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Chesapeake Medical Group Inc: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
Chesapeake Medical Group Inc (EIN 54-1857174)
Tax period
2011-04-01 to 2012-03-31
Filed
2013-02-15
IRS object ID
201300469349302160
Schema version
2011v1.5
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-02-15T13:25:35-06:00Timestamp
Tax Period End Date2012-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN540737372EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PBMARES LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1701 TOWN CENTER DRIVE SUITE 900AddressLine1
CityNEWPORT NEWSCity
StateVAState
ZIP Code236064287ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN541857174EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHESAPEAKE MEDICAL GROUP INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHESNameControl
Phone8044358582Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1328AddressLine1
CityKILMARNOCKCity
StateVAState
ZIP Code22482ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJAMES M HOLMES JRName
TitlePRESIDENTTitle
Phone8044358582Phone
Date Signed2013-02-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS R BROOKSName
PTINP00168242PTIN
Phone7578731587Phone
Date Prepared2013-02-15DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJAMES M HOLMES JRNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1328AddressLine1
CityKILMARNOCKCity
StateVAState
ZIP Code22482ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6917540GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionPROVIDE 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees107TotalNbrEmployees
Total Nbr Volunteers4TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6244651ProgramServiceRevenuePriorYear
Program Service Revenue CY6903242ProgramServiceRevenueCY
Investment Income Prior Year622InvestmentIncomePriorYear
Investment Income Current Year738InvestmentIncomeCurrentYear
Other Revenue Prior Year-1027OtherRevenuePriorYear
Other Revenue Current Year-1096OtherRevenueCurrentYear
Total Revenue Prior Year6244246TotalRevenuePriorYear
Total Revenue Current Year6902884TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4690256SalariesEtcPriorYear
Salaries Etc Current Year5153683SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1830314OtherExpensePriorYear
Other Expenses Current Year1686169OtherExpensesCurrentYear
Total Expenses Prior Year6520570TotalExpensesPriorYear
Total Expenses Current Year6839852TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-276324RevenuesLessExpensesPriorYear
Revenues Less Expenses CY63032RevenuesLessExpensesCY
Total Assets BOY1383986TotalAssetsBOY
Total Assets EOY1419920TotalAssetsEOY
Total Liabilities BOY6903672TotalLiabilitiesBOY
Total Liabilities EOY6876572TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-5519686NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-5456652NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense5975010Expense
Revenue6903242Revenue
DescriptionDURING THE FISCAL YEAR, CMG EMPLOYED 12 PHYSICIANS AND 4 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 79,820 PATIENTS DURING THE FISCAL YEAR. OF THE TOTAL SERVICES RENDERED, 62% WAS BILLED TO MEDICARE/MEDICAID; 24% TO ANTHEM; 6% TO OTHER COMMERCIAL PAYORS; AND 8% WAS BILLED DIRECTLY TO PATIENTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense196975Expense
DescriptionDURING 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.Description
FieldValueIRS element (for citing)
Total Program Service Expense6171985TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With109610NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees107NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJOHN HEADLEYNamePerson
Telephone Number8044358000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 HARRIS ROADAddressLine1
CityKILMARNOCKCity
StateVAState
ZIP Code22482ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JAMES M HOLMES JR
PRESIDENT6.00XX028529525978
BONNIE B ABBOTT
VICE PRESIDENT40.00XX83187014853
JAMES E BRYANT MD
BOARD MEMBER1.00X021588112101
DAVID R ANTONIO MD
BOARD MEMBER1.00X000
STEPHEN K WHITEWAY
BOARD MEMBER1.00X000
MARIAN L WALKER
BOARD MEMBER1.00X000
NORMAN R TINGLE JR MD
PHYSICIAN40.00X38041808468
STEVEN OLTERMANN MD
PHYSICIAN40.00271786019988X
MATTHEW VOGEL MD
PHYSICIAN40.0017707250013504X
JOHN DANIEL MD
PHYSICIAN40.00156807015421X
MATHEW JAEGER MD
PHYSICIAN40.00163104010082X
DARLENE STIBAL
PHYSICIAN40.00281015013739X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1513389TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs501676TotalReportableCompFrmRltdOrgs
Total Other Compensation134134TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHESAPEAKE HEALTH SERVICESBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 HARRIS ROADAddressLine1
CityKILMARNOCKCity
StateVAState
ZIP Code22480ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesMANAGEMENT FEEDescriptionOfServices
Compensation117416Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENU62111066713406671340
SERVICE CONTRACT REVEN561000231902231902
FieldValueIRS element (for citing)
Total Program Service Revenue6903242TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column738TotalRevenueColumn
Exclusion$738ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real13560Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real14656Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-1096Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-1096TotalRevenueColumn
Exclusion-$1,096ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column6902884TotalRevenueColumn
Related Or Exempt Function Income6903242RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$358ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total98490Total
Management And General98490ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4320982Total
Program Services4046406ProgramServices
Management And General274576ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total64384Total
Program Services61364ProgramServices
Management And General3020ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total379938Total
Program Services355558ProgramServices
Management And General24380ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total289889Total
Program Services266021ProgramServices
Management And General23868ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total117416Total
Management And General117416ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total9482Total
Management And General9482ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total255063Total
Program Services197965ProgramServices
Management And General57098ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total13872Total
Program Services13016ProgramServices
Management And General856ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total128202Total
Program Services98849ProgramServices
Management And General29353ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total236920Total
Program Services215108ProgramServices
Management And General21812ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total6681Total
Program Services1409ProgramServices
Management And General5272ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total33485Total
Program Services33485ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total72439Total
Program Services72439ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total179349Total
Program Services179349ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
BAD DEBT EXPENSE285481285481
MEDICAL SUPPLIES AND PH266642266642
DUES, SUBSCRIPTIONS AND3995039950
REPAIRS, MAINTENANCE AN3594335943

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total5244Total
Program Services3000ProgramServices
Management And General2244ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6839852Total
Program Services6171985ProgramServices
Management And General667867ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY80040BOY
EOY110626EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY401446BOY
EOY355306EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY96277BOY
EOY107032EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY26026BOY
EOY47194EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1637857LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec840751LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY777222BOY
EOY797106EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY2975BOY
EOY2656EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY1383986BOY
EOY1419920EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY283418BOY
EOY336466EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY604118BOY
EOY578881EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6016136BOY
EOY5961225EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6903672BOY
EOY6876572EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-5519686BOY
EOY-5456652EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-5519686BOY
EOY-5456652EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1383986BOY
EOY1419920EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses63032ReconcilationRevenueExpenses
Reconcilation Other Changes2ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHESAPEAKE HOSPITAL CORPBusinessNameLine1
FieldValueIRS element (for citing)
EIN237424835EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Organized In US1OrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis34000OtherCostOrOtherBasis
Book Value34000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis918419OtherCostOrOtherBasis
Depreciation314133Depreciation
Book Value604286BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis166154OtherCostOrOtherBasis
Depreciation117871Depreciation
Book Value48283BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis519284OtherCostOrOtherBasis
Depreciation408747Depreciation
Book Value110537BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings797106TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO RAPPAHANNOCK GEN HOSP$4,065,981
DUE TO CHESAPEAKE HEALTH SVCS$1,895,244
FieldValueIRS element (for citing)
Total Of Amounts5961225TotalOfAmounts
Total Revenue6902884TotalRevenue
Total Expenses6839852TotalExpenses
Excess Or Deficit For Year63032ExcessOrDeficitForYear
Other$2OtherAmount
Total Adjustments2TotalAdjustments
Excess Or Deficit Per FS63034ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt6917540TotRevenueEtcAuditedFinclStmt
Other Revenues14656OtherRevenues
Revenue Not Rptd F99014656RevenueNotRptdF990
Revenue Subtotal6902884RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9906902884TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt6854508TotExpensesEtcAuditedFinclStmt
Other Expenses Included14656OtherExpensesIncluded
Expenses Not Rptd F99014656ExpensesNotRptdF990
Expenses Subtotal6839852ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9906839852TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X: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. CPS IS A WHOLLY-OWNED, TAXABLE SUBSIDIARY OF RHS. RHS IS SUBJECT TO INCOME TAXES ON PROFITS, IF ANY, FROM CPS. 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, 2012 AND 2011. WITH FEW EXCEPTIONS, RHS IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY FEDERAL, STATE OR LOCAL AUTHORITIES FOR YEARS BEFORE 2008.
PART XI, LINE 8 - OTHER ADJUSTMENTS:ROUNDING 2.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 14,656.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 14,656.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JAMES M HOLMES JR
0283745000155006330019648031127300
JAMES E BRYANT MD
021588100000548106620022798200
NORMAN R TINGLE JR MD
380418000003600048680388886000
STEVEN OLTERMANN MD
2717860000073500126380291774000
MATTHEW VOGEL MD
1770720000500539908105019057650000
JOHN DANIEL MD
1568070000030000124210172228000
MATHEW JAEGER MD
163104000003000070820173186000
DARLENE STIBAL
2810150000000137390294754000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
CHESAPEAKE BANK
JAMES M HOLMES JR IS AN OFFICER OF CMG & A BOARD MEMBER OF CHESAPEAKE BANK32502INTEREST PAID ON OUTSTANDING LOANS0
JAMES M HOLMES
CHESAPEAKE HEALTH SERVICES117416HOLMES 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

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART V, LINE 7GQUESTIONS 7G DOES NOT APPLY TO THE ORGANIZATION BECAUSE THE ORGANIZATION DID NOT HAVE CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY.
FORM 990, PART V, LINE 7HQUESTIONS 7H DOES NOT APPLY TO THE ORGANIZATION BECAUSE THE ORGANIZATION DID NOT HAVE CONTRIBUTIONS OF CARS, BOATS, AIRPLANES OR OTHER VEHICLES DURING THE YEAR.
FORM 990, PART VI, SECTION A, LINE 3DAILY MANAGEMENT DUTIES ARE HANDLED BY CHESAPEAKE HEALTH SERVICES.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS STOCKHOLDERS.
FORM 990, PART VI, SECTION B, LINE 11WHEN 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 12CALL 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 15THE 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 19ALL DOCUMENTS ARE AVAILABLE UPON REQUEST BY APPOINTMENT IN ADMINISTRATIONS, MONDAY THROUGH FRIDAY, DURING REGULAR BUSINESS HOURS.
FORM 990, PART XI, LINE 5:ROUNDING 2. TOTAL TO FORM 990, PART XI, LINE 5: 2.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CTHE 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 VIIJAMES 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
CHESAPEAKE HOSPITAL CORPORATION
PO BOX 1449KILMARNOCKVA22482237424835HOSPITALVA501(C)(3)3N/A0
CHESAPEAKE HEALTH SERVICES INC
PO BOX 1449KILMARNOCKVA22482541513371MANAGEMENT SERVICESVA501(C)(3)11N/A0
RAPPAHANNOCK GENERAL HOSPITAL FOUNDATION
PO BOX 1449KILMARNOCKVA22482541210450FUNDRAISINGVA501(C)(3)11N/A0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CHESAPEAKE HOSPITAL CORPORATION
K187319CASH
CHESAPEAKE HEALTH SERVICES
L117416CASH
CHESAPEAKE HOSPITAL CORPORATION
E4065981CASH
CHESAPEAKE HEALTH SERVICES
E1895244CASH
CHESAPEAKE HEALTH SERVICES
J97056CASH