UVA CULPEPER MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- UVA CULPEPER MEDICAL CENTER (EIN 54-0622371)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-17
- IRS object ID
- 201522299349301702
- Schema version
- 2013v4.0
- 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 I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-17T09:26:12-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 FRANKLIN RD SE SUITE 501 | AddressLine1 |
| City | ROANOKE | City |
| State | VA | State |
| ZIP Code | 240112114 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540622371 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CULP | BusinessNameControlTxt |
| Phone | 5408294100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | C GREG NAPPS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5408298803 | PhoneNum |
| Signature | 2015-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PATRICK T MURTAUGH | PreparerPersonNm |
| PTIN | P01230482 | PTIN |
| Phone | 5409896144 | PhoneNum |
| Preparation | 2015-08-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | C GREG NAPPS | PrincipalOfficerNm |
US Address USAddress
| 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 | $93,036,214 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UVACULPEPERHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | VA | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION OF CULPEPER REGIONAL HOSPITAL IS TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH BY PROVIDING THE BEST POSSIBLE HEALTH CARE SERVICES. WE WILL ALWAYS MAKE THE NEEDS OF OUR PATIENTS OUR TOP PRIORITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 779 | TotalEmployeeCnt |
| Total Volunteers | 250 | TotalVolunteersCnt |
| Total Gross UBI | $10,276 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$8,479 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $278,992 | PYContributionsGrantsAmt |
| CY Contributions Grants | $87,396 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $78,820,831 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $89,301,975 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,868,117 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,140,807 | CYInvestmentIncomeAmt |
| PY Other Revenue | $2,301,389 | PYOtherRevenueAmt |
| CY Other Revenue | $2,452,912 | CYOtherRevenueAmt |
| PY Total Revenue | $83,269,329 | PYTotalRevenueAmt |
| CY Total Revenue | $92,983,090 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,615 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $40,450 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $37,192,194 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $34,551,312 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $45,520,741 | PYOtherExpensesAmt |
| CY Other Expenses | $45,441,412 | CYOtherExpensesAmt |
| PY Total Expenses | $82,723,550 | PYTotalExpensesAmt |
| CY Total Expenses | $80,033,174 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $545,779 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $12,949,916 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $89,196,037 | TotalAssetsBOYAmt |
| Total Assets EOY | $95,578,806 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,406,516 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,363,098 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $77,789,521 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $86,215,708 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF CULPEPER REGIONAL HOSPITAL IS TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH BY PROVIDING THE BEST POSSIBLE HEALTH CARE SERVICES. WE WILL ALWAYS MAKE THE NEEDS OF OUR PATIENTS OUR TOP PRIORITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $62,503,166 | ExpenseAmt |
| Grant | $40,450 | GrantAmt |
| Revenue | $91,948,563 | RevenueAmt |
| Desc | THE COMMUNITY BENEFIT CONTRIBUTION OF CULPEPER REGIONAL HOSPITAL IS TO PROVIDE PROGRAMS AND ACTIVITIES THAT IMPROVE ACCESS TO HEALTH CARE AND IMPROVE HEALTH IN OUR COMMUNITY. CULPEPER REGIONAL HOSPITAL IS A 70-BED, NON-PROFIT, ACUTE CARE HOSPITAL WITH COMPREHENSIVE SERVICES PROVIDING A 24 HOUR, PHYSICIAN STAFFED EMERGENCY DEPARTMENT, FAMILY BIRTH CENTER, SURGICAL SERVICES, INTENSIVE CARE UNIT AND MORE. CRH PROVIDES MEDICAL AND OTHER HEALTH CARE SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. OUR MISSION IS TO HELP PEOPLE ACHIEVE AND MAINTAIN OPTIMAL HEALTH BY PROVIDING THE BEST POSSIBLE HEALTH CARE SERVICES. WE ALWAYS MAKE THE NEEDS OF OUR PATIENTS OUR TOP PRIORITY. WE ALSO PARTNER WITH LOCAL NON-PROFIT ORGANIZATIONS (THE CHAMBER OF COMMERCE AND LOCAL SCHOOLS), TO SUPPORT LOCAL EVENTS AND PROVIDE HEALTH AND WELLNESS PROGRAMS. ALL UNINSURED PATIENTS, REGARDLESS OF INCOME LEVEL OR COUNTY OF RESIDENCE, RECEIVE A 20% DISCOUNT ON HOSPITAL SERVICES AND AN ADDITIONAL 15% DISCOUNT FOR PAYMENT WITHIN 30 DAYS. CRH WORKS WITH LOCAL COMMUNITY COLLEGES TO PROVIDE TOURS, LECTURES, AND INTERNSHIPS FOR STUDENTS. CRH PUBLISHES TWO MAJOR COMMUNITY NEWSLETTERS. "SIMPLY HEALTH" AND "AGING WELL" ARE PUBLISHED 3 TIMES A YEAR; THEY REACH 50,000 HOMES IN CULPEPER AND SURROUNDING COUNTIES. FOR LINKS TO ADDITIONAL COMMUNITY BENEFIT INFORMATION, PLEASE SEE CULPEPER REGIONAL HOSPITAL'S WEBSITE: WWW.UVACULPEPERHOSPITAL.COM | Desc |
| Total Program Service Expenses | $62,503,166 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 42 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 779 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | C GREG NAPPS | PersonNm |
| Phone | 5408298803 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| LARRY FITZGERALD | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ROBERT GIBSON MD | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| SHARON CLARK | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| SALLY NAN BARBER | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CHARLES CRIST | ||||||||
| CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RICHARDS SHANNON MD | ||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CLARISSA BERRY | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| NEAL DEANE | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| CHARLES BARRELL | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KHALID ATHAR | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KAREN HARRIS | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JEFFERY HETMANSKI | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| THOMAS REYNOLDS MD | ||||||||
| TRUSTEE | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| C GREG NAPPS | ||||||||
| CEO | 40.00 | Yes (X) | Yes (X) | $219,305 | $0 | $25,547 | 8.00 | |
| H LEE KIRK JR | ||||||||
| PRESIDENT | 40.00 | Yes (X) | $451,737 | $0 | $29,405 | 12.00 | ||
| SAM MORGAN | ||||||||
| SENIOR VICE PRESIDENT CFO | 40.00 | Yes (X) | $156,304 | $0 | $3,971 | |||
| JANICE SUTER | ||||||||
| VP NURSING | 40.00 | $169,433 | $0 | $12,917 | Yes (X) | |||
| DENNIS SMITH | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | $147,356 | $0 | $21,480 | Yes (X) | |||
| MORTON CHILES MD | ||||||||
| VP MEDICAL STAFF SERVICES | 40.00 | $190,709 | $0 | $18,871 | Yes (X) | |||
| DEBRA O'CONNELL | ||||||||
| PHO DIRECTOR | 40.00 | $161,152 | $0 | $19,245 | Yes (X) | |||
| SUSAN EDWARDS | ||||||||
| HUMAN RESOURCES DIRECTOR | 40.00 | $139,626 | $0 | $24,384 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,635,622 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $155,820 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GILBANE BUILDING COMPANY | |||||
| 7 JACKSON WALKWAY | PROVIDENCE | RI | 02903 | ARCHITECTURE | $5,694,216 |
| UVA PHYSICIANS GROUP | |||||
| 500 RAY C HUNT DR | CHARLOTTESVILLE | VA | 22903 | PHYSICIAN SUPPORT | $2,660,209 |
| WE BOWERS INC | |||||
| 506 SHAW RD STE 327 | STERLING | VA | 20166 | ARCHITECTURE | $2,514,907 |
| ANESTHESIA PROFESSIONAL | |||||
| 301 SUNSET LANE | CULPEPER | VA | 22701 | PHYSICIAN SUPPORT | $1,175,589 |
| RIDEGELINE PHYSICIAN SERVICES PLC | |||||
| 501 SUNSET LANE | CULPEPER | VA | 22701 | PHYSICIAN SUPPORT | $1,061,059 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 37 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $87,396 | RelatedOrganizationsAmt |
| Total Contributions | $87,396 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 622310 | $88,840,122 | $88,840,122 |
| CSC K-1 | 622310 | $463,785 | $463,785 |
| CMA K-1 | 622310 | -$1,932 | -$1,932 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $89,301,975 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $936,855 | TotalRevenueColumnAmt |
| Exclusion | $936,855 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,417 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,440 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$4,023 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,023 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$4,023 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $198,818 | SecuritiesAmt |
| Other | $47,818 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $42,684 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $198,818 | SecuritiesAmt |
| Other | $5,134 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $203,952 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $203,952 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| OTHER REVENUE | 622110 | $2,208,498 | $2,208,498 | |
| CAFETERIA | 722210 | $238,161 | $238,161 | |
| OUTSIDE CATERING | 722320 | $10,276 | $10,276 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,456,935 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,983,090 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $91,948,563 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $10,276 | UnrelatedBusinessRevenueAmt |
| Exclusion | $936,855 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,515 | TotalAmt |
| Program Services | $34,515 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,935 | TotalAmt |
| Program Services | $5,935 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,791,442 | TotalAmt |
| Management And General | $1,791,442 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,278 | TotalAmt |
| Program Services | $47,278 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,374,786 | TotalAmt |
| Program Services | $17,354,609 | ProgramServicesAmt |
| Management And General | $9,020,177 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$1 | TotalAmt |
| Program Services | -$1 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,283,202 | TotalAmt |
| Program Services | $2,818,347 | ProgramServicesAmt |
| Management And General | $1,464,855 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,054,605 | TotalAmt |
| Program Services | $1,351,930 | ProgramServicesAmt |
| Management And General | $702,675 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366,511 | TotalAmt |
| Management And General | $366,511 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,979 | TotalAmt |
| Management And General | $111,979 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,753 | TotalAmt |
| Management And General | $8,753 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,535 | TotalAmt |
| Program Services | $51,018 | ProgramServicesAmt |
| Management And General | $26,517 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,478 | TotalAmt |
| Management And General | $264,478 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,644 | TotalAmt |
| Management And General | $138,644 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $910,855 | TotalAmt |
| Program Services | $518,276 | ProgramServicesAmt |
| Management And General | $392,579 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,160,286 | TotalAmt |
| Program Services | $660,203 | ProgramServicesAmt |
| Management And General | $500,083 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,087 | TotalAmt |
| Program Services | $65,199 | ProgramServicesAmt |
| Management And General | $33,888 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,524 | TotalAmt |
| Program Services | $52,524 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,349,406 | TotalAmt |
| Program Services | $5,349,406 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $528,485 | TotalAmt |
| Program Services | $347,743 | ProgramServicesAmt |
| Management And General | $180,742 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL & PHARMACY SUPP | $11,423,332 | $11,423,332 | |
| BAD DEBT | $10,743,646 | $10,743,646 | |
| PHYSICIAN FEES & SUPPOR | $6,382,655 | $6,382,655 | |
| PURCHASED SERVICES | $3,312,875 | $2,179,872 | $1,133,003 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,510,361 | TotalAmt |
| Program Services | $3,116,679 | ProgramServicesAmt |
| Management And General | $1,393,682 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,033,174 | TotalAmt |
| Program Services | $62,503,166 | ProgramServicesAmt |
| Management And General | $17,530,008 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,330,151 | BOYAmt |
| EOY | $12,283,325 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,832,959 | BOYAmt |
| EOY | $5,757,516 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $600,488 | BOYAmt |
| EOY | $337,299 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,288,659 | BOYAmt |
| EOY | $1,271,891 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $824,878 | BOYAmt |
| EOY | $1,015,948 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $98,856,058 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $55,834,475 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,490,223 | BOYAmt |
| EOY | $43,021,583 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,204,303 | BOYAmt |
| EOY | $2,443,898 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $660,588 | BOYAmt |
| EOY | $2,581,810 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,963,788 | BOYAmt |
| EOY | $26,865,536 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,196,037 | BOYAmt |
| EOY | $95,578,806 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,733,579 | BOYAmt |
| EOY | $8,388,699 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,672,937 | BOYAmt |
| EOY | $974,399 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,406,516 | BOYAmt |
| EOY | $9,363,098 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,273,640 | BOYAmt |
| EOY | $84,729,719 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,515,881 | BOYAmt |
| EOY | $1,485,989 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,789,521 | BOYAmt |
| EOY | $86,215,708 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $89,196,037 | BOYAmt |
| EOY | $95,578,806 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $12,949,916 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $2,788 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$4,526,517 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $195,052 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $6,615 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $201,667 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $197,250 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$2,198 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $195,052 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $165,761 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $31,489 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $197,250 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $164,185 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,576 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $165,761 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $163,583 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $602 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $164,185 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.17700 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.82300 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $150,000 | OtherCostOrOtherBasisAmt |
| Book Value | $150,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,868,292 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,744,600 | DepreciationAmt |
| Book Value | $11,123,692 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $349,097 | OtherCostOrOtherBasisAmt |
| Depreciation | $348,068 | DepreciationAmt |
| Book Value | $1,029 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $71,141,192 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,412,242 | DepreciationAmt |
| Book Value | $28,728,950 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,347,477 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,329,565 | DepreciationAmt |
| Book Value | $3,017,912 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $43,021,583 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INVESTMENTS IN AFFILIATES | $500,771 |
| DUE FROM AFFILIATES | $24,474,414 |
| SETTLEMENTS DUE FROM THIRD PARTY | $1,890,351 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $26,865,536 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | ENDOWMENT FUNDS ARE HELD BY CULPEPER REGIONAL HEALTH SYSTEM FOUNDATION, A PART OF CULPEPER REGIONAL HEALTH SYSTEM, FOR THE FURTHERANCE OF THE MISSION OF CULPEPER MEMORIAL HOSPITAL. |
| PART X, LINE 2: | MANAGEMENT HAS RECEIVED A TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE INDICATING THAT THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS AN ORGANIZATION OTHER THAN A PRIVATE FOUNDATION. FEDERAL TAX LAW REQUIRES THAT THE HOSPITAL BE OPERATED IN A MANNER CONSISTENT WITH ITS EXEMPTION APPLICATION IN ORDER TO MAINTAIN ITS EXEMPT STATUS. MANAGEMENT HAS ANALYZED THE OPERATIONS OF THE HOSPITAL AND CONCLUDED THAT IT REMAINS IN COMPLIANCE WITH THE REQUIREMENTS FOR EXEMPTION. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES UNDER APPLICABLE STATE STATUTES. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2014. FISCAL YEARS ENDING ON OR AFTER 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,186,906 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,186,906 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04600 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,069,227 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,008,694 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$1,939,467 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,256,133 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,008,694 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,247,439 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04600 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $521,009 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $521,009 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00750 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,623,973 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,623,973 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02340 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,144,982 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,144,982 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03090 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,401,115 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,008,694 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,392,421 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07690 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,330,530 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $476,211 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $24,624,310 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $31,907,957 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$7,283,647 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 2 CULPEPER SURG CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | OUTPATIENT SURGICAL SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.55110 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.44890 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
US Address USAddress
| 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) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | CULPEPERHEALTH.ORG/ABOUT-US/COMMUNITY-HEA | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (1) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted On Website | Yes (X) | PostedOnWebsiteInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CULPEPER REGIONAL HOSPITAL | PART V, SECTION B, LINE 3: THREE FOCUS GROUPS WERE HELD WITH 32 LOCAL KEY INFORMANTS, INCLUDING PHYSICIANS, REPRESENTATIVES FROM PUBLIC HEALTH, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY LEADERS. ORGANIZATIONS REPRESENTED INCLUDED CULPEPER HEAD START, TOWN OF CULPEPER POLICE DEPARTMENT, PIEDMONT UNITED WAY, CULPEPER PUBLIC SCHOOLS, MADISON FREE CLINIC, AND BOYS AND GIRLS CLUB IN ADDITIONAL TO SEVERAL OTHERS. SEVERAL OF THESE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. |
| CULPEPER REGIONAL HOSPITAL | PART V, SECTION B, LINE 5D: HTTP://WWW.CULPEPERHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| CULPEPER REGIONAL HOSPITAL | PART V, SECTION B, LINE 14G: THE POLICY IS GIVEN TO ALL SELF-PAY PATIENTS. |
| CULPEPER REGIONAL HOSPITAL | PART V, SECTION B, LINE 20D: CULPEPER MEMORIAL HOSPITAL OFFERS AN AUTOMATIC 20% DISCOUNT TO ALL FAP-ELIGIBLE INDIVIDUALS PRIOR TO ANY PAYMENT ARRANGEMENTS AND/OR FINANCIAL ASSISTANCE THEY MAY BE QUALIFIED TO RECEIVE. UNINSURED PATIENTS ALSO QUALIFY FOR AN ADDITIONAL 15% DISCOUNT ON TOP OF THAT UPON TIMELY PAYMENT. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER SURGERY CENTER | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 541 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | SURGERY CENTER | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COSTING METHODOLOGY USED TO CALCULATE AMOUNTS REPORTED IN LINE 7 WAS A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| PART I, LINE 7G: | IT IS PART OF CULPEPER REGIONAL HOSPITAL'S MISSION TO ENSURE AVAILABILITY OF HEALTH CARE SERVICES TO PATIENTS IN THE COMMUNITY, 24 HOURS A DAY, 7 DAYS A WEEK, REGARDLESS OF THE PATIENTS ABILITY TO PAY. CULPEPER REGIONAL HOSPITAL IS A SMALL COMMUNITY HOSPITAL LOCATED IN A RURAL AREA THAT HAS DIFFICULTY ATTRACTING AND RETAINING PHYSICIANS. IN ORDER TO ENSURE 24/7 COVERAGE OF INPATIENT INTERNAL MEDICAL SERVICES, EMERGENCY SERVICES, AND MULTI-SPECIALTY SERVICES WITHIN THE COMMUNITY (EACH OF WHICH IS AN IDENTIFIED COMMUNITY NEED), CULPEPER REGIONAL HOSPITAL PROVIDES PHYSICIAN SUBSIDIES TO ATTRACT AND KEEP PHYSICIANS IN THE COMMUNITY. IF CULPEPER REGIONAL HOSPITAL DID NOT PROVIDE THESE SUBSIDIZED HEALTH SERVICES, COMMUNITY MEMBERS WOULD OFTEN BE FORCED TO LEAVE THE COMMUNITY TO RECEIVE CARE. THESE SUBSIDIZED HEALTH SERVICES COSTS HAVE NOT BEEN INCLUDED IN THE SHORTFALLS LISTED FOR MEDICAID OR MEDICARE, OR AS ANOTHER COMMUNITY BENEFIT OR COMMUNITY BUILDING ACTIVITY REPORTED IN PART I, LINE 7 OR PART II. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 10,743,646. |
| PART III, LINE 2: | THE COSTING METHODOLOGY USED TO CALCULATE AMOUNTS REPORTED IN LINE 2 WAS A COST-TO-CHARGES RATIO DERIVED FROM THE RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS MULTIPLIED AGAINST THE HOSPITAL'S BAD DEBT EXPENSE. |
| PART III, LINE 3: | IN ORDER TO ESTIMATE THE HOSPITAL'S BAD DEBT EXPENSE, AT COST, ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S CHARITY CARE POLICY, THE HOSPITAL USED THE FOLLOWING METHODOLOGY. FIRST, FOR EACH ACCOUNT ATTRIBUTABLE TO A SELF PAY PATIENT THAT HAD A BALANCE OVER $5,000, THE HOSPITAL USES A SOFTWARE PROGRAM THAT PULLS INFORMATION FROM VARIOUS SOURCES TO PREDICT WHETHER THE PATIENT THAT HAD RECEIVED THE CARE LIKELY WOULD QUALIFY UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. IF THE SOFTWARE PROGRAM IDENTIFIED A PATIENT AS LIKELY QUALIFYING FOR THE FINANCIAL ASSISTANCE, THE HOSPITAL PRESUMES THE PATIENT'S ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY AND WRITES OFF THE AMOUNT TO CHARITY. THEN, THE HOSPITAL EXAMINES THE OUTSTANDING SELF PAY ACCOUNTS THAT HAVE A BALANCE OF LESS THAN $5,000. THE HOSPITAL DOES NOT USE THE AFOREMENTIONED SOFTWARE PROGRAM TO DETERMINE WHETHER THE PATIENTS INCURRING THESE ACCOUNTS ARE LIKELY TO QUALIFY FOR FINANCIAL ASSISTANCE. AS A RESULT, THESE ACCOUNTS ARE INCLUDED IN THE HOSPITAL'S BAD DEBT EXPENSE, IF THEY ARE NOT PAID UPON. FINALLY, THE HOSPITAL APPLIES THE PERCENTAGE OF SELF-PAY ACCOUNTS WITH A BALANCE IN EXCESS OF $5,000 THAT ARE PRESUMED TO QUALIFY FOR FINANCIAL ASSISTANCE (APPROXIMATELY 20%) TO THE BAD DEBT EXPENSE ATTRIBUTABLE TO THE SELF-PAY ACCOUNTS UNDER $5,000 TO ESTIMATE THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY IF SUFFICIENT INFORMATION HAD BEEN MADE AVAILABLE TO MAKE A DETERMINATION OF ELIGIBILITY. THIS BAD DEBT EXPENSE WAS THEN MULTIPLIED BY THE COST-TO-CHARGE RATIO TO DETERMINE THE BAD DEBT EXPENSE AT COST ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.THE HOSPITAL'S BAD DEBT EXPENSE, AT COST, ATTRIBUTABLE TO PATIENTS THAT LIKELY QUALIFY FOR FINANCIAL ASSISTANCE SHOULD BE CONSIDERED A COMMUNITY BENEFIT PROVIDED BY THE HOSPITAL. ALTHOUGH THE HOSPITAL HAS MADE A STRONG EFFORT TO PROVIDE PRESUMPTIVE CHARITY CARE TO SELF-PAY PATIENTS, IT IS NOT FEASIBLE FOR THE HOSPITAL TO MAKE A CHARITY CARE DETERMINATION WITH RESPECT TO ALL OF THE PATIENTS THAT DO NOT COMPLETE THE FINANCIAL APPLICATION PROCESS, PARTICULARLY WITH RESPECT TO SMALL BALANCES. SINCE THESE PATIENTS WOULD HAVE QUALIFIED UNDER THE FINANCIAL ASSISTANCE POLICY IF THEY WOULD HAVE COMPLETED THE APPLICATION, THE BAD DEBT EXPENSE ASSOCIATED WITH TREATING THEM SHOULD STILL BE TREATED AS A COMMUNITY BENEFIT. THE LACK OF COMPLETION OF THE FINANCIAL ASSISTANCE POLICY SHOULD NOT ALTER THE CHARACTER OF THE COST. |
| PART III, LINE 4: | THE HOSPITAL RECORDS ITS PROVISION FOR BAS DEBTS ASSOCIATED WITH PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS). ACCORDINGLY, THE PROVISION FOR BAD DEBTS IS INCLUDED AS A COMPONENT OF NET PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. |
| PART III, LINE 8: | THE COSTING METHOLODOGY USED TO DETERMINE THE MEDICARE SHORTFALL REPORTED ON LINE 7 WAS CALCULATED USING THE COST-TO-CHARGE RATIO FROM THE MEDICARE COST REPORT AND THEREFORE ONLY INCLUDE ALLOWABLE COSTS AS DEFINED BY MEDICARE.THE ORGANIZATION'S SHORTFALL, AS REPORTED IN SCHEDULE H, PART III, SECTION B, 7, SHOULD BE CONSIDERED A COMMUNITY BENEFIT. ALTHOUGH PROVIDING THE BEST POSSIBLE CARE TO OUR MEDICARE PATIENTS CREATES A FINANCIAL LOSS, PART OF THE MISSION OF OUR ORGANIZATION IS TO SERVE ELDERLY PATIENTS WITHIN THE COMMUNITY, AND WE BELIEVE PROVIDING SUCH CARE HAS CONTRIBUTED TO THE IMPROVEMENT OF COMMUNITY HEALTH. FURTHERMORE, BY PROVIDING THE BEST POSSIBLE CARE TO OUR MEDICARE PATIENTS, WE RELIEVE THE GOVERNMENT AND OTHER SURROUNDING HOSPITALS OF THE FINANCIAL BURDEN OF TREATING THESE PATIENTS INSURED BY THE PROGRAM NOW. |
| PART III, LINE 9B: | CULPEPER REGIONAL HOSPITAL MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES (INCLUDING ACTIONS THE HOSPITAL MAY TAKE IN THE EVENT OF NON-PAYMENT, INCLUDING COLLECTIONS ACTIONS AND REPORTING TO CREDIT AGENCIES) THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM CULPEPER REGIONAL HOSPITAL, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH CULPEPER REGIONAL HOSPITAL. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, CULPEPER REGIONAL HOSPITAL MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. CULPEPER REGIONAL HOSPITAL WILL NOT IMPOSE EXTTRAORDINARY COLLECTIONS ACTIONS WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT IS ELIGIBLE FOR CHARITY CARE UNDER THIS FINANCIAL ASSISTANCE POLICY. REASONABLE EFFORTS SHALL INCLUDE VALIDATING THAT THE PATIENT OWES THE UNPAID BILLS AND THAT ALL SOURCES OF THIRD-PARTY PAYMENTS HAVE BEEN IDENTIFIED AND BILLED BY THE HOSPITAL,DOCUMENTATION THAT CULPEPER REGIONAL HOSPITAL HAS OR HAS ATTEMPTED TO OFFER THE PATIENT THE OPPORTUNITY TO APPLY FOR CHARITY CAR PURSUANT TO THIS POLICY AND THAT THE PATIENT HAS NOT COMPLIED WITH THE HOSPITAL'S APPLICATION REQUIREMENTS AND DOCUMENTATION THAT THE PATIENT HAS BEEN OFFERED A PAYMENT PLAN BUT HAS NOT HONORED THE TERMS OF THAT PLAN. |
| PART VI, LINE 2: | IN AUGUST 2014, CULPEPER REGIONAL HOSPITAL (CRH) CONTRACTED WITH PROFESSIONAL RESEARCH CONSULTANTS, INC. TO CONDUCT A COMMUNITY NEEDS ASSESSMENT (CHNA) FOR ITS PRIMARY AND SECONDARY SERVICE AREAS, WHICH INCLUDE CULPEPER, MADISON AND ORANGE COUNTIES. IN AN EFFORT TO GENERATE COMMUNITY INPUT AND GAIN A COMPREHENSIVE UNDERSTANDING OF OUR HEALTH NEEDS AND SERVICE GAPS, WE SURVEYED 400 ADULTS AND ASKED FOR INPUT FROM APPROXIMATELY 100 KEY STAKEHOLDERS. AFTER COMPLETION OF THE NEEDS ASSESSMENT, IN NOVEMBER 2014, CRH INVITED THE KEY STAKEHOLDERS AND OTHER COMMUNITY MEMBERS TO A PUBLIC FORUM TO SHARE FINDINGS FROM THE REPORT AND ENGAGE STAKEHOLDERS IN VALUABLE DIALOGUE AROUND IDENTIFIED HEALTH CONCERNS. IDEAS WERE DISCUSSED AND SYNTHESIZED TO PRODUCE A COMMUNITY-BASED PRIORITY LIST.THE CHNA IDENTIFIED THE FOLLOWING 12 KEY AREAS OF FOCUS: MENTAL HEALTH & DISORDERS, ACCESS TO HEALTHCARE SERVICES, DIABETES, CANCER, HEART DISEASE & STROKE, NUTRITION, PHYSICAL ACTIVITY, & WEIGHT, ORAL HEALTH, RESPIRATORY DISEASES, IMMUNIZATION & INFECTIOUS DISEASES, CHRONIC KIDNEY DISEASE, ARTHRITIS, OSTEOPOROSIS & CHRONIC BACK CONDITIONS, AND INJURY & VIOLENCE. CULPEPER HOSPITAL HAS SELECTED ACCESS TO HEALTHCARE SERVICES, CANCER, HEART DISEASE & STROKE, AND DIABETES AS PRIORITIES TO ADDRESS. THEY WILL WORK COLLABORATIVELY WITH COMMUNITY PARTNERS TO ADDRESS ORAL HEALTH AND MENTAL HEALTH.CRH'S IMPLEMENTATION STRATEGY FOR THE ABOVE INCLUDES:CULPEPER HOSPITAL IS PARTNERING WITH UVA HEALTH SYSTEM TO BRING ORTHOPEDICS, CARDIOLOGISTS AND OB/GYN PRACTITIONERS TO THE COMMUNITY. IN ADDITION, THE PRIMARY AND SPECIALTY CARE CLINICS ARE ACTIVELY RECRUITING MORE PROVIDERS AND IS BEGINNING TO OFFER EVENING AND WEEKEND HOURS. UVA CULPEPER HOSPITAL PROVIDES A PHYSICIAN REFERRAL SYSTEM THROUGH OUR WEBSITE. ADDITIONALLY, IN JUNE 2015, WE REDESIGNED OUR WEBSITE TO MAKE IT EASIER TO SEARCH FOR INFORMATION AND EDUCATIONAL RESOURCES. FURTHERMORE, CULPEPER HOSPITAL IS FORMING A SPEAKERS' BUREAU TO PROVIDE EDUCATION ABOUT LEADING HEALTHCARE NEEDS. CULPEPER HOSPITAL PURCHASED UVA HOPE CANCER CARE CULPEPER. WITH THIS ACQUISITION, THE HOSPITAL DOUBLED ITS INFUSION SPACE AND ADDED A DEDICATED PHARMACY, PHARMACIST AND LAB IN THE CLINIC. THIS POSITIONS THE HOSPITAL TO CONTINUE TO GROW THE EXISTING CANCER SERVICES WITH BOTH MEDICAL ONCOLOGY AND RADIATION SERVICES. IN ADDITION, CULPEPER HOSPITAL SPONSORED AND PLANS PAMPER ME PINK, AN ANNUAL BREAST CANCER AWARENESS AND EDUCATION EVENT FOR MORE THAN 600 WOMEN, WITH SPEAKERS, EXHIBITORS AND PATIENT TESTIMONIALS. THE MONEY RAISED FROM THIS PROGRAM FUNDS MAMMOGRAMS AND FOLLOW-UP TESTING FOR WOMEN WHO DON'T HAVE THE MEANS TO PAY FOR A MAMMOGRAM. THE HOSPITAL CREATED EDUCATIONAL BROCHURES ON DIGITAL MAMMOGRAPHY, BREAST ULTRASOUND FOR DENSE BREASTS, BREAST SELF EXAMS, STEREOTACTIC BREAST BIOPSIES, SRT FACT SHEET, SRT PHYSICIAN RESOURCE SHEET, LYMPHEDEMA AND GENERAL SERVICES GUIDE. WE HAVE PRODUCED PAMPER ME PINK BROCHURES, FLYERS, POSTERS, FACT SHEETS, APPLICATIONS (IN SPANISH AND ENGLISH) AND SAVE-THE-DATE CARDS. THE HOSPITAL HOSTS A CANCER SUPPORT GROUP AND HAS PRODUCED AN INFORMATIONAL RACK CARD AND FLYER AND POSTS THE INFORMATION PROMINENTLY ON THE WEBSITE. THE HOSPITAL ALSO SPONSORS COMMUNITY EVENTS FOCUSED ON CANCER RESEARCH AND EDUCATION, INCLUDING THE RELAY FOR LIFE SURVIVOR'S DINNER AND THE RELAY FOR LIFE ANNUAL EVENT.CULPEPER HOSPITAL IS WORKING WITH UVA HEALTH SYSTEM TO BRING TWO ADDITIONAL CARDIOLOGISTS TO CULPEPER HOSPITAL IN 2016. TO PROMOTE HEART HEALTH, CULPEPER HOSPITAL SPONSORS HEART MONTH ACTIVITIES, INCLUDING A NATIONAL "WEAR RED DAY" EVENT FOR EMPLOYEES, HEART HEALTHY MEALS EVERY FRIDAY IN FEBRUARY AND THE SPONSORSHIP OF THE AMERICAN HEART ASSOCIATION HEART BALL. CULPEPER HOSPITAL HAS A DIABETES EDUCATOR, A SELF-MANAGEMENT PROGRAM AND A PARTNERSHIP WITH POWELL WELLNESS CENTER TO PROVIDE DIABETES MANAGEMENT THROUGH EDUCATION AND EXERCISE. INFORMATION ON DIABETES IS AVAILABLE ON OUR WEBSITE, THROUGH OUR ON-HOLD MESSAGING AND THROUGH A BROCHURE ABOUT THE PROGRAM. CULPEPER HOSPITAL AND THE PIEDMONT REGIONAL DENTAL CLINIC ARE DISCUSSING WAYS IN WHICH THE HOSPITAL CAN HELP PROVIDE ASSISTANCE WITH SPACE OR RENT. CULPEPER HOSPITAL IS PARTNERING WITH THE CRISIS INTERVENTION TEAM WITH THE RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES BOARD. THIS BOARD SERVICES CULPEPER, FAUQUIER, MADISON, ORANGE AND RAPPAHANNOCK COUNTIES AND PROVIDES TRAINING ON THE RECOGNITION AND PROPER HANDLING OF MENTAL HEALTH RELATED ISSUES. THE PROGRAM IS COMPRISED OF LOCAL STAKEHOLDERS INCLUDING LAW ENFORCEMENT, EMERGENCY DISPATCHERS, MENTAL HEALTH TREATMENT PROVIDERS, HOSPITALS, ETC.CULPEPER HOSPITAL PUBLISHES A BI-MONTHLY EMPLOYEE NEWSLETTER, WHICH PATIENTS CAN ACCESS THROUGH OUR WEBSITE. THE NEWSLETTER OFTEN COVERS TOPICS RELATING TO A WIDE RANGE OF PUBLIC HEALTH ISSUES. OUR ON-HOLD MESSAGING, PHYSICIAN REFERRAL SERVICES AND OUR REDESIGNED WEBSITE ALL PROVIDE ADDITIONAL EDUCATIONAL INFORMATION ON A VARIETY OF HEALTH RELATED TOPICS. |
| PART VI, LINE 3: | CULPEPER REGIONAL HOSPITAL HAS SEVERAL WAYS THAT IT INFORMS AND EDUCATES PATIENTS WHO MAY BE IN NEED AND ARE ELIGIBLE FOR ASSISSTANCE. WHEN STAFF (CASHIER, FINANCIAL COUNSELOR, AND REGISTERS) ARE SPEAKING WITH A PATIENT THAT STATES THEY ARE NOT ABLE TO PAY, THE PATIENT IS ENCOURAGED TO APPLY FOR FINANCIAL ASSISTANCE. BROCHURES DESCRIBING THE FINANCIAL ASSISTANCE POLICY ARE PLACED IN OUR BILLING STATEMENTS, AS WELL AS THE APPLICABLE POVERTY GUIDELINES FOR QUALIFYING FOR FINANCIAL ASSISTANCE. IN ADDITION, FINANCIAL ASSISTANCE APPLICATIONS, AS WELL AS FAQS WITH RESPECT TO THE FINANCIAL ASSISTANCE POLICY, ARE HANDED OUT TO PATIENTS UPON REGISTRATION. THE HOSPITAL'S WEBSITE POSTS THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND GUIDELINES FOR APPLYING. |
| PART VI, LINE 4: | CULPEPER REGIONAL HOSPITAL CURRENTLY DEFINES ITS PRIMARY AND SECONDARY SERVICE AREAS AS FOLLOWS: THE PRIMARY SERVICE AREA INCLUDES CULPEPER COUNTY, AND THE SECONDARY SERVICE AREA INCLUDES MADISON AND ORANGE COUNTIES, PLUS THE ZIP CODES OF 22923 (BARBOURSVILLE) AND 22942 (GORDONSVILLE). PROJECTED POPULATION FOR 2018 IS 110,349. THE AVERAGE HOUSEHOLD INCOME FOR THIS AREA IS $73,581. POPULATION DISTRIBUTION BY AGE IS AS FOLLOWS: 0-17 YEARS 24.1%, 18-64 YEARS 60.8%, 65 YEARS AND OLDER 15.1%. RACE/ETHNICITY DISTRIBUTION IS AS FOLLOWS: WHITE 80.3%, BLACK 13.8%, WITH 5.7% RESPONDING AS HISPANIC OR LATINO. AN ESTIMATED 16.5% OF THE POPULATION AGE 25 AND OLDER DO NOT HAVE A HIGH SCHOOL EDUCATION. |
| PART VI, LINE 5: | CULPEPER REGIONAL HOSPITAL PROMOTES THE HEALTH OF ITS COMMUNITY IN SEVERAL WAYS. FIRST, THE HOSPITAL PROVIDES MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS FOR ITS DEPARTMENTS. ADDITIONALLY, ALL FINANCIAL SURPLUSES GENERATED BY THE HOSPITAL ARE USED EXCLUSIVELY TO IMPROVE PATIENT CARE SERVICES AND TO FURTHER THE CHARITABLE PURPOSES OF ORGANIZATION. |
| PART VI, LINE 6: | CULPEPER REGIONAL HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM THAT PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO ITS COMMUNITY. THE HOSPITAL IS AFFILIATED WITH CULPEPER REGIONAL HEALTH SYSTEM, A RELATED TAX-EXEMPT ORGANIZATION THAT HOLDS A 51% INTEREST IN THE HOSPITAL. ADDITIONALLY, THE UNIVERSITY OF VIRGINIA (A STATE ORGANIZATION) HOLDS A 49% INTEREST IN THE HOSPITAL ON BEHALF OF ITS MEDICAL CENTER.THE HOSPITAL IS AN ACUTE CARE HOSPITAL, WHICH IS A SOLE COMMUNITY PROVIDER. THE HOSPITAL PROVIDES ESSENTIAL HEALTH CARE SERVICES TO THE COMMUNITY, INCLUDING EMERGENCY SERVICES, WHICH WOULD NOT OTHERWISE BE PROVIDED DUE TO THEIR UNPROFITABLE NATURE. OTHERWISE, THESE HEALTH CARE SERVICES WOULD NEED TO BE PROVIDED BY ANOTHER TAX-EXEMPT ORGANIZATION OR DIRECTLY BY THE GOVERNMENT. IN ADDITION, CULPEPER REGIONAL HEALTH SYSTEM UNDERTAKES A NUMBER OF ACTIVITIES THAT BENEFIT THE COMMUNITY. FOR INSTANCE, CULPEPER REGIONAL HEALTH SYSTEM RUNS A FREE 12-WEEK PROGRAM DESIGNED TO HELP MEMBERS OF THE COMMUNITY LIVE A HEALTHIER LIFESTYLE, NAMED DROP IT! THE HEALTHY LIVING AND WEIGHT LOSS CHALLENGE. THE PROGRAM INCLUDES A HEALTH FAIR WITH HEALTH SCREENINGS, INTERACTIVE FITNESS DEMONSTRATIONS, NUTRITIONAL INFORMATION AND OTHERHEALTH AND WELLNESS BOOTHS. THE PROGRAM ALSO INCLUDES GROUP EXERCISE CLASSES, HELD EACH MONDAY DURING THE 12 WEEKS. FOR EACH POUND A PARTICIPANT LOSES DURING THE PROGRAM, A DESIGNATED AMOUNT IS DONATED TO BENEFIT ALLIED AND NURSING HEALTH PROGRAMS IN THE REGION. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HEALTH SYSTEM | BusinessNameLine1 |
US Address USAddress
| 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) |
|---|---|---|
| Recipient EIN | 521366700 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $34,515 | CashGrantAmt |
| Purpose Of Grant | ASSISTANCE FOR FREE CLINIC NURSING STAFF | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS FOR STUDIES IN THE MEDICAL FIELD | GrantTypeTxt |
| Recipient | 3 | RecipientCnt |
| Cash Grant | $5,935 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | CRHS SCHOLARSHIPS: 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. CULPEPER MEMORIAL HOSPITAL PROVIDES ASSISTANCE SPECIFICALLY FOR FREE CLINIC NURSING STAFF. THIS FUNDING IS PAID DIRECTLY BY THE HOSPITAL. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C GREG NAPPS | ||||||||||||||
| CEO | $179,827 | $0 | $39,478 | $0 | $0 | $0 | $4,968 | $0 | $20,579 | $0 | $244,852 | $0 | $0 | $0 |
| H LEE KIRK JR | ||||||||||||||
| PRESIDENT | $388,298 | $0 | $59,700 | $0 | $3,739 | $0 | $8,151 | $0 | $21,254 | $0 | $481,142 | $0 | $0 | $0 |
| SAM MORGAN | ||||||||||||||
| SENIOR VICE PRESIDENT CFO | $130,305 | $0 | $25,999 | $0 | $0 | $0 | $2,555 | $0 | $1,416 | $0 | $160,275 | $0 | $0 | $0 |
| JANICE SUTER | ||||||||||||||
| VP NURSING | $139,449 | $0 | $29,984 | $0 | $0 | $0 | $3,774 | $0 | $9,143 | $0 | $182,350 | $0 | $0 | $0 |
| DENNIS SMITH | ||||||||||||||
| DIRECTOR OF PHARMACY | $147,356 | $0 | $0 | $0 | $0 | $0 | $2,915 | $0 | $18,565 | $0 | $168,836 | $0 | $0 | $0 |
| MORTON CHILES MD | ||||||||||||||
| VP MEDICAL STAFF SERVICES | $154,673 | $0 | $36,036 | $0 | $0 | $0 | $4,075 | $0 | $14,796 | $0 | $209,580 | $0 | $0 | $0 |
| DEBRA O'CONNELL | ||||||||||||||
| PHO DIRECTOR | $146,314 | $0 | $14,838 | $0 | $0 | $0 | $3,923 | $0 | $15,322 | $0 | $180,397 | $0 | $0 | $0 |
| SUSAN EDWARDS | ||||||||||||||
| HUMAN RESOURCES DIRECTOR | $111,182 | $0 | $28,444 | $0 | $0 | $0 | $3,167 | $0 | $21,217 | $0 | $164,010 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | THE ORGANIZATION PROVIDES HEALTH/SOCIAL CLUB DUES AS A BENEFIT FOR THE PRESIDENT/CEO. THE VALUE OF THIS BENEFIT IS INCLUDED ON THE CEO'S FORM W-2 AS WAGE INCOME. THIS BENEFIT STOPPED EFFECTIVE OCTOBER 2013. |
| PART I, LINE 4A | SAM MORGAN, SENIOR VICE PRESIDENT & CFO, RECEIVED SEVERANCE PAY IN THE AMOUNT OF $44,243 FROM MAY TO SEPTEMBER 2014. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDUSTRIAL DEVELOP AUTHORITY OF TOWN CULPEPER VA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 541312068 | BondIssuerEIN |
| CUSIP | 000000000 | CUSIPNum |
| Bond Issued | 2003-12-23 | BondIssuedDt |
| Issue Price | $8,262,873 | IssuePriceAmt |
| Purpose | HEALTH FACILITIES REV BOND 03 | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $7,288,474 | RetiredAmt |
| Total Proceeds | $8,302,651 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $125,000 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $2,914,778 | CapitalExpendituresAmt |
| Other Spent Proceeds | $5,262,573 | OtherSpentProceedsAmt |
| Substantial Completion | 2004 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THOMAS REYNOLDS MD | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $47,278 | TransactionAmt |
| Transaction | DR. REYNOLDS' WIFE CHARLA REYNOLDS IS EMPLOYED BY THE HOSPITAL AS A SPEECH THERAPY COORDINATOR. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION HAS TWO MEMBERS, NAMELY CULPEPER REGIONAL HEALTH SYSTEM, AND THE RECTOR AND VISITORS OF THE UNIVERSITY OF VIRGINIA ON BEHALF OF ITS MEDICAL CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATION HAS TWO MEMBERS WITH VOTING RIGHTS SOLELY TO ELECT AND REMOVE TRUSTEES PROVIDED FOR IN THE ARTICLES BUT SHALL NOT HAVE VOTING RIGHTS FOR ANY OTHER PURPOSE. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE REVIEW OF THE 990 IS PERFORMED BY THE CHIEF FINANICAL OFFICER AND CONTROLLER, THE FINANCE COMMITTEE AND THEN BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. THE CEO BEING THE ONE RESPONSIBLE FOR SIGNING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | AT THE BEGINNING OF EACH MEETING OF THE BOARD BEGINS WITH VOLUNTARY VERBAL SELF-DISCLOSURE OF ANY CONFLICTS WITH ANY ITEMS ON THE AGENDA. AS ADDITONAL ISSUES ARISE DURING THE COURSE OF THE MEETING, A SIMILAR SELF-DISCLOSURE IS EXPECTED TO BE MADE. CHALLENGES BY PARTICIPANTS ARE ENCOURAGED IF SELF-DISCLOSURES ARE NOT FORTH-COMING. DURING THE COURSE OF DOING BUSINESS, IF CONFLICTS ARE SUSPECTED BY ANYONE, THEY ARE ENCOURAGED TO NOTIFY THE CEO OF THEIR SUSPICIONS. THE CEO WILL INVESTIGATE, EMPLOYING LEGAL COUNSEL AS NECESSARY, AND WILL RESOLVE AS APPROPRIATE. ULTIMATELY IT IS THE RESPONSIBILTY OF THE CEO AND THE CHAIRMAN OF THE BOARD TO ENFORCE THE POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | CEO, VP'S AND CORPORATE COMPLIANCE OFFICERS & QUALITY AND SAFETY OFFICERS ARE INCLUDED IN THE REVIEW. SULLIVAN COTTER IS USED FOR OUTSIDE OBJECTIVE REVIEW OF EXECUTIVE COMPENSATION. THE PRACTICE HAS BEEN TO UPDATE MARKET DATA EVERY TWO YEARS. THIS INFORMATION IS PROVIDED TO THE CRH EXECUTIVE/COMPENSATION COMMITTEE, WITH A SENSITIVITY TO HAVING APPROPRIATE COMPOSITION OF INDEPENDENT TRUSTEES. CHANGES IN COMPENSATION ARE THEN REPORTED TO THE FULL CRH BOARD |
| 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 IX, LINE 24E | EQUIPMENT RENTAL : PROGRAM SERVICE EXPENSES 769,336. MANAGEMENT AND GENERAL EXPENSES 582,749. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,352,085. OTHER : PROGRAM SERVICE EXPENSES 380,217. MANAGEMENT AND GENERAL EXPENSES 288,003. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 668,220. FOOD: PROGRAM SERVICE EXPENSES 290,362. MANAGEMENT AND GENERAL EXPENSES 150,918. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 441,280. REFERENCE LAB : PROGRAM SERVICE EXPENSES 384,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 384,660. MARKETING : PROGRAM SERVICE EXPENSES 365,682. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 365,682. TELEPHONE : PROGRAM SERVICE EXPENSES 159,237. MANAGEMENT AND GENERAL EXPENSES 120,617. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 279,854. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 176,766. MANAGEMENT AND GENERAL EXPENSES 91,876. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 268,642. MINOR EQUIPMENT: PROGRAM SERVICE EXPENSES 102,114. MANAGEMENT AND GENERAL EXPENSES 77,349. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 179,463. MAINTENANCE CONTRACTS : PROGRAM SERVICE EXPENSES 171,246. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 171,246. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 74,925. MANAGEMENT AND GENERAL EXPENSES 56,754. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,679. COLLECTIONS : PROGRAM SERVICE EXPENSES 113,241. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 113,241. GROUNDS MAINTENANCE: PROGRAM SERVICE EXPENSES 27,903. MANAGEMENT AND GENERAL EXPENSES 21,136. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,039. LINENS & UNIFORMS : PROGRAM SERVICE EXPENSES 44,357. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,357. INSPECTION : PROGRAM SERVICE EXPENSES 32,627. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,627. LICENSING : PROGRAM SERVICE EXPENSES 24,006. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,006. RECOGNITION AWARD : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,280. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,280. |
| FORM 990, PART XI, LINE 9: | BOOK-TAX ADJUSTMENT TO PASSTHROUGH INCOME 503,375. RECLASS OF INTEREST IN NET ASSETS OF FOUNDATION -29,892. DISTRIBUTIONS -5,000,000. |
| FORM 990, PART XI, LINE 2C | THE PROCESS OF FINANCIAL STATEMENT REVIEW AND OVERSIGHT HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CULPEPER REGIONAL HEALTH SYSTEM | |||||||||||
| 501 SUNSET LANE | CULPEPER | VA | 22701 | 541366700 | MGMT | VA | 501(C)(3) | LINE 11A, I | N/A | 0 | |
| UVA PHYSICIANS GROUP | |||||||||||
| 500 RAY C HUNT DR | CHARLOTTESVILLE | VA | 22903 | 541124769 | PHYSICIANS SUPPORT | VA | 501(C)(3) | LINE 9 | Yes (1) | UVASTATE OF VA | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CULPEPER SURGERY CENTER LLC | ||||||||||||
| 541 SUNSET LANE | CULPEPER | VA | 22701 | HEALTHCARE | VA | CULPEPER HOSPITAL | RELATED | $2,345,910 | $1,486,442 | 0 | 0 | 0.55110 |
| CULPEPER MEDICAL ASSOCIATES | ||||||||||||
| 100 SAUNDERS STREET | CULPEPER | VA | 22701 | MEDICAL SERVICES | VA | CULPEPER HOSPITAL | RELATED | $19,542 | $80,899 | 0 | 0 | 0.51000 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER PHYSICIAN HOSPITAL ORGANIZATION | BusinessNameLine1 |
US Address USAddress
| 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 Activities | MEMBERSHIP ORGANIZATION | PrimaryActivitiesTxt |
| Legal Domicile State | VA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $400,820 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $210,022 | ShareOfEOYAssetsAmt |
| Ownership | 0.63500 | OwnershipPct |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CULPEPER PHYSICIAN HOSPITAL ORGANIZATION | ||
| N | $395,022 | COST |
| CULPEPER REGIONAL HEALTH SYSTEM | ||
| K | $353,440 | COST |
| CULPEPER REGIONAL HEALTH SYSTEM | ||
| R | $5,000,000 | COST |
| CULPEPER REGIONAL HEALTH SYSTEM | ||
| C | $87,396 | COST |