STRATEGY STUDIO / PUBLIC DATA EXPLORER

CLARKSVILLE SENIOR CARE LLC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
CLARKSVILLE SENIOR CARE LLC (EIN 54-1957066)
Tax period
2009-09-01 to 2010-08-31
Filed
2011-07-11
IRS object ID
201101929349300135
Schema version
2009v1.7
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)
Timestamp2011-07-11T13:00:34-04:00Timestamp
Tax Period End Date2010-08-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11676 International DriveAddressLine1
CityMcLeanCity
StateVAState
ZIP Code22102ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-09-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN541957066EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Clarksville Senior Care LLCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCLARNameControl
Phone4345173183Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12204 Wilborn AvenueAddressLine1
CitySouth BostonCity
StateVAState
ZIP Code24592ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSTEWART NELSONName
TitleCHIEF FINANCIAL OFFICERTitle
Date Signed2011-07-06DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone7032868000Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHRIS A LUMSDENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12204 WILBORN AVENUEAddressLine1
CitySOUTH BOSTONCity
StateVAState
ZIP Code24592ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8289591GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.hrhs.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2001YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionTHE 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 Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees160TotalNbrEmployees
Total Nbr Volunteers119TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year758ContributionsGrantsPriorYear
Contributions Grants Current Year5153ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7575794ProgramServiceRevenuePriorYear
Program Service Revenue CY7687451ProgramServiceRevenueCY
Investment Income Prior Year-824InvestmentIncomePriorYear
Investment Income Current Year-8029InvestmentIncomeCurrentYear
Other Revenue Prior Year17369OtherRevenuePriorYear
Other Revenue Current Year20258OtherRevenueCurrentYear
Total Revenue Prior Year7593097TotalRevenuePriorYear
Total Revenue Current Year7704833TotalRevenueCurrentYear
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 Year4376991SalariesEtcPriorYear
Salaries Etc Current Year4750776SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2726577OtherExpensePriorYear
Other Expenses Current Year2747683OtherExpensesCurrentYear
Total Expenses Prior Year7103568TotalExpensesPriorYear
Total Expenses Current Year7498459TotalExpensesCurrentYear
Revenues Less Expenses Prior Year489529RevenuesLessExpensesPriorYear
Revenues Less Expenses CY206374RevenuesLessExpensesCY
Total Assets BOY7452350TotalAssetsBOY
Total Assets EOY8207434TotalAssetsEOY
Total Liabilities BOY5645867TotalLiabilitiesBOY
Total Liabilities EOY6211075TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1806483NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1996359NetAssetsOrFundBalancesEOY
Mission DescriptionTHE PURPOSE OF HALIFAX REGIONAL HEALTH SYSTEM IS TO PROVIDE THE HIGHEST QUALITY CARE BASED ON THE HEALTHCARE NEEDS OF THE PEOPLE WE SERVE. 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense6355274Expense
Grants0Grants
Revenue7687451Revenue
DescriptionCLARKSVILLE SENIOR CARE, LLC, DOING BUSINESS AS MEADOWVIEW TERRACE OPERATES A 120-BED, DUALLY CERTIFIED (MEDICAID AND MEDICARE) NURSING FACILITY, WHICH INCLUDES A 24-BED ALZHEIMER'S SPECIAL CARE NEIGHBORHOOD. 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 FY10 58.4 PERCENT OF THE FACILITY'S REVENUES WERE REIMBURSABLE UNDER THE MEDICAID PROGRAM AND 21.0 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 SIXTY-NINE 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 2010, MEADOWVIEW TERRACE PARTICIPATED IN THE VIRGINIA ADVANCE DIRECTIVE DAY BY PROVIDING INFORMATION ON ADVANCE DIRECTIVES IN THE FACILITY'S LOBBY WITH STAFF AVAILABLE TO ANSWER QUESTIONS AND ALSO OFFERED A PROGRAM ON ADVANCED DIRECTIVES AND END OF LIFE DECISIONS FREE OF CHARGE TO THE COMMUNITY. 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 ASSISTED WITH BLOOD PRESSURE SCREENINGS. MORE THAN 400 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. TOPICS IN FY10 INCLUDED ADVANCED DIRECTIVES, MDS 3.0 AND ALZHEIMER'S DISEASE. DIABETES EDUCATION THE REGISTERED 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. ALTHOUGH THIS IS A FRANCHISED PROGRAM, MEADOWVIEW TERRACE PROVIDED MEETING SPACE AT A REDUCED RATE. ALZHEIMER'S SUPPORT GROUP FROM SEPTEMBER 2009 THROUGH JUNE 2010 MEADOWVIEW TERRACE PROVIDED FREE SPACE AND REFRESHMENTS FOR MONTHLY MEETINGS OF THE CLARKSVILLE ALZHEIMER'S SUPPORT GROUP. THE FACILITY ORGANIZED THESE MEETINGS AND TWO STAFF MEMBERS SERVED AS CO-FACILITATORS. FINANCIAL AND IN-KIND CONTRIBUTIONS FOOD DRIVES IN FY10 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. CLARKSVILLE LAKE FESTIVAL (LAKEFEST) MEADOWVIEW TERRACE STAFF MANNED A BOOTH DURING CLARKSVILLE'S LAKE FESTIVAL EVENT. THE TEAM PROVIDED FREE CHILLED BOTTLES OF WATER, ADVANCE DIRECTIVE INFORMATION AND INFORMATION ABOUT LONG-TERM CARE TO THOUSANDS OF VISITORS ON THIS HOT SUMMER'S DAY. ON THURSDAY NIGHT, PRIOR TO THE FESTIVAL'S OPENING ON FRIDAY EVENING, STAFF MEMBERS OPERATED A CONCESSION STAND AND PROVIDED SUPPER FOR THE HOT-AIR BALLOONISTS WHO DEMONSTRATE THE ART OF BALLOONING TO THE FESTIVAL-GOERS AND TO SPECTATORS. ALL PROCEEDS FROM THIS SUPPER WENT TO THE SOUTHEASTERN VIRGINIA CHAPTER OF THE ALZHEIMER'S ASSOCIATION. ALZHEIMER'S MEMORY WALK THE MEADOWVIEW TERRACE STAFF AND VOLUNTEERS ORGANIZE, COORDINATE, ADVERTISE AND HOST AN ANNUAL ALZHEIMER'S MEMORY WALK. A NUMBER OF FUNDRAISING EVENTS ARE HELD THROUGHOUT THE YEAR BY MEADOWVIEW TERRACE LEADING UP TO THE BIG EVENT- THE ALZHEIMER'S MEMORY WALK, WITH APPROXIMATELY 125 WALKERS PARTICIPATING IN FY10. ALL MONEY RAISED IN THESE EVENTS IS DONATED TO THE SOUTHEASTERN VIRGINIA CHAPTER OF THE ALZHEIMER'S ASSOCIATION. THE MONEY 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. OVER FOURTEEN THOUSAND DOLLARS ($14,000) WAS COLLECTED FROM THE FUND-RAISING EFFORTS THROUGHOUT THE YEAR INCLUDING BAKE SALES AND FOOD SALES AT A LOCAL EVENTS AND THE MEMORY WALK ITSELF. IN ADDITION, MEADOWVIEW TERRACE PROVIDED SPACE AND LUNCH FOR THE AREA ALZHEIMER'S WALK TEAM COMMITTEE CAPTAIN MEETINGS. 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 200 POUNDS OF DOG AND CAT FOOD WAS COLLECTED AND DONATED TO THE CLARKSVILLE SPCA. THE FACILITY ALSO COLLECTED NEWSPAPERS TO DONATE TO THE SPCA. THE ACTIVITY DEPARTMENT "ADOPTED" 6 CHILDREN AND THE MEADOWVIEW MANAGERS ALSO EACH ADOPTED A CHILD THROUGH MECKLENBURG COUNTY SOCIAL SERVICES PROVIDING CASH AND GIFTS DURING THE HOLIDAY SEASON. AT THANKSGIVING, THE FACILITY DONATED SEVEN TURKEYS TO SOCIAL SERVICES. IN FY10 MEADOWVIEW TERRACE ONCE AGAIN SPONSORED A KINDERGARTEN CLASS AT CLARKSVILLE ELEMENTARY SCHOOL, PROVIDING THE TWENTY STUDENTS WITH SCHOOL SUPPLIES. SPONSORSHIP CONTINUES THROUGHOUT THE YEAR WITH PARTIES AND GIFTS FOR THE STUDENTS. 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, AND FOR AARP SAFE DRIVING CLASSES. 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). 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 FOR VIRGINIA EMPLOYMENT COMMISSION, SOUTHSIDE VIRGINIA COMMUNITY COLLEGE AND OTHER COMMITTEES AND BOARDS. IN FY10 MEADOWVIEW'S ADMINISTRATOR SERVED AS CHAIRMAN OF THE BOARD OF LEADERSHIP MECKLENBURG, AND ANOTHER STAFF MEMBER SERVED ON THE BOARD. IN FY10 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 PRODescription
Total Program Service Expense6355274TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees160NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSTEWART R NELSON CFONamePerson
Telephone Number4345173183TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12204 WILBORN AVENUEAddressLine1
CitySOUTH BOSTONCity
StateVAState
ZIP Code24592ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
CAROL C THOMAS
SECRETARY1.0XX000
WILLIAM E COLEMAN
CHAIRMAN1.0XX000
DAVID H WHITE JR
VICE CHAIRMAN1.0XX000
J AUBREY HOUGHTON
TREASURER1.0XX000
JAMES WITKO
BOARD MEMBER1.0X000
CHRIS A LUMSDEN
CHIEF EXECUTIVE OFFICER1.0X849434757240774
STEWART R NELSON
CHIEF FINANCIAL OFFICER1.0X593223614919183
THOMAS S KLUGE
CHIEF OPERATING OFFICER1.0520821018035301X
JILL ALLEN
CSC MEDICAL DIRECTOR40.0128587015496X
FieldValueIRS element (for citing)
Total Reportable Comp From Org148221TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs793901TotalReportableCompFrmRltdOrgs
Total Other Compensation110754TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonFUNCTIONAL PATHWAYSNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1317 EBENEZER ROAD SUITE 7AddressLine1
CityKNOXVILLECity
StateTNState
ZIP Code37923ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesPATIENT CARE SERVICEDescriptionOfServices
Compensation482584Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions5153AllOtherContributions
Total Contributions5153TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REVENUEDescription
Business Code623000BusinessCode
Total Revenue Column7687451TotalRevenueColumn
Related Or Exempt Function Income7687451RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue7687451TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3981TotalRevenueColumn
Exclusion$3,981ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities572748Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities584758Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-12010Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-12010TotalRevenueColumn
Exclusion-$12,010ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFE AND VENDING72100019473$19,473
MISCELLANEOUS900099785$785
FieldValueIRS element (for citing)
Total Other Revenue20258TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7704833TotalRevenueColumn
Related Or Exempt Function Income7687451RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$12,229ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total14321Total
Management And General14321ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3458736Total
Program Services2980157ProgramServices
Management And General478579ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1029711Total
Program Services883573ProgramServices
Management And General146138ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total248008Total
Program Services212810ProgramServices
Management And General35198ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total7004Total
Management And General7004ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total17557Total
Management And General17557ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total763435Total
Program Services703162ProgramServices
Management And General60273ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total554106Total
Program Services481068ProgramServices
Management And General73038ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total183096Total
Program Services183096ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total5712Total
Program Services824ProgramServices
Management And General4888ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total137230Total
Program Services137230ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total475999Total
Program Services475999ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total136029Total
Management And General136029ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
FOOD STOCK215324215324
BAD DEBT4949849498
EDUCATION1627316273
MEMBERSHIPS91249124
VEHICLES568240661616

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total171614Total
Program Services12194ProgramServices
Management And General159420ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total7498459Total
Program Services6355274ProgramServices
Management And General1143185ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY150234BOY
EOY713980EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1681000BOY
EOY565362EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY575707BOY
EOY569771EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY46877BOY
EOY55373EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY85502BOY
EOY162749EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10318601LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4536931LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4171267BOY
EOY5781670EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY667435BOY
EOY248818EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY74328BOY
EOY109711EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7452350BOY
EOY8207434EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY568482BOY
EOY1016318EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY677947EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY4542410BOY
EOY3921631EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY534975BOY
EOY595179EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5645867BOY
EOY6211075EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1806483BOY
EOY1996359EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1806483BOY
EOY1996359EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7452350BOY
EOY8207434EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1HALIFAX REGIONAL HOSPITAL INCORPORATEDBusinessNameLine1
FieldValueIRS element (for citing)
EIN540648699EIN
Type Of Organization03TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Amount$7,498,459Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts7498459SumOfAmounts

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$739OtherActivitiesAmount
Total Lobbying Expenditures IIB739TotalLobbyingExpendituresIIB

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierOTHER LOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1(I)ReturnReference
ExplanationPORTION OF DUES PAID TO THE VIRGINIA HEALTH CARE ASSOCIATION THAT IS ATTRIBUTABLE TO LOBBYING EXPENSES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis400146OtherCostOrOtherBasis
Book Value400146BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5654965OtherCostOrOtherBasis
Depreciation3197784Depreciation
Book Value2457181BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1403983OtherCostOrOtherBasis
Depreciation958054Depreciation
Book Value445929BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2859507OtherCostOrOtherBasis
Depreciation381093Depreciation
Book Value2478414BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5781670TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
DUE TO THIRD PARTIES$175,734
DUE TO HALIFAX REGIONAL HOSPITAL$113,432
PATIENT SECURITY DEPOSITS$61,174
ACCRUED PENSION OBLIGATION$90,452
OTHER LIABILITIES$154,387
FieldValueIRS element (for citing)
Total Of Amounts595179TotalOfAmounts
Total Revenue7704833TotalRevenue
Total Expenses7498459TotalExpenses
Excess Or Deficit For Year206374ExcessOrDeficitForYear
Net Unrealized GL On Investments23763NetUnrealizedGLOnInvestments
Other-$40,261OtherAmount
Total Adjustments-16498TotalAdjustments
Excess Or Deficit Per FS189876ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt7728596TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments23763NetUnrealizedGainsInvestments
Revenue Not Rptd F99023763RevenueNotRptdF990
Revenue Subtotal7704833RevenueSubtotal
Total Revenue Per Form9907704833TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt7538720TotExpensesEtcAuditedFinclStmt
Other Expenses Included40261OtherExpensesIncluded
Expenses Not Rptd F99040261ExpensesNotRptdF990
Expenses Subtotal7498459ExpensesSubtotal
Total Expenses Per Form9907498459TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FIN 48 FINANCIAL STATEMENT FOOTNOTESCHEDULE D, PART XTHE 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.
RECONCILIATIONSCHEDULE D, PART XI, LINE 8 AND PART XIII, LINE 2DOTHER CHANGES IN PENSION LIABILITY..................$ 40,261 ======== TOTAL...............................................$ 40,261

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 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
CHRIS A LUMSDEN
8494304717000428557672271160316693986438697600
STEWART R NELSON
59322128080002334155616706671854655525470900
THOMAS S KLUGE
5208186839000233415401787958816294633624435300

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1INDUSTRIAL DEVELOPMENT AUTHORITY CLARKSVILLEBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN546001219IssuerEIN
Date Issued2010-04-01DateIssued
Issue Price4000000IssuePrice
Description Of PurposeSERIES 2000 REFUNDING REVENUE BONDDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds4000000TotalProceeds
Amount Defeased4000000AmountDefeased
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadefalseFinalAllocationMade
Adequate Books And Recds MaintaindfalseAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatefalseExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
BUSINESS/FAMILY RELATIONSHIPPART VI, LINE 2DAVID WHITE AND CHRIS LUMSDEN HAVE A BUSINESS RELATIONSHIP.
ORGANIZATION'S FORM 990 REVIEW PROCESSPART VI, LINE 11THE RETURN IS PREPARED BY ORGANIZATION' 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 POLICYPART VI, LINE 12CTHE CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS 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.
PROCESS FOR DETERMINING COMPENSATIONPART VI, LINE 15ORGANIZATION SEEKS TO PAY REASONABLE COMPENSATION UNDER SECTION 4958 TO ATTRACT AND RETAIN THE APPROPRIATE CALIBER OF EMPLOYEES DEDICATED TO CARRYING OUT ITS TAX-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 ORGANIZATION' 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.
GOVERNING DOCUMENTSPART VI, LINE 19THE ORGANIZATION DOES CURRENTLY MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
SINGLE AUDIT ACT AND OMB CIRCULAR A-133PART XI, LINE 3BA-133 AUDIT SCHEDULED TO BE COMPLETED BEFORE AUGUST 31, 2011.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
HALIFAX REGIONAL HOSPITAL INCORPORATED
2204 WILBORN AVENUESOUTH BOSTONVA24592540648699HEALTHCAREVA501(C)(3)3HRHS
HALIFAX REGIONAL DEVELOPMENT FOUNDATION
2204 WILBORN AVENUESOUTH BOSTONVA24592541801459HLTH/WELFAREVA501(C)(3)11A TYPE IHRHS
HALIFAX REGIONAL LONG TERM CARE INC
103 ROSE HILL DRIVESOUTH BOSTONVA24592546074529SENIOR CAREVA501(C)(3)11A TYPE IHRHS
HALIFAX REGIONAL PROPERTIES INC
2204 WILBORN AVENUESOUTH BOSTONVA24558541801463HLTH/WELFAREVA501(C)(3)11A TYPE IHRHS
HALIFAX REGIONAL HEALTH SYSTEM INC
2204 WILBORN AVENUESOUTH BOSTONVA24558541801466HEALTHCAREVA501(C)(3)11B TYPE IINA

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
SOUTHSIDE HEALTH SERVICES INC
2204 WILBORN AVENUESOUTH BOSTONVA24592541417772HEALTH SERVICESVANAC Corp
DOMINION HEALTH MEDICAL ASSOCIATES LTD
2204 WILBORN AVENUESOUTH BOSTONVA24592541060357PHYSICIAN PRACTICVANAC Corp
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
HALIFAX REGIONAL HOSPITAL INC
n340742
HALIFAX REGIONAL HOSPITAL INC
o1197434