UVA CULPEPER MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- UVA CULPEPER MEDICAL CENTER (EIN 54-0622371)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-15
- IRS object ID
- 201422279349301202
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-08-15T08:34:22-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540622371 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CULP | NameControl |
| Phone | 5408294100 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | C GREG NAPPS | Name |
| Title | ACTING CEO | Title |
| Phone | 5408298803 | Phone |
| Date Signed | 2014-08-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL P NORTON | Name |
| PTIN | P00430694 | PTIN |
| Phone | 5409896144 | Phone |
| Date Prepared | 2014-08-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | C GREG NAPPS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 83278722 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CULPEPERHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1956 | YearFormation |
| State Legal Domicile | VA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 779 | TotalNbrEmployees |
| Total Nbr Volunteers | 250 | TotalNbrVolunteers |
| Total Gross UBI | 10903 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -10830 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 195488 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 278992 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 75253370 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 78820831 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1860480 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1868117 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 526567 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2301389 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 77835905 | TotalRevenuePriorYear |
| Total Revenue Current Year | 83269329 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 4895 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 10615 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 34880505 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 37192194 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 39906355 | OtherExpensePriorYear |
| Other Expenses Current Year | 45520741 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 74791755 | TotalExpensesPriorYear |
| Total Expenses Current Year | 82723550 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3044150 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 545779 | RevenuesLessExpensesCY |
| Total Assets BOY | 88224569 | TotalAssetsBOY |
| Total Assets EOY | 89196037 | TotalAssetsEOY |
| Total Liabilities BOY | 10752857 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 11406516 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 77471712 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 77789521 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 65502530 | Expense |
| Grants | 10615 | Grants |
| Revenue | 81143056 | Revenue |
| Description | 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.CULPEPERHOSPITAL.COM | Description |
| Total Program Service Expense | 65502530 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 30 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 779 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | C GREG NAPPS | NamePerson |
| Telephone Number | 5408298803 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 SUNSET LANE | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| R EDWARD HOWELL | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| LARRY FITZGERALD | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| ROBERT GIBSON MD | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| ROBERT A ROSEN MD | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| SHARON CLARK | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| NANCY DUNLAP MD | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| BRADLEY E HAWS | |||||||
| TRUSTEE | 2.00 | X | 0 | 0 | 0 | ||
| PATRICK HOGAN | |||||||
| TREASURER | 2.00 | X | 0 | 0 | 0 | ||
| TOM REYNOLDS MD | |||||||
| CHAIR | 2.00 | X | 0 | 0 | 0 | X | |
| CONSTANCE KINCHELOE | |||||||
| SECRETARY | 2.00 | X | 0 | 0 | 0 | X | |
| CHARLES CRIST | |||||||
| VICE CHAIR | 2.00 | X | 0 | 0 | 0 | X | |
| MICHAEL ARMM | |||||||
| IMMEDIATE PAST CHAIR | 2.00 | X | 0 | 0 | 0 | X | |
| CHARLES BARRELL | |||||||
| TREASURER | 2.00 | X | 0 | 0 | 0 | X | |
| H LEE KIRK JR | |||||||
| PRESIDENT/CEO | 40.00 | X | 437300 | 0 | 33703 | X | |
| SAM MORGAN | |||||||
| SENIOR VICE PRESIDENT CFO | 40.00 | 201189 | 0 | 10407 | X | ||
| C GREG NAPPS | |||||||
| ACTING CEO | 40.00 | 195537 | 0 | 23780 | X | ||
| JANICE SUTER | |||||||
| VP NURSING | 40.00 | 155497 | 0 | 17577 | X | ||
| DENNIS SMITH | |||||||
| DIRECTOR OF PHARMACY | 40.00 | 146308 | 0 | 24992 | X | ||
| MORTON CHILES MD | |||||||
| VP MEDICAL STAFF SERVICES | 40.00 | 164750 | 0 | 18104 | X | ||
| DEBRA O'CONNELL | |||||||
| PHO DIRECTOR | 40.00 | 160351 | 0 | 21981 | X | ||
| TRACEY SHIFFELETT | |||||||
| BUSINESS OFFICE DIRECTOR | 40.00 | 129596 | 0 | 6961 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1590528 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 157505 | TotalOtherCompensation |
| Number Individuals GT100 K | 27 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| GILBANE BUILDING COMPANY | |||||
| 7 JACKSON WALKWAY | PROVIDENCE | RI | 02903 | ARCHITECTURE | 3184385 |
| WE BOWERS INC | |||||
| 506 SHAW RD STE 327 | STERLING | VA | 20166 | ARCHITECTURE | 2514907 |
| UVA PHYSICIANS GROUP | |||||
| 500 RAY C HUNT DR | CHARLOTTESVILLE | VA | 22903 | PHYSICIAN SUPPORT | 1941330 |
| RIDEGELINE PHYSICIAN SERVICES PLC | |||||
| 501 SUNSET LANE | CULPEPER | VA | 22701 | PHYSICIAN SUPPORT | 849332 |
| ANESTHESIA PROFESSIONAL | |||||
| 301 SUNSET LANE | CULPEPER | VA | 22701 | PHYSICIAN SUPPORT | 799255 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 20 | NumberOfContractorsGT100K |
| Related Organizations | 278992 | RelatedOrganizations |
| Total Contributions | 278992 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICES | 622310 | 79540611 | 79540611 |
| CSC K-1 | 622310 | 661942 | 661942 |
| CMA K-1 | 622310 | -1381722 | -1381722 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 78820831 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1836378 | TotalRevenueColumn |
| Exclusion | $1,836,378 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 38958 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 9393 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 29565 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29565 | TotalRevenueColumn |
| Related Or Exempt Function Income | 29565 | RelatedOrExemptFunctionIncome |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 29231 | Securities |
| Other | 2508 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 29231 | Securities |
| Other | 2508 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31739 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31739 | RelatedOrExemptFunctionIncome |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| OTHER REVENUE | 622110 | 1979764 | 1979764 | |
| CAFETERIA | 722210 | 281157 | 281157 | |
| OUTSIDE CATERING | 722320 | 10903 | 10903 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2271824 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 83269329 | TotalRevenueColumn |
| Related Or Exempt Function Income | 81143056 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 10903 | UnrelatedBusinessRevenue |
| Exclusion | $1,836,378 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10615 | Total |
| Program Services | 10615 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1577821 | Total |
| Management And General | 1577821 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27547334 | Total |
| Program Services | 19834080 | ProgramServices |
| Management And General | 7713254 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 564216 | Total |
| Program Services | 434446 | ProgramServices |
| Management And General | 129770 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5328898 | Total |
| Program Services | 4103251 | ProgramServices |
| Management And General | 1225647 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2173925 | Total |
| Program Services | 1673922 | ProgramServices |
| Management And General | 500003 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 294380 | Total |
| Management And General | 294380 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109216 | Total |
| Management And General | 109216 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10410 | Total |
| Management And General | 10410 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 191827 | Total |
| Program Services | 143870 | ProgramServices |
| Management And General | 47957 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 377328 | Total |
| Management And General | 377328 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153107 | Total |
| Management And General | 153107 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 760040 | Total |
| Program Services | 380020 | ProgramServices |
| Management And General | 380020 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 845541 | Total |
| Program Services | 845541 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 139174 | Total |
| Program Services | 90463 | ProgramServices |
| Management And General | 48711 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 102592 | Total |
| Program Services | 102592 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4858353 | Total |
| Program Services | 4858353 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 519405 | Total |
| Program Services | 498629 | ProgramServices |
| Management And General | 20776 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 12457174 | 10588598 | 1868576 |
| MEDICAL & PHARMACY SUPP | 11495392 | 10460807 | 1034585 |
| PHYSICIAN FEES | 4651935 | 4651935 | |
| PURCHASED SERVICES | 3496700 | 2622525 | 874175 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5058167 | Total |
| Program Services | 4202883 | ProgramServices |
| Management And General | 855284 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82723550 | Total |
| Program Services | 65502530 | ProgramServices |
| Management And General | 17221020 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4498583 | BOY |
| EOY | 4330151 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8537721 | BOY |
| EOY | 6832959 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 482121 | BOY |
| EOY | 600488 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1633761 | BOY |
| EOY | 1288659 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1001214 | BOY |
| EOY | 824878 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 90188385 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 51698162 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27471560 | BOY |
| EOY | 38490223 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2840449 | BOY |
| EOY | 3204303 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 630786 | BOY |
| EOY | 660588 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41128374 | BOY |
| EOY | 32963788 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88224569 | BOY |
| EOY | 89196037 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6748014 | BOY |
| EOY | 9733579 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3017498 | BOY |
| EOY | 1672937 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 987345 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10752857 | BOY |
| EOY | 11406516 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75934659 | BOY |
| EOY | 76273640 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1537053 | BOY |
| EOY | 1515881 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77471712 | BOY |
| EOY | 77789521 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88224569 | BOY |
| EOY | 89196037 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 545779 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 239090 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -467060 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 150000 | InvestmentCostOrOtherBasis |
| Book Value | 150000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 16902199 | InvestmentCostOrOtherBasis |
| Depreciation | 11557627 | Depreciation |
| Book Value | 5344572 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 349097 | InvestmentCostOrOtherBasis |
| Depreciation | 347954 | Depreciation |
| Book Value | 1143 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 60456280 | InvestmentCostOrOtherBasis |
| Depreciation | 38874181 | Depreciation |
| Book Value | 21582099 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 12330809 | InvestmentCostOrOtherBasis |
| Depreciation | 918400 | Depreciation |
| Book Value | 11412409 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 38490223 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| INVESTMENTS IN AFFILIATES | -51979 |
| OTHER RECEIVABLES | 187081 |
| DUE FROM AFFILIATES | 30823210 |
| SETTLEMENTS DUE FROM THIRD PARTY | 489595 |
| INTEREST IN CERTAIN NET ASSETS OF CULPEPER REGIONAL HEALTH SYSTEM | 1515881 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 32963788 | TotalBookValueOtherAssets |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON OR AFTER 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2515442 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2515442 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03040 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7282931 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6131853 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1151078 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01390 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9798373 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6131853 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3666520 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04430 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 501935 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 501935 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00610 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1107353 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1107353 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01340 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1609288 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1609288 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01950 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11407661 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6131853 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5275808 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06380 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,877,918 | BadDebtExpenseAmount |
| Amount Attributable To | 481721 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 25674317 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 32229804 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -6555487 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|
| 1 CULPEPER MED ASSOC | ||
| MULTI-SPECIALTY MEDICAL PRACTICE | 0.51000 | |
| 2 CULPEPER SURG CENTER | ||
| OUTPATIENT SURGICAL SERVICES | 0.55110 | 0.44890 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
Address Address
| 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 | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 10 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 11 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (11 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| CULPEPER MEDICAL ASSOCIATES LLC | ||||
| 14115 LOVERS LANE STE 100 | CULPEPER | VA | 22701 | CMA CORPORATE OFFICE |
| WILDERNESS MEDICAL CENTER | ||||
| 4376 GERMANNA HIGHWAY | LOCUST GROVE | VA | 22508 | PHYSICIAN PRACTICE |
| CMA SURGICAL SERVICES | ||||
| 541 SUNSET LANE STE 303 | CULPEPER | VA | 22701 | PHYSICIAN PRACTICE |
| PEDIATRIC CARE OF CULPEPER | ||||
| 540 A SUNSET LANE | CULPEPER | VA | 22701 | PHYSICIAN PRACTICE |
| COMMONWEALTH MEDICAL | ||||
| 1043 OAKLAWN DRIVE | CULPEPER | VA | 22701 | PHYSICIAN PRACTICE |
| CULPEPER FAMILY PRACTICE ASSOC | ||||
| 1200 SUNSET LANE STE 2210 | CULPEPER | VA | 22701 | PHYSICIAN PRACTICE |
| PEDIATRIC MEDICAL ASSOCIATES | ||||
| 633 SUNSET LANE STE C | CULPEPER | VA | 22701 | PHYSICIAN PRACTICE |
| CULPEPER PEDIATRIC SERVICES | ||||
| 633 SUNSET LANE STE A | CULPEPER | VA | 22701 | PHYSICIAN PRACTICE |
| CMA FAMILY PHYSICIANS | ||||
| 16240 BENNET RD | CULPEPER | VA | 22701 | PHYSICIAN PRACTICE |
| MADISON PRIMARY CARE | ||||
| 1007 COMMERCE LANE | ROCHELLE | VA | 22738 | PHYSICIAN PRACTICE |
| CULPEPER SURGERY CENTER | ||||
| 541 SUNSET LANE | CULPEPER | VA | 22701 | SURGERY CENTER |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 6A: CULPEPER REGIONAL HOSPITAL, INC PREPARES ITS OWN COMMUNITY BENEFIT REPORT. | |
| 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 THE 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, L7 COL(F): THE ORGANIZATION REMOVED THE BAD DEBT EXPENSE FROM THE TOTAL EXPENSE PRIOR TO THE CALCULATIONS. | |
| PART III, LINE 4: THE COSTING METHODOLOGY USED TO CALCULATE AMOUNTS REPORTED IN LINE 2 WAS A COST-TO-CHARGES RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, WHICH WAS MULTIPLIED AGAINST THE HOSPITAL'S BAD DEBT EXPENSE TO ARRIVE AT THE HOSPITAL'S BAD DEBT EXPENSE AT COST.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 IN EXCESS OF $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 CALCULATED PURSUANT TO WORKSHEET 2 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 COMMUNITYBENEFIT 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 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 CULPEPPER REGIONAL HOSPITAL, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH CULPEPPER REGIONAL HOSPITAL. FOR PATIENTS WHO QUALIFY FOR CHARITY AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DISCOUNTED HOSPITAL BILLS, CULPEPPER REGIONAL HOSPITAL MAY OFFER EXTENDED PAYMENT PLANS, WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES, AND WILL CEASE ALL COLLECTION EFFORTS. CULPEPPER 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 CULPEPPER 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 V, SECTION B, LINE 14G: THE POLICY IS GIVEN TO ALL SELF-PAY PATIENTS. | CULPEPER REGIONAL HOSPITAL |
| PART VI, LINE 2: IN AUGUST 2011, CULPEPER REGIONAL HOSPITAL (CRH) CONTRACTED WITH COMMUNITY HEALTH SOLUTIONS, 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 ASKED FOR INPUT FROM APPROXIMATELY 100 KEY STAKEHOLDERS. WE HAD A 41% COMPLETION RATE FOR THE SURVEYS THAT WERE DISTRIBUTED TO THE ABOVE STAKEHOLDERS. AFTER COMPLETION OF THE NEEDS ASSESSMENT, IN NOVEMBER 2011, 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.AT THE CONCLUSION OF THE CHNA PROCESS, CRH IDENTIFIED THE FOLLOWING KEY AREAS OF FOCUS: CHILDHOOD OBESITY ADULT OBESITY DIABETES HEART DISEASE & STROKE MENTAL ILLNESSCRH'S IMPLEMENTATION STRATEGY FOR THE ABOVE INCLUDED: EXPANSION OF THE DROP IT! HEALTHY LIVING AND WEIGHT LOSS CHALLENGE, A 12-WEEK PROGRAM AND HEALTH FAIR IN PARTNERSHIP WITH GERMANNA COMMUNITY COLLEGE NURSING PROGRAM. IN ADDITION TO THE KICK-OFF HEALTH FAIR OFFERED IN CULPEPER, IN 2013 WE ADDED A HEALTH FAIR IN MADISON COUNTY. BOTH INCLUDE FREE HEALTH SCREENINGS SUCH AS CHOLESTEROL, A1C, BLOOD PRESSURE, AS WELL AS INFORMATION ON NUTRITION AND LIVING AN ACTIVE LIFESTYLE. CRH OFFERS REGULAR COMMUNITY OUTREACH SEMINARS RELATED TO THE TREATMENT AND MANAGEMENT OF CHRONIC DISEASE AND LIVING A HEALTHY LIFESTYLE. CRH HAS A NEWLY ACCREDITED (2013) DIABETES CARE, SELF-MANAGEMENT, AND EDUCATION PROGRAM CALLED TAKE CONTROL OF DIABETES. WE ALSO SPONSOR A DIABETES SUPPORT GROUP AND FREE COMMUNITY CLASSES. CRH HOSTS A MONTHLY FARMERS MARKET FROM MAY TO OCTOBER OFFERING FRESH FRUITS AND VEGETABLES. CRH LAUNCHED A NEW STROKE ALERT AND MANAGEMENT SYSTEM CALLED STROKE TELEMEDICINE AND TELE-EDUCATION (STAT) IN JANUARY 2012. IN ADDITION TO THE LAUNCH, WE HELD A DEMONSTRATION AND EDUCATION EVENT FOR EMS PERSONNEL. CRH LAUNCHED THE SILVER SCREEN PROGRAM IN THE SPRING OF 2013, WHICH SCREENS PATIENTS FOR MENTAL ILLNESS AT THREE ACCESS POINT IN THE ORGANIZATION. IF A PATIENT ANSWERS YES TO ANY OF THE QUESTIONS, THEY ARE PROVIDED WITH A CARD THAT LISTS COMMUNITY RESOURCES. CRH DEVELOPS ARTICLES FOR OUR QUARTERLY MAGAZINE, SIMPLY HEALTH, RELATED TO THE TREATMENT AND MANAGEMENT OF CHRONIC DISEASE AND LIVING A HEALTHY LIFESTYLE. CRH FINANCIALLY SUPPORTS AND ACTIVELY PARTICIPATES ON COMMUNITY RELATIONS COMMITTEES IN CULPEPER, MADISON AND ORANGE COUNTIES.IN ADDITION TO THE ABOVE, CRH HAS ADDRESSED SOME OF THE IDENTIFIED SERVICE GAPS FROM THE CHNA PROCESS: AGING SERVICES ACTIVE PARTNERSHIP WITH AGING TOGETHER, INCLUDING SPONSORSHIP OF FALLS SYMPOSIUM. ALSO, HOSTED A COMMUNITY SEMINAR ON AGING AND BRAIN HEALTH. HEALTH CARE COVERAGE SELF-PAY PATIENTS - PATIENTS WHO HAVE NO INSURANCE COVERAGE WILL AUTOMATICALLY RECEIVE A 20 PERCENT DISCOUNT AT THE TIME OF SERVICE. THIS DISCOUNT IS GRANTED PRIOR TO ANY PAYMENT ARRANGEMENTS AND/OR FINANCIAL ASSISTANCE YOU MAY BE QUALIFIED TO RECEIVE. UNINSURED PATIENTS, WHO PAY THEIR ACCOUNT IN FULL WITHIN 30 DAYS OF THE DATE LISTED ON THE INITIAL STATEMENT, WILL QUALIFY FOR AN ADDITIONAL 15 PERCENT DISCOUNT. FREE CLINIC OF CULPEPER (FINANCIALLY SUPPORTED BY CRH) - PATIENTS ARE UNINSURED RESIDENTS OF THE TOWN OR COUNTY OF CULPEPER WHO HAVE MET THE ELIGIBILITY REQUIREMENTS OF THE CLINIC. THEY ARE ADULTS BETWEEN THE AGES OF 19 AND 64 WHO ARE WORKING, SEEKING EMPLOYMENT OR DISABLED THAT HAVE INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL. DENTAL CARE/ORAL CARE ACTIVE PARTNERSHIP WITH PIEDMONT REGIONAL DENTAL CLINIC AND SUPPORT OF THE CULPEPER DENTAL CLINIC. TRANSPORTATION FINANCIAL SUPPORT OF COMMUNITY TRANSPORTATION PROGRAMS. | |
| 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). THE POPULATION ESTIMATE FOR 2013 FOR THIS AREA IS 106,050, WITH 52,746 MALES AND 53,304 FEMALES. PROJECTED POPULATION FOR 2018 IS 110,349, WHICH IS A 4.1% CHANGE. THE AVERAGE HOUSEHOLD INCOME FOR THIS AREA IS $73,581. POPULATION DISTRIBUTION BY AGE IS AS FOLLOWS: 0-17 YEARS 24.0%, 18-34 YEARS 18.8%, 35-54 YEARS 27.9%, 55+ YEARS 29.5%. RACE/ETHNICITY DISTRIBUTION IS AS FOLLOWS: WHITE NON-HISPANIC 76.5%, BLACK NON-HISPANIC 12.8%, HISPANIC 6.7%, ASIAN & PACIFIC IS. NON-HISPANIC 1.1%, ALL OTHERS 2.8%. EDUCATION LEVELS ARE AS FOLLOWS: LESS THAN HIGH SCHOOL 6.5%, SOME HIGH SCHOOL 10.4%, HIGH SCHOOL DEGREE 33.5%, SOME COLLEGE/ASSOC. DEGREE 27.3%, BACHELOR DEGREE OR GREATER 22.3%. | |
| 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 SECTION 501(C)(3) TAX-EXEMPT 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) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER REGIONAL HEALTH SYSTEM | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 592 | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 521366700 | EINOfRecipient |
| Amount Of Cash Grant | 28216 | AmountOfCashGrant |
| Purpose Of Grant | FREE CLINIC | PurposeOfGrant |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS FOR STUDIES IN THE MEDICAL FIELD | TypeOfGrant |
| Number Of Recipients | 3 | NumberOfRecipients |
| Amount Of Cash Grant | 10615 | AmountOfCashGrant |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| H LEE KIRK JR | ||||||||||||||
| PRESIDENT/CEO | 321567 | 0 | 100733 | 0 | 15000 | 0 | 10000 | 0 | 23703 | 0 | 471003 | 0 | 0 | 0 |
| SAM MORGAN | ||||||||||||||
| SENIOR VICE PRESIDENT CFO | 182575 | 0 | 18614 | 0 | 0 | 0 | 7261 | 0 | 3146 | 0 | 211596 | 0 | 0 | 0 |
| C GREG NAPPS | ||||||||||||||
| ACTING CEO | 181591 | 0 | 13946 | 0 | 0 | 0 | 2579 | 0 | 21201 | 0 | 219317 | 0 | 0 | 0 |
| JANICE SUTER | ||||||||||||||
| VP NURSING | 139639 | 0 | 15858 | 0 | 0 | 0 | 5712 | 0 | 11865 | 0 | 173074 | 0 | 0 | 0 |
| DENNIS SMITH | ||||||||||||||
| DIRECTOR OF PHARMACY | 146308 | 0 | 0 | 0 | 0 | 0 | 4376 | 0 | 20616 | 0 | 171300 | 0 | 0 | 0 |
| MORTON CHILES MD | ||||||||||||||
| VP MEDICAL STAFF SERVICES | 147358 | 0 | 17392 | 0 | 0 | 0 | 6110 | 0 | 11994 | 0 | 182854 | 0 | 0 | 0 |
| DEBRA O'CONNELL | ||||||||||||||
| PHO DIRECTOR | 145883 | 0 | 14468 | 0 | 0 | 0 | 5730 | 0 | 16251 | 0 | 182332 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 1A | ReturnReference |
| Explanation | 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. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| 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) |
|---|---|---|
| Issuer EIN | 541312068 | IssuerEIN |
| CUSIP Number | 000000000 | CUSIPNumber |
| Date Issued | 2003-12-23 | DateIssued |
| Issue Price | 8262873 | IssuePrice |
| Description Of Purpose | HEALTH FACILITIES REV BOND 03 | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 5903476 | AmountRetired |
| Total Proceeds | 8302651 | TotalProceeds |
| Issuance Costs From Proceeds | 125000 | IssuanceCostsFromProceeds |
| Capital Expenditures | 2914778 | CapitalExpenditures |
| Other Spent Proceeds | 5262573 | OtherSpentProceeds |
| Year Of Subst Completion | 2004 | YearOfSubstCompletion |
| Current Refunding | 1 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 0 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIDGELINE PHYSICIAN SERVICES PLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | ROBERT ROSEN, BOARD MEMBER, IS PARTNER IN ORGANIZATION. | Relationship |
| Amount Of Transaction | 849332 | AmountOfTransaction |
| Description Of Transaction | COMPENSATION PAID FOR PHYSICIAN SUPPORT SERVICES. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 REPSONSIBLE ONE 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. UTLMATELY 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 & ADDED QUALITY AND SAFETY OFFICER FOR THE FALL 2012 REVIEW. CRH HAS HISTORICALLY USED YAFFE AND IN 2012 CONVERTED TO SULLIVAN COTTER FOR OUTSIDE OBJECTIVE REVIEW OF EXECUTIVE COMPENSATION . THE PRACTICE HAS BEEN TO UPDATE MARKET DATA EVERY TWO YEARS, 2010 & 2012. 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 XI, LINE 9: | BOOK LOSS ON PARTNERSHIPS -1,164,700. K-1 CMA LOSS 1,381,722. K-1 CSC -662,914. RECLASS OF INTEREST IN NET ASSETS OF FOUNDATION -21,172. ROUNDING 4. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XI, LINE 2C | THE PROCESS OF FINANCIAL STATEMENT REVIEW AND OVERSIGHT HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | 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 | 1 | UVASTATE OF VA | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CULPEPER SURGERY CENTER LLC | ||||||||||||
| 541 SUNSET LANE | CULPEPER | VA | 22701 | HEALTHCARE | VA | CULPEPER HOSPITAL | RELATED | 2324728 | 1706135 | 0 | 0 | 0.55110 |
| CULPEPER MEDICAL ASSOCIATES | ||||||||||||
| 100 SAUNDERS STREET | CULPEPER | VA | 22701 | MEDICAL SERVICES | VA | CULPEPER HOSPITAL | RELATED | 2726381 | 291823 | 0 | 0 | 0.51000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER PHYSICIAN HOSPITAL ORGANIZATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 592 | AddressLine1 |
| City | CULPEPER | City |
| State | VA | State |
| ZIP Code | 22701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 541703526 | EIN |
| Primary Activity | MEMBERSHIP ORGANIZATION | PrimaryActivity |
| Legal Domicile State | VA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULPEPER HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 396188 | ShareOfTotalIncome |
| Share Of EOY Assets | 231147 | ShareOfEOYAssets |
| Percentage Ownership | 0.63500 | PercentageOwnership |
| Controlled Org | 0 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| CULPEPER PHYSICIAN HOSPITAL ORGANIZATION | ||
| N | 363836 | COST |
| CULPEPER REGIONAL HEALTH SYSTEM | ||
| P | 1621125 | COST |