CLARKSVILLE SENIOR CARE LLC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CLARKSVILLE SENIOR CARE LLC (EIN 54-1957066)
- Tax period
- 2011-09-01 to 2012-08-31
- Filed
- 2013-07-12
- IRS object ID
- 201301939349300325
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-07-12T10:35:11-05:00 | Timestamp |
| Tax Period End Date | 2012-08-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1676 International Drive | AddressLine1 |
| City | McLean | City |
| State | VA | State |
| ZIP Code | 22102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-09-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 541957066 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARKSVILLE SENIOR CARE LLC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % STEWART R NELSON | InCareOfName |
| Name Control | CLAR | NameControl |
| Phone | 4345173183 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2204 WILBORN AVENUE | AddressLine1 |
| City | SOUTH BOSTON | City |
| State | VA | State |
| ZIP Code | 24592 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEWART NELSON | Name |
| Title | CFO | Title |
| Date Signed | 2013-07-11 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7032868000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHRIS A LUMSDEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2204 WILBORN AVENUE | AddressLine1 |
| City | SOUTH BOSTON | City |
| State | VA | State |
| ZIP Code | 24592 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9688820 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MEADOWVIEWTERRACE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | VA | StateLegalDomicile |
| Activity Or Mission Description | THE PURPOSE OF CLARKSVILLE SENIOR CARE, LLC IS TO PROVIDE THE HIGHEST QUALITY OF CARE TO THOSE INDIVIDUALS REQUIRING LONG-TERM CARE SERVICES, RESULTING IN THE HIGHEST ACHIEVABLE QUALITY OF LIFE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 203 | TotalNbrEmployees |
| Total Nbr Volunteers | 85 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1433300 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 50014 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8993105 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9512641 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 10108 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8572 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 20417 | OtherRevenuePriorYear |
| Other Revenue Current Year | 39894 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10456930 | TotalRevenuePriorYear |
| Total Revenue Current Year | 9611121 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 750000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5021787 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5806203 | 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 | 3383516 | OtherExpensePriorYear |
| Other Expenses Current Year | 3215751 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 8405303 | TotalExpensesPriorYear |
| Total Expenses Current Year | 9771954 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2051627 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -160833 | RevenuesLessExpensesCY |
| Total Assets BOY | 10076786 | TotalAssetsBOY |
| Total Assets EOY | 9706215 | TotalAssetsEOY |
| Total Liabilities BOY | 5911625 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5804527 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4165161 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3901688 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | CLARKSVILLE SENIOR CARE, LLC IS ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF HALIFAX REGIONAL HOSPITAL, INC. FOR MORE INFORMATION, SEE SCHEDULE O. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 8659654 | Expense |
| Grants | 750000 | Grants |
| Revenue | 9512641 | Revenue |
| Description | THIS ORGANIZATION, DOING BUSINESS AS MEADOWVIEW TERRACE OPERATES A 150-BED, DUALLY CERTIFIED (MEDICAID AND MEDICARE) NURSING FACILITY, WHICH INCLUDES 42 BEDS FOR ALZHEIMER'S SPECIAL CARE RESIDENTS IN TWO DISTINCT HOUSEHOLD/NEIGHBORHOODS. MEADOWVIEW TERRACE IS LOCATED IN MECKLENBURG COUNTY IN CLARKSVILLE, VIRGINIA. THE NURSING FACILITY PROVIDES PERSONAL CARE, HEALTH CARE SERVICES AND REHABILITATION SERVICES FOR PERSONS NEEDING LONG TERM CARE AND WHOSE SPECIAL NEEDS CANNOT BE MET IN INDEPENDENT LIVING ENVIRONMENTS. FOR MORE INFORMATION, SEE SCHEDULE O. | Description |
| Total Program Service Expense | 8659654 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | true | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 36 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 203 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | false | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | STEWART R NELSON | NamePerson |
| Telephone Number | 4345173183 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2204 WILBORN AVENUE | AddressLine1 |
| City | SOUTH BOSTON | City |
| State | VA | State |
| ZIP Code | 24592 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (10 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DAVID H WHITE JR | ||||||||
| CHAIRMAN | 1.0 | X | X | 0 | 0 | 0 | ||
| J AUBREY HOUGHTON | ||||||||
| TREASURER | 1.0 | X | X | 0 | 0 | 0 | ||
| CAROL C THOMAS | ||||||||
| VICE CHAIRMAN | 1.0 | X | X | 0 | 0 | 0 | ||
| HABIB BASSIL MD | ||||||||
| SECRETARY | 1.0 | X | X | 0 | 59600 | 0 | ||
| JAMES PRIEST DDS | ||||||||
| BOARD MEMBER (BEGINNING 11/11) | 1.0 | X | 0 | 0 | 0 | |||
| JAMES WITKO MD | ||||||||
| BOARD MEMBER (THROUGH 11/11) | 1.0 | X | 0 | 10365 | 0 | |||
| CHRIS A LUMSDEN | ||||||||
| CHIEF EXECUTIVE OFFICER | 2.0 | X | 7568 | 409349 | 39911 | |||
| STEWART R NELSON | ||||||||
| CHIEF FINANCIAL OFFICER | 2.0 | X | 5074 | 269076 | 27595 | |||
| THOMAS S KLUGE | ||||||||
| CHIEF OPERATING OFFICER | 2.0 | 4187 | 226095 | 42802 | X | |||
| JILL ALLEN | ||||||||
| MEDICAL DIRECTOR | 40.0 | 164069 | 0 | 22643 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 180898 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 974485 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 132951 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | FUNCTIONAL PATHWAYS | NamePerson |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 317 EBENEZER ROAD SUITE 7 | AddressLine1 |
| City | KNOXVILLE | City |
| State | TN | State |
| ZIP Code | 37923 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | PATIENT CARE SERVICE | DescriptionOfServices |
| Compensation | 513446 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 46688 | GovernmentGrants |
| All Other Contributions | 3326 | AllOtherContributions |
| Total Contributions | 50014 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 623000 | 9479947 | 9479947 |
| BARBER AND BEAUTY SHOP REVENUE | 812900 | 32694 | 32694 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9512641 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8329 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $8,329 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 77942 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 77699 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 243 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 243 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $243 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFE AND VENDING | 722210 | 11333 | $11,333 |
| MISCELLANEOUS | 900099 | 3561 | $3,561 |
| INSURANCE PROCEEDS | 900099 | 25000 | $25,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 39894 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9611121 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9512641 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $48,466 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 750000 | Total |
| Program Services | 750000 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21618 | Total |
| Management And General | 21618 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4390834 | Total |
| Program Services | 3847976 | ProgramServices |
| Management And General | 542858 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 121332 | Total |
| Program Services | 105814 | ProgramServices |
| Management And General | 15518 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 948847 | Total |
| Program Services | 831000 | ProgramServices |
| Management And General | 117847 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 323572 | Total |
| Program Services | 282178 | ProgramServices |
| Management And General | 41394 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5346 | Total |
| Management And General | 5346 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19991 | Total |
| Management And General | 19991 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 761 | Total |
| Management And General | 761 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 877648 | Total |
| Program Services | 820678 | ProgramServices |
| Management And General | 56970 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 556167 | Total |
| Program Services | 501579 | ProgramServices |
| Management And General | 54588 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 267169 | Total |
| Program Services | 267169 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4750 | Total |
| Program Services | 1041 | ProgramServices |
| Management And General | 3709 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 146092 | Total |
| Program Services | 146092 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 632897 | Total |
| Program Services | 632897 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111905 | Total |
| Management And General | 111905 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| FOOD STOCK | 306800 | 306800 | ||
| BAD DEBT | 36742 | 36742 | ||
| EQUIPMENT RENTAL & MAINTENANCE | 95257 | 91556 | 3701 | 0 |
| EDUCATION | 17368 | 17368 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 136858 | Total |
| Program Services | 20764 | ProgramServices |
| Management And General | 116094 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9771954 | Total |
| Program Services | 8659654 | ProgramServices |
| Management And General | 1112300 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1212685 | BOY |
| EOY | 1708214 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 626282 | BOY |
| EOY | 115271 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 811725 | BOY |
| EOY | 776079 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42108 | BOY |
| EOY | 35370 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80055 | BOY |
| EOY | 126956 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 12257653 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5764303 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6892160 | BOY |
| EOY | 6493350 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 278135 | BOY |
| EOY | 294031 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 133636 | BOY |
| EOY | 156944 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10076786 | BOY |
| EOY | 9706215 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 872380 | BOY |
| EOY | 854629 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 807557 | BOY |
| EOY | 760869 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3716148 | BOY |
| EOY | 3506926 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38339 | BOY |
| EOY | 81144 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1456 | BOY |
| EOY | 1457 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 475745 | BOY |
| EOY | 599502 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5911625 | BOY |
| EOY | 5804527 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4165161 | BOY |
| EOY | 3901688 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4165161 | BOY |
| EOY | 3901688 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10076786 | BOY |
| EOY | 9706215 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -160833 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -102640 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL HOSPITAL INCORPORATED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 540648699 | EIN |
| Type Of Organization | 03 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Amount | $9,021,954 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 9021954 | SumOfAmounts |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $926 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 926 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER LOBBYING ACTIVITIES | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE I | ReturnReference |
| Explanation | A PORTION OF DUES PAID TO THE VIRGINIA HEALTH CARE ASSOCIATION IS ATTRIBUTABLE TO LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | true | IncludedOnFS |
| Current Year Minus3 Years | CurrentYearMinus3Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 400146 | OtherCostOrOtherBasis |
| Book Value | 400146 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8972967 | OtherCostOrOtherBasis |
| Depreciation | 4078829 | Depreciation |
| Book Value | 4894138 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1991404 | OtherCostOrOtherBasis |
| Depreciation | 1221482 | Depreciation |
| Book Value | 769922 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 893136 | OtherCostOrOtherBasis |
| Depreciation | 463992 | Depreciation |
| Book Value | 429144 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 6493350 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (5 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO THIRD PARTY PROGRAMS | $171,652 |
| DUE TO HALIFAX REGIONAL HOSPIT | $195,359 |
| PATIENT SECURITY DEPOSITS | $115,271 |
| ACCRUED PENSION OBLIGATION | $30,478 |
| OTHER LONG-TERM LIABILITIES | $86,742 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 599502 | TotalOfAmounts |
| Total Revenue | 9611121 | TotalRevenue |
| Total Expenses | 9771954 | TotalExpenses |
| Excess Or Deficit For Year | -160833 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 5427 | NetUnrealizedGLOnInvestments |
| Other | -$108,067 | OtherAmount |
| Total Adjustments | -102640 | TotalAdjustments |
| Excess Or Deficit Per FS | -263473 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 9507720 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 5427 | NetUnrealizedGainsInvestments |
| Other Revenues | -108067 | OtherRevenues |
| Revenue Not Rptd F990 | -102640 | RevenueNotRptdF990 |
| Revenue Subtotal | 9610360 | RevenueSubtotal |
| Investment Expenses Not Included | 761 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 761 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 9611121 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 9771193 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 9771193 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 761 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 761 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 9771954 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PATIENT ACCOUNTS | SCHEDULE D, PART IV, LINE 2B | THE ORGANIZATION SERVES AS CUSTODIAN OVER PATIENT ACCOUNTS, AND THESE AMOUNTS HAVE BEEN INCLUDED ON THE AUDITED FINANCIAL STATEMENTS AS A LIABILITY. FIN 48 FINANCIAL STATEMENT FOOTNOTE SCHEDULE D, PART X THE COMPANY IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS AMENDED. THE COMPANY DOES NOT BELIEVE ITS FINANCIAL STATEMENTS INCLUDE (OR REFLECT) ANY UNCERTAIN TAX POSITIONS. |
| RECONCILIATION OF CHANGE IN NET ASSETS AND REVENUE | SCHEDULE D, PART XI, LINE 8 AND PART XII, LINE 2D | OTHER CHANGES IN PENSION LIABILITY..................$ (108,067) |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HALIFAX REGIONAL LONG TERM CARE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2204 WILBORN AVENUE | AddressLine1 |
| City | SOUTH BOSTON | City |
| State | VA | State |
| ZIP Code | 24558 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 546074529 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 750000 | AmountOfCashGrant |
| Purpose Of Grant | TO FUND OPERATING EXPENSES | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | MONITORING THE USE OF GRANT FUNDS | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | GRANTS FROM CLARKSVILLE SENIOR CENTER, LLC ARE ONLY MADE TO AFFILIATES WHOSE FINANCIAL RECORDS ARE MAINTAINED BY HALIFAX REGIONAL HEALTH SYSTEM. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHRIS A LUMSDEN | |||||||||||||
| 7568 | 336494 | 0 | 30000 | 0 | 42855 | 1204 | 30596 | 307 | 7804 | 9079 | 447749 | 0 | 0 |
| STEWART R NELSON | |||||||||||||
| 5074 | 225735 | 0 | 20000 | 0 | 23341 | 975 | 24785 | 69 | 1766 | 6118 | 295627 | 0 | 0 |
| JILL ALLEN | |||||||||||||
| 164069 | 0 | 0 | 0 | 0 | 0 | 22643 | 0 | 0 | 0 | 186712 | 0 | 0 | 0 |
| THOMAS S KLUGE | |||||||||||||
| 4187 | 192754 | 0 | 10000 | 0 | 23341 | 932 | 23698 | 688 | 17484 | 5807 | 267277 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXECUTIVE COMPENSATION DETERMINATION | Identifier |
| Return Reference | SCHEDULE J, PART I, LINE 3 | ReturnReference |
| Explanation | THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE METHODS LISTED ON LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDUSTRIAL DEVAUTHORITY-TOWN OF CLARKSVILLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 546001219 | IssuerEIN |
| Date Issued | 2010-04-01 | DateIssued |
| Issue Price | 4000000 | IssuePrice |
| Description Of Purpose | FUNDING OF CONSTRUCTION | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 0 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 4000000 | TotalProceeds |
| Amount In Reserve Fund | 0 | AmountInReserveFund |
| Capitalized Interest | 0 | CapitalizedInterest |
| Refunding Escrow | 4000000 | RefundingEscrow |
| Issuance Costs From Proceeds | 0 | IssuanceCostsFromProceeds |
| Credit Enhancement | 0 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 0 | CapitalExpenditures |
| Other Spent Proceeds | 0 | OtherSpentProceeds |
| Amount Unspent | 0 | AmountUnspent |
| Year Of Subst Completion | 2011 | YearOfSubstCompletion |
| Current Refunding | true | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | false | FinalAllocationMade |
| Adequate Books And Recds Maintaind | false | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | false | Form8038TFiled |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
Name Of GIC Provider NameOfGICProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | false | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (20 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANZATION MISSION | PART III, LINE 1 | CLARKSVILLE SENIOR CARE, LLC IS ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF HALIFAX REGIONAL HOSPITAL, INC. THE FUNCTIONS TO BE PERFORMED ARE TO PROVIDE EXTENDED CARE, OUTPATIENT CARE, HOME CARE, ASSISTED LIVING CARE, SENIOR LIVING COMMUNITY OR HOME FOR THE AGED, AND RELATED MEDICAL SERVICES FOR HALIFAX REGIONAL LONG TERM CARE, INC. IN SUPPORT OF HALIFAX REGIONAL HOSPITAL, INC., AND TO CARRY OUT OTHER EXCLUSIVELY CHARITABLE, EDUCATIONAL, OR SCIENTIFIC PURPOSES OF HALIFAX REGIONAL HOSPITAL, INC. |
| PROGRAM SERVICE ACCOMPLISHMENT | PART III, LINE 4A | THIS ORGANIZATION, DOING BUSINESS AS MEADOWVIEW TERRACE OPERATES A 150-BED, DUALLY CERTIFIED (MEDICAID AND MEDICARE) NURSING FACILITY, WHICH INCLUDES 42 BEDS FOR ALZHEIMER'S SPECIAL CARE RESIDENTS IN TWO DISTINCT HOUSEHOLD/NEIGHBORHOODS. MEADOWVIEW TERRACE IS LOCATED IN MECKLENBURG COUNTY IN CLARKSVILLE, VIRGINIA. THE NURSING FACILITY PROVIDES PERSONAL CARE, HEALTH CARE SERVICES AND REHABILITATION SERVICES FOR PERSONS NEEDING LONG TERM CARE AND WHOSE SPECIAL NEEDS CANNOT BE MET IN INDEPENDENT LIVING ENVIRONMENTS. IN FY12 61.2 PERCENT OF THE FACILITY'S REVENUES WERE REIMBURSABLE UNDER THE MEDICAID PROGRAM AND 15.7 PERCENT WERE REIMBURSABLE UNDER MEDICARE. MEADOWVIEW TERRACE UTILIZES EXCESS REVENUE OVER EXPENSES TO UPGRADE FACILITIES, TO PURCHASE NEW EQUIPMENT AND TO UPGRADE CLINICAL AND INFORMATION TECHNOLOGY IN ORDER TO IMPROVE QUALITY AND RESIDENT SAFETY. MEADOWVIEW TERRACE WORKS IN CONJUNCTION WITH HALIFAX REGIONAL HOSPITAL TO PROVIDE HEALTH INFORMATION TO THE COMMUNITY. WITH THE HIGH PREVALENCE OF ALZHEIMER'S DISEASE (5.3 MILLION AMERICANS) AND WITH A LARGE PERCENT OF NURSING HOME RESIDENTS HAVING ALZHEIMER'S DISEASE OR A RELATED DEMENTIA, MEADOWVIEW TERRACE DEVOTES RESOURCES TO ACTIVITIES THAT WILL HELP RAISE AWARENESS OF ALZHEIMER'S DISEASE AND THAT WILL HELP THOSE AFFECTED BY THE DISEASE TO LEARN AND UNDERSTAND MORE ABOUT IT. IN ADDITION, MEADOWVIEW TERRACE HELPS TO SUPPORT COMMUNITY ACTIVITIES BY PROVIDING STAFF EXPERTISE AND RESOURCES FOR A NUMBER OF ORGANIZATIONS. COMMUNITY HEALTH IMPROVEMENT SERVICES & EDUCATION *ADVANCE DIRECTIVE DAY IN APRIL 2012, MEADOWVIEW TERRACE PARTICIPATED IN THE VIRGINIA ADVANCE DIRECTIVE DAY BY PROVIDING INFORMATION ON ADVANCE DIRECTIVES IN THE FACILITY'S LIBRARY WITH STAFF AVAILABLE TO ANSWER QUESTIONS. *HEALTHY LIVING EXPO AGAIN THIS YEAR, MEADOWVIEW TERRACE PARTICIPATED IN HALIFAX REGIONAL HEALTH SYSTEM'S HEALTHY LIVING EXPO, AN ANNUAL COMMUNITY HEALTH FAIR THAT PROVIDES A MYRIAD OF FREE HEALTH SCREENINGS AND HEALTH AND WELLNESS EDUCATIONAL ACTIVITIES AND INFORMATION TO THE PUBLIC. IN ADDITION TO ASSISTING WITH PLANNING FOR THIS EVENT, MEADOWVIEW TERRACE PROVIDED LONG TERM CARE INFORMATION, NUTRITION COUNSELING AND INFORMATION RELATED TO EXERCISE FOR THE ELDERLY. MORE THAN 500 INDIVIDUALS WERE REACHED THROUGH THIS COMMUNITY HEALTH EVENT. *TOWN MEETINGS & NATIONAL CELEBRATIONS/OBSERVANCES FOR PUBLIC MEADOWVIEW TERRACE PERIODICALLY HOSTS FREE FAMILY NIGHT PROGRAMS WHICH ARE OPEN TO AND PROMOTED TO THE PUBLIC. THESE MEETINGS ARE PROGRAMS OF INTEREST TO THE GENERAL PUBLIC AND FEATURE AN INVITED SPEAKER. IN FY12 FAMILY NIGHTS FOCUSED ON BEHAVIOR MANAGEMENT (SEPTEMBER 2011) AND SKILLED SERVICES (JANUARY 2012.) *DIABETES EDUCATION THE DIETITIAN AT MEADOWVIEW TERRACE WORKED IN CONJUNCTION WITH HALIFAX REGIONAL HOSPITAL STAFF TO TEACH DIABETES EDUCATION CLASSES THROUGHOUT THE YEAR. THESE CLASSES ARE FREE OF CHARGE AND OFFERED MONTHLY. *WEIGHT WATCHERS SUPPORT GROUP WEIGHT WATCHERS MEETS WEEKLY AT MEADOWVIEW TERRACE TO WEIGH IN AND FOR EDUCATIONAL MEETINGS COVERING NUTRITION, FOOD BUYING AND PREPARATIONS, ETC. FINANCIAL AND IN-KIND CONTRIBUTIONS *FOOD DRIVES IN FY12 MEADOWVIEW TERRACE COORDINATED A FOOD DRIVE AND COLLECTED 300 POUNDS OF CANS AND BOXES OF NON-PERISHABLE FOOD WHICH WERE DONATED TO THE CLARKSVILLE FOOD PANTRY DURING THEIR ANNUAL FOOD DRIVE TO HELP PUT FOOD ON THE TABLES OF THOSE HAVING DIFFICULTY PROVIDING FOR THEIR FAMILIES. *ALZHEIMER'S ASSOCIATION THE MEADOWVIEW TERRACE STAFF AND VOLUNTEERS ORGANIZE, COORDINATE, ADVERTISE AND HOST FUNDRAISING EVENTS TO SUPPORT THE WORK OF THE SOUTHEASTERN VIRGINIA CHAPTER OF THE ALZHEIMER'S ASSOCIATION. THE MONEY RAISED IS USED LOCALLY TO SUPPORT ALZHEIMER'S RELATED PROGRAMS INCLUDING FAMILY ORIENTATIONS, THE 24-HOUR HELPLINE, EDUCATIONAL SEMINARS AND TRAINING SESSIONS FOR BOTH FAMILY AND PROFESSIONAL CAREGIVERS, THE SAFE RETURN PROGRAM, LOCAL SUPPORT GROUPS AND THE SPEAKER'S BUREAU, ALL OF WHICH ASSIST INDIVIDUALS AND FAMILIES AFFECTED BY THE DISEASE. NEARLY $5200 WAS COLLECTED FROM THE FUND-RAISING EFFORTS THROUGHOUT THE YEAR AND DONATED TO THE ASSOCIATION. *OTHER IN-KIND CONTRIBUTIONS MEADOWVIEW TERRACE HELD BAKE SALES TO RAISE MONEY FOR THE MECKLENBURG COUNTY DEPARTMENT OF SOCIAL SERVICES CHRISTMAS PROGRAM, (GIFTS FOR NEEDY CHILDREN). IN ADDITION, OVER 150 POUNDS OF DOG AND CAT FOOD WAS COLLECTED AND DONATED TO THE CLARKSVILLE SPCA. THE FACILITY ALSO COLLECTED NEWSPAPERS TO DONATE TO THE SPCA. IN FY12 MEADOWVIEW TERRACE SPONSORED THE BACKPACK BUDDIES PROGRAM AT CLARKSVILLE ELEMENTARY SCHOOL, PROVIDING STUDENTS WITH SCHOOL SUPPLIES. SPONSORSHIP CONTINUED THROUGHOUT THE YEAR WITH STAFF PROVIDING PARTIES AND GIFTS FOR A THIRD GRADE CLASS. FACILITY USE MEADOWVIEW TERRACE PROVIDES FREE SPACE AND AVAILABLE EQUIPMENT FOR AREA WELLNESS PROGRAMS, COMMUNITY MEETINGS, SUPPORT GROUPS AND CLINICAL TRAINING PROGRAMS. FREE SPACE IS PROVIDED FOR VARIOUS COMMUNITY GROUPS TO MEET INCLUDING THE GIDEONS WHO HOLD THEIR ANNUAL BANQUET AT MEADOWVIEW TERRACE, AND SPACE IS PROVIDED AT NO CHARGE FOR BELTONE HEARING CLINICS WHICH ARE OPEN TO THE PUBLIC |
| PROGRAM SERVICE ACCOMPLISHMENT | PART III, LINE 4A CONTINUED | *MEADOWVIEW TERRACE SERVES AS A CLINICAL SITE FOR: -BLUESTONE HIGH SCHOOL, NURSING ASSISTANT STUDENTS (APPROXIMATELY 20 STUDENTS PER SEMESTER) -BLUESTONE HIGH SCHOOL SPECIAL EDUCATION STUDENTS (FIVE EACH SEMESTER) -SOUTHSIDE VIRGINIA COMMUNITY COLLEGE, SVCC, NURSING ASSISTANT STUDENTS AT ESTES CENTER (APPROXIMATELY 60 STUDENTS) -SVCC, ESTES CENTER (APPROXIMATELY 20 LPN STUDENTS) -SOUTHERN VIRGINIA HIGHER EDUCATION CENTER RN STUDENTS (APPROXIMATELY 20 PER SEMESTER) COMMUNITY BUILDING MEADOWVIEW TERRACE TAKES PRIDE IN BEING A CONTRIBUTING MEMBER OF THE CLARKSVILLE AND MECKLENBURG COUNTY COMMUNITY AND AS SUCH REACHES OUT INTO THE COMMUNITY IN A VARIETY OF WAYS. *INTERGENERATIONAL PROGRAMS EACH YEAR, MEADOWVIEW TERRACE PLANS, COORDINATES AND HOSTS A COMMUNITY "SAFE TRICK OR TREAT" AT THE FACILITY ON HALLOWEEN. THIS EVENT PROVIDES A SAFE HAVEN FOR CHILDREN TO TRICK OR TREAT, GOING FROM NEIGHBORHOOD TO NEIGHBORHOOD IN THE FACILITY AND INCLUDES REFRESHMENTS FOR ALL PARTICIPANTS. THE FACILITY ALSO PLANS, COORDINATES AND HOSTS A BREAKFAST WITH SANTA AND AN EASTER EGG HUNT EACH YEAR FOR THE CHILDREN OF STAFF, AND RESIDENTS' GRANDCHILDREN, COMPLETE WITH REFRESHMENTS AND PRIZES FOR ALL. THE BOY SCOUT, GIRL SCOUT AND CUB SCOUT TROOPS CONTINUE TO VISIT AND INTERACT WITH RESIDENTS AS PART OF THEIR BADGE PROGRAM. PEOPLE OF ALL AGES FROM VARIOUS COMMUNITY GROUPS, CLUBS, CHURCHES AND SCHOOLS SHARE THEIR TALENTS WITH RESIDENTS, STAFF MEMBERS AND FAMILIES THROUGHOUT THE YEAR. *COMMUNITY INVOLVEMENT EMPLOYEES PARTICIPATE IN AND SHARE THEIR TALENTS AND EXPERTISE AS MEMBERS OF VARIOUS CIVIC AND RELIGIOUS ORGANIZATIONS IN THEIR RESPECTIVE COMMUNITIES. THEY PARTICIPATE IN THE CHAMBER OF COMMERCE, IN THE RURITAN CLUB AND THE AARP, AND THEY SERVE ON ADVISORY BOARDS SUCH AS THE VIRGINIA EMPLOYMENT COMMISSION, SOUTHSIDE VIRGINIA COMMUNITY COLLEGE AND OTHER COMMITTEES AND BOARDS INCLUDING THE MECKLENBURG COUNTY BUSINESS EDUCATION PARTNERSHIP. THIS YEAR THEY PARTICIPATED IN A SPELLING BEE TO RAISE MONEY FOR SCHOLARSHIPS. IN FY12 THE FACILITY PARTICIPATED IN THE DOWNTOWN CLARKSVILLE VETERANS PROGRAM, THE JULY 4TH PARADE AND THE CHRISTMAS PARADE IN BOTH CLARKSVILLE AND CHASE CITY. OTHER *VOLUNTEER SERVICES PROGRAM MORE THAN 100 VOLUNTEERS FROM THE COMMUNITY, BOTH INDIVIDUALS AND GROUPS, HAVE DONATED OVER 5,000 HOURS AT MEADOWVIEW TERRACE DURING FY12, PROVIDING COMPANIONSHIP, RECREATION AND SPIRITUAL ACTIVITIES FOR RESIDENTS. VOLUNTEERS COORDINATE BINGO GAMES, CRAFT ACTIVITIES, CHAPEL SERVICES, BIRTHDAY OBSERVANCES AND HOLIDAY CELEBRATIONS. THEY ALSO ACCOMPANY RESIDENTS ON PICNICS AND OUT-OF-RESIDENCE ACTIVITIES, INCLUDING BUS TRIPS TO COUNTY FAIRS, LAKEFEST, PARADES, BOYDTON DAY AND OTHER COMMUNITY EVENTS/FESTIVALS. THE VOLUNTEERS ASSIST WITH THE ANNUAL HALLOWEEN "SAFE TRICK-OR-TREAT NIGHT," "BREAKFAST WITH SANTA," EASTER EGG HUNTS AND COOKOUTS FOR RESIDENTS AND FAMILIES AND PROVIDE ONE ON ONE FRIENDLY VISITS TO RESIDENTS. MEADOWVIEW'S VOLUNTEERS ALSO ORGANIZE AND IMPLEMENT THE FACILITY'S FUNDRAISING EVENTS. *HEALTHY DIRECTIONS EMPLOYEE PROGRAMS A VARIETY OF WELLNESS PROGRAMS ARE HELD ON A MONTHLY BASIS TO HELP EMPLOYEES AND THEIR FAMILY MEMBERS WITH WEIGHT LOSS, EXERCISE, AND NUTRITION TO LOWER BMI, CHOLESTEROL, GLUCOSE, BLOOD PRESSURE AND RISKS FOR HEART ATTACK, STROKE AND OTHER COMPLICATIONS OF CARDIOVASCULAR DISEASE. BY LOOKING BETTER AND FEELING BETTER, EMPLOYEES "SHOW" THE COMMUNITY THAT GOOD HEALTH IS ACHIEVABLE AND SET A GOOD EXAMPLE FOR THE HEALTHCARE ROLE THE ORGANIZATION PLAYS IN THE COMMUNITY. *SPECIAL OBSERVANCES IN ADDITION, RESIDENTS, FAMILY MEMBERS AND VISITORS HAD THE OPPORTUNITY TO PARTICIPATE IN A BLACK HISTORY CELEBRATION, AND CELEBRATIONS FOR VETERAN'S DAY, MOTHER'S DAY, FATHER'S DAY AND OTHER SPECIAL OBSERVANCES. |
| FAMILY AND BUSINESS RELATIONSHIPS | PART VI, LINE 2 | DAVID WHITE AND CHRIS LUMSDEN HAVE A BUSINESS RELATIONSHIP. |
| MEMBERS | PART VI, LINE 6 | PER THE ORGANIZATION'S OPERATING AGREEMENT, ARTICLE II, THE ORGANIZATION HAS A SOLE MEMBER, HALIFAX REGIONAL HEALTH SYSTEM, INC. ARTICLE X, SECTION 10.5, NOTES THAT, "IN THE EVENT OF THE DISSOLUTION OF THE LLC, THE ASSETS OF THE LLC SHALL BE DISTRIBUTED TO THE MEMBER IF THE MEMBER IS THEN AN ORGANIZATION DESCRIBED IN SECTION 501 (C)(3) OF THE CODE." |
| FORM 990 REVIEW | PART VI, LINE 11B | THE RETURN IS PREPARED BY ORGANIZATION'S INDEPENDENT ACCOUNTING FIRM, BASED ON INFORMATION PROVIDED BY ORGANIZATION AND IN CONSULTATION WITH ORGANIZATION STAFF. THE DRAFT PREPARED BY THE ACCOUNTING FIRM IS THEN CAREFULLY REVIEWED BY ORGANIZATION MANAGEMENT AND STAFF. CHANGES ARE MADE AS APPROPRIATE. THE FINAL VERSION IS MADE AVAILABLE TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS. |
| CONFLICT OF INTEREST POLICY | PART VI, LINE 12C | ALL MEMBERS OF THE BOARD ARE ALSO MEMBERS OF THE BOARD OF DIRECTORS OF HALIFAX REGIONAL HEALTH SYSTEM. THE CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO EACH MEMBER OF THE HALIFAX REGIONAL HEALTH SYSTEM BOARD IN JANUARY EVERY YEAR. THE QUESTIONNAIRE MUST BE COMPLETED BY ALL MEMBERS. A REPORT OF THE DISCLOSED POTENTIAL CONFLICTS IS PRESENTED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS TO THE BOARD IN EXECUTIVE SESSION ANNUALLY. IF IT IS DETERMINED BY THE BOARD SECRETARY, BOARD PRESIDENT, AND MEDICAL STAFF PRESIDENT THAT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE CIRCUMSTANCES OF THE CONFLICT OF INTEREST SHALL BE SET FORTH IN DETAIL BY THE AFFECTED PARTY. SUBSEQUENTLY, WHEN A RESOLUTION CANNOT BE FOUND TO THE SATISFACTION OF THE BOARD SECRETARY, BOARD PRESIDENT, AND MEDICAL STAFF PRESIDENT, THE MATTER WILL BE REVIEWED AND ADDRESSED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. A RECOMMENDATION WILL BE MADE TO THE AFFECTED PARTY ON HOW TO REMOVE THE CONFLICT. IF THE CONFLICT CANNOT BE RESOLVED TO THE SATISFACTION OF THE EXECUTIVE COMMITTEE, A RECOMMENDATION WILL BE MADE TO REMOVE THE AFFECTED BOARD MEMBER FROM THE BOARD OF DIRECTORS. IN SUCH CASE WHERE REMOVAL IS RECOMMENDED, PROVISIONS OF 4.6 OF THE CORPORATE BYLAWS WILL BE FOLLOWED. THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE ARE RETAINED BY THE SECRETARY TO THE BOARD OF DIRECTORS. |
| DOCUMENT RETENTION & DESTRUCTION POLICY | PART VI, LINE 14 | A DOCUMENT RETENTION & DESTRUCTION POLICY HAS BEEN IN PLACE AND FUNCTIONAL SINCE OCTOBER 21, 1999. THE BOARD OF DIRECTORS FORMALLY APPROVED THE POLICY IN MAY 2012. |
| OFFICER COMPENSATION REVIEW | PART VI, LINES 15 A/B | HALIFAX REGIONAL HEALTH SYSTEM SEEKS TO PAY REASONABLE COMPENSATION UNDER SECTION 4958 TO ATTRACT AND RETAIN THE APPROPRIATE CALIBER OF EMPLOYEES DEDICATED TO CARRYING OUT THE EXEMPT MISSION. LIKEWISE, CLARKSVILLE SENIOR CARE, LLC. SEEKS TO PAY REASONABLE COMPENSATION UNDER SECTION 4958 TO ATTRACT AND RETAIN THE APPROPRIATE CALIBER OF EMPLOYEES DEDICATED TO CARRYING OUT THE EXEMPT MISSION. ORGANIZATION PERIODICALLY CONDUCTS A REVIEW TO DETERMINE THE GOING FAIR MARKET COMPENSATION RANGES FOR COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. ORGANIZATION SETS COMPENSATION WITHIN THE RANGE OF THE GOING MARKET RATE. NO INDIVIDUAL HAVING A CONFLICT OF INTEREST UNDER THE ORGANIZATIONS' CONFLICT OF INTEREST POLICY IS PERMITTED TO PARTICIPATE IN THE REVIEW OR DECISION. ORGANIZATION MAINTAINS RECORDS REGARDING COMPENSATION. THE CHAIRMAN OF THE BOARD OF DIRECTORS ALSO SERVES AS CHAIRMAN OF THE EXECUTIVE (COMPENSATION) COMMITTEE, COORDINATING WITH THE CHIEF EXECUTIVE OFFICER TO REVIEW ANNUAL PERFORMANCE AND COMPARATIVE MARKET INFORMATION FOR THE POSITION OF CHIEF EXECUTIVE OFFICER (CEO), CHIEF OPERATING OFFICER (COO), AND CHIEF FINANCIAL OFFICER (CFO). A RECOMMENDATION IS PRESENTED TO THE EXECUTIVE COMMITTEE BY THE CHAIRMAN. THE EXECUTIVE COMMITTEE TAKES ACTION ON THE RECOMMENDATION. THE FULL BOARD OF DIRECTORS IS MADE AWARE THAT THE EXECUTIVE COMMITTEE HAS TAKEN ACTION OF COMPENSATION FOR THE CEO, COO, AND CFO WITH DETAILS AVAILABLE FOR THEIR REVIEW UPON REQUEST. |
| DOCUMENT REVIEW POLICY | PART VI, LINE 19 | THE ORGANIZATION CURRENTLY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND CONSOLIDATED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| OTHER CHANGE IN NET ASSETS | PART XI, LINE 5 | UNREALIZED GAIN ON INVESTMENT ...................... $ 5,427 OTHER CHANGES IN PENSION LIABILITY ................. (108,067) ------------- $ (102,640) |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DAVID H WHITE JR TITLE:CHAIRMAN HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:J AUBREY HOUGHTON TITLE:TREASURER HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:CAROL C THOMAS TITLE:VICE CHAIRMAN HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:HABIB BASSIL MD TITLE:SECRETARY HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JAMES PRIEST DDS TITLE:BOARD MEMBER (BEGINNING 11/11) HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:JAMES WITKO MD TITLE:BOARD MEMBER (THROUGH 11/11) HOURS:5 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:CHRIS A LUMSDEN TITLE:CHIEF EXECUTIVE OFFICER HOURS:35 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:STEWART R NELSON TITLE:CHIEF FINANCIAL OFFICER HOURS:35 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:THOMAS S KLUGE TITLE:CHIEF OPERATING OFFICER HOURS:35 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| HALIFAX REGIONAL HOSPITAL INCORPORATED | ||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 540648699 | HEALTHCARE | VA | 501 (C) 3 | 3 | HRHS | true |
| HALIFAX REGIONAL DEVELOPMENT FOUNDATION | ||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541801459 | HLTH/WELFARE | VA | 502 (C) 3 | 11A TYPE I | HRHS | true |
| HALIFAX REGIONAL LONG TERM CARE INC | ||||||||||
| 103 ROSE HILL DRIVE | SOUTH BOSTON | VA | 24592 | 546074529 | SENIOR CARE | VA | 503 (C) 3 | 11A TYPE I | HRHS | true |
| HALIFAX REGIONAL PROPERTIES INC | ||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24558 | 541801463 | HLTH/WELFARE | VA | 504 (C) 3 | 11A TYPE I | HRHS | true |
| HALIFAX REGIONAL HEALTH SERVICES INC | ||||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24558 | 541801466 | HEALTHCARE | VA | 505 (C) 3 | 11B TYPE II | NA | false |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| SOUTHSIDE HEALTH SERVICES INC | ||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541417772 | HEALTH SERVICES | VA | NA | C Corp |
| DOMINION HEALTH MEDICAL ASSOCIATES LTD | ||||||||
| 2204 WILBORN AVENUE | SOUTH BOSTON | VA | 24592 | 541060357 | PHYS PRACTICE | VA | NA | C Corp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| HALIFAX REGIONAL LONG TERM CARE INC | ||
| B | 750000 | COST |
| HALIFAX REGIONAL HOSPITAL INC | ||
| N | 455621 | COST |
| HALIFAX REGIONAL HOSPITAL INC | ||
| O | 1333051 | COST |