CULPEPER WELLNESS FOUNDATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- CULPEPER WELLNESS FOUNDATION (EIN 52-1366700)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-08-12
- IRS object ID
- 201212259349300601
- Schema version
- 2010v3.7
- 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 | 2012-08-12T11:27:46-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COHEN RUTHERFORD KNIGHT PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6903 ROCKLEDGE DRIVE SUITE 500 | AddressLine1 |
| City | BETHESDA | City |
| State | MD | State |
| ZIP Code | 208171800 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | 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 |
| Date Signed | 2012-08-09 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3018281008 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | 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 | 3577156 | GrossReceipts |
| Group Return For Affiliates | false | 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 | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | 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 | 338406 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 433354 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1577366 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1595251 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 318622 | InvestmentIncomePriorYear |
| Investment Income Current Year | 215403 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 708853 | OtherRevenuePriorYear |
| Other Revenue Current Year | 925691 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 2943247 | TotalRevenuePriorYear |
| Total Revenue Current Year | 3169699 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 11424 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 437245 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1323057 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1387543 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 10944 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 1763765 | OtherExpensePriorYear |
| Other Expenses Current Year | 1492299 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3098246 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3317087 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -154999 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -147388 | RevenuesLessExpensesCY |
| Total Assets BOY | 24994875 | TotalAssetsBOY |
| Total Assets EOY | 23954089 | TotalAssetsEOY |
| Total Liabilities BOY | 505646 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 442031 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 24489229 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 23512058 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE ORGANIZATION'S MISSION IS TO SUPPORT THE MISSION OF CULPEPER REGIONAL HOSPITAL. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 1814531 | Expense |
| Description | POWELL WELLNESS CENTER, LLC, 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. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 355721 | Expense |
| Grants | 355721 | Grants |
| Description | CRHS Foundation was organized & is operated for the purpose of soliciting, receiving, & administering gifts, grants & contributions for the benefit of Culpeper Memorial Hospital, DBA Culpeper Regional Hospital. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 81524 | Expense |
| Grants | 81524 | Grants |
| Description | CRHS manages real estate properties, AN AUXILIARY, A FREE CLINIC AND PROVIDES SCHOLARSHIPS for the purpose of promoting the vision & mission of Culpeper Memorial Hospital, DBA Culpeper Regional Hospital. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 2251776 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| 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 | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | 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 | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | 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 | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 19 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | 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 |
| States Where Copy Of Return Is Filed | VA | StatesWhereCopyOfReturnIsFiled |
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer |
|---|---|---|---|---|---|---|---|
| CONSTANCE KINCHELOE | |||||||
| BOARD MEMBER | 4.0 | X | 0 | 0 | 0 | ||
| KARL BEIER MD | |||||||
| IMMEDIATE PAST BOARD CHAIR | 4.0 | X | 0 | 0 | 0 | ||
| MICHAEL ARMM | |||||||
| CHAIR | 5.0 | X | 0 | 0 | 0 | X | |
| WILLIAM CANNON JR | |||||||
| TREASURER | 4.0 | X | 0 | 0 | 0 | X | |
| JOAN PROCTOR | |||||||
| CHAIR- CRHS AUXILIARY | 4.0 | X | 0 | 0 | 0 | ||
| TOM REYNOLDS MD | |||||||
| VICE CHAIR | 4.0 | X | 0 | 0 | 0 | X | |
| CHARLES CRIST | |||||||
| CHAIR, FREE CLINIC OF CULPEPER | 2.0 | X | 0 | 0 | 0 | ||
| DAVID JONES | |||||||
| CHAIR CRHS FOUNDATION | 2.0 | X | 0 | 0 | 0 | ||
| C WAYNE HAWKINS | |||||||
| SECRETARY | 2.0 | X | 0 | 0 | 0 | X | |
| H B SEDWICK | |||||||
| CHAIR, CRHS REAL ESTATE | 2.0 | X | 0 | 0 | 0 | ||
| BREVARD WALLACE MD | |||||||
| CHAIR POWELL WELLNESS CENTER | 2.0 | X | 0 | 0 | 0 | ||
| SAMUEL MORGAN | |||||||
| SENIOR VICE PRESIDENT & CFO | 8.0 | 0 | 189930 | 5167 | X | ||
| H LEE KIRK JR | |||||||
| PRESIDENT/CEO | 12.0 | 0 | 387901 | 18941 | X | ||
| JOHN G MAXWELL | |||||||
| SR VICE PRESIDENT & COO | 8.0 | 0 | 169933 | 20041 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 747764 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 44149 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 12026 | FederatedCampaigns |
| Fundraising Events | 19722 | FundraisingEvents |
| Related Organizations | 16640 | RelatedOrganizations |
| All Other Contributions | 384966 | AllOtherContributions |
| Total Contributions | 433354 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|
| PWC MEMBERSHIP DUES | 1518234 | 1518234 | 0 |
| PWC ASSESSMENT FEES | 77017 | 77017 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1595251 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 137496 | TotalRevenueColumn |
| Exclusion | $137,496 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 874345 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 364561 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 509784 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 509784 | TotalRevenueColumn |
| Exclusion | $509,784 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 77907 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 77907 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 77907 | TotalRevenueColumn |
| Exclusion | $77,907 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 28128 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 19722 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 42896 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -14768 | TotalRevenueColumn |
| Exclusion | -$14,768 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| PWC CAFE | 21746 | 21746 |
| PWC MISC INCOME | 19644 | 19644 |
| PWC KID'S CORNER | 9375 | 9375 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 379910 | TotalRevenueColumn |
| Related Or Exempt Function Income | 379910 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 430675 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3169699 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2025926 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $710,419 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 353471 | Total |
| Program Services | 353471 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 83774 | Total |
| Program Services | 83774 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1159651 | Total |
| Program Services | 639465 | ProgramServices |
| Management And General | 520186 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 227892 | Total |
| Program Services | 148546 | ProgramServices |
| Management And General | 79346 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1085 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 1085 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35505 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 35505 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21308 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 21308 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105755 | Total |
| Program Services | 45243 | ProgramServices |
| Management And General | 60312 | ManagementAndGeneral |
| Fundraising | 200 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158874 | Total |
| Program Services | 124347 | ProgramServices |
| Management And General | 31153 | ManagementAndGeneral |
| Fundraising | 3374 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29861 | Total |
| Program Services | 29861 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24046 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 24046 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 399036 | Total |
| Program Services | 394306 | ProgramServices |
| Management And General | 4730 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30787 | Total |
| Program Services | 28060 | ProgramServices |
| Management And General | 2727 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| UTILITIES | 220883 | 220110 | 773 | 0 |
| MINOR EQUIPMENT | 4488 | 4488 | 0 | 0 |
| REPAIRS AND MAINTENANCE | 56281 | 56246 | 35 | 0 |
| TRAINING | 4574 | 0 | 4574 | 0 |
| DUES AND SUBCRIPTIONS | 3122 | 0 | 3122 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 396694 | Total |
| Program Services | 123859 | ProgramServices |
| Management And General | 265465 | ManagementAndGeneral |
| Fundraising | 7370 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3317087 | Total |
| Program Services | 2251776 | ProgramServices |
| Management And General | 1054367 | ManagementAndGeneral |
| Fundraising | 10944 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2197262 | BOY |
| EOY | 1310621 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 633997 | BOY |
| EOY | 466558 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16177 | BOY |
| EOY | 88620 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 243676 | BOY |
| EOY | 149062 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8561 | BOY |
| EOY | 11336 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16994 | BOY |
| EOY | 10534 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 19676910 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4095606 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15109946 | BOY |
| EOY | 15581304 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5821096 | BOY |
| EOY | 5552811 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 945822 | BOY |
| EOY | 783243 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1344 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24994875 | BOY |
| EOY | 23954089 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 356485 | BOY |
| EOY | 279456 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13914 | BOY |
| EOY | 15006 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 135247 | BOY |
| EOY | 147569 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 505646 | BOY |
| EOY | 442031 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23045685 | BOY |
| EOY | 22353171 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1279359 | BOY |
| EOY | 993126 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 164185 | BOY |
| EOY | 165761 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24489229 | BOY |
| EOY | 23512058 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24994875 | BOY |
| EOY | 23954089 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -147388 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -829783 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | 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 | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER MEMORIAL HOSPITAL DBA CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540622371 | EIN |
| Type Of Organization | 03 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Supported Organization Notified | true | SupportedOrganizationNotified |
| Organized In US | true | OrganizedInUS |
| Amount | $353,471 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 353471 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2528632 | OtherCostOrOtherBasis |
| Book Value | 2528632 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13302347 | OtherCostOrOtherBasis |
| Depreciation | 2817343 | Depreciation |
| Book Value | 10485004 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Depreciation | 0 | Depreciation |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3188597 | OtherCostOrOtherBasis |
| Depreciation | 1256600 | Depreciation |
| Book Value | 1931997 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 657334 | OtherCostOrOtherBasis |
| Depreciation | 21663 | Depreciation |
| Book Value | 635671 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 15581304 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO CMH | $119,768 |
| ANNUITY PAYABLE | $27,801 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 147569 | TotalOfAmounts |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GALA | NameOfEvent1 |
| Gross Receipts Event1 | 26250 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 10290 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 15960 | GrossRevenueEvent1 |
| Food And Beverage Event1 | 17666 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 2500 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 7995 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF | NameOfEvent2 |
| Gross Receipts Event2 | 21600 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 9432 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 12168 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 2593 | NonCashPrizesEvent2 |
| Food And Beverage Event2 | 3265 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 8877 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 0 | TotalNumberOfOtherEvents |
| Gross Receipts Total | 47850 | GrossReceiptsTotal |
| Charitable Contributions Total | 19722 | CharitableContributionsTotal |
| Gross Revenue Total Events | 28128 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 2593 | NonCashPrizesTotalEvents |
| Food And Beverage Total Events | 20931 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 2500 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 16872 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 42896 | DirectExpenseSummaryEvents |
| Net Income Summary | -14768 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | 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) |
|---|---|---|
| Amount Of Cash Grant | 353471 | AmountOfCashGrant |
| Purpose Of Grant | DONATIONS FROM FOUNDATION FOR HOSPITAL PPE | PurposeOfGrant |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 25 | NumberOfRecipients |
| Amount Of Cash Grant | 83774 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. |
| part i, line 2 | CULPEPER REGIONAL HEALTH SYSTEM PROVIDES FUNDS TO CULPEPER REGIONAL HOSPITAL TO PROVIDE FUNDS FOR PROPERTY, PLANT AND EQUIPMENT. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMUEL MORGAN | |||||||||||
| 0 | 177180 | 0 | 12750 | 0 | 0 | 0 | 1831 | 0 | 3336 | 0 | 195097 |
| H LEE KIRK JR | |||||||||||
| 0 | 372901 | 0 | 0 | 0 | 15000 | 0 | 2990 | 0 | 15951 | 0 | 406842 |
| JOHN G MAXWELL | |||||||||||
| 0 | 158082 | 0 | 11851 | 0 | 0 | 0 | 0 | 0 | 20041 | 0 | 189974 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | top managment compensation | Identifier |
| Explanation | 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 establish the compensation of the CEO. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (18 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. |
| 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. |
| MAKING DOCUMENTS AVAILABLE | PART VI, LINE 19 | THIS ORGANIZATION MAKES its GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| part xi, line 5 | reconciliation of net assets | unrealized loss $(447,251) unrealized gain 1,576 book invest in ptrshp 63,202 scholarships 73,774 foundation bad debt 3,065 grant to hospital 353,471 fy11 drop it move to liab (121,548) net assets released (752,345) k-1 pob ( 3,727) ----------- total (829,783) |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:CONSTANCE KINCHELOE TITLE:BOARD MEMBER HOURS:2 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:KARL BEIER MD TITLE:IMMEDIATE PAST BOARD CHAIR HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MICHAEL ARMM TITLE:CHAIR HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:WILLIAM CANNON JR TITLE:TREASURER HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JOAN PROCTOR TITLE:CHAIR- CRHS AUXILIARY HOURS: |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:TOM REYNOLDS MD TITLE:VICE CHAIR HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:CHARLES CRIST TITLE:CHAIR, FREE CLINIC OF CULPEPER HOURS: |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DAVID JONES TITLE:CHAIR CRHS FOUNDATION HOURS: |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:C WAYNE HAWKINS TITLE:SECRETARY HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:H B SEDWICK TITLE:CHAIR, CRHS REAL ESTATE HOURS: |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:BREVARD WALLACE MD TITLE:CHAIR POWELL WELLNESS CENTER HOURS: |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SAMUEL MORGAN TITLE:SENIOR VICE PRESIDENT & CFO HOURS:36 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:H LEE KIRK JR TITLE:PRESIDENT/CEO HOURS:34 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JOHN G MAXWELL TITLE:SR VICE PRESIDENT & COO HOURS:36 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POWELL WELLNESS CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1005 GOLF DRIVE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204803079 | EIN |
| Primary Activities | WELLNESS CENT | PrimaryActivities |
| Legal Domicile State | VA | LegalDomicileState |
| Total Income | 2195630 | TotalIncome |
| EOY Assets | 10077661 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRHS | BusinessNameLine1 |
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 HOS | 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 |
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 ORG | 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 CORP | TypeOfEntity |
| Share Of Total Income | 0 | ShareOfTotalIncome |
| Share Of EOY Assets | 0 | ShareOfEOYAssets |
| Percentage Ownership | 0.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | crh | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | i | TransactionType |
| Amount Involved | 349350 | AmountInvolved |
Comments