2014-02-15T06:42:43-06:00 2013-03-31 540737372 PBMARES LLP 701 TOWN CENTER DRIVE SUITE 900 NEWPORT NEWS VA 23606 990 2012-04-01 541857174 CHESAPEAKE MEDICAL GROUP INC CHES 8044358582 PO BOX 1328 KILMARNOCK VA 22482 JAMES M HOLMES JR 8044358582 2014-02-13 1 THOMAS R BROOKS P00168242 7578731587 2014-02-13 X 2012 2015-11-30 17:44:51Z JAMES M HOLMES JR PO BOX 1328 KILMARNOCK VA 22482 6686782 0 X RAPPAHANNOCKHEALTH.COM X 1994 VA PROVIDE QUALITY, COMPASSIONATE, COST EFFECTIVE PRIMARY MEDICAL CARE SERVICES TO THE COMMUNITY AS A WHOLE IN A DEFINED GEOGRAPHIC AREA OF THE NORTHERN NECK AND MIDDLE PENINSULA OF VIRGINIA. 7 3 107 4 0 0 0 0 6903242 6672691 738 531 -1096 -609 6902884 6672613 0 0 0 0 5153683 5141257 0 0 0 1686169 1959802 6839852 7101059 63032 -428446 1419920 1363871 6876572 7248969 -5456652 -5885098 X THE MISSION OF CHESAPEAKE MEDICAL GROUP, INC., (CMG) IS TO PROVIDE QUALITY, COMPASSIONATE, COST EFFECTIVE PRIMARY MEDICAL CARE SERVICES TO THE COMMUNITY AS A WHOLE IN A DEFINED GEOGRAPHIC AREA OF THE NORTHERN NECKAND MIDDLE PENINSULA OF VIRGINIA. THE COMPANY WILL PURSUE ITS MISSION THROUGH THE DEVELOPMENT AND MANAGEMENT OF ONE GROUP MEDICAL PRACTICE OPERATING AT MULTIPLE LOCATIONS WHICH ARE REASONABLY EQUIPPED AND EFFICIENTLY STAFFED BY COMPETENT CLINICAL AND ADMINISTRATIVE INDIVIDUALS. THE CORPORATION IS COMMITTED TO PROVIDING MEDICAL SERVICES WITHOUT REGARD TO THE PATIENTS' RACE, COLOR, CREED, NATIONAL ORIGIN, RELIGION OR DISABILITY AND WILL PROVIDE PRIMARY MEDICAL CARE TO ANY INDIVIDUAL WITH AN ACUTE INJURY OR ILLNESS WITHOUT REGARD TO THEIR ABILITY TO PAY. 0 0 6167807 6672691 DURING THE FISCAL YEAR, CMG EMPLOYED 12 PHYSICIANS AND 6 NURSE PRACTITIONERS WHO PROVIDED EITHER FAMILY PRACTICE, PEDIATRIC, GYN OR SURGICAL MEDICAL CARE AT 8 OFFICES LOCATED IN THREE COUNTIES. CMG PROVIDERS SAW A TOTAL OF 65,742 PATIENTS DURING THE FISCAL YEAR. OF THE TOTAL SERVICES RENDERED, 62% WAS BILLED TO MEDICARE/MEDICAID; 24% TO ANTHEM; 9% TO OTHER COMMERCIAL PAYORS; AND 5% WAS BILLED DIRECTLY TO PATIENTS. 172675 DURING THE YEAR, CMG PHYSICIANS AND NURSE PRACTITIONERS PROVIDED NUMEROUS SERVICES FOR THE COMMUNITY WHICH INCLUDED:A. PROVIDING ADMISSION SERVICES AND COVERAGE TO FIVE AREA NURSING HOMES.B. PROVIDING FREE HEALTH CARE TO INDIGENT PATIENTS THROUGH PARTICIPATION WITH THE NORTHERN NECK FREE HEALTH CLINIC.C. PROVIDING FREE COMMUNITY EDUCATION THROUGH SPEAKING AND TEACHING ENGAGEMENTS ON NUMEROUS TOPICS. D. PARTICIPATION IN DISCOUNTED SPORTS PHYSICALS FOR SECONDARY SCHOOL STUDENTS OF LANCASTER, MIDDLESEX, NORTHUMBERLAND, RICHMOND, WESTMORELAND AND ESSEX COUNTIES.E. PARTICIPATION IN FREE HEALTH SCREENING EVENTS IN NORTHUMBERLAND COUNTIES.THE HEALTH SCREENINGS INCLUDED FREE BLOOD GLUCOSE TESTING; CHOLESTEROL TESTING; AND BLOOD PRESSURE TESTING. ADDITIONALLY, PREVENTATIVE HEALTH CARE INFORMATION WAS PROVIDED AT EACH SCREENING EVENT.F. PROVIDING FREE MEDICAL SERVICES FOR CHILDREN IN THE ANNUAL CUB SCOUT DAY CAMP HELD IN LANCASTER COUNTY.G. OUR POLICY REMAINS TO PROVIDE CARE TO ANY PATIENT (OTHER THAN ROUTINE CARE)REGARDLESS OF THEIR ABILITY TO PAY. 6340482 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 X 10 0 107 1 0 0 0 0 0 0 0 0 0 0 X 7 3 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JOHN HEADLEY 8044358000 101 HARRIS ROAD KILMARNOCK VA 22482 JAMES M HOLMES JR 6.00 34.00 X X 0 318682 26582 BONNIE B ABBOTT 40.00 0.00 X 91905 0 9106 JAMES E BRYANT MD 1.00 39.00 X 0 196247 11742 DAVID R ANTONIO MD 1.00 0.00 X 0 0 0 STEPHEN K WHITEWAY 1.00 0.00 X 0 500 0 MARIAN L WALKER 1.00 0.00 X 0 0 0 NORMAN R TINGLE JR MD 40.00 0.00 X 419082 0 9733 MARVENE RUIT 39.00 1.00 X 0 110931 16526 STEVEN OLTERMANN MD 40.00 0.00 X 267765 0 14818 MATTHEW VOGEL MD 40.00 0.00 X 176620 0 11611 JOHN DANIEL MD 40.00 0.00 X 152716 0 9688 MATHEW JAEGER MD 40.00 0.00 X 164279 0 8907 DARLENE STIBAL 40.00 0.00 X 285016 0 10218 1557383 626360 128931 6 0 1 0 CHESAPEAKE HEALTH SERVICES 101 HARRIS ROAD KILMARNOCK VA 22480 MANAGEMENT FEE 237381 1 PATIENT SERVICE REVENU 621110 6376118 6376118 SERVICE CONTRACT REVEN 561000 296573 296573 6672691 531 531 13560 14169 -609 -609 -609 6672613 6672691 0 -78 532671 491571 41100 3928000 3624896 303104 60435 55771 4664 344346 317851 26495 275805 254584 21221 237381 237381 773 773 374514 301672 72842 9859 5247 4612 120314 99915 20399 261732 239830 21902 6310 2183 4127 33983 33983 77789 77789 187086 187086 MEDICAL SUPPLIES AND PH 283632 283632 BAD DEBT EXPENSE 278847 278847 REPAIRS, MAINTENANCE AN 46592 44640 1952 DUES, SUBSCRIPTIONS AND 38114 38114 2876 2871 5 7101059 6340482 760577 0 110626 14917 355306 343765 107032 103091 47194 29034 1789228 918501 797106 870727 2656 2337 1419920 1363871 336466 337286 578881 552364 5961225 6359319 6876572 7248969 X -5456652 -5885098 -5456652 -5885098 1419920 1363871 -428446 0 X X 0 1 X 1 0 X X X 0 0 0 CHESAPEAKE HOSPITAL CORP 237424835 3 1 1 0 1 0 34000 34000 880801 352381 528420 170104 129708 40396 704323 436412 267911 870727 DUE TO RAPPAHANNOCK GEN HOSP 4173867 DUE TO CHESAPEAKE HEALTH SVC 2185452 6359319 X 6686782 14169 14169 6672613 0 6672613 7115228 14169 14169 7101059 0 7101059 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: SCHEDULE D RHS, THE HOSPITAL, CMG AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. EFFECTIVE 2009, FASB ACCOUNTING STANDARDS CODIFICATION 740 PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. RHS'S MANAGEMENT HAS EVALUATED THE IMPACT OF THE STANDARD TO ITS FINANCIAL STATEMENTS, BUT DOES NOT ANTICIPATE A MATERIAL EFFECT. RHS IS NOT AWARE OF ANY MATERIAL UNCERTAIN TAX POSITIONS AND HAS NOT ACCRUED THE EFFECT OF ANY UNCERTAIN TAX POSITIONS AS OF MARCH 31, 2013 AND 2012. WITH FEW EXCEPTIONS, RHS IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY FEDERAL, STATE OR LOCAL AUTHORITIES FOR YEARS BEFORE 2009. RHS'S POLICY IS TO CLASSIFY INCOME TAX RELATED INTEREST AND PENALTIES IN INTEREST EXPENSE AND OTHER EXPENSES, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 14,169. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 14,169. X X X X X 0 0 0 0 0 0 0 0 0 JAMES M HOLMES JR 0 298003 0 0 0 20679 0 7003 0 19579 0 345264 0 0 JAMES E BRYANT MD 0 196247 0 0 0 0 0 5850 0 5892 0 207989 0 0 NORMAN R TINGLE JR MD 419082 0 0 0 0 0 3600 0 6133 0 428815 0 0 0 STEVEN OLTERMANN MD 267765 0 0 0 0 0 7350 0 7468 0 282583 0 0 0 MATTHEW VOGEL MD 176620 0 0 0 0 0 5399 0 6212 0 188231 0 0 0 JOHN DANIEL MD 152716 0 0 0 0 0 3000 0 6688 0 162404 0 0 0 MATHEW JAEGER MD 164279 0 0 0 0 0 3000 0 5907 0 173186 0 0 0 DARLENE STIBAL 285016 0 0 0 0 0 0 0 10218 0 295234 0 0 0 SUPPLEMENTAL INFORMATION PART III $19,879 OF OTHER COMPENSATION LISTED FOR JAMES M. HOLMES, JR. IS FROM A RHS THIRD PARTY STOCK OPTION PLAN FOR EMPLOYEES. THE PLAN BEGAN IN 1998 AND WAS SET UP TO PROVIDE ADDITIONAL RETIREMENT BENEFITS AND WAS ONLY FUNDED FOR A FEW YEARS. JAMES M HOLMES CHESAPEAKE HEALTH SERVICES 237381 HOLMES IS AN EMPLOYEE OF CHESAPEAKE HEALTH SERVICES WHO IS THE MANAGEMENT COMPANY FOR CHESAPEAKE MEDICAL GROUP, INC. AMOUNT OF TRANSACTION IS TOTAL PAID FOR MANAGEMENT FEE. 0 FORM 990, PART V, LINE 7G AND H QUESTIONS 7G AND H DOES NOT APPLY TO THE ORGANIZATION BECAUSE THE ORGANIZATION DID NOT HAVE CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY OR CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 3 DAILY MANAGEMENT DUTIES ARE HANDLED BY CHESAPEAKE HEALTH SERVICES. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS STOCKHOLDERS. FORM 990, PART VI, SECTION B, LINE 11 WHEN THE COMPLETED FORM 990 COMES BACK FROM THE OUTSIDE TAX PREPARERS, IT IS REVIEWED BY THE CHESAPEAKE HEALTH SERVICES (CHS) VICE PRESIDENT-PATIENT FINANCIAL SERVCIES OR CHS CHIEF FINANCIAL OFFICER FOR ACCURACY. ONCE IT IS DETERMINED TO BE THE FINAL DRAFT, THE PACKAGE IS GIVEN TO THE PRESIDENT. THE PRESIDENT WILL SCHEDULE A MEETING OF THE CHS BOARD'S EXECUTIVE COMMITTEE WHICH CONSISTS OF THE CHAIRMAN-CHESAPEAKE HEALTH SERVICES BOARD, CHAIRMAN-CHESAPEAKE HOSPITAL CORPORATION BOARD, FINANCE COMMITTEE CHAIRMAN, AND A MEMBER OF THE CHS BOARD. THE EXECUTIVE COMMITTEE REVIEWS THE RETURN IN DETAIL AND RECOMMENDS THAT THE BOARD OF DIRECTORS ACCEPT IT. AT THE NEXT SCHEDULED RGH BOARD MEETING (OR A CALLED MEETING IF NECESSARY TO MAIL THE RETURN ON TIME), THE FORM 990 IS DISCUSSED WITH COPIES BEING AVAILABLE FOR ANY OTHER BOARD MEMBER TO REVIEW. ONCE THIS MEETING AND APPROVAL OF THE FORM 990 HAVE TAKEN PLACE, THE RETURN IS SIGNED AND E-FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL DOCUMENTS ARE AVAILABLE TO THE PUBLIC FOR REVIEW IN ADMINISTRATION DURING REGULAR BUSINESS HOURS, MONDAY THROUGH FRIDAY. ALL BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT ONCE A YEAR STATING THEY WILL MAKE THE BOARD AWARE IF THERE IS A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE CHESAPEAKE HEALTH SERVICES (CHS) EXECUTIVE SALARY COMMITTEE OF THE BOARD OF DIRECTORS MEETS AT LEAST ANNUALLY TO REVIEW THE COMPENSATION OF THE CEO, OFFICERS & OTHER KEY EMPLOYEES. THESE ARE SHARED POSITIONS WITH CHESAPEAKE HEALTH SERVICES, RAPPAHANNOCK GENERAL HOSPITAL, RAPPAHANNOCK GENERAL HOSPITAL FOUNDATION AND CHESAPEAKE MEDICAL GROUP. THE CHS PRESIDENT WILL SCHEDULE A MEETING OF THE BOARD'S EXECUTIVE SALARY COMMITTEE WHICH CONSISTS OF THE CHAIRMAN-CHESAPEAKE HEALTH SERVICES BOARD, CHAIRMAN-CHESAPEAKE HOSPITAL CORPORATION BOARD, FINANCE COMMITTEE CHAIRMAN, AND A MEMBER OF THE CHS BOARD. THE CHS EXECUTIVE COMMITTEE REVIEWS THE CURRENT SALARY AND BENEFITS OF EACH OFFICER AND KEY EMPLOYEE AND RECOMMENDS ADJUSTMENTS AS NECESSARY. THEIR REVIEW CONSISTS OF COMPARING THE SALARY AND BENEFITS TO A PERIODIC SURVEY DONE BY AN OUTSIDE THIRD PARTY OR HOSPITAL-RELATED CIRCULATIONS. IF IT HAS BEEN DETERMINED THAT NO INCREASES WILL BE GIVEN IN THE FISCAL YEAR, NO MEETING WILL TAKE PLACE. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST BY APPOINTMENT IN ADMINISTRATIONS, MONDAY THROUGH FRIDAY, DURING REGULAR BUSINESS HOURS. FORM 990, PART XI, LINE 2C THE AUDIT COMMITTEE OF THE CHESAPEAKE HEALTH SERVICES IS RESPONSIBLE UNDER ITS CORPORATE DOCUMENTS FOR THE SELECTION OF THE INDEPENDENT AUDITORS AND FOR THE OVERSIGHT OF THE ANNUAL AUDIT PROCESS THAT WILL COVER ALL OF THE ENTITIES, ACCOUNTS AND ACTIVITIES PRESENTED IN THE CONSOLIDATED ANNUAL FINANCIAL STATEMENTS, INCLUDING AMOUNTS REPORTED HEREIN. THERE HAS BEEN NO CHANGE IN THE PROCEDURE FROM THE PRIOR YEAR. FORM 990, PART VII JAMES M. HOLMES, JR. IS EMPLOYED BY CHESAPEAKE HEALTH SERVICES AND WORKS 40+ HOURS PER WEEK FOR THAT ENTITY. JAMES E. BRYANT, MD IS EMPLOYED BY CHESAPEAKE HOSPITAL CORPORATION AND WORKS 40+ HOURS PER WEEK FOR THAT ENTITY. CHESAPEAKE HOSPITAL CORPORATION PO BOX 1449 KILMARNOCK VA 22482 237424835 HOSPITAL VA 501(C)(3) 3 N/A 0 CHESAPEAKE HEALTH SERVICES INC PO BOX 1449 KILMARNOCK VA 22482 541513371 MANAGEMENT SERVICES VA 501(C)(3) 11 N/A 0 RAPPAHANNOCK GENERAL HOSPITAL FOUNDATION PO BOX 1449 KILMARNOCK VA 22482 541210450 FUNDRAISING VA 501(C)(3) 11 N/A 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 0 0 CHESAPEAKE HOSPITAL CORPORATION L 141069 CASH CHESAPEAKE HEALTH SERVICES M 237381 CASH CHESAPEAKE HOSPITAL CORPORATION E 4173867 CASH CHESAPEAKE HEALTH SERVICES E 2185452 CASH CHESAPEAKE HEALTH SERVICES K 93012 CASH