ORGANIZATION DOES NOT HAVE A PROCESS FOR ESTIMATING THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE POLICY. THE ORGANIZATION MAKES ITS BEST EFFORT TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY WITH EVERY PATIENT. | |
| PART II: THIS CRITICAL ACCESS HOSPITAL HAS LIMITED COMMUNITY BUILDING ACTIVITES. | |
| PART III, LINE 8: THE HOSPITAL PROVIDES SERVICES TO PATIENTS REGARDLESS OF ABILITY TO PAY. AS A RESULT, THE HOSPITAL HAS INCURRED LOSSES BY SERVING MEDICARE PATIENTS. THE UNREIMBURSED SERVICES THE HOSPITAL PROVIDES TO THE COMMUNITY SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE THE HEALTHCARE NEEDS OF THE COMMUNITY WOULD OTHERWISE BE UNMET. | |
| PART III, LINE 9B: IT IS THE POLICY OF WILLIAMSBURG REGIONAL HOSPITAL TO PRESERVE THE ASSETS OF THE HOSPITAL WHILE ACHIEVING THE GOAL OF ADMINISTERING MEDICAL CARE TO THOSE IN NEED, WITHOUT REGARD TO RACE, COLOR, ANCESTRY, NATIONAL ORIGIN, RELIGION, SEXUAL ORIENTATION, AGE, SEX, MARITAL OR DISABILITY STATUS. ALL WHO RECEIVE MEDICAL CARE AND ARE CAPABLE OF PAYING FOR ALL OR PART OF THE COST OF THESE SERVICES MUST DO SO. IT IS THE POLICY OF WILLIAMSBURG REGIONAL HOSPITAL TO COLLECT PAYMENT FOR SERVICES RENDERED OR PROVIDE FINANCIAL ASSISTANCE TO ALL PATIENTS WHO OWE OUTSTANDING PATIENT BALANCES. FINANCIAL COUNSELORS WILL SCREEN OR PRESCREEN ANY PATIENT OR RESPONSIBLE PARTY THAT IS UNEMPLOYED OR WHO INDICATES THAT FINANCIAL ASSISTANCE MAY BE NEEDED. | |
| PART V, SECTION B, LINE 13G: CHARITY PROGRAM MENTIONED ON THE FIRST STATEMENT SENT OUT TO PATIENTS. | WILLIAMSBURG REGIONAL HOSPITAL |
| PART V, SECTION B, LINE 15E: REPORTING DEBT TO SET OFF PROGRAM TO THE STATE, WHEREBY INDIVIDUALS STATE TAX REFUNDS MAY BE CAPTURED AND APPLIED TO DEBT. | WILLIAMSBURG REGIONAL HOSPITAL |
| PART V, SECTION B, LINE 16E: RSI SENDS SET OFF FILE TO STATE EVERY YEAR. | WILLIAMSBURG REGIONAL HOSPITAL |
| PART V, SECTION B, LINE 19D: ALL SERVICES BILLED AT SAME RATE. | WILLIAMSBURG REGIONAL HOSPITAL |
| PART V, SECTION B, LINE 21: THE HOSPITAL BILLS SELF PAY PATIENTS AT THE NORMAL ESTABLISHED RATES. HOWEVER, IF THE PATIENTS COME IN TO SETTLE THE BILL, OFTEN TIMES THEY WILL BE GIVEN A DISCOUNT FOR PROMPT PAYMENT, ESPECIALLY IF THEY HAVE CASH IN HAND. | WILLIAMSBURG REGIONAL HOSPITAL |
| PART VI, LINE 2: THIS IS A CRITICAL ACCESS HOSPITAL THAT PROVIDES MEDICAL SERVICES TO THE COMMUNITY. | |
| PART VI, LINE 3: PATIENT SERVICE CENTER. | |
| PART VI, LINE 4: THIS IS A CRITICAL ACCESS HOSPITAL THAT PROVIDES MEDICAL SERVICES TO THE COMMUNITY. | |
| PART VI, LINE 5: THIS IS A CRITICAL ACCESS HOSPITAL THAT PROVIDES MEDICAL SERVICES TO THE COMMUNITY. | |
| PART VI, LINE 6: N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 (2 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK D FIELDER MD | |||||||||||||
| 190175 | 0 | 0 | 0 | 0 | 0 | 1879 | 0 | 9584 | 0 | 201638 | 0 | 0 | 0 |
| NAGASUMANTH VEMULA MD | |||||||||||||
| 257832 | 0 | 0 | 0 | 0 | 0 | 2002 | 0 | 10565 | 0 | 270399 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | EXCHANGE BANK OF SC | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | AN OFFICER OF THE HOSPITAL IS ALSO AN OFFICER OF EXCHANGE BANK OF SC | Relationship |
| Description Of Transaction | JOHN MARTIN IS THE CHAIRMAN OF THE BOARD FOR THE FILING ORGANIZATION AND ALSO AN EXECUTIVE OF THE EXCHANGE BANK OF SC, WHICH HELD $128,447 FOR THE HOSPITAL AT SEPTEMBER 30, 2012. EXCHANGE BANK OF SC ALSO PROVIDED THE HOSPITAL WITH A NOTE PAYABLE DURING 2009. THE BALANCE OF THIS NOTE WAS $12,135 AS OF SEPTEMBER 30, 2012. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 TAX RETURN IS REVIEWED BY MANAGEMENT AND MADE AVAILABLE TO THE GOVERNING BODY BEFORE RETURNS FOR FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICTS OF INTEREST ARE DISCLOSED ANNUALLY. WHEN A CONFLICT ARISES, THE BOARD MEMBER IS EXCUSED FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF TRUSTEES AND THE HOSPITAL ATTORNEY DETERMINE THE SPECIFICS OF THE EMPLOYMENT CONTRACT WITH THE CEO OR TOP MANAGEMENT OFFICIAL. IN 2008, THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. OTHER MANAGEMENT SALARIES ARE DETERMINED JOINTLY BY THE HUMAN RESOURCE DEPARTMENT AND THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. |
| FORM 990, PART VII, DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS: | OFFICERS LISTED ON PART VII WORK AN AVERAGE OF 40 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND THE RELATED ENTITY LISTED ON SCHEDULE R. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAMSBURG REGIONAL FOUNDATION INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO DRAWER 568 | AddressLine1 |
| City | KINGSTREE | City |
| State | SC | State |
| ZIP Code | 29556 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200161602 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivities |
| Legal Domicile State | SC | LegalDomicileState |
| Exempt Code Section | 501(C)3 | ExemptCodeSection |
| Public Charity Status | 509(A)3 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| 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 | 0 | 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 |
| 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 | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |