2015-08-17T09:26:12-05:00 2014-09-30 560747981 DIXON HUGHES GOODMAN LLP 111 FRANKLIN RD SE SUITE 501 ROANOKE VA 240112114 990 2013-10-01 540622371 CULPEPER MEMORIAL HOSPITAL INC CULP 5408294100 501 SUNSET LANE CULPEPER VA 22701 C GREG NAPPS CEO 5408298803 2015-08-14 1 PATRICK T MURTAUGH P01230482 5409896144 2015-08-14 2013 2016-03-07 17:11:31Z CULPEPER REGIONAL HOSPITAL C GREG NAPPS 501 SUNSET LANE CULPEPER VA 22701 93036214 0 X WWW.UVACULPEPERHOSPITAL.COM X 1956 VA 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. 14 12 779 250 10276 -8479 278992 87396 78820831 89301975 1868117 1140807 2301389 2452912 83269329 92983090 10615 40450 0 0 37192194 34551312 0 0 0 45520741 45441412 82723550 80033174 545779 12949916 89196037 95578806 11406516 9363098 77789521 86215708 X 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. 0 0 62503166 40450 91948563 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 62503166 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 42 0 1 779 1 1 1 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X C GREG NAPPS 5408298803 501 SUNSET LANE CULPEPER VA 22701 LARRY FITZGERALD TREASURER 2.00 X X 0 0 0 ROBERT GIBSON MD TRUSTEE 2.00 X 0 0 0 SHARON CLARK SECRETARY 2.00 X X 0 0 0 SALLY NAN BARBER TRUSTEE 2.00 X 0 0 0 CHARLES CRIST CHAIR 2.00 X X 0 0 0 RICHARDS SHANNON MD VICE CHAIR 2.00 X X 0 0 0 CLARISSA BERRY TRUSTEE 2.00 X 0 0 0 NEAL DEANE TRUSTEE 2.00 X 0 0 0 CHARLES BARRELL TRUSTEE 2.00 X 0 0 0 KHALID ATHAR TRUSTEE 2.00 X 0 0 0 KAREN HARRIS TRUSTEE 2.00 X 0 0 0 JEFFERY HETMANSKI TRUSTEE 2.00 X 0 0 0 THOMAS REYNOLDS MD TRUSTEE 2.00 X 0 0 0 C GREG NAPPS CEO 40.00 8.00 X X 219305 0 25547 H LEE KIRK JR PRESIDENT 40.00 12.00 X 451737 0 29405 SAM MORGAN SENIOR VICE PRESIDENT CFO 40.00 X 156304 0 3971 JANICE SUTER VP NURSING 40.00 X 169433 0 12917 DENNIS SMITH DIRECTOR OF PHARMACY 40.00 X 147356 0 21480 MORTON CHILES MD VP MEDICAL STAFF SERVICES 40.00 X 190709 0 18871 DEBRA O'CONNELL PHO DIRECTOR 40.00 X 161152 0 19245 SUSAN EDWARDS HUMAN RESOURCES DIRECTOR 40.00 X 139626 0 24384 1635622 0 155820 30 0 1 0 GILBANE BUILDING COMPANY 7 JACKSON WALKWAY PROVIDENCE RI 02903 ARCHITECTURE 5694216 UVA PHYSICIANS GROUP 500 RAY C HUNT DR CHARLOTTESVILLE VA 22903 PHYSICIAN SUPPORT 2660209 WE BOWERS INC 506 SHAW RD STE 327 STERLING VA 20166 ARCHITECTURE 2514907 ANESTHESIA PROFESSIONAL 301 SUNSET LANE CULPEPER VA 22701 PHYSICIAN SUPPORT 1175589 RIDEGELINE PHYSICIAN SERVICES PLC 501 SUNSET LANE CULPEPER VA 22701 PHYSICIAN SUPPORT 1061059 37 87396 87396 PATIENT SERVICES 622310 88840122 88840122 CSC K-1 622310 463785 463785 CMA K-1 622310 -1932 -1932 89301975 936855 936855 6417 10440 -4023 -4023 -4023 198818 47818 0 42684 198818 5134 203952 203952 OTHER REVENUE 622110 2208498 2208498 CAFETERIA 722210 238161 238161 OUTSIDE CATERING 722320 10276 10276 2456935 92983090 91948563 10276 936855 X 34515 34515 5935 5935 1791442 1791442 47278 47278 26374786 17354609 9020177 -1 -1 4283202 2818347 1464855 2054605 1351930 702675 366511 366511 111979 111979 8753 8753 77535 51018 26517 264478 264478 138644 138644 910855 518276 392579 1160286 660203 500083 99087 65199 33888 52524 52524 5349406 5349406 528485 347743 180742 MEDICAL & PHARMACY SUPP 11423332 11423332 BAD DEBT 10743646 10743646 PHYSICIAN FEES & SUPPOR 6382655 6382655 PURCHASED SERVICES 3312875 2179872 1133003 4510361 3116679 1393682 80033174 62503166 17530008 0 4330151 12283325 6832959 5757516 600488 337299 1288659 1271891 824878 1015948 98856058 55834475 38490223 43021583 3204303 2443898 660588 2581810 32963788 26865536 89196037 95578806 9733579 8388699 1672937 974399 11406516 9363098 X 76273640 84729719 1515881 1485989 77789521 86215708 89196037 95578806 X 12949916 2788 -4526517 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 195052 6615 201667 197250 -2198 195052 165761 31489 197250 164185 1576 165761 163583 602 164185 0.17700 0.82300 0 1 1 150000 150000 22868292 11744600 11123692 349097 348068 1029 71141192 42412242 28728950 4347477 1329565 3017912 43021583 INVESTMENTS IN AFFILIATES 500771 DUE FROM AFFILIATES 24474414 SETTLEMENTS DUE FROM THIRD PARTY 1890351 26865536 X 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. 1 1 1 X 1 X 1 0 1 1 3186906 3186906 0.04600 7069227 9008694 -1939467 0.00000 10256133 9008694 1247439 0.04600 521009 521009 0.00750 1623973 1623973 0.02340 2144982 2144982 0.03090 12401115 9008694 3392421 0.07690 1 3330530 476211 24624310 31907957 -7283647 X 1 1 2 CULPEPER SURG CENTER OUTPATIENT SURGICAL SERVICES 0.55110 0.44890 1 1 CULPEPER REGIONAL HOSPITAL 501 SUNSET LANE CULPEPER VA 22701 X X X CULPEPER REGIONAL HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X CULPEPERHEALTH.ORG/ABOUT-US/COMMUNITY-HEA X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X X X 1 0 1 X 0 0 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. 1 CULPEPER SURGERY CENTER 541 SUNSET LANE CULPEPER VA 22701 SURGERY CENTER 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. 0 CULPEPER REGIONAL HEALTH SYSTEM PO BOX 592 CULPEPER VA 22701 521366700 501(C)(3) 34515 ASSISTANCE FOR FREE CLINIC NURSING STAFF 1 0 SCHOLARSHIPS FOR STUDIES IN THE MEDICAL FIELD 3 5935 PART I, LINE 2: 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. X 1 1 X X X 1 0 0 0 0 0 0 0 0 C GREG NAPPS CEO 179827 0 39478 0 0 0 4968 0 20579 0 244852 0 0 0 H LEE KIRK JR PRESIDENT 388298 0 59700 0 3739 0 8151 0 21254 0 481142 0 0 0 SAM MORGAN SENIOR VICE PRESIDENT CFO 130305 0 25999 0 0 0 2555 0 1416 0 160275 0 0 0 JANICE SUTER VP NURSING 139449 0 29984 0 0 0 3774 0 9143 0 182350 0 0 0 DENNIS SMITH DIRECTOR OF PHARMACY 147356 0 0 0 0 0 2915 0 18565 0 168836 0 0 0 MORTON CHILES MD VP MEDICAL STAFF SERVICES 154673 0 36036 0 0 0 4075 0 14796 0 209580 0 0 0 DEBRA O'CONNELL PHO DIRECTOR 146314 0 14838 0 0 0 3923 0 15322 0 180397 0 0 0 SUSAN EDWARDS HUMAN RESOURCES DIRECTOR 111182 0 28444 0 0 0 3167 0 21217 0 164010 0 0 0 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. A INDUSTRIAL DEVELOP AUTHORITY OF TOWN CULPEPER VA 541312068 000000000 2003-12-23 8262873 HEALTH FACILITIES REV BOND 03 0 0 0 A 7288474 8302651 125000 2914778 5262573 2004 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 THOMAS REYNOLDS MD BOARD MEMBER 47278 DR. REYNOLDS' WIFE CHARLA REYNOLDS IS EMPLOYED BY THE HOSPITAL AS A SPEECH THERAPY COORDINATOR. 0 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. 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 UVASTATE OF VA 1 CULPEPER SURGERY CENTER LLC 541 SUNSET LANE CULPEPER VA 22701 HEALTHCARE VA CULPEPER HOSPITAL RELATED 2345910 1486442 0 0 0.55110 CULPEPER MEDICAL ASSOCIATES 100 SAUNDERS STREET CULPEPER VA 22701 MEDICAL SERVICES VA CULPEPER HOSPITAL RELATED 19542 80899 0 0 0.51000 CULPEPER PHYSICIAN HOSPITAL ORGANIZATION PO BOX 592 CULPEPER VA 22701 541703526 MEMBERSHIP ORGANIZATION VA CULPEPER HOSPITAL C 400820 210022 0.63500 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 CULPEPER PHYSICIAN HOSPITAL ORGANIZATION N 395022 COST CULPEPER REGIONAL HEALTH SYSTEM K 353440 COST CULPEPER REGIONAL HEALTH SYSTEM R 5000000 COST CULPEPER REGIONAL HEALTH SYSTEM C 87396 COST