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Chesapeake Hospital Corporation: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
Chesapeake Hospital Corporation (EIN 23-7424835)
Tax period
2010-04-01 to 2011-03-31
Filed
2012-03-01
IRS object ID
201210619349302466
Schema version
2010v3.4
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)
Timestamp2012-03-01T16:01:06-06:00Timestamp
Tax Period End Date2011-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1WITT MARES PLCBusinessNameLine1

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 Date2010-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237424835EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHESAPEAKE HOSPITAL CORPORATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHESNameControl
Phone8044358582Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1449AddressLine1
CityKILMARNOCKCity
StateVAState
ZIP Code22482ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJAMES M HOLMESName
TitlePRESIDENTTitle
Phone8044358582Phone
Date Signed2012-03-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameTHOMAS R BROOKSName
Phone7578731587Phone
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1RAPPAHANOCK GENERAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonJAMES M HOLMES JRNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 1449AddressLine1
CityKILMARNOCKCity
StateVAState
ZIP Code22482ZIPCode
FieldValueIRS element (for citing)
Gross Receipts34190251GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.RGH-HOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1977YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION OPERATES AN ACUTE CARE GENERAL HOSPITAL.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees411TotalNbrEmployees
Total Nbr Volunteers122TotalNbrVolunteers
Total Gross UBI-932TotalGrossUBI
Net Unrelated Business Txbl Income-1783NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year521551ContributionsGrantsPriorYear
Contributions Grants Current Year409433ContributionsGrantsCurrentYear
Program Service Revenue Prior Year35664123ProgramServiceRevenuePriorYear
Program Service Revenue CY33659241ProgramServiceRevenueCY
Investment Income Prior Year25326InvestmentIncomePriorYear
Investment Income Current Year18925InvestmentIncomeCurrentYear
Other Revenue Prior Year-35697OtherRevenuePriorYear
Other Revenue Current Year-81300OtherRevenueCurrentYear
Total Revenue Prior Year36175303TotalRevenuePriorYear
Total Revenue Current Year34006299TotalRevenueCurrentYear
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 Year18090632SalariesEtcPriorYear
Salaries Etc Current Year17806850SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year22956TotalFundrsngExpCurrentYear
Other Expense Prior Year17607577OtherExpensePriorYear
Other Expenses Current Year17638111OtherExpensesCurrentYear
Total Expenses Prior Year35698209TotalExpensesPriorYear
Total Expenses Current Year35444961TotalExpensesCurrentYear
Revenues Less Expenses Prior Year477094RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1438662RevenuesLessExpensesCY
Total Assets BOY26378535TotalAssetsBOY
Total Assets EOY25781129TotalAssetsEOY
Total Liabilities BOY9878939TotalLiabilitiesBOY
Total Liabilities EOY10668341TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY16499596NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY15112788NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE ORGANIZATION OPERATES AN ACUTE CARE GENERAL HOSPITAL. THE HOSPITAL HAS A COMMUNITY BASED BOARD OF DIRECTORS, HAS A OPEN MEDICAL STAFF, OPERATES AN EMERGENCY ROOM PROVIDING CARE TO ALL REGARDLESS OF ABILITY TO PAY, AND PROVIDES NON-EMERGENCY SERVICES TO ANY WITH THE ABILITY TO PAY INCLUDING MEDICARE AND MEDICAID COVERED INDIVIDUALS. THE ORGANIZATION IS DEDICATED TO THE PROVISION OF QUALITY, COMPASSIONATE CARE TO ALL PATIENTS IN THE MOST COST EFFECTIVE MANNER. THIS WILL BE ACCOMPLISHED THROUGH THE MOST EFFECTIVE USE OF AVAILABLE RESOURCES AND WILL REFLECT ETHICAL DECISIONS, INCLUDING THE EFFECTIVE MANAGEMENT OF PAIN, MADE JOINTLY BY THE PATIENTS, THE FAMILY, AND HEALTH CARE PROFESSIONALS INVOLVED IN HIS CARE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense30857017Expense
Revenue33654703Revenue
DescriptionRAPPAHANOCK GENERAL HOSPITAL IS THE ONLY PROVIDER OF INPATIENT AND OUTPATIENT ACUTE CARE SERVICES WITHIN A FIVE COUNTY AREA. THE HOSPITAL IS LICENSED TO OPERATE 76 BEDS, INCLUDING 47 MEDICAL/SURGICAL BEDS, 7 INTENSIVE/CRITICAL CARE BEDS, 12 TELEMETRY CARE BEDS AND 10 PSYCH BEDS. THE HOSPITAL ALSO OFFERS OUR COMMUNITY MAJOR DIAGNOSTIC AND TREATMENT CAPABILITIES; CLINICAL AND BLOOD BANK LABORATORY SERVICES; RADIOLOGY SERVICES INCLUDING DIAGNOSTIC X-RAY, DIGITAL MAMMOGRAPHY, DIGITAL FLOUROSCOPY, BONE DENSITOMETRY, ARTERIOGRAPHY, ANGIOGRAPHY WITH DIGITAL SUBTRACTION, NONINVASIVE VASCULAR LABORATORY, ULTRASONOGRAPHY, NUCLEAR MEDICINE, MRI, CT SCANNING, INPATIENT AND SAME DAY SURGERY; RESPIRATORY THERAPY; PHYSICAL THERAPY; HOME HEALTH, LITHOTRIPSY; AND RADIATION THERAPY.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense407489Expense
DescriptionCHESAPEAKE HOSPITAL CORPORATION PROVIDED NUMEROUS SERVICES FOR THE COMMUNITY WHICH INCLUDED, HEALTH FAIRS FOR DIFFERENT CIVIC GROUPS IN THE FIVE COUNTY AREAS. THE SERVICES OFFERED BY THE HOSPITAL RANGE FROM CHOLESTEROL, BLOOD PRESSURE, GLUCOSE, LITERATURE AND CANCER INFORMATION AND/OR SCREENINGS. COMMUNITY BENEFITS ARE PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED ON ACTIVITIES AND SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. THIS INCLUDES THE CANCER TREATMENT AND EDUCATION CENTER SUPPORT GROUPS AND EDUCATION FOR PATIENTS AND THEIR FAMILIES. THE EMERGENCY DEPARTMENT OFFERS CPR, HEART SAVER COURSES, AND PEDIATRIC BASIS LIFE SUPPORT. WE ALSO SPONSOR A DIABETIC EDUCATION COURSE FOR PEOPLE WITH DIABETES AND THEIR FAMILIES. THE ORGANIZATION ALSO VOLUNTEERS STAFF AND FACILITIES FOR FREE SPORTS PHYSICALS FOR SECONDARY STUDENTS IN THE AREA. THE ORGANIZATION WAS INVOLVED IN 76 PROGRAMS AND SERVED 1,251 INDIVIDUALS.Description
FieldValueIRS element (for citing)
Total Program Service Expense31264506TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
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 Assets1ReportOtherAssets
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
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
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 Organization1BsnssRltnshpWithOrganization
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 Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With109626NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees411NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
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 Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
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
States Where Copy Of Return Is FiledVAStatesWhereCopyOfReturnIsFiled
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 (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JAMES M HOLMES JR
PRESIDENT40.00XX170029072216869
MATTHEW VOGEL MD
HEAD OF MEDICAL STAFF40.00X160017998211305
JAMES CARTER JR
VOTING BOARD MEMBER1.00X185000
JEFF CHASE JR
VOTING BOARD MEMBER1.00X120000
DAVID H CHARLTON
VOTING BOARD MEMBER1.00X100000
FREDRICK COLE
VOTING BOARD MEMBER1.00X100000
ELIZABETH CROWTHER
VOTING BOARD MEMBER1.00X130000
EDWARD P HARROW JR
VOTING BOARD MEMBER1.00X80000
B H HUBBARD III
CHAIRMAN OF THE BOARD1.00X200000
GARFIELD PARKER
VOTING BOARD MEMBER1.00X70000
WAYNE PENICK
VOTING BOARD MEMBER1.00X155000
STEPHEN WHITEWAY
VOTING BOARD MEMBER1.00X100000
KEVIN MCGRATH MD
PHYSICIAN40.00X70000
J RANDY HESTER
SR VP-OPERATIONS/SECRETARY40.00X135020165914098
BERNARD P LOCKSTAMPFOR JR
VP FINANCE-TREASURER40.00X130016290713478
PAUL SUTHERLAND MD
PHYSICIAN40.00282750016015X
VIRGINIA GALE
PHYSICIAN40.00223798015978X
STEPHEN PERKINS
PHYSICIAN40.00251401016838X
BARBARA PERONA
ANESTHESIOLOGIST40.00391151014194X
IRA ROCK
ANESTHESIOLOGIST40.00346709011195X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1514859TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs835270TotalReportableCompFrmRltdOrgs
Total Other Compensation129970TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
DIAMOND HEALTHCARE CORP
PO BOX 85050RICHMONDVA23285PROGRAM MANAGEMENT SERVICE1098049
CHESAPEAKE HEALTH SERVICES
PO BOX 1328KILMARNOCKVA22482MANAGEMENT SERVICES972377
CHAS LUNSFORD
PO BOX 2571ROANOKEVA24010GENERAL INSURANCE504423
DR SANAA BUTT
7302 COUNT FLEET DRMIDLOTHIANVA23112PROFESSIONAL SERVICES147714
DR RICHARD CARPENTER
PO BOX 3391MARTINSVILLEVA241153391HEALTH INSURANCE120000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Related Organizations343530RelatedOrganizations
All Other Contributions65903AllOtherContributions
Total Contributions409433TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE6230002842145728421457
PHYSICIAN PRACTICE SER62300049478464947846
CAFETERIA900099202197202197
OTHER REVENUE6230004887448874
COLLECTION FEES9000993432934329

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column4538TotalRevenueColumn
Unrelated Business Revenue4538UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Program Service Revenue33659241TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5675TotalRevenueColumn
Exclusion$5,675ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real102652Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real183952Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-81300Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-81300TotalRevenueColumn
Unrelated Business Revenue-5470UnrelatedBusinessRevenue
Exclusion-$75,830ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other13250Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other13250Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column13250TotalRevenueColumn
Exclusion$13,250ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column34006299TotalRevenueColumn
Related Or Exempt Function Income33654703RelatedOrExemptFunctionIncome
Unrelated Business Revenue-932UnrelatedBusinessRevenue
Exclusion-$56,905ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total16550Total
Management And General16550ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total14859155Total
Program Services13295816ProgramServices
Management And General1563339ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total255374Total
Program Services255374ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1643001Total
Program Services1643001ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1032770Total
Program Services1032770ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1028627Total
Management And General1028627ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total102269Total
Management And General102269ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total96217Total
Management And General96217ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3383026Total
Program Services2887012ProgramServices
Management And General496014ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total26240Total
Management And General26240ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total34011Total
Program Services34011ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total532211Total
Program Services532211ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total113517Total
Program Services98403ProgramServices
Management And General15114ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total299943Total
Program Services299943ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1129833Total
Program Services1129833ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total298498Total
Program Services298498ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES61830596183059
BAD DEBTS25525272552527
REPAIRS & RENTALS846194846194
REPAIRS & RENTALS630088630088
RECRUITMENT101884101884

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total279967Total
Program Services73970ProgramServices
Management And General183041ManagementAndGeneral
Fundraising22956Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total35444961Total
Program Services31264506ProgramServices
Management And General4157499ManagementAndGeneral
Fundraising22956Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY1230EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY399150BOY
EOY261909EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY10333818BOY
EOY10355427EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY953599BOY
EOY953339EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY565034BOY
EOY487895EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis30843491LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec22575207LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9296850BOY
EOY8268284EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY49669BOY
EOY49669EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4780415BOY
EOY5403376EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY26378535BOY
EOY25781129EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3777948BOY
EOY4060492EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1430534BOY
EOY1278555EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4670457BOY
EOY5329294EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9878939BOY
EOY10668341EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY16400306BOY
EOY15017891EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY99290BOY
EOY94897EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16499596BOY
EOY15112788EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY26378535BOY
EOY25781129EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1438662ReconcilationRevenueExpenses
Reconcilation Other Changes51854ReconcilationOtherChanges
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)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB0TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
Explanation24% OF VHHA AND AHA DUES PAID BY THE HOSPITAL ARE ATTRIBUTABLE TO LOBBYING.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1045796OtherCostOrOtherBasis
Book Value1045796BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10653921OtherCostOrOtherBasis
Depreciation6748330Depreciation
Book Value3905591BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis115110OtherCostOrOtherBasis
Depreciation98918Depreciation
Book Value16192BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis18193311OtherCostOrOtherBasis
Depreciation15149040Depreciation
Book Value3044271BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis835353OtherCostOrOtherBasis
Depreciation578919Depreciation
Book Value256434BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8268284TotalOfBookValueLandBuildings

Other Assets OtherAssets (7 entries)

DescriptionDescriptionBook ValueBookValue
ASSETS WHOSE USE IS LIMITED122754
DUE FROM CPS1501
DUE FROM CMG4279935
DUE FROM RGHF AND AUXILLARY623289
DEFERRED FINANCING COSTS75667
DUE FROM CHS286950
OTHER RECEIVABLES13280
FieldValueIRS element (for citing)
Total Book Value Other Assets5403376TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
NOTE PAYABLE-SIEMENS$1,007,232
DUE TO CHS$3,461,850
SETTLEMENTS DUE TO THIRD PARTY PAYOR$860,212
FieldValueIRS element (for citing)
Total Of Amounts5329294TotalOfAmounts
Total Revenue34006299TotalRevenue
Total Expenses35444961TotalExpenses
Excess Or Deficit For Year-1438662ExcessOrDeficitForYear
Other$51,854OtherAmount
Total Adjustments51854TotalAdjustments
Excess Or Deficit Per FS-1386808ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt34177636TotRevenueEtcAuditedFinclStmt
Other Revenues183952OtherRevenues
Revenue Not Rptd F990183952RevenueNotRptdF990
Revenue Subtotal33993684RevenueSubtotal
Other Revenues Not Included12615OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt12615RevenueNotRptdOnFinStmt
Total Revenue Per Form99034006299TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt35560048TotExpensesEtcAuditedFinclStmt
Other Expenses Included183952OtherExpensesIncluded
Expenses Not Rptd F990183952ExpensesNotRptdF990
Expenses Subtotal35376096ExpensesSubtotal
Other Expenses Not Included68865OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt68865ExpensesNotRptdOnFinStmt
Total Expenses Per Form99035444961TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 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. RHSS 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, 2010.
PART XI, LINE 8 - OTHER ADJUSTMENTS:DONATIONS TEMPORARILY RESTRICTED NET ASSETS 11,858. DIRECT PAYMENTS TEMPORARILY RESTRICTED NET ASSETS -17,026. INTEREST INCOME TEMPORARILY RESTRICTED NET ASSETS 773. PROFESSIONAL FEES ALLOCATED TO RGH 56,250. ROUNDING -1.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 183,952.
PART XII, LINE 4B - OTHER ADJUSTMENTS:RESTRICTED DONATIONS REDUCTION OF INTEREST ON RECEIVABLE ACCOUNTS 12,615.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSES 183,952.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:PROFESSIONAL FEES ALLOCATED TO RGH 56,250. REDUCTION OF INTEREST ON RECEIVABLE ACCOUNTS 12,615.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1442599TotalCommunityBenefitExpense
Net Community Benefit Expense1442599NetCommunityBenefitExpense
Percent Of Total Expense0.04390PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense334619TotalCommunityBenefitExpense
Net Community Benefit Expense334619NetCommunityBenefitExpense
Percent Of Total Expense0.01020PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1777218TotalCommunityBenefitExpense
Net Community Benefit Expense1777218NetCommunityBenefitExpense
Percent Of Total Expense0.05410PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs76NumberOfActivitiesOrPrograms
Persons Served1251PersonsServed
Total Community Benefit Expense407489TotalCommunityBenefitExpense
Net Community Benefit Expense407489NetCommunityBenefitExpense
Percent Of Total Expense0.01240PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs76NumberOfActivitiesOrPrograms
Persons Served1251PersonsServed
Total Community Benefit Expense407489TotalCommunityBenefitExpense
Net Community Benefit Expense407489NetCommunityBenefitExpense
Percent Of Total Expense0.01240PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs76NumberOfActivitiesOrPrograms
Persons Served1251PersonsServed
Total Community Benefit Expense2184707TotalCommunityBenefitExpense
Net Community Benefit Expense2184707NetCommunityBenefitExpense
Percent Of Total Expense0.06650PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs76NumberOfActivitiesOrPrograms
Persons Served1251PersonsServed
Total Community Building Expense407489TotalCommunityBuildingExpense
Net Community Building Expense407489NetCommunityBuildingExpense
Percent Of Total Expense0.01240PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs76NumberOfActivitiesOrPrograms
Persons Served1251PersonsServed
Total Community Building Expense407489TotalCommunityBuildingExpense
Net Community Building Expense407489NetCommunityBuildingExpense
Percent Of Total Expense0.01240PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,416,652BadDebtExpenseAmount
Amount Reimbursed By Medicare15960963AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare17891098CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1930135MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line11 CHESAPEAKE HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityMANAGEMENT SERVICESDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.00000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.00000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1RAPPAHANOCK GENERAL HOSPITALBusinessNameLine1

Address Address

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

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1RAPPAHANNOCK GENERAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted0CHNAConducted
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted0UsesFPGDiscounted
Explains Basis0ExplainsBasis
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Provided On AdmissionXProvidedOnAdmission
Actions On Nonpayment1ActionsOnNonpayment
Permit Lien On ResidenceXPermitLienOnResidence
Collection Activities1CollectionActivities
Lien On ResidenceXLienOnResidence
Notify Upon AdmissionXNotifyUponAdmission
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: DETERMINATION OF CHARITY WILL BE MADE THROUGH KNOWLEDGE OF THE MEDICAL AND SOCIAL-ECONOMIC SITUATION AND ITS VARIOUS FINANCIAL IMPLICATIONS; AN INTERVIEW WITH PATIENT (RESPONSIBLE PARTY) AND INVESTIGATION OF FINANCIAL RESOURCES. THE DECISION WILL BE BASED ON COOPERATIVE MEDICAL, SOCIAL SERVICE, AND ADMINISTRATIVE JUDGMENT.
PART I, L7 COL(F): COSTING METHOD IS OVERALL COST TO CHARGE RATIO FROM MEDICARE COST REPORT. NO BAD DEBT IS INCLUDED IN THE CALCULATION.
PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT ESTABLISHED BILLING RATES WHEN PATIENT SERVICES ARE RENDERED. PROVISIONS FOR UNCOLLECTIBLE ACCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE RECORDED AS DEDUCTIONS FROM PATIENT ACCOUNTS RECEIVABLE TO REDUCE RECORDED AMOUNTS TO NET REALIZABLE VALUE. CONTRACTUAL ADJUSTMENTS REPRESENT THE DIFFERENCE BETWEEN ESTABLISHED BILLING RATES AND AMOUNTS REIMBURSED (PRINCIPALLY FROM FEDERAL AND STATE GOVERNMENTS UNDER MEDICARE AND MEDICAID AND OTHER COMMERCIAL INSURERS INCLUDING ANTHEM).
PART III, LINE 8: COSTING METHOD IS COST TO CHARGE RATIO FROM MEDICARE REPORT. SHORTFALL OF MEDICARE PAYMENTS RECEIVED DIRECTLY BENEFIT THE COMMUNITY CITIZENS.
PART III, LINE 9B: PATIENTS WHO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE ARE ASKED TO MEET WITH A FINANCIAL COUNSELOR TO DETERMINE FINANCIAL NEED. IF CHARITY GUIDELINES ARE MET, THEN PATIENT ACCOUNTS ARE ADJUSTED ACCORDINGLY.
PART V, SECTION A: THIS ORGANIZATION HAS NO OTHER FACILITIES OTHER THAN THE ONE LISTED ON PART V
PART V, SECTION B, LINE 21: THE HOSPITAL CHARGES ALL PATIENTS GROSS CHARGES REGARDLESS OF WHETHER THE PATIENT IS COVERED BY INSURANCE OR NOT. EXPECTED PAYMENT FOR THOSE CHARGES ARE BASED ON NEGOTIATED DISCOUNTED GROUP OR INDIVIDUAL RATES. HOSPITAL POLICIES OFFER SELF PAY PATIENTS PROMPT PAY DISCOUNTS AND NEGOTIATED RATES COMPARABLE TO COMMERCIAL INSURANCE DISCOUNTED RATES.RAPPAHANNOCK GENERAL HOSPITAL
PART VI, LINE 2: THE ORGANIZATION LOOKS AT THE AREA'S POPULATION, AGE, INCOME AND FINANCIAL NEEDS OF THE AREA.
PART VI, LINE 3: THE HOPITAL HAS A CHARITY POLICY, FINANCIAL COUNSELING PROGRAM AND BROCHURES PROVIDED TO PATIENTS TO INFORM AND EDUCATE PATIENTS AND THEIR FAMILIES ABOUT ELIGIBILITY FOR ASSISTANCE.
PART VI, LINE 4: THE ORGANIZATION SERVES THE MIDDLE PENINSULA-NORTHERN NECK COUNTIES OF VIRGINIA. THESE COUNTIES INCLUDE:COUNTY POPULATION SQ. MILES 65 PLUS PER CAPITA INCOMELANCASTER 231NORTHUMBERLAND 286RICHMOND CO. 216WESTMORELAND 253MATHEWS 252MIDDLESEX 130
PART VI, LINE 6: CHESAPEAKE HOSPITAL CORPORATION PROVIDED NUMEROUS SERVICES FOR THE COMMUNITY WHICH INCLUDED HEALTH FAIRS FOR DIFFERENT CIVIC GROUPS IN THE SIX COUNTY AREAS. THE SERVICES OFFERED BY THE HOSPITAL RANGE FROM CHOLESTEROL, BLOOD PRESSURE, GLUCOSE LITERATURE AND CANCER INFORMATION AND/OR SCREENINGS. COMMUNITY BENEFITS ARE PROVIDED THROUGH MANY REDUCED PRICE SERVICES WHICH THE HOSPITAL BELIEVES WILL SERVE A BONA FIDE COMMUNITY HEALTH NEED. THIS INCLUDES THE CANCER TREATMENT AND EDUCATION CENTER SUPPORT GROUPS AND EDUCATION FOR PATIENTS AND THEIR FAMILIES. THE EMERGENCY DEPARTMENT OFFERS CPR, HEART SAVER COURSES, AND PEDIATRIC BASIS LIFE SUPPORT. WE ALSO SPONSOR A DIABETIC EDUCATION COURSE FOR PEOPLE WITH DIABETES AND THEIR FAMILIES. THE ORGANIZATION ALSO VOLUNTEERS STAFF AND FACILITIES FOR FREE SPORTS PHYSICALS FOR SECONDARY STUDENTS IN THE AREA. THE ORGANIZATION SUPPORTS THE LOSS INCURRED BY ITS SISTER COMPANY CHESAPEAKE MEDICAL GROUP (CMG). CMG REPRESSENTS SEVERAL GROUPS OF PHYSICIANS INCLUDING FAMILY PRACTICE, PEDIATRICS, GYN, SURGERY AND OTHERS, THAT WERE NOT ABLE TO SURVIVE WITHOUT THE ASSISTANCE FROM RGH. CMG HAS THE ONLY PEDIATRIC SERVICES IN THE AREA. CMG PROVIDES PHYSICIAN CARE REGARDLESS OF THE INSURANCE WHILE OTHER PHYSICIANS IN THE AREA NO LONGER ACCEPT NEW MEDICAID PATIENTS. CMG ALSO PROVIDES COVERAGE FOR THOSE PATIENTS WITH NO INSURANCE.
PART VI, LINE 7: AS A NOT-FOR PROFIT HEALTHCARE ORGANIZATION, IT IS THE PURPOSE AND RESPONSIBILITY TO PROVIDE OUTSTANDING CARE TO EVERYONE WHO NEEDS IT, REGARDLESS OF THEIR ABILITY TO PAY. RGH'S OPERATIONS ARE SIGNIFICANTLY IMPACTED BY CHARITY CARE AND THE MEDICARE/MEDICAID SHORTFALLS. IN ADDITION TO THE ESSENTIAL HEALTH CARE SERVICES PROVIDED THAT RAPPAHANNOCK HEALTH SYSTEM (RHS) PROVIDES TO OUR COMMUNITY, THE HEALTH SYSTEM HAS A SIGNIFICANT ECONOMIC IMPACT ON OUR COMMUNITY. RHS IS THE LARGEST EMPLOYER IN LANCASTER COUNTY PROVIDING JOBS FOR MORE THAN 500 PEOPLE WHO LIVE IN KILMARNOCK AND THE SURROUNDING AREAS. RHS HAS SEVERAL AFFILIATES. ONE IS THE CHESAPEAKE MEDICAL GROUP WHICH PROVIDES QUALITY, COMPASSIONATE, COST EFFECTIVE PRIMARY MEDICAL CARE SERVICES TO THE KILMARNOCK AREA. CHESAPEAKE HEALTH SERVICES MANAGES THE VARIOUS ENTITIES. CHESAPEAKE PHARMACY SERVICES, INC. PROVIDES PHARMACY SERVICES FOR THE AREA WHILE RAPPAHANOCK GENERAL HOSPITAL FOUNDATION ASSISTS IN PROVIDING FUNDRAISING ABILITIES.
VAREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
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 Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 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
02749060017001581605184011685170030759100
MATTHEW VOGEL MD
017998200160000539905906160019128700
J RANDY HESTER
019985300135018060462109477135021575700
BERNARD P LOCKSTAMPFOR JR
016110100130018060404409434130017638500
PAUL SUTHERLAND MD
282750000006630093850298765000
VIRGINIA GALE
223798000006120098580239776000
STEPHEN PERKINS
2514010000067370101010268239000
BARBARA PERONA
3911510000010500036940405345000
IRA ROCK
3467090000000111950357904000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 7ReturnReference
ExplanationPORTION OF PHYSICIAN CONTRACTS PAYMENTS ARE VARIABLE BASED ON CASH COLLECTEDExplanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
NORTHERN NECK STATE BANK
SEE SCHEDULE OREAL ESTATE0
CHESAPEAKE BANK
SEE SCHEDULE OLOANS0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART V, LINE 7GTHE ORGANIZATION DID NOT RECEIVE ANY CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY.
SEE SCHEDULE L DETAIL FOR BUSINESS RELATIONSHIPS.FORM 990, PART VI, SECTION A, LINE 2
WHEN THE COMPLETED FORM 990 COMES BACK FROM THE OUTSIDE TAX PREPARERS, IT IS REVIEWED BY THE CHESAPEAKE HEALTH SERVICES (CHS) VICE PRESIDENT-FINANCE OR CHS CONTROLLER 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 11
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 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 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST IN THE ADMINISTRATION OFFICE.
FORM 990, PART XI, LINE 5:DONATIONS TEMPORARILY RESTRICTED NET ASSETS 11,858. DIRECT PAYMENTS TEMPORARILY RESTRICTED NET ASSETS -17,026. INTEREST INCOME TEMPORARILY RESTRICTED NET ASSETS 773. PROFESSIONAL FEES ALLOCATED TO RGH 56,250. ROUNDING -1. TOTAL TO FORM 990, PART XI, LINE 5: 51,854.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CTHE ORGANIZATION DOES HAVE A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT BUT THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990 SCHEDULE LC WAYNE PENICK IS A CHESAPEAKE HOSPITAL CORPORATION BOARD MEMBER AND BOARD VICE CHAIRMAN AND IS EMPLOYED BY NORTHERN NECK STATE BANK WHICH CHESAPEAKE HOSPITAL CORPORATION DOES BUSINESS WITH. EDWARD P HARROW JR IS A CHESAPEAKE HOSPITAL CORPORATION BOARD MEMBER AND HANDLES ALL OF THE TITLE ISURANCE FOR REAL ESTATE CLOSINGS AT TIDELAND TITLE AGENCY, LC. JOHN DORSEY IS A CHESAPEAKE HOSPITAL CORPORATION BOARD MEMBER AND HAS BEEN USED AS REAL ESTATE AGENT WHEN NEEDED FOR SELECT PROPERTIES OF VIRGINIA. JAMES M HOLMES JR IS AN OFFICER OF CHESAPEAKE HOSPITAL CORPORATION AND IS BOARD MEMBER OF CHESAPEAKE BANK.BUSINESS RELATIONSHIPS

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 HEALTH SERVICES
101 HARRIS ROADKILMARNOCKVA22482541513371PARENTVA501(C)(3)11N/A0
RAPPAHANOCK GENERAL HOSP FND
101 HARRIS ROADKILMARNOCKVA22482541210450SUPPORTING ORGANIZATIONVA501(C)(3)11N/A0
CHESAPEAKE MEDICAL GROUP
101 HARRIS ROADKILMARNOCKVA22482541857174HEALTHCARE SERVICESVA501(C)(3)11N/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1CHESAPEAKE PHARMACY SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 HARRIS ROADAddressLine1
CityKILMARNOCKCity
StateVAState
ZIP Code22482ZIPCode
FieldValueIRS element (for citing)
EIN541822516EIN
Primary ActivityPHARMACYPrimaryActivity
Legal Domicile StateVALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
CHESAPEAKE HEALTH SERVICES
L972377
CHESAPEAKE MEDICAL GROUP
P388393
RAPPAHANNOCK GENERAL HOSPITAL FOUNDATION
C343530
CHESAPEAKE MEDICAL GROUP
D4279935
RAPPAHANNOCK GENERAL HOSPITAL FOUNDATION
D584380
CHESAPEAKE HEALTH SERVICES
E3461850
CHESAPEAKE MEDICAL GROUP
L216141
CHESAPEAKE MEDICAL GROUP
I55200