Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
Riverside Healthcare Association Inc Group
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
608 Denbigh Blvd
Suite 800
Room/suite
City or town, state or country, and ZIP + 4
Newport News, VA23608
D Employer identification number

90-1000718
E Telephone number

G Gross receipts $ 1,193,423,528
F Name and address of principal officer:
WILLIAM DOWNEY CEOPRESIDENT
608 DENBIGH BLVD STE 800
NEWPORT NEWS,VA23608
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
RIVERSIDEONLINE.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet5701
K Form of organization:
 
L Year of formation:  
M State of legal domicile:
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: PROVIDE GENERAL MEDICAL SERVICES TO THE COMMUNITY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 198
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 147
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 9,678
6 Total number of volunteers (estimate if necessary) ............. 6 736
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,373,252
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,162,524 2,575,716
9 Program service revenue (Part VIII, line 2g) ......... 821,906,497 908,547,284
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 30,162,179 16,045,340
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 223,868,823 254,847,651
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,079,100,023 1,182,015,991
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 8,025,036 8,028,209
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 415,933,982 496,480,490
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet52,783    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 619,205,079 639,457,486
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,043,164,097 1,143,966,185
19 Revenue less expenses. Subtract line 18 from line 12....... 35,935,926 38,049,806
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 755,670,692 967,799,624
21 Total liabilities (Part X, line 26)............. 314,843,100 490,202,803
22 Net assets or fund balances. Subtract line 21 from line 20..... 440,827,592 477,596,821
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: TO CARE FOR OTHERS AS WE WOULD CARE FOR THOSE WE LOVE - TO ENHANCE THEIR WELL-BEING AND IMPROVE THEIR HEALTH.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 893,977,855 including grants of $ 8,028,209 ) (Revenue $ 1,155,990,563 )
General hospital services provided to the community: 2,038,325 persons were benefited in 2012 with quantifiable community benefits of $78,636,420.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet893,977,855
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
871
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
9,678
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
198
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
147
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
VA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletVP OF FINANCERIVERSIDE HEALTHCARE ASSOCIATION INEWPORT NEWSVA23608 (757) 875-7838
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) ALAN WITT........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(2) ALEXANDER DILLARD........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(3) ALFRED POOLE........................................................................
CHAIRMAN
 1.0
.......................   		X           0 0 0
(4) ALLEN JONES........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(5) BARBARA DEARMON........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(6) BENJAMIN GARRETT........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(7) BETTY BLEVINS........................................................................
BOARD MEMBER
 40.0
.......................   		X           2,082 0 95
(8) BLAIR MARSTELLER........................................................................
BOARD MEMBER
 40.0
.......................   		X           360,903 0 42,271
(9) BYRD SAVILLE........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(10) CARAMINE KELLAM........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(11) CAROLYN FELLING........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(12) CARRIE MOSS........................................................................
BOARD MEMBER
 40.0
.......................   		X           452,831 0 25,590
(13) CARRINGTON RANDOLPH........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(14) CHANNING HALL........................................................................
VICE CHAIRMAN
 1.0
.......................   		X           0 0 0
(15) CHARLENE SMITH........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(16) CHARLES HIGGINS........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(17) CHARLES MINTER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) CHARLES REVERE........................................................................
CHAIRMAN
 1.0
.......................   		X           0 0 0
(19) CONWAY SMITH........................................................................
VICE CHAIRMAN
 1.0
.......................   		X           0 0 0
(20) CONWAY SHEILD........................................................................
CHAIRMAN
 1.0
.......................   		X           0 0 0
(21) CYNTHIA HUDSON........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(22) DANIEL SHERLOCK........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(23) DANNY CANTWELL........................................................................
PRESIDENT, MEDICAL STAFF
 1.0
.......................   		X           0 0 0
(24) DARRYL FISHER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(25) DAVID JONES........................................................................
BOARD MEMBER
 39.0
.......................1.0 		X           248,119 0 36,657
(26) DAYTON RITT........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(27) DEBRA BOYER........................................................................
BOARD MEMBER
 40.0
.......................   		X           256,679 0 44,588
(28) DELORIS BECKER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(29) DWAYNE BLAKE........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(30) EUGENE CONNER........................................................................
VICE CHAIRMAN
 1.0
.......................   		X           0 0 0
(31) FRANCES ELLIS........................................................................
VICE CHAIRMAN
 1.0
.......................   		X           0 0 0
(32) FREDRICK ARNOLD........................................................................
PRESIDENT, MEDICAL STAFF
 40.0
.......................   		X           235,693 0 30,642
(33) GARY KAVIT........................................................................
BOARD MEMBER
 40.0
.......................   		X           461,464 0 39,667
(34) GARY STARKEY........................................................................
MEDICAL DIRECTOR/RBHC
 1.0
.......................   		X           0 0 0
(35) GORDON GENTRY........................................................................
CHAIRMAN
 1.0
.......................   		X           0 0 0
(36) GREGG SHIVERS........................................................................
SERVICE LINE CHIEF,RWRH
 40.0
.......................   		X           337,244 0 43,060
(37) HALL HOWARD........................................................................
BOARD MEMBER
 40.0
.......................   		X           105,669 0 14,730
(38) HERBERT KELLY........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(39) IVY MITCHELL........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(40) JAMES DUDLEY........................................................................
SERVICE LINE CHIEF
 39.0
.......................1.0 		X           370,506 0 40,849
(41) JAMES EDWARDS........................................................................
BOARD MEMBER
 40.0
.......................   		X           184,757 0 27,246
(42) JAMES MCCORRY........................................................................
SERVICE LINE CHIEF, RDHW
 40.0
.......................   		X           349,140 0 20,298
(43) JAMES MULLINS........................................................................
BOARD MEMBER
 40.0
.......................   		X           306,916 0 28,998
(44) JAMES THORN........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(45) JEFFREY HENKE........................................................................
BOARD MEMBER
 40.0
.......................   		X           450,342 0 48,685
(46) JEROLD ALLEN........................................................................
CHAIRMAN
 1.0
.......................   		X           0 0 0
(47) JOE FRANK........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(48) JOHN GRETES........................................................................
BOARD MEMBER
 40.0
.......................   		X           402,414 0 34,374
(49) JOHN ISHON........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(50) JOSEPH WILSON........................................................................
BOARD MEMBER
 40.0
.......................   		X           443,191 0 30,223
(51) KEITH HANGER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(52) KIRBY SMITH........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(53) LINDA PHILLIPS........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(54) MARSHALL CROSS........................................................................
CHAIRMAN/RRMC OPERS COUNCIL,EX
 40.0
.......................   		X           599,166 0 34,881
(55) MICHAEL MCAULIFFE........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(56) MYRON HODGES........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(57) NHU YEARGIN........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(58) PAMELA FAWVER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(59) PATRICIA BARRY........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(60) PATRICIA MORELLI........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(61) PATRICK PARCELLS........................................................................
SR VP, ADMINISTRATOR RRMC
 39.0
.......................1.0 		X   X       648,298 0 30,305
(62) PAUL HARTMANN........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(63) PAUL TREOLO........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(64) REBECCA MCCOY........................................................................
VICE CHAIRMAN
 1.0
.......................   		X           0 0 0
(65) RICHARD CROWDER........................................................................
BOARD MEMBER
 1.0
.......................   		X           1,900 0 86
(66) RICHARD DUNN........................................................................
BOARD MEMBER
 40.0
.......................   		X           250,629 0 39,832
(67) RICHARD PEARCE........................................................................
EXEC VICE CHAIRMAN & SPECIAL A
 39.0
.......................1.0 		X           1,108,596 0 33,592
(68) ROBERT DAVIS........................................................................
BOARD MEMBER
 40.0
.......................   		X           277,327 0 36,214
(69) ROBERT GORDON........................................................................
CHAIRMAN
 1.0
.......................   		X           0 0 0
(70) ROBERT HARDING........................................................................
BOARD MEMBER
 40.0
.......................   		X           268,105 0 36,152
(71) ROBERT MARBLE........................................................................
CHAIRMAN
 1.0
.......................   		X           0 0 0
(72) ROBERT TURBYFILL........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(73) ROGER SCHULTZ........................................................................
BOARD MEMBER
 40.0
.......................   		X           520,225 0 38,114
(74) RONALD SAUNDERS........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(75) SHAWKE SOUEIDAN........................................................................
BOARD MEMBER
 40.0
.......................   		X           448,119 0 41,849
(76) SHERRIN ALSOP........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(77) STEVEN ADAMS........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(78) STEWART JENNINGS........................................................................
BOARD MEMBER
 40.0
.......................   		X           204,414 0 37,556
(79) THOMAS BAKER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(80) THOMAS PAYNE........................................................................
VICE CHAIRMAN
 1.0
.......................   		X           0 0 0
(81) THOMAS REAGAN........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(82) VERNEETA WILLIAMS........................................................................
BOARD MEMBER
 40.0
.......................   		X           193,846 0 20,494
(83) VERONICA DONAHUE........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(84) VICKI HAUSER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(85) WADE BROUGHMAN........................................................................
EXEC VP,COO & SECRETARY/TREASU
 39.0
.......................1.0 		X   X       756,749 0 38,737
(86) WALTER BYRDE........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(87) WANDA AUSTIN........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(88) WILLIAM HEATH........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(89) WILLIAM BENSON........................................................................
VICE CHAIRMAN
 1.0
.......................   		X           0 0 0
(90) WILLIAM BRAUER........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(91) WILLIAM DOWNEY........................................................................
PRESIDENT,CEO RHS
 39.0
.......................1.0 		X   X       1,068,287 0 38,496
(92) WILLIAM GRACE........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(93) WILLIAM MASSEY........................................................................
BOARD MEMBER
 1.0
.......................   		X           0 0 0
(94) BARRY GROSS........................................................................
EXEC VP/CMO RHS
 40.0
.......................   		    X       682,709 0 30,542
(95) CHARLES FRAZIER........................................................................
VP, CLINICAL INNOVATION
 40.0
.......................   		    X       429,526 0 45,408
(96) CHARLES GRAHAM........................................................................
VP, PHYSICIAN SERVICES
 40.0
.......................   		    X       440,065 0 31,468
(97) CHRISTOPHER STOLLE........................................................................
VP MEDICAL AFFAIRS
 40.0
.......................   		    X       424,941 0 21,941
(98) CRAIG CONNORS........................................................................
VP, HOME & COMMUNITY BASED SVS
 40.0
.......................   		    X       248,932 0 41,010
(99) DEBORA TANNER........................................................................
VP/ADMINISTRATOR
 40.0
.......................   		    X       208,807 0 29,789
(100) DIANA LOVECCHIO........................................................................
VP, CONSTR MGMT & SHARED SVS
 40.0
.......................   		    X       288,539 0 31,546
(101) ELISABETH WILLIAMS........................................................................
VP
 40.0
.......................   		    X       179,691 0 34,689
(102) ELIZABETH MARTIN........................................................................
VP/ADMINISTRATOR RTH
 40.0
.......................   		    X       352,757 0 42,678
(103) FAYE GARGIULO........................................................................
VP, RESEARCH/DISCOVERY/PHY REC
 40.0
.......................   		    X       295,470 0 31,759
(104) FRANK MARTIN........................................................................
SR VP, LHARS
 40.0
.......................   		    X       386,475 0 34,361
(105) GWENDOLYN HARTZOG........................................................................
VP PATIENT CARE SVS, CNO
 40.0
.......................   		    X       294,366 0 24,596
(106) JAMES LESNICK........................................................................
VP/MEDICAL DIRECTOR RMG
 40.0
.......................   		    X       790,373 0 48,190
(107) JASON HOUSER........................................................................
VP, LEGAL AFFAIRS
 40.0
.......................   		    X       342,623 0 38,102
(108) JOHN STANLEY........................................................................
SR VP, CIO
 40.0
.......................   		    X       460,218 0 39,258
(109) KEITH PERCIC........................................................................
VP
 40.0
.......................   		    X       354,235 0 39,010
(110) MEDFORD RAMEY........................................................................
VP, COMMUNITY DEVELOPMENT
 40.0
.......................   		    X       145,295 0 18,716
(111) MEGAN KLECKNER........................................................................
VP/ADMINISTRATOR RWR & SECRETA
 40.0
.......................   		    X       243,907 0 25,814
(112) MICHAEL DOUCETTE........................................................................
VP RRMC OPERATIONS
 40.0
.......................   		    X       367,457 0 40,585
(113) RENEE ROUNTREE........................................................................
VP EMERGENCY & TRAUMA SVS
 40.0
.......................   		    X       248,363 0 20,427
(114) RHONDRA MATTHEWS........................................................................
SR VP, PHILANTHROPY
 40.0
.......................   		    X       385,009 0 31,611
(115) ROBERT BRYANT........................................................................
VP/COO FACILITY BASED SVS
 40.0
.......................   		    X       358,609 0 40,968
(116) S FLEISCHER........................................................................
VP
 40.0
.......................   		    X       181,731 0 13,198
(117) SALLY HARTMAN........................................................................
VP, HUMAN RESOURCES
 40.0
.......................   		    X       337,553 0 28,857
(118) STEPHEN MCCARY........................................................................
VP, RDHW
 40.0
.......................   		    X       250,456 0 35,695
(119) SUSAN MCANDREWS........................................................................
VP RN
 40.0
.......................   		    X       314,039 0 28,985
(120) TRACEE CARMEAN........................................................................
VP, EDUCATION
 40.0
.......................   		    X       251,910 0 36,763
(121) WALTER AUSTIN........................................................................
SENIOR VP FINANCE AND CFO
 40.0
.......................   		    X       145,878 0 9,773
(122) TERRIS KENNEDY........................................................................
SR VP. RHS CNO
 39.0
.......................1.0 		    X       386,171 0 18,221
(123) ALLAN ERBE........................................................................
ADMINISTRATOR
 40.0
.......................   		      X     155,584 0 14,584
(124) JUSTIN CRAIN........................................................................
DIRECTOR
 40.0
.......................   		      X     169,206 0 19,753
(125) DEBORAH ATKINSON........................................................................
EXEC DIRECTOR
 40.0
.......................   		      X     129,045 0 13,761
(126) MARY DELPRINCE........................................................................
DIRECTOR
 40.0
.......................   		      X     180,694 0 22,805
(127) TRACEY DOWLING........................................................................
DIRECTOR ADMINISTRATIVE
 40.0
.......................   		      X     161,254 0 27,810
(128) JAMES FOSS........................................................................
DIRECTOR
 40.0
.......................   		      X     201,725 0 24,350
(129) JENNIFER GREENWELL........................................................................
CFO
 40.0
.......................   		      X     200,770 0 31,238
(130) JANET HOWARD........................................................................
DIRECTOR RMG PRACTICE MGMT
 40.0
.......................   		      X     213,809 0 23,674
(131) KYLE ALLEN........................................................................
MEDICAL DIRECTOR, LHARS
 40.0
.......................   		      X     373,991 0 39,067
(132) BARBARA LABONTE........................................................................
DIRECTOR ADMINISTRATIVE
 40.0
.......................   		      X     187,493 0 20,006
(133) DENNIS LOFTUS........................................................................
DIRECTOR ADMINISTRATIVE
 40.0
.......................   		      X     205,517 0 41,274
(134) TODD MARTIN........................................................................
DIRECTOR
 40.0
.......................   		      X     172,369 0 18,681
(135) BRADEN MILLER........................................................................
CFO
 40.0
.......................   		      X     243,868 0 42,906
(136) ANTHONY MINA........................................................................
DIRECTOR DEVELOPMENT
 40.0
.......................   		      X     225,400 0 42,336
(137) RAYMOND NEWTON........................................................................
DIRECTOR RMG PRACTICE MGMT
 40.0
.......................   		      X     232,027 0 21,458
(138) JOHN PETERMAN........................................................................
DIRECTOR
 40.0
.......................   		      X     184,850 0 25,133
(139) LISA SALSBERRY........................................................................
DIRECTOR
 40.0
.......................   		      X     211,635 0 38,754
(140) SANDRA SNAPP........................................................................
DIRECTOR
 40.0
.......................   		      X     180,710 0 18,752
(141) THOMAS CLEARY........................................................................
PRESIDENT, MEDICAL STAFF
 40.0
.......................   		      X     224,463 0 17,778
(142) ROSS YOUNGER........................................................................
DIRECTOR
 40.0
.......................   		      X     369,401 0 43,685
(143) WILLIAM MCALLISTER........................................................................
PHYSICIAN
 37.0
.......................   		        X   1,309,680 0 32,947
(144) DEAN KOSTOV........................................................................
PHYSICIAN
 36.0
.......................   		        X   1,299,557 0 13,871
(145) ROBERT CULLOM........................................................................
PHYSICIAN
 37.0
.......................   		        X   1,004,836 0 1,062
(146) JAVIER AMADEO........................................................................
PHYSICIAN
 37.0
.......................   		        X   926,826 0 17,612
(147) BRIAN KEEL........................................................................
PHYSICIAN
 35.0
.......................   		        X   921,686 0 1,497
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 30,796,112 0 2,463,035
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet570
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Fair Oaks Ansthesia Assoc, 3998 Fair Ridge Dr Ste 300FAIRFAXVA22033 HEALTHCARE SERVICES 4,824,714
Fisher Scientific Company LLC, PO BOX 404705ATLANTAGA303844705 RADIOLOGY SERVICES 1,692,950
Radiology Svcs of Hampton Roads, 814 Greenbrier Circle Ste HCHESAPEAKEVA23320 Radiology Services 1,051,701
The Jacobs Group LLC, 491 McLaws Circle Ste 2WILLIAMSBURGVA23185 Consulting Services 845,176
Ernst Young LLP, PO BOX 640382PITTSBURGPA152640382 ACCOUNTING SERVICES 791,772
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet29
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 2,056,307
f All other contributions, gifts, grants, and
similar amounts not included above1f 		519,409
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 2,575,716
Program Service Revenue Business Code
2a PROGRAM SERVICE REVENUE 900099 908,547,284 908,547,284    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 908,547,284
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 22,124,048     22,124,048
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 21,721,972  
b Less: rental expenses 22,261,439  
c Rental income or (loss) -539,467 0
d Net rental income or (loss).......MediumBullet -539,467     -539,467
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory -17,099,660 167,050
b Less: cost or other basis and sales expenses -11,221,894 367,992
c Gain or (loss) -5,877,766 -200,942
d Net gain or (loss)..........MediumBullet -6,078,708     -6,078,708
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a SVCS TO AFFILIATES 900099 223,456,539 223,456,539    
b OPTICAL SALES 900099 7,127,099 7,127,099    
c OTHER FUNCTIONAL INCOME 900099 16,255,802 16,255,802    
d All other revenue .... 8,547,678 603,839 4,373,252 3,570,587
e Total. Add lines 11a–11d ...... MediumBullet 255,387,118
12 Total revenue. See Instructions......MediumBullet 1,182,015,991 1,155,990,563 4,373,252 19,076,460
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 8,028,209 8,028,209
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 27,792,572   27,792,572  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 391,715,690 363,179,363 28,536,327  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 23,386,050 10,330,731 13,055,319  
9 Other employee benefits ....... 28,303,596 18,329,444 9,974,152  
10 Payroll taxes ........... 25,282,582 22,149,253 3,133,329  
11 Fees for services (non-employees):        
a Management ...... 44,611   44,611  
b Legal ......... 885,652   885,652  
c Accounting ........... 597,548   597,548  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 120,695   120,695  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 23,546,422 23,546,422    
12 Advertising and promotion .... 4,114,006 1,156,650 2,952,613 4,743
13 Office expenses ....... 159,800,900 148,849,314 10,903,690 47,896
14 Information technology ...... 27,448,637 3,044,501 24,404,136  
15 Royalties .. 0      
16 Occupancy ........... 49,711,372 49,711,372    
17 Travel ............ 2,200,990 1,667,362 533,628  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 46,854 25,207 21,647  
20 Interest ........... 5,019,771 2,197,534 2,822,237  
21 Payments to affiliates ....... 147,311,254 79,352,169 67,959,085  
22 Depreciation, depletion, and amortization ..... 29,940,078 26,893,320 3,046,758  
23 Insurance .............. 59,502,891 6,649,030 52,853,861  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a PROFESSIONAL SERVICES 45,537,862 45,537,718   144
b BAD DEBT EXPENSE 83,117,326 83,117,326    
c NET GAIN/LOSS DEBT FINANCE 250,629   250,629  
d TAXES 259,988 212,930 47,058  
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 1,143,966,185 893,977,855 249,935,547 52,783
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 18,098,524 1 49,022,375
2 Savings and temporary cash investments ......... 529,820,883 2 548,558,548
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. -16,110,430 4 119,971,366
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 11,146,896 8 12,366,200
9 Prepaid expenses and deferred charges .......... 9,413,116 9 10,735,762
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 580,906,248
b Less: accumulated depreciation ..... 10b 377,415,970 190,263,926 10c 203,490,278
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... -895,456 13 14,139,752
14 Intangible assets ............... 9,334,858 14 9,353,958
15 Other assets. See Part IV, line 11 ........... 4,598,375 15 161,385
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 755,670,692 16 967,799,624
Liabilities 17 Accounts payable and accrued expenses ......... 228,373,062 17 431,321,036
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 3,358,020 19 5,091,555
20 Tax-exempt bond liabilities ............. 52,289,137 20 26,889,437
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 30,822,881 25 26,900,775
26 Total liabilities. Add lines 17 through 25......... 314,843,100 26 490,202,803
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 436,119,756 27 472,019,230
28 Temporarily restricted net assets ........... 4,607,836 28 5,477,591
29 Permanently restricted net assets ........... 100,000 29 100,000
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 440,827,592 33 477,596,821
34 Total liabilities and net assets/fund balances ........ 755,670,692 34 967,799,624
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
1,182,015,991
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,143,966,185
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
38,049,806
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
440,827,592
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
-1,212,715
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-67,862
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
477,596,821
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
(A) FRANCIS N SANDERS
  		540683174 03   No Yes   Yes   0
(B) PATRICK HENRY HOSPITAL INC
  		540601803 03   No Yes   Yes   0
(C) REHABILITATION INSTITUTE OF VIRGINIA INC
  		521432269 03   No Yes   Yes   35,280
(D) RIVERSIDE BEHAVIORAL CENTER INC
  		541979321 03   No Yes   Yes   90,283
(E) RIVERSIDE CONVALESCENT CENTERS INC
  		521276323 03   No Yes   Yes   0
(F) RIVERSIDE HOSPITAL INC
  		521245746 03   No Yes   Yes   915,200
(G) RIVERSIDE MIDDLE PENINSULA HOSPITAL INC
  		521241836 03   No Yes   Yes   15,075
(H) RIVERSIDE TAPPAHANNOCK HOSIPTAL INC
  		541489410 03   No Yes   Yes   365,297
(I) SANDERS COMMON LTD
  		524233030 03   No Yes   Yes   0
Total                 1,421,135

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Riverside Healthcare Association Inc Group
  		Employer identification number

90-1000718
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Riverside Healthcare Association Inc Group
  		Employer identification number

90-1000718
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Riverside Healthcare Association Inc Group
  		Employer identification number

90-1000718
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
54,544
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
78,638
j
Total. Add lines 1c through 1i ...............................
133,182
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Other Lobbying Activities Part II-B, Line 1 (I) Salary and Expenses $78,638. Dues $54,544. Lobbies on issues related to certificates of public need and all issues affecting healthcare such as hospitals, patients, physicians, and health insurance.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 1,208,060 1,356,116 1,250,833 1,009,557 1,247,637
b Contributions ........          
c Net investment earnings, gains, and losses 149,106 19,944 161,283 241,276 -226,613
d Grants or scholarships ..... 52,000 168,000 56,000   11,467
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ...... 1,305,166 1,208,060 1,356,116 1,250,833 1,009,557
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   11,671,817 11,671,817
b Buildings ................   238,356,486 119,523,684 118,832,802
c Leasehold improvements ............        
d Equipment ................   315,989,053 246,525,635 69,463,418
e Other .................   14,888,892 11,366,651 3,522,241
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 203,490,278
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
OTHER CURRENT LIABILITIES 6,848,893
OBLIGATION UNDER CAPITAL LEASE 18,480,559
NOTE PAYABLE-CURRENT 652,563
CONTINGENT LIABILITY 918,760





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 26,900,775
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D Part V Line 4   Endowment funds are used for scholarships
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		8 24,477 16,089,247   16,089,247 1.520 %
b Medicaid (from Worksheet 3,
column a) .... 		11 24,108 28,884,381 22,960,895 5,923,486 0.560 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		19 48,585 44,973,628 22,960,895 22,012,733 2.080 %
Other Benefits
 546 88,482 1,710,624   1,710,624 0.160 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		298 2,654 17,893,518 9,086,006 8,807,512 0.830 %
g Subsidized health services
(from Worksheet 6) .. 		1 5,737 5,563,966 4,513,286 1,050,680 0.100 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		99 51,373 598,526   598,526 0.060 %
j Total. Other Benefits .. 944 148,246 25,766,634 13,599,292 12,167,342 1.150 %
k Total. Add lines 7d and 7j . 963 196,831 70,740,262 36,560,187 34,180,075 3.230 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 19 1,659 9,417   6,417  
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 1 120 71   71  
7 Community health improvement advocacy 2 601 1,845   1,845  
8 Workforce development            
9 Other            
10 Total 22 2,380 11,333   8,333  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
83,117,326
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
184,481,098
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
174,678,819
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
9,802,279
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?5
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Riverside Regional Medical Center
500 J CLYDE MORRIS BLVD
NEWPORT NEWS,VA23601 		X X   X   X X     1
2 Riverside Walter Reed Hospital
7519 HOSPITAL DRIVE
GLOUCESTER,VA23061 		X X         X     2
3 Riverside Tappahannock Hospital
618 HOSPITAL ROAD
TAPPAHANNOCK,VA22560 		X X         X     3
4 Riverside Rehabilitation Institute
245 CHESAPEAKE AVENUE
NEWPORT NEWS,VA23607 		X               Inpat Rehabilitation 4
5 Riverside Behavioral Health Center
2244 EXECUTIVE DRIVE
HAMPTON,VA23666 		X               Inpat Psychiatric 5
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Riverside Regional Medical Center
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 250.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Riverside Walter Reed Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 250.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Riverside Tappahannock Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 250.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Riverside Rehabilitation Institute
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 250.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19   No
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Riverside Behavioral Health Center
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 250.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?43
Name and address Type of Facility (describe)
1 Brentwood Medical Education
10510 Jefferson Avenue
Newport News,VA23601 		Physician Clinic
2 PCI-Newport News
12100 Warwick Blvd
Newport News,VA23601 		Infusion Therapy Center
3 Riverside Cancer Institute Ctr-Va Beach
1200 First Colonial Rd 204A
Virginia Beach,VA23455 		Infusion Therapy Center
4 Riverside Cancer Institute Ctr-Chesapeak
110 Wimbledon Square Ste E1
Chesapeake,VA23320 		Infusion Therapy Center
5 Riverside Cancer Institute Ctr-Suffolk
5835 Harbor View Blvd Ste C1
Suffolk,VA23435 		Infusion Therapy Center
6 Riverside Diagnostic & Breast Imaging Ct
895 Middle Ground Blvd Ste 104
Newport News,VA23606 		Diagnostic Center
7 Riverside Home Care
856 J Clyde Morris Blvd
Newport News,VA23601 		Home Health Agency
8 PACE-Hampton
4107 West Mercury Blvd
Hampton,VA23666 		Elderly Care Services
9 PACE-Manchester
701 Gordon Avenue
Richmond,VA23224 		Elderly Care Services
10 PACE-Petersburg
319 Brown Street
Petersburg,VA23803 		Elderly Care Services
11 PACE-Mactavish
1300 Mactavish Avenue
Richmond,VA23230 		Elderly Care Services
12 Patriots Colony
6000 Patriots Colony
Williamsburg,VA23188 		Retirement Center
13 Riverside Cancer Institute Ctr-Gloucest
7544 Medical Center
Gloucester,VA23061 		Infusion Therapy Center
14 Riverside Radiation Oncology-Wmbg
3901 Treyburn Drive
Williamsburg,VA23085 		Radiation Oncology Center
15 Hampton Surgery Center
850 Enterprise Parkway Ste 100
Hampton,VA23666 		Surgery Center
16 Riverside Diagnostic Ctr-Hampton
850 Enterprise Parkway Ste 1500
Hampton,VA23666 		Diagnostic Center
17 Riverside Radiaton Oncology-Npt News
12100 Warwick Blvd
Newport News,VA23601 		Radiation Oncology Center
18 Riverside Convalescent-Warwick Forest
1000 Old Denbigh Blvd
Newport News,VA23602 		Nursing Home/Convalescent Svcs
19 Riverside Convalescent-Hampton
414 Algonquin Road
Hampton,VA23661 		Nursing Home/Convalescent Svcs
20 Riverside Convalescent-Mathews
Route 611 PO Box 370
Mathews,VA23109 		Nursing Home/Convalescent Svcs
21 Riverside Convalescent-Saluda
672 Gloucester Road
Saluda,VA23149 		Nursing Home/Convalescent Svcs
22 Riverside Convalescent-Smithfield
200 Lumar Road
Smithfield,VA23430 		Nursing Home/Convalescent Svcs
23 Riverside Convalescent-West Point
2960 Chelsa Road
West Point,VA23181 		Nursing Home/Convalescent Svcs
24 Sanders Retirement Center
7385 Walker Avenue
Gloucester,VA23061 		Retirement Services
25 Riverside Convalescent-Orchard
20 Delfae Drive
Warsaw,VA22572 		Nursing Home/Convalescent Svcs
26 Riverside Cancer Institute Ctr-Wmbg
120 Kings Way
Williamsburg,VA23185 		Infusion Therapy Center
27 Riverside Diagnostic Center-Williamsburg
120 Kings Way Ste 1200
Williamsburg,VA23185 		Diagnostic Center
28 Riverside Radiation Oncology-Gloucester
7544 Medical Drive Ste A
Gloucester,VA23061 		Radiation Oncology Center
29 PACE-Newport News
439 C Oriana Road
Newport News,VA23608 		Elderly Care Services
30 Riverside Convalescent-Regional
1000 Old Denbigh Blvd
Newport News,VA23602 		Nursing Home/Convalescent Svcs
31 Riverside Diagnostic Center Smithfield
202 Gumwood Drive
Smithfield,VA23430 		Diagnostic Center
32 Riverside Diagnostic Center Mt Clement
300 Mount Clement Park Ste A2
Tappahannock,VA22560 		Diagnostic Center
33 Riverside Neurology Ctr
12200 Warwick Blvd Ste 110
Newport News,VA23608 		Neurology Center
34 Peninisula GastroRiverside Endoscopy Ct
101 Phillip Roth Street Ste B
Newport News,VA23606 		Gastroenterology/Endoscopy Ct
35 Riverside Pain & Interventional Center
12420 Warwick Blvd Ste C
Newport News,VA23606 		Pain & Interventional Center
36 Riverside Physical Therapy-Hampton
850 Enterprise Parkway Ste 2100
Hampton,VA23666 		Physical Therapy
37 Riverside Physical Therapy-Denbigh
12650 Jefferson Ave Ste 100
Newport News,VA23602 		Physical Therapy
38 Riverside Pulmonary and Sleep Center
12200 Warwick Blvd Ste 210
Newport News,VA23601 		Pulmonary and Sleep Center
39 Riverside Diabetes Services
12200 Warwick Blvd Ste 590A
Newport News,VA23601 		Diabetes Services
40 Riverside Physical Therapy-Mt Clement
300 Mt Clement Park Ste D
Tappahannock,VA22560 		Physical Therapy
41 Riverside Physical Therapy-Hayes
2656 George Washington Mem Hwy Ste
Hayes,VA23072 		Physical Therapy
42 Riverside Hayes Diagnostic Imaging Ctr
2246 George Washington Mem Hwy
Hayes,VA23072 		Diagnostic Imaging Center
43 Riverside Rehab Outpatient Therapy-Wlbg
120 Monticello Ave Ste 200
Williamsburg,VA23185 		Outpatient Therapy
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
Part I, line 3c   Part I, line 3c - Free care uses 250% of the FPG. Our policies do not include "discounted" care. Part 1, line 6b - The community needs assessment is done for all entities of Riverside Healthcare Association. Part 1, line 7 column f - Bad debt expenses removed from total expense in line 7 column f is $83,117,326 Part I, line 7 a. The cost to charge ratio calculated on Worksheet 2 was used for the charity expense calculation. b. Medicaid cost and net revenue are directly from the Medicaid cost report e. Community health improvement is actual cost accumulated by the individuals participating in the activities. g. There are no physician costs in the subsidized health services. i. Cash and in kind contributions are the actual dollar value of cash or items given. Part II - In 2012 Riverside partnered with local organizations to support community programs including career development for under-privileged youth; science and space education; and investment in capital improvements designed to enhance quality of life and health on the Virginia Peninsula. Part III, Line 3 --- Patients eligible under the Financial Assistance Policy were provided 100% discount and not included in bad debt expense Part III, line 4 - Bad debt is the amount remaining on a patient's account after cash payments, third party payer contractual adjustments and hospital discounts have been taken. Before the amount is written off to bad debt the account is sent to a collection agency, which returns the account when they have exhausted all possible efforts. Upon return the account balance is written off to bad debt. The system's financial statements do not contain a footnote specifically for bad debt. Bad debt is referenced in Note 4 Community Benefit Expense. It states "Distinguishing uncollected patient revenue between charity and bad debt requires full consideration of both the financial and non-financial circumstances of the patient, which are not always available to the organization. Therefore, both charity and bad debt are included as a component of benefits for the indigent." The bad debt expense on the audited system financial statements is bad debt charges written off. This amount is considered a community benefit. Patient accounts are not written down to bad debt if we know they qualify for one of our financial assistance programs. Even if a financial assistance status is not known but a financial assistance application is pending we do not send the patient's account to bad debt. The policy states, "If a patient has completed a hospital's application for financial assistance that account should not be advanced for collection pending determination of eligibility." In the event a patient pays part of their bill prior to being approved for financial assistance, any excess payments made by the patient are refunded by the facility. Part III, line 8 - Medicare costs are determined by CMS regulations and guidelines. In years where there is a shortfall from Medicare, the shortfall is recognized as a community benefit. Part III, line 9b - Patients eligible under the written Financial Assistance Policy were provided 100% discount and were therefore excluded from debt collection processes. Part V, Section B - line 11- Patients eligible under the Financial Assistance Policy were provided 100% discount and therefore FPG was not used to determine eligibility for discounted care. Part V, Section B - line 16e - In accordance with 501(r), no collection activity, including third party collections, beyond mailing statements was taken prior to making a reasonable effort to determine the patient's eligibility under the FAP. Part V, Section B - line 20d - Patients eligible under the Financial Assistance Policy were provided 100% discount and therefore the maximum amount charged to patients once they were determined to be eligible under FAP was $0.00 Part VI, Line 2 - Needs Assessment - Riverside identifies unmet community health needs using the database of the Virginia Atlas of Community Health. The database contains county-level and zip code-level data for 240 population, economic, and health indicators. It can produce maps to illustrate the health of a community. The database contains an additional 32 "Adult Health Behavior" data points that include county-level estimates of people with chronic diseases. Riverside makes internal decisions for resource allocation, using the community needs index. Risk factors and high-risk groups are identified with the key issues that are barriers to obtaining desired results. Riverside documents its investment in the community of the key groups, which programs are funded and how service lines address the health needs of the community. After analyzing the information, Riverside recommends action and sets future goals in each identified area of health-related needs. Riverside also uses data from the needs assessments performed by other community agencies to identify and respond to local needs. Part VI, Line 3 - Patient Education of Eligibility for Assistance - Patients are notified of the FAP while in the hospital, notice is included on the patient statement, and patients are educated directly by customer service agents when they inquire about their bill. They are also contacted for assistance in screening for eligibility for federal, state, and local government programs. Part VI, Line 4 - Community Information - The service area for Riverside Healthcare Association, dba Riverside Health System, covers a wide geographic area, from the Potomac River to south of the James River in southeastern Virginia. The broader Virginia Peninsula area encompassing James City County, York County, New Kent County, Isle of Wight County and the cities of Williamsburg, Newport News, Poquoson and Hampton, has a 2012 census projected population of 530,220 persons. Riverside Regional Medical Center in Newport News is the only trauma center (Level II) located in this area. The Virginia Peninsula is bordered on the east by the Chesapeake Bay and Hampton Roads, on the south by the James River and the north by the York River. Access to health care facilities not located on the Peninsula is restricted by tunnels and bridges, with three connections to various points across the James, and one bridge north across the York. Numerous waterways, inlets and marshland are prominent in the landscape and restrict traffic in certain areas, requiring a system of bridges or circuitous routes for local travel. Interstate 64 runs the length of the Peninsula, providing access some 75 miles from Riverside Regional Medical Center to downtown Richmond and 40 miles to downtown Norfolk (via Hampton Roads Tunnel). Some 80,000 to 90,000 cars travel along this interstate corridor daily. Riverside owns and operates several diagnostic centers throughout its service area. The hospital facilities operate outpatient programs in addition to those in free-standing ambulatory centers. Reasons behind this outpatient "reach" include: the lack of interconnected public transportation; the traffic congestion on Interstates and urban roadways; and the significant elderly population in the service area. Many of the senior citizens, particularly in outlying areas, rely on friends and family members to transport them to appointments. Surplus funds are used to promote and improve access to services in the areas close to where residents live. This Peninsula area is generally considered to have a high quality of life in accordance with standard socioeconomic variables, and a comparatively low cost of living. With the relative exception of the City of Williamsburg, drugs, crime and poverty negatively impact the more densely populated areas of the communities. Demographically and occupationally, the Riverside service area is primarily what has traditionally been defined as a blue-collar community. Between the large military presence and the supporting defense industry, almost 50% of the economy is connected to defense. The largest private employer is Huntington Ingalls Newport News Shipbuilding with 22,000 workers. The community's population of people over age 65 is growing quickly, and that aging population points to even stronger hospital utilization in the coming years. The age group of 65 and older comprises 10.3% of the population. Approximately 30% of households have incomes of $35,000 or less, so Riverside's charity mission is strong and ongoing with a concerted effort directed to children at risk. Within the market, all of the localities with the exception of the City of Poquoson qualify for partial designation as Medically Underserved Service Areas. There is strong competition within 60 miles of Riverside Regional Medical Center. Within seven miles on each side and 20 miles north there are three medical surgical hospitals and within 20 to 60 miles across the Hampton Roads harbor there are six facilities. Riverside Behavioral Health Center and Riverside Rehabilitation Institute are the only service providers of
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number
90-1000718
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Alzheimer's Association
6350 Center Drive
St 102
Norfolk,VA23502 		13-3039601 501(c)(3) 20,000       End Alzheimer's Walk
(2) American Diabetes Association
870 Greenbrier Cr
St 404
Chesapeake,VA23320 		13-1623888 501(c)(3) 7,500       Sponsorship
(3) An Achievable Dream Foundation Inc
10858 Warwick Blvd
St A
Newport News,VA23601 		54-1621932 501(c)(3) 66,000       Sponsorship
(4) Boys and Girls Clubs of the Virginia Peninsula Fou
11825 Rocklanding
St B
Newport News,VA23606 		54-1568297 501(c)(3) 10,000       Sponsorship
(5) Christopher Newport Univ Education Foundation
1 University Place
Newport News,VA23606 		54-1156248 501(c)(3) 25,000       4th Install - 5 year pledge
(6) College of William & Mary
PO Box 8795
Williamsburg,VA23187 		54-0734117 501(c)(3) 18,500       Sponsorship
(7) Community Free Clinic of Newport News
727 25th Street
Newport News,VA23607 		27-3510814 501(c)(3) 249,996       Installment
(8) Fear 2 Freedom Inc
113 Meadow Rue Court
Williamsburg,VA23185 		45-2143034 501(c)(3) 10,000       Sponsorship
(9) Hampton Roads Educational
5200 Hampton Blvd
Norfolk,VA23508 		54-0843118 501(c)(3) 30,000       Pledge 2012
(10) Hospice House
4445 Powhatan PKWY
Williamsburg,VA23188 		52-1289657 501(c)(3) 6,600       Culinary Affair
(11) Hospice Support Care
4445 Powhatan PKWY
Williamsburg,VA23188 		52-1289657 501(c)(3) 38,950       Charitable Contrbut
(12) IMAX
11742 Jefferson Ave
st 350
Newport News,VA23606 		54-2057957 501(c)(3) 100,000       Sponsorship - IMAX
(13) March of Dimes
860 Greenbrier Circle
St 502
Chesapeake,VA23320 		13-1846366 501(c)(3) 10,000       Sponsorship
(14) Office of Human Affairs
2410 Wickham Avenue
Newport News,VA23607 		23-7014485 501(c)(3) 15,000       46th Annual Award
(15) Olde Town Medical Center
5249 Olde Town Road
Williamsburg,VA23188 		54-1663905 501(c)(3) 32,950       Charitable Contrbut
(16) Peninsula Metropolitan YMCA
101 Long Green Blvd
Yorktown,VA23693 		54-0524905 501(c)(3) 10,000       Sponsorship
(17) Pilots Youth Baseball Organization
PO Box 7376
Hampton,VA23669 		54-2051226 501(c)(3) 7,500       Sponsorship
(18) People to People
PO Box 12888
Newport News,VA23612 		54-0600387 501(c)(3) 20,000       Grant Disbursement
(19) Physico-control-Carrollton Volunteer Rescue Squad
PO Box 97023
Redmond,WA98073 		54-1052865 501(c)(3) 6,190       RRMC 5yt-Lifenet
(20) Riverside Health System
608 Denbigh Blvd
St 800
Newport News,VA23608 		52-1245746 501(c)(3) 31,184       Riverside Help Fund
(21) RX Partnership
2924 Emerywood Pkwy
St 300
Richmond,VA23294 		57-1186937 501(c)(3) 12,000       4th Install-5 yr grant
(22) ST Mary's Home
6171 Kempsville Circle
Norfolk,VA23502 		54-0505952 501(c)(3) 15,000       2nd Install-Sponshp
(23) The Mariner's Museum
100 Museum Drive
Newport News,VA23606 		54-0541801 501(c)(3) 20,000       USS Monitor Display
(24) United Way of the Virginia Peninsula
739 Thimble Shoals
St 302
Newport News,VA23606 		54-0535602 501(c)(3) 7,500       Sponsorship
(25) Vhref
PO Box 31394
Richmond,VA23294 		54-0801059 501(c)(3) 10,000       Sponsorship - VHIN-007
(26) Virginia Center for Inclusive
5511 Staples Mill Road
St 202
Richmond,VA23228 		20-3188273 501(c)(3) 7,500       Grant 2012
(27) Virginia Health Care Foundation
707 E Main Street
St 1350
Richmond,VA23219 		54-1639924 501(c)(3) 34,000       Pledge - Healthcare
(28) Virginia Living Museum Inc
524 J Clyde Morris
Newport News,VA23601 		54-6055922 501(c)(3) 11,000       3rd Installment
(29) WM Jordan Charitable Foundation
PO Box 1337
Newport News,VA23601 		54-6407107 501(c)(3) 500,000       Sponsorship
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
31
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Grant Explanation Schedule I, Part I, Line 2 A fund distribution form is completed and signed by an authorized administrator of the benefiting facility. Requests are approved according to the specifics of the fund's governing charter. If a fund request doesn't comply the money is not distributed.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)ALLAN ERBEADMINISTRATOR (i)
(ii)		 120,094
0 		25,894
0 		9,596
0 		8,779
0 		5,805
0 		170,168
0 		0
0
(2)BARRY GROSSEXEC VP/CMO RHS (i)
(ii)		 467,423
0 		123,036
0 		92,250
0 		22,897
0 		7,645
0 		713,251
0 		0
0
(3)BLAIR MARSTELLERBOARD MEMBER (i)
(ii)		 348,068
0 		0
0 		12,835
0 		18,862
0 		23,409
0 		403,174
0 		0
0
(4)CARRIE MOSSBOARD MEMBER (i)
(ii)		 214,136
0 		172,224
0 		66,471
0 		24,900
0 		690
0 		478,421
0 		0
0
(5)CHARLES FRAZIERVP, CLINICAL INNOVATION (i)
(ii)		 303,124
0 		71,724
0 		54,678
0 		25,112
0 		20,296
0 		474,934
0 		0
0
(6)CHARLES GRAHAMVP, PHYSICIAN SERVICES (i)
(ii)		 304,878
0 		74,498
0 		60,689
0 		13,862
0 		17,606
0 		471,533
0 		0
0
(7)CHRISTOPHER STOLLEVP MEDICAL AFFAIRS (i)
(ii)		 303,410
0 		66,416
0 		55,115
0 		20,112
0 		1,829
0 		446,882
0 		0
0
(8)CRAIG CONNORSVP, HOME & COMMUNITY BASED SVS (i)
(ii)		 171,210
0 		37,800
0 		39,922
0 		18,885
0 		22,125
0 		289,942
0 		0
0
(9)JUSTIN CRAINDIRECTOR (i)
(ii)		 142,229
0 		26,977
0 		0
0 		13,800
0 		5,953
0 		188,959
0 		0
0
(10)DAVID JONESBOARD MEMBER (i)
(ii)		 115,285
0 		32,380
0 		100,454
0 		20,112
0 		16,545
0 		284,776
0 		0
0
(11)DEBORA TANNERVP/ADMINISTRATOR (i)
(ii)		 167,421
0 		0
0 		41,386
0 		19,544
0 		10,245
0 		238,596
0 		0
0
(12)DEBRA BOYERBOARD MEMBER (i)
(ii)		 194,151
0 		45,196
0 		17,332
0 		25,112
0 		19,476
0 		301,267
0 		0
0
(13)MARY DELPRINCEDIRECTOR (i)
(ii)		 150,237
0 		29,963
0 		494
0 		14,930
0 		7,875
0 		203,499
0 		0
0
(14)DIANA LOVECCHIOVP, CONSTR MGMT & SHARED SVS (i)
(ii)		 191,921
0 		53,475
0 		43,143
0 		20,112
0 		11,434
0 		320,085
0 		0
0
(15)TRACEY DOWLINGDIRECTOR ADMINISTRATIVE (i)
(ii)		 135,024
0 		26,230
0 		0
0 		12,870
0 		14,940
0 		189,064
0 		0
0
(16)ELISABETH WILLIAMSVP (i)
(ii)		 161,557
0 		0
0 		18,134
0 		0
0 		34,689
0 		214,380
0 		0
0
(17)ELIZABETH MARTINVP/ADMINISTRATOR RTH (i)
(ii)		 254,259
0 		53,369
0 		45,129
0 		25,112
0 		17,566
0 		395,435
0 		0
0
(18)FAYE GARGIULOVP, RESEARCH/DISCOVERY/PHY REC (i)
(ii)		 208,359
0 		45,145
0 		41,966
0 		24,681
0 		7,078
0 		327,229
0 		0
0
(19)JAMES FOSSDIRECTOR (i)
(ii)		 166,573
0 		15,287
0 		19,865
0 		15,484
0 		8,866
0 		226,075
0 		0
0
(20)FRANK MARTINSR VP, LHARS (i)
(ii)		 270,098
0 		57,308
0 		59,069
0 		22,897
0 		11,464
0 		420,836
0 		0
0
(21)FREDRICK ARNOLDPRESIDENT, MEDICAL STAFF (i)
(ii)		 192,859
0 		20,255
0 		22,579
0 		19,135
0 		11,507
0 		266,335
0 		0
0
(22)GARY KAVITBOARD MEMBER (i)
(ii)		 313,717
0 		0
0 		147,747
0 		20,112
0 		19,555
0 		501,131
0 		0
0
(23)JENNIFER GREENWELLCFO (i)
(ii)		 168,913
0 		31,857
0 		0
0 		19,004
0 		12,234
0 		232,008
0 		0
0
(24)GREGG SHIVERSSERVICE LINE CHIEF,RWRH (i)
(ii)		 287,754
0 		14,000
0 		35,490
0 		20,112
0 		22,948
0 		380,304
0 		0
0
(25)GWENDOLYN HARTZOGVP PATIENT CARE SVS, CNO (i)
(ii)		 203,518
0 		46,361
0 		44,487
0 		18,815
0 		5,781
0 		318,962
0 		0
0
(26)JANET HOWARDDIRECTOR RMG PRACTICE MGMT (i)
(ii)		 103,429
0 		7,788
0 		102,592
0 		10,377
0 		13,297
0 		237,483
0 		0
0
(27)JAMES DUDLEYSERVICE LINE CHIEF (i)
(ii)		 209,275
0 		1,500
0 		159,731
0 		20,112
0 		20,737
0 		411,355
0 		0
0
(28)JAMES EDWARDSBOARD MEMBER (i)
(ii)		 147,678
0 		20,581
0 		16,498
0 		17,293
0 		9,953
0 		212,003
0 		0
0
(29)JAMES LESNICKVP/MEDICAL DIRECTOR RMG (i)
(ii)		 582,678
0 		134,876
0 		72,819
0 		18,862
0 		29,328
0 		838,563
0 		0
0
(30)JAMES MCCORRYSERVICE LINE CHIEF, RDHW (i)
(ii)		 258,048
0 		0
0 		91,092
0 		19,561
0 		737
0 		369,438
0 		0
0
(31)JAMES MULLINSBOARD MEMBER (i)
(ii)		 301,950
0 		0
0 		4,966
0 		22,897
0 		6,101
0 		335,914
0 		0
0
(32)JASON HOUSERVP, LEGAL AFFAIRS (i)
(ii)		 247,352
0 		54,281
0 		40,990
0 		20,112
0 		17,990
0 		380,725
0 		0
0
(33)JEFFREY HENKEBOARD MEMBER (i)
(ii)		 311,868
0 		127,477
0 		10,997
0 		25,112
0 		23,573
0 		499,027
0 		0
0
(34)JOHN GRETESBOARD MEMBER (i)
(ii)		 297,007
0 		89,950
0 		15,457
0 		20,112
0 		14,262
0 		436,788
0 		0
0
(35)JOHN STANLEYSR VP, CIO (i)
(ii)		 328,298
0 		77,490
0 		54,430
0 		22,897
0 		16,361
0 		499,476
0 		0
0
(36)JOSEPH WILSONBOARD MEMBER (i)
(ii)		 430,517
0 		0
0 		12,674
0 		20,112
0 		10,111
0 		473,414
0 		0
0
(37)KEITH PERCICVP (i)
(ii)		 225,967
0 		54,513
0 		73,755
0 		22,897
0 		16,113
0 		393,245
0 		0
0
(38)KYLE ALLENMEDICAL DIRECTOR, LHARS (i)
(ii)		 371,874
0 		0
0 		2,117
0 		20,112
0 		18,955
0 		413,058
0 		0
0
(39)BARBARA LABONTEDIRECTOR ADMINISTRATIVE (i)
(ii)		 149,841
0 		30,315
0 		7,337
0 		18,886
0 		1,120
0 		207,499
0 		0
0
(40)DENNIS LOFTUSDIRECTOR ADMINISTRATIVE (i)
(ii)		 173,325
0 		16,342
0 		15,850
0 		21,494
0 		19,780
0 		246,791
0 		0
0
(41)MARSHALL CROSSCHAIRMAN/RRMC OPERS COUNCIL,EX (i)
(ii)		 425,858
0 		146,697
0 		26,611
0 		20,112
0 		14,769
0 		634,047
0 		0
0
(42)TODD MARTINDIRECTOR (i)
(ii)		 163,380
0 		8,458
0 		531
0 		14,019
0 		4,662
0 		191,050
0 		0
0
(43)MEDFORD RAMEYVP, COMMUNITY DEVELOPMENT (i)
(ii)		 27,649
0 		48,668
0 		68,978
0 		13,378
0 		5,338
0 		164,011
0 		0
0
(44)MEGAN KLECKNERVP/ADMINISTRATOR RWR & SECRETA (i)
(ii)		 173,960
0 		37,620
0 		32,327
0 		19,754
0 		6,060
0 		269,721
0 		0
0
(45)MICHAEL DOUCETTEVP RRMC OPERATIONS (i)
(ii)		 261,861
0 		62,618
0 		42,978
0 		24,071
0 		16,514
0 		408,042
0 		0
0
(46)BRADEN MILLERCFO (i)
(ii)		 192,315
0 		40,603
0 		10,950
0 		20,112
0 		22,794
0 		286,774
0 		0
0
(47)ANTHONY MINADIRECTOR DEVELOPMENT (i)
(ii)		 191,324
0 		0
0 		34,076
0 		18,831
0 		23,505
0 		267,736
0 		0
0
(48)RAYMOND NEWTONDIRECTOR RMG PRACTICE MGMT (i)
(ii)		 222,862
0 		0
0 		9,165
0 		18,622
0 		2,836
0 		253,485
0 		0
0
(49)PATRICK PARCELLSSR VP, ADMINISTRATOR RRMC (i)
(ii)		 463,199
0 		100,274
0 		84,825
0 		0
0 		0
0 		648,298
0 		0
0
(50)JOHN PETERMANDIRECTOR (i)
(ii)		 149,617
0 		25,827
0 		9,406
0 		18,884
0 		6,249
0 		209,983
0 		0
0
(51)RENEE ROUNTREEVP EMERGENCY & TRAUMA SVS (i)
(ii)		 175,001
0 		39,036
0 		34,326
0 		19,801
0 		626
0 		268,790
0 		0
0
(52)RHONDRA MATTHEWSSR VP, PHILANTHROPY (i)
(ii)		 266,917
0 		63,850
0 		54,242
0 		20,112
0 		11,499
0 		416,620
0 		0
0
(53)RICHARD DUNNBOARD MEMBER (i)
(ii)		 179,675
0 		59,176
0 		11,778
0 		0
0 		0
0 		250,629
0 		0
0
(54)RICHARD PEARCEEXEC VICE CHAIRMAN & SPECIAL A (i)
(ii)		 608,837
0 		346,500
0 		153,259
0 		22,897
0 		10,695
0 		1,142,188
0 		0
0
(55)ROBERT BRYANTVP/COO FACILITY BASED SVS (i)
(ii)		 236,077
0 		52,785
0 		69,747
0 		24,823
0 		16,145
0 		399,577
0 		0
0
(56)ROBERT DAVISBOARD MEMBER (i)
(ii)		 249,574
0 		20,531
0 		7,222
0 		20,112
0 		16,102
0 		313,541
0 		0
0
(57)ROBERT HARDINGBOARD MEMBER (i)
(ii)		 212,302
0 		43,500
0 		12,303
0 		22,897
0 		13,255
0 		304,257
0 		0
0
(58)ROGER SCHULTZBOARD MEMBER (i)
(ii)		 505,946
0 		0
0 		14,279
0 		20,112
0 		18,002
0 		558,339
0 		0
0
(59)S FLEISCHERVP (i)
(ii)		 86,800
0 		45,500
0 		49,431
0 		11,661
0 		1,537
0 		194,929
0 		0
0
(60)SALLY HARTMANVP, HUMAN RESOURCES (i)
(ii)		 243,000
0 		53,520
0 		41,033
0 		23,618
0 		5,239
0 		366,410
0 		0
0
(61)LISA SALSBERRYDIRECTOR (i)
(ii)		 179,571
0 		0
0 		32,064
0 		17,463
0 		21,291
0 		250,389
0 		0
0
(62)SHAWKE SOUEIDANBOARD MEMBER (i)
(ii)		 391,409
0 		53,496
0 		3,214
0 		17,612
0 		24,237
0 		489,968
0 		0
0
(63)SANDRA SNAPPDIRECTOR (i)
(ii)		 152,684
0 		27,925
0 		101
0 		18,152
0 		600
0 		199,462
0 		0
0
(64)STEPHEN MCCARYVP, RDHW (i)
(ii)		 175,304
0 		28,150
0 		47,002
0 		19,546
0 		16,149
0 		286,151
0 		0
0
(65)STEWART JENNINGSBOARD MEMBER (i)
(ii)		 201,184
0 		2,951
0 		279
0 		16,882
0 		20,674
0 		241,970
0 		0
0
(66)SUSAN MCANDREWSVP RN (i)
(ii)		 213,131
0 		63,099
0 		37,809
0 		18,893
0 		10,092
0 		343,024
0 		0
0
(67)THOMAS CLEARYPRESIDENT, MEDICAL STAFF (i)
(ii)		 217,813
0 		1,250
0 		5,400
0 		17,778
0 		0
0 		242,241
0 		0
0
(68)TRACEE CARMEANVP, EDUCATION (i)
(ii)		 166,709
0 		50,478
0 		34,723
0 		25,112
0 		11,651
0 		288,673
0 		0
0
(69)VERNEETA WILLIAMSBOARD MEMBER (i)
(ii)		 193,385
0 		0
0 		461
0 		14,475
0 		6,019
0 		214,340
0 		0
0
(70)WADE BROUGHMANEXEC VP,COO & SECRETARY/TREASU (i)
(ii)		 500,483
0 		127,411
0 		128,855
0 		18,862
0 		19,875
0 		795,486
0 		0
0
(71)WALTER AUSTINSENIOR VP FINANCE AND CFO (i)
(ii)		 138,831
0 		0
0 		7,047
0 		3,638
0 		6,135
0 		155,651
0 		0
0
(72)WILLIAM DOWNEYPRESIDENT,CEO RHS (i)
(ii)		 656,762
0 		211,750
0 		199,775
0 		25,112
0 		13,384
0 		1,106,783
0 		0
0
(73)ROSS YOUNGERDIRECTOR (i)
(ii)		 368,234
0 		0
0 		1,167
0 		20,112
0 		23,573
0 		413,086
0 		0
0
(74)WILLIAM MCALLISTERPHYSICIAN (i)
(ii)		 968,954
0 		316,983
0 		23,743
0 		16,362
0 		16,585
0 		1,342,627
0 		0
0
(75)DEAN KOSTOVPHYSICIAN (i)
(ii)		 653,278
0 		632,168
0 		14,111
0 		13,862
0 		9
0 		1,313,428
0 		0
0
(76)ROBERT CULLOMPHYSICIAN (i)
(ii)		 306,151
0 		681,713
0 		16,972
0 		0
0 		1,062
0 		1,005,898
0 		0
0
(77)JAVIER AMADEOPHYSICIAN (i)
(ii)		 619,829
0 		286,260
0 		20,737
0 		17,612
0 		0
0 		944,438
0 		0
0
(78)BRIAN KEELPHYSICIAN (i)
(ii)		 292,985
0 		609,460
0 		19,241
0 		600
0 		897
0 		923,183
0 		0
0
(79)TERRIS KENNEDYSR VP. RHS CNO (i)
(ii)		 245,096
0 		52,697
0 		88,378
0 		17,774
0 		447
0 		404,392
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J, Part I, Line 3   The compensation committee of the parent corporation, Riverside Healthcare Association, Inc. reviews and approves the compensation for top management using independent consultants and surveys.
Schedule J, Part 1, Line 4   BARRY GROSS $66,472 CHARLES FRAZIER $37,163 CHARLES GRAHAM $37,625 CHRISTOPHER STOLLE $37,313 CRAIG CONNORS $21,000 DEBORA TANNER $21,500 DIANA LOVECCHIO $23,250 ELIZABETH MARTIN $31,394 FAYE GARGIULO $25,363 FRANK MARTIN $31,838 GWENDOLYN HARTZOG $24,925 JAMES LESNICK $40,375 JASON HOUSER $28,125 JOHN STANLEY $40,150 KEITH PERCIC $27,813 MEDFORD RAMEY $22,531 MEGAN KLECKNER $19,594 MICHAEL DOUCETTE $31,625 PATRICK PARCELLS $50,644 RENEE ROUNTREE $20,987 RICHARD PEARCE $126,000 ROBERT BRYANT $29,325 RHONDRA MATTHEWS $33,169 S FLEISCHER $22,750 SALLY HARTMAN $27,875 LISA SALSBERRY $17,751 STEPHEN MCCARY $22,251 SUSAN MCANDREWS $25,650 TERRIS KENNEDY $27,375 TRACEE CARMEAN $20,688 WADE BROUGHMAN $68,835 WILLIAM DOWNEY $115,500
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number
90-1000718
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Economic Development Authority City NN
  		52-1290859   12-20-2011 24,570,000 2011A issue refunding of 1997 outs   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 24,570,000      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 24,400,000      
7 Issuance costs from proceeds . . . . . . . . . . . . 170,000      
8 Credit enhancement from proceeds . . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 0      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X              
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .                
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .                
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .                
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .                
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0%   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet   %   %   %   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . .   %   %   %   %
7 Does the bond issue meet the private security or payment test? . . . . .                
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .                
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.   %   %   %   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
               
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . . X              
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . . . .                
e Was a hedge terminated? . . . . . . .                
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . . 0
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Bond Information Part I Line A The 2011 A, B, C & the 2012 Bond Series are issued as Health System Revenue Bonds under the parent Riverside Health System. Therefore, Riverside Health System (the parent) is listed as the issuer on the 8038 form filed with the IRS. Patriot's Colony (A subsidiary of Riverside Health System) is one of the borrowers along with Riverside Health System, and it holds the liability for the 2011 A Bond Series that was issued on 12/20/2011 for $24,570,000. The debt is therefore included on the schedule K on this Group Form 990 that includes Patriot's Colony.
Schedule K (Form 990) 2012

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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $ 0
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) WADE BROUGHMAN SEE PART V 51,583 SEE PART V   No
(2) Thomas Cleary SEE PART V 203,042 SEE PART V   No
(3) Linda Phillips SEE PART V 167,016 SEE PART V   No
(4) Charles Revere SEE PART V 220,144 SEE PART V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
WADE BROUGHMAN   Schedule L, Part IV Wade Broughman's family member is employed by Riverside Hospital, Inc.
Thomas Cleary   Schedule L, Part IV Thomas Cleary's family member has a business relationship with Riverside Hospital, Inc.
Linda Phillips   Schedule L, Part IV Linda Phillips's family member has a business relationship with Riverside Middle Peninsula Hospital, Inc.
Charles Revere   Schedule L, Part IV Charles Revere's family member has a business relationship with Riverside Middle Peninsula Hospital, Inc.
Schedule L (Form 990 or 990-EZ) 2012

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Identifier Return Reference Explanation
SCHEDULE O   Part V, 3A Riverside Hospital, Inc. EIN 52-1245746, a subordinate company, had unrelated business income greater than $1,000 and 990-T was filed. Part VI, Section A, Line 2 Bill Downey and Gordon Gentry have a business relationship. Alan Witt and Bill Downey have a business relationship. Part VI, Section A, Line 6 The Organization is a not for profit corporation with members. The members have the right to participate in the Organization's governance, including electing members of the governing body and to approve significant decisions of the governing body. Part VI, Section A, Line 7a Members of the governing body are subject to approval by the Member. Part VI, Section A, Line 7b Significant items such as merger, amendment of charter documents, and appointment of Board members requires the approval of the member corporation. Part VI, Section B, Line 11B On behalf of the Organization's governing body, the Riverside Healthcare Association, Inc. Board of Directors Salary and Pension Committee reviews key data from the Form 990. The entire Form 990 was reviewed by an independent accounting firm before filing. Part VI, Section B, line 12c A report of potential Conflicts of Interest are reviewed by the Compliance Officer. Further concern as reflected in the Conflict of Interest, Financial Disclosure, and Compliance Certification Questionnaire is reviewed by the Riverside Health System President to determine if additional follow-up is necessary. Part VI, Section B, Line 15 A&B The Riverside Healthcare Association, Inc. Board of Directors Salary and Pension Committee determines the compensation of the President and Senior Executives. The Committee relies on market comparative information provided by a reputable independent third party expert to establish the reasonableness of compensation levels. Part VI, Section C, Line 19 The Organization makes its governing documents, conflict of interest policy, and financial statements available to the general public upon request. Part XI Line 9 2004 Bond Swap EQ Adj (67,862)
Form 5471   STATEMENT OF CONTROLLED FOREIGN CORPORATION RIVERSIDE HEALTHCARE ASSOCIATION (GROUP), INC. PARTICIPATION CORPORATION EIN: 90-1000718 FOR THE TAX YEAR ENDED DECEMBER 31, 2012 THIS STATEMENT IS BEING FILED PURSUANT TO TREAS. REG 1.6038-2(J)(3). RIVERSIDE HEALTHCARE ASSOCIATION (GROUP), INC'S FILING REQUIREMENT OF FORM 5471 FOR THE CONTROLLED FOREIGN CORPORATION LISTED BELOW HAS BEEN SATISFIED BY RIVERSIDE HEALTHCARE ASSOCIATION,INC. (FEIN: 52-1241835). RIVERSIDE HEALTHCARE ASSOCIATION, INC. HAS INCLUDED THE FORM 5471 WITH ITS FORM 990 WHICH WAS FILED ELECTRONICALLY (E-FILE). RIVERSIDE HEALTHCARE ASSOCIATION, INC.'S ADDRESS IS 608 DENBIGH BLVD, SUITE 800, NEWPORT NEWS, VIRGINIA 23608-4487. RHS MEDINSUR, LTD CRAIG APPIN HOUSE 8 WESLEY STREET HAMILTON, BERMUDA 01/01/2012 - 12/31/2012
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Riverside Healthcare Association Inc Group
 
Employer identification number

90-1000718
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity
(1) Virginia Surgical Management LLC
608 Denbigh Blvd Ste 800
Newport News,VA23608
54-2057012 		Surg Ctr Mngt VA 4,360,306 2,532,066 NA
 
(2) Peninsula Cancer Institute LLC
608 Denbigh Blvd Ste 800
Newport News,VA23608
20-1872200 		PHYSICIAN OFC VA 9,740,362 40,288,598 NA
 








Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) Shore Health Services Inc

608 Denbigh Blvd Suite 800

Newport News,VA23608
54-0560500 		Gen Med/Surg VA 501(c)(3) 3 RHA Inc
 
Yes
 
(2) Shore Life Care inc

608 Denbigh Blvd Suite 800

Newport News,VA23608
54-1876370 		Nursing Care VA 501(c)(3) 3 SHS INC
 
Yes
 
(3) Charlottesville Area Retirement Svc Inc

608 Denbigh Blvd Suite 800

Newport News,VA23608
45-4854018 		Elderly Svcs VA 501(c)(3) 11a RRS Inc
 
Yes
 
(4) Newport News General & Nonsectarian

608 Denbigh Blvd Suite 800

Newport News,VA23608
54-0505934 		Holding Corp VA 501(c)(2) N/A RHA Inc
 
Yes
 
(5) Riverside Healthcare Assocation Inc

608 Denbigh Blvd Suite 800

Newport News,VA23608
52-1241835 		Parent Comp. VA 501(c)(3) 11a N/A
 
No
(6) Tilden and Va Davis Suport Found Inc

608 Denbigh Blvd Suite 800

Newport News,VA23608
54-1527703 		Nursing Care VA 501(c)(3) 11a RHA Inc
 
Yes
 
(7) Shore Rehabilitation Services

608 Denbigh Blvd Suite 800

NEWPORT NEWS,VA23608
54-1823669 		SPECIALTY VA 501(c)(3) 3 SHS INC
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) PRA LLC

608 Denbigh Blvd Suite 800
Newport News,VA23608
03-0596051 		SURGERY CTR VA RVS Hosp Inc
  		EXCLUDED 1,212,956 5,423,175   No   Yes   93.319 %
(2) ChesRVSUVA Radsur

608 Denbigh Blvd 800
NN,VA23608
54-2152920 		OUTPAIENT SVCS VA PRA LLC
  		EXCLUDED 1,299,795 3,936,060   No   Yes   50.000 %










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Riverside Med Equipment Center Inc

608 Denbigh Blvd Suite 800
Newport News,VA23608
54-1325596 		Other Acctg S VA RHA Inc
  		C Corp       Yes  
(2) RHS Medinsur LTD

Craig Appin House 8 Wesley Street
Hamilton    
BD
52-1241835 		Insurance Company BD RHA Inc
  		C Corp       Yes  
(3) Peninsula Hospital Services

1148 Old Denbigh Blvd Suite 800
Newport News,VA23608
54-0991295 		Comm. Laundry VA Rvs Hlth Fndtn
  		C Corp 3,873,716 3,747,091 62.270 % Yes  








Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Newport News General & Nonsectarian Hosp Inc

 J 11,256,432 MARKET VALUE
(2) Newport News General & Nonsectarian Hosp Inc

 L 640,844 MARKET VALUE




Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID:  
Software Version: