EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: EASTERN SHORE RURAL HEALTH SYSTEM INCORPORATED (EIN 51-0196935)
Tax period: 2012-06-01 to 2013-05-31
Filed: 2013-10-08
IRS object ID: 201332819349300718
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 J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-10-08T10:17:33-05:00	Timestamp
Tax Period End Date	2013-05-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ROBINSON FARMER COX ASSOCIATES	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	530 WESTFIELD RD	AddressLine1
City	CHARLOTTESVILLE	City
State	VA	State
ZIP Code	229011726	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-06-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	510196935	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	EASTERN SHORE RURAL HEALTH	BusinessNameLine1
Business Name Line2	SYSTEM INC	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	EAST	NameControl
Phone	7574140400	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	9434 HOSPITAL AVE	AddressLine1
City	NASSAWADOX	City
State	VA	State
ZIP Code	23413	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	NANCY STERN	Name
Title	EXECUTIVE DIRECTOR	Title
Phone	7574140400	Phone
Date Signed	2013-10-07	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	DAVID E FOLEY	Name
Phone	4349738314	Phone
Date Prepared	2013-10-08	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	NANCY STERN	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	9434 HOSPITAL AVE	AddressLine1
City	NASSAWADOX	City
State	VA	State
ZIP Code	23413	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	20166933	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.ESRH.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1976	YearFormation
State Legal Domicile	VA	StateLegalDomicile
Activity Or Mission Description	OPERATION OF FEDERALLY SUPPORTED COMMUNITY HEALTH CENTERS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	16	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	16	NbrIndependentVotingMembers
Total Nbr Employees	231	TotalNbrEmployees
Total Nbr Volunteers	19	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	4304592	ContributionsGrantsPriorYear
Contributions Grants Current Year	7610551	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	11114742	ProgramServiceRevenuePriorYear
Program Service Revenue CY	12532412	ProgramServiceRevenueCY
Investment Income Prior Year	7317	InvestmentIncomePriorYear
Investment Income Current Year	5896	InvestmentIncomeCurrentYear
Other Revenue Prior Year	54256	OtherRevenuePriorYear
Other Revenue Current Year	18074	OtherRevenueCurrentYear
Total Revenue Prior Year	15480907	TotalRevenuePriorYear
Total Revenue Current Year	20166933	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	10426822	SalariesEtcPriorYear
Salaries Etc Current Year	11100761	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	274777	TotalFundrsngExpCurrentYear
Other Expense Prior Year	3656394	OtherExpensePriorYear
Other Expenses Current Year	4382763	OtherExpensesCurrentYear
Total Expenses Prior Year	14083216	TotalExpensesPriorYear
Total Expenses Current Year	15483524	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	1397691	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	4683409	RevenuesLessExpensesCY
Total Assets BOY	12538140	TotalAssetsBOY
Total Assets EOY	17332945	TotalAssetsEOY
Total Liabilities BOY	3612264	TotalLiabilitiesBOY
Total Liabilities EOY	3723660	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	8925876	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	13609285	NetAssetsOrFundBalancesEOY
Mission Description	OPERATION OF FEDERALLY SUPPORTED COMMUNITY HEALTH CENTERS.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	13471339	Expense
Revenue	12532412	Revenue
Description	ORGANIZATION OPERATES FIVE FEDERALLY SUPPORTED COMMUNITY HEALTH CENTERS ON THE EASTERN SHORE OF VIRGINIA. THE SERVICE IS PROVIDED TO APPROXIMATELY 45,000 RESIDENTS IN TWO OF VIRGINIA'S MOST ECONOMICALLY DISADVANTAGED COUNTIES.	Description
Total Program Service Expense	13471339	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	21	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	231	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	16	NbrVotingGoverningBodyMembers
Number Independent Voting Members	16	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	NANCY STERN	NamePerson
Telephone Number	7574140400	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	9434 HOSPITAL AVE	AddressLine1
City	NASSAWADOX	City
State	VA	State
ZIP Code	23413	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (28 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
SAM BELOTE
BOARD MEMBER	2.00	X	0	0	0
MARTHA WHITE
BOARD MEMBER	2.00	X	0	0	0
HARRY DEITCH
BOARD MEMBER	2.00	X	0	0	0
SORAYA GOMEZ-BUCKNER
BOARD MEMBER	2.00	X	0	0	0
CALEB FOWLER
BOARD MEMBER	2.00	X	0	0	0
DENISE BLAND
BOARD MEMBER	2.00	X	0	0	0
CALVIN BRICKHOUSE
BOARD MEMBER	2.00	X	0	0	0
PETE DUER
BOARD MEMBER	2.00	X	0	0	0
CARAMINE KELLAM
BOARD MEMBER	2.00	X	0	0	0
BOB MAYES
BOARD MEMBER	2.00	X	0	0	0
JOHN SCHULZ
BOARD MEMBER	2.00	X	0	0	0
ALFONSO MONTALVO
BOARD MEMBER	2.00	X	0	0	0
DIANNE REIMANN
BOARD MEMBER	2.00	X	0	0	0
WILLIAM STURGIS
BOARD MEMBER	2.00	X	0	0	0
DELORES THOMPSON
BOARD MEMBER	2.00	X	0	0	0
FLORENCE WRIGHT
BOARD MEMBER	2.00	X	0	0	0
BLAIR CHICK
MEDICAL DIRE	40.00		205568	0	22500	X
NANCY STERN
CHIEF EXECUT	40.00		152796	0	12192	X
KANDICE BRUNO
CHIEF FINANC	40.00		101276	0	15124	X
ANNE CRABBE
CHIEF OPERAT	40.00		87671	0	8742	X
JEANNETTE EDWARDS
DIRECTOR OF	40.00		85047	0	8480	X
KIMBERLY SAVAGE
CHIEF COMPLI	40.00		83133	0	5200	X
MIKE ZODUN
CHIEF INFORM	40.00		73755	0	6663	X
JEANNE ROLL
DOCTOR	40.00		172972	0	12000		X
THOMAS HOLLANDSWORTH
DOCTOR	40.00		172283	0	17000		X
DAVID HOSHINO
DOCTOR	40.00		171945	0	17131		X
DAVID RIOPEL
DOCTOR	40.00		155459	0	15496		X
EDWARD GRIGGS
DENTIST	40.00		150193	0	22500		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1612098	TotalReportableCompFromOrg
Total Other Compensation	163028	TotalOtherCompensation
Number Individuals GT100 K	18	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	GEORGE MILES AND BUHR	BusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	206 WEST MAIN STREET	AddressLine1
City	SALISBURY	City
State	MD	State
ZIP Code	21801	ZIPCode

Field	Value	IRS element (for citing)
Description Of Services	ARCHITECTUAL	DescriptionOfServices
Compensation	269789	Compensation

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	1	NumberOfContractorsGT100K
Government Grants	7435719	GovernmentGrants
All Other Contributions	174832	AllOtherContributions
Noncash Contributions	16483	NoncashContributions
Total Contributions	7610551	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE	9530655	9530655
340B	2279257	2279257
MEANINGFUL USE	722500	722500

Field	Value	IRS element (for citing)
Total Program Service Revenue	12532412	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	5896	TotalRevenueColumn
Exclusion	$5,896	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	11160	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	11160	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	11160	TotalRevenueColumn
Related Or Exempt Function Income	11160	RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Total Revenue Column	6914	TotalRevenueColumn
Related Or Exempt Function Income	6914	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	6914	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	20166933	TotalRevenueColumn
Related Or Exempt Function Income	12550486	RelatedOrExemptFunctionIncome
Exclusion	$5,896	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	990366	Total
Program Services	263070	ProgramServices
Management And General	525656	ManagementAndGeneral
Fundraising	201640	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	8552445	Total
Program Services	7845954	ProgramServices
Management And General	698717	ManagementAndGeneral
Fundraising	7774	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	175895	Total
Program Services	159972	ProgramServices
Management And General	15325	ManagementAndGeneral
Fundraising	598	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	773958	Total
Program Services	710154	ProgramServices
Management And General	61412	ManagementAndGeneral
Fundraising	2392	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	608097	Total
Program Services	553048	ProgramServices
Management And General	52981	ManagementAndGeneral
Fundraising	2068	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	40474	Total
Management And General	40474	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	22500	Total
Management And General	22500	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	267656	Total
Program Services	224902	ProgramServices
Fundraising	42754	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	109242	Total
Program Services	74417	ProgramServices
Management And General	34825	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	411167	Total
Program Services	327220	ProgramServices
Management And General	75791	ManagementAndGeneral
Fundraising	8156	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	52942	Total
Program Services	52942	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	88217	Total
Program Services	14647	ProgramServices
Management And General	68309	ManagementAndGeneral
Fundraising	5261	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	99446	Total
Program Services	95962	ProgramServices
Management And General	3484	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	376552	Total
Program Services	359614	ProgramServices
Management And General	16026	ManagementAndGeneral
Fundraising	912	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	40097	Total
Management And General	40097	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
PHARMACY PROGRAMS	1434247	1434247
MEDICAL SUPPLIES	969870	969870
TELEPHONE & UTILITIES	278785	240240	36062	2483
REPAIRS & MAINTENANCE	148638	137162	10737	739

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	42930	Total
Program Services	7918	ProgramServices
Management And General	35012	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	15483524	Total
Program Services	13471339	ProgramServices
Management And General	1737408	ManagementAndGeneral
Fundraising	274777	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1977761	BOY
EOY	1998666	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2036264	BOY
EOY	1952573	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	14259	BOY
EOY	15650	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	16730152	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	3371096	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	8502856	BOY
EOY	13359056	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	7000	BOY
EOY	7000	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	12538140	BOY
EOY	17332945	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1175024	BOY
EOY	1316104	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	2433482	BOY
EOY	2403367	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	3758	BOY
EOY	4189	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3612264	BOY
EOY	3723660	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	8912577	BOY
EOY	13609285	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	13299	BOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	8925876	BOY
EOY	13609285	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	12538140	BOY
EOY	17332945	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	4683409	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3800876	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	5330230	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4842593	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4304592	CurrentTaxYearMinus1Year
Current Tax Year	7610551	CurrentTaxYear
Total	25888842	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	7621659	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	8152733	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	8685373	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	11114742	CurrentTaxYearMinus1Year
Current Tax Year	12532412	CurrentTaxYear
Total	48106919	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	11422535	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	13482963	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	13527966	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	15419334	CurrentTaxYearMinus1Year
Current Tax Year	20142963	CurrentTaxYear
Total	73995761	Total

Field	Value	IRS element (for citing)
Public Support Total509	73995761	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	12794	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	17711	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	22305	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	18177	CurrentTaxYearMinus1Year
Current Tax Year	17056	CurrentTaxYear
Total	88043	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	12794	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	17711	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	22305	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	18177	CurrentTaxYearMinus1Year
Current Tax Year	17056	CurrentTaxYear
Total	88043	Total

Other Income509 OtherIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	66642	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	82653	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	58989	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	43396	CurrentTaxYearMinus1Year
Current Tax Year	6914	CurrentTaxYear
Total	258594	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	11501971	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	13583327	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	13609260	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	15480907	CurrentTaxYearMinus1Year
Current Tax Year	20166933	CurrentTaxYear
Total	74342398	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99530	PublicSupportPercentage509
Prior Year Support Percentage	0.99310	PriorYearSupportPercentage
Investment Income Percentage	0.00000	InvestmentIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

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	762393	OtherCostOrOtherBasis
Book Value	762393	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	8684355	OtherCostOrOtherBasis
Depreciation	2521761	Depreciation
Book Value	6162594	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1135819	OtherCostOrOtherBasis
Depreciation	849335	Depreciation
Book Value	286484	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	6147585	OtherCostOrOtherBasis
Book Value	6147585	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	13359056	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	OTHER LIABILITIES	Description
Amount	$4,189	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	4189	TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt	20166933	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	20166933	RevenueSubtotal
Total Revenue Per Form990	20166933	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	15483524	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	15483524	ExpensesSubtotal
Total Expenses Per Form990	15483524	TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Deferred Comp Filing OrgDeferredCompFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
BLAIR CHICK
MEDICAL DIRECTOR	205568	22500	228068
NANCY STERN
CHIEF EXECUTIVE OFF	152796	12192	164988
JEANNE ROLL
DOCTOR	172972	12000	184972
THOMAS HOLLANDSWORTH
DOCTOR	172283	17000	189283
DAVID HOSHINO
DOCTOR	171945	17131	189076
DAVID RIOPEL
DOCTOR	155459	15496	170955
EDWARD GRIGGS
DENTIST	150193	22500	172693

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	FORM 990 IS REVIEWED BY THE CEO, CFO, AND THE BOARD OF DIRECTORS PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	OVER THE PAST YEAR EASTERN SHORE RURAL HEALTH SYSTEM, INC. IMPLEMENTED A MORE ROBUST CONFLICT OF INTEREST POLICY THAT NOW REQUIRES BOARD MEMBERS TO ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY. DURING THE MEETING HELD ON AUGUST 29, 2013 ALL BOARD MEMBERS SIGNED THE POLICY. HEREAFTER, THE POLICY WILL BE RESIGNED ANNUALLY AT THE JUNE BOARD MEETING.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE ORGANIZATION INCLUDES AN AVERAGE SALARY INCREASE FOR ALL STAFF IN THE BUDGET SUBMITTED TO THE BOARD OF DIRECTORS FOR APPROVAL ON AN ANNUAL BASIS. THIS BUDGET IS PART OF THE 330 GRANT APPLICATION SUBMITTED TO THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, HEALTH RESOURCES AND SERVICES ADMINISTRATION FOR GRANT FUNDING THAT REPRESENTS 30% OF THE TOTAL BUDGET. GENERALLY, THE GRANT APPLICATION IS SUBMITTED TO THE BOARD IN JANUARY AT A SPECIAL CALLED MEETING AND IS VOTED ON FOR APPROVAL OR AMENDMENTS A WEEK LATER AT THE REGULARLY SCHEDULED MONTHLY BOARD MEETING. THE BUDGET CONTAINS AN AVERAGE INCREASE THAT WILL BE AVAILABLE FOR ALL STAFF, CONTRACTUAL EMPLOYEES, OFFICERS, AND THE CEO. NEXT, IN JUNE OF EACH YEAR, ALL EMPLOYEES, INCLUDING THE CEO, ARE EVALUATED THROUGH A WRITTEN APPRAISAL PROCESS. THE CEO IS EVALUATED BY THE BOARD CHAIR. ALL EVALUATIONS REQUIRE A MINIMUM OF TWO INDEPENDENT EVALUATIONS IN ADDITION TO THE SUPERVISOR AND EACH EMPLOYEE SUBMITS A WRITTEN SELF-APPRAISAL. THE EVALUATIONS ARE WRITTEN AND BASED ON THE ESSENTIAL JOB FUNCTIONS. PERFORMANCE OF EACH FUNCTION IS ASSIGNED A NUMERICAL VALUE. THE EVALUATIONS ALSO SET GOALS FOR THE UPCOMING YEAR AND EVALUATE THE LEVEL OF ACHIEVEMENT OF GOALS ESTABLISHED DURING THE PRIOR EVALUATION PERIOD. UPON COMPLETION OF ALL EVALUATIONS, THE BOARD DETERMINES THE PERCENTAGE INCREASE FOR THE CEO BASED ON THE NUMERIC SCORE ACHIEVED, THE ACCOMPLISHMENT OF GOALS ESTABLISHED IN THE PRIOR YEAR, THE FINANCIAL POSITION OF THE ORGANIZATION, THE RANGE APPROVED IN THE BUDGET CYCLE, AND COMPENSATION OF CEOS FROM THE COMMUNITY HEALTH CENTERS LOCATED IN VIRGINIA. THIS INFORMATION IS GATHERED FROM AN ANNUAL COMPENSATION SURVEY GATHERED FROM ALL COMMUNITY HEALTH CENTERS IN THE STATE AND CONDUCTED BY THE VIRGINIA COMMUNITY HEALTHCARE ASSOCIATION.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	FOLLOWING THE BUDGET AND EVALUATION PROCESS (DESCRIBED FOR CEO), THE CEO DETERMINES THE PERCENT INCREASES FOR THE OTHER OFFICERS BASED ON THE NUMERIC SCORES OF EVALUATIONS, THE RANGE SET BY THE BOARD DURING THE BUDGET CYCLE, FINANCIAL POSITION OF THE ORGANIZATION, AND PREVAILING COMPENSATION FROM THE SALARY SURVEY. THE CHIEF HUMAN RESOURCE OFFICER AND THE CHIEF FINANCIAL OFFICER USE THE NUMERIC VALUE OF EACH EMPLOYEE'S EVALUATION TO DETERMINE THE PERCENT INCREASE FROM THE POOL APPROVED BY THE BOARD IN THE BUDGET. THESE PROPOSED RAISES ARE THEN SUBMITTED TO THE CEO FOR FINAL APPROVAL.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE ORGANIZATION PROVIDES ITS GOVERNING DOCUMENTS, POLICIES, AND TAX RETURNS TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE ON THE ORGANIZATION'S WEBSITE.