TY 2012 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) HABIB F BASSIL MD........................................................................ SECRETARY (THROUGH 06/13)	1.0 .......................5.0	X	X	78,750	0
(2) W W BENNETT........................................................................ VICE CHAIRMAN	1.0 .......................5.0	X	X	0	0
(3) BRET ANTHONY BERNECHE........................................................................ BOARD MEMBER	1.0 .......................5.0	X		0	0
(4) WILLIAM E COLEMAN........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X		0	0
(5) WILLIAM CONFROY........................................................................ CHAIRMAN	1.0 .......................5.0	X	X	0	0
(6) MARSHALL CREWS........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X		0	0
(7) W JOSEPH FERGUSON MD........................................................................ BOARD MEMBER	1.0 .......................5.0	X		75,525	17,948
(8) BEN E FINCHER........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X		0	0
(9) DABNEY T P GILLIAM JR........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X		0	0
(10) GREGORY V GORDON........................................................................ BOARD MEMBER	1.0 .......................5.0	X		0	0
(11) MELODY HACKNEY........................................................................ BOARD MEMBER (THROUGH 11/12)	1.0 .......................5.0	X		0	0
(12) GAHEAR F HAMLOR MD........................................................................ BOARD MEMBER (THROUGH 11/12)	1.0 .......................5.0	X		128,934	20,791
(13) RICHARD O HARRELL III........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X		0	0
(14) STEPHANIE HEINTZLEMAN........................................................................ BOARD MEMBER (THROUGH 11/12)	1.0 .......................5.0	X		0	0
(15) J AUBREY HOUGHTON........................................................................ TREASURER	1.0 .......................5.0	X	X	0	0
(16) SAID B ISKANDAR MD........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X		0	0
(17) STANLEY L JEFFRESS JR........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X		0	0

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) TOMMY C LEGGETT........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			0	0
(19) BLAINE G LENHART........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			0	0
(20) MICHAEL LYON........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			0	0
(21) VALDIVIA MARSHALL........................................................................ BOARD MEMBER	1.0 .......................5.0	X			0	0
(22) WILLIAM C MACCARTY III MD........................................................................ BOARD MEMBER (THROUGH 11/12)	1.0 .......................5.0	X			495,427	30,583
(23) EARLE W MOORE MD........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			242,804	26,536
(24) J KENNETH MORGAN........................................................................ BOARD MEMBER	1.0 .......................5.0	X			0	0
(25) JAMES H PRIEST DDS........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			0	0
(26) ARTHUR W REYNOLDS........................................................................ SECRETARY	1.0 .......................5.0	X	X		0	0
(27) KATHRYN ROBERTS........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			0	0
(28) LARRY SNEED CPA........................................................................ BOARD MEMBER	1.0 .......................5.0	X			0	0
(29) DENNIS C STANLEY MD........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			8,550	0
(30) CAROL C THOMAS........................................................................ VICE CHAIRMAN (THROUGH 06/13)	1.0 .......................5.0	X	X		0	0
(31) TERRANCE J TRUITT MD........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			39,096	0
(32) GARY D WALKER........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			0	0
(33) PHILLIP W WARD MD........................................................................ BOARD MEMBER (THRU 04/12/13)	1.0 .......................5.0	X			27,360	0
(34) DAVID H WHITE JR........................................................................ CHAIRMAN (THROUGH 06/13)	1.0 .......................5.0	X	X		0	0
(35) J LOGAN YOUNG........................................................................ BOARD MEMBER (THROUGH 06/13)	1.0 .......................5.0	X			0	0
(36) CHRIS A LUMSDEN........................................................................ CEO(THRU 6/30)/PRES-EFF 7/1/13	1.0 .......................39.0		X		393,655	21,110
(37) STEWART R NELSON........................................................................ CHIEF FINANCIAL OFFICER	1.0 .......................39.0		X		259,403	4,655
(38) THOMAS S KLUGE........................................................................ CHIEF OPERATING OFFICER	1.0 .......................39.0			X	223,770	14,338

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	0	1	992,541
2	Savings and temporary cash investments .........	0	2	0
3	Pledges and grants receivable, net ...........	0	3	0
4	Accounts receivable, net .............	0	4	0
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 ..............	0	8	0
9	Prepaid expenses and deferred charges ..........	0	9	6,288
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation .....	10b		0	10c
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 .....	0	13	0
14	Intangible assets ...............	0	14	0
15	Other assets. See Part IV, line 11 ...........	83,977,064	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)......	83,977,064	16	998,829
	17	Accounts payable and accrued expenses .........	0	17	100
18	Grants payable .................	0	18	0
19	Deferred revenue ................	0	19	0
20	Tax-exempt bond liabilities .............	0	20	0
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....................	0	25	0
26	Total liabilities. Add lines 17 through 25.........	0	26	100
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	82,672,436	27	998,729
28	Temporarily restricted net assets ...........	1,304,628	28	0
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	83,977,064	33	998,729
34	Total liabilities and net assets/fund balances ........	83,977,064	34	998,829

- TIN:

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.

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

HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number

54-1801466

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

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)

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
(i) Name of supported organization	(ii) EIN		Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support
(A) HALIFAX REGIONAL HOSPITAL INC	540648699	03	Yes						0
(B) HALIFAX REGIONAL LONG TERM CARE INC	546074529	0	Yes						0
(C) HALIFAX REGIONAL DEVELOPMENT FOUNDATION INC	541801459	0	Yes						0
(D) HALIFAX REGIONAL PROPERTIES INC	541801463	0	Yes						0
(E) CLARKSVILLE SENIOR CARE LLC	541957066	0	Yes						0
Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

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)		(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)		(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).

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

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)		(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)		(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.)..

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

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

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
SUBSEQUENT TO 6/30/2013, HALIFAX REGIONAL HOSPITAL, INC. REMAINED AS THE SUPPORTED ORGANIZATION.

Schedule A (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2012

Name of the organization

HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number

54-1801466

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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 HALIFAX REGIONAL HEALTH SYSTEM INC

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	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (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 HALIFAX REGIONAL HEALTH SYSTEM INC

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
HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number

54-1801466

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

(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

(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

(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

(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:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number

54-1801466

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

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 ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

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 .................
b	Buildings ................
c	Leasehold improvements ............
d	Equipment ................
e	Other .................
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther 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.)

Part VIII

InvestmentsProgram 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.)

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.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0









Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		0
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

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
TAX STATUS	SCHEDULE D, PART X	The Hospital does not believe its consolidated financial statements include (or reflect) any uncertain tax positions.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number

54-1801466

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

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? .......

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)WILLIAM C MACCARTY III MDBOARD MEMBER (THROUGH 11/12)	(i) (ii)	0 495,427	0 0	0 0	0 12,500	0 18,083	0 526,010	0 0
(2)EARLE W MOORE MDBOARD MEMBER (THROUGH 06/13)	(i) (ii)	0 242,804	0 0	0 0	0 12,239	0 14,297	0 269,340	0 0
(3)CHRIS A LUMSDENCEO(THRU 6/30)/PRES-EFF 7/1/13	(i) (ii)	0 320,800	0 30,000	0 42,855	0 2,501	0 18,609	0 414,765	0 0
(4)STEWART R NELSONCHIEF FINANCIAL OFFICER	(i) (ii)	0 216,062	0 20,000	0 23,341	0 2,804	0 1,851	0 264,058	0 0
(5)THOMAS S KLUGECHIEF OPERATING OFFICER	(i) (ii)	0 190,429	0 10,000	0 23,341	0 -4,037	0 18,375	0 238,108	0 0

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 (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets

Complete if the organization answered "Yes" to Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number
54-1801466

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed. Click to see attachment

1(a)Description of asset(s) distributed or transaction expenses paid	(b)Date of distribution	(c)Fair market value of asset(s) distributed or amount of transaction expenses	(d)Method of determining FMV for asset(s) distributed or transaction expenses	(e)EIN of recipient	(f)Name and address of recipient	(g)IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .

Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . .

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? . . . . .

If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III. bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2012)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If “No,” describe in Part III . . . . . . . . . . .

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? . . . . . .

If “Yes,” did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . .

Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . .

Did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws? .

If "Yes" to line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If “No,” explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
EQUITY IN SUBSIDIARIES	07-01-2013	99,558,026	INDEPENDENT APPRAISAL	54-0648699	HALIFAX REGIONAL HOSPITAL INC 2204 WILBORN AVENUE SOUTH BOSTON,VA24592	501(c)(3)

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .

Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? . . . . . . .

If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III. bullet

Schedule N(Form 990 or 990-EZ) (2012)

Schedule N (Form 990 or 990-EZ) (2012)

Page 3

Part III

Supplemental Information. Complete to provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
EMPLOYEES OF TRANSFEREE ORGANIZATION	SCHEDULE N, PART II, LINE 2	HALIFAX REGIONAL HEALTH SYSTEM, INC. TRANSFERRED, ASSIGNED AND CONVEYED TO HALIFAX REGIONAL HOSPITAL ALL TANGIBLE AND INTANGIBLE ASSETS OF HRHS INCLUDING ALL SHARES OF STOCK, MEMBERSHIP INTERESTS AND OTHER SECURITIES ON JULY 1, 2013. HRHS ARTICLES OF INCORPORATION AND ITS BYLAWS WERE AMENDED AND RESTATED TO REFLECT THE FOLLOWING SIGNIFICANT CHANGE: " THE BOARD SHALL BE COMPOSED OF NO FEWER THAN SIX DIRECTORS, NOT LESS THAN ONE-HALF OF WHOM SHALL BE PERSONS THEN SERVING AS CLASS A DIRECTORS OF HALIFAX REGIONAL HOSPITAL. BECAUSE HRHS AND HALIFAX REGIONAL HOSPITAL, INC. SHARED BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES, SOME OF THE BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES OF HRHS WERE ALSO BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES OF THE TRANSFEREE ORGANIZATION, HALIFAX REGIONAL HOSPITAL.

Schedule N (Form 990 or 990-EZ) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

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

HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number

54-1801466

Identifier	Return Reference	Explanation
ORGANIZATION'S PURPOSE	PART III, LINE 4	Halifax Regional Health System (HRHS), a not-for-profit organization, is a multidivisional organization providing acute and long-term care, Alzheimer's/dementia care, home health, hospice, rehabilitation, behavioral health services, and a multitude of outpatient services to approximately 80,000 residents in the region; and providing primary care services in four locations throughout the service area. Governed by a 36-member volunteer board of directors, the system serves Halifax, Charlotte and Mecklenburg counties and surrounding communities. HRHS serves an area designated as a medical, dental and mental Health Professional Shortage Area (HPSA) and a Virginia Medically Underserved Area (VMUA). This non-profit, tax-exempt system consists of a parent company and six primary operating companies, Halifax Regional Hospital, Inc. (HRH); Halifax Regional Long Term Care, Inc., dba The Woodview and Seasons at The Woodview; Clarksville Senior Care, LLC, dba MeadowView Terrace; Halifax Regional Development Foundation, Inc.; Halifax Regional Properties, Inc.; and Southside Health Services, Inc. The purpose of Halifax Regional Health System is "to provide the highest quality care based on the healthcare needs of the people we serve." Our vision is "to be the leader in providing person-centered care through a continuum of quality and cost effective services that improves the general health of the communities we serve." Healthcare takes many forms at Halifax Regional Health System, including medical services for inpatients and outpatients, acute-care and skilled-care services, rehabilitation programs, long term care, specialized Alzheimer's/dementia care, home health and hospice services and behavioral health, as well as health screenings, patient education and community wellness. To support the general health and welfare of over 80,000 persons in the region, wellness is promoted through various initiatives, such as health screenings, seminars and classes, co-sponsored programs and charitable contributions offered by a community-health oriented administration, board of directors and volunteers. For the most part, educational programs and screenings are free. Others are offered at reduced rates. Halifax Regional Hospital (HRH) is an acute care facility licensed to operate 192 beds, including 122 medical/surgical beds, 10 intensive/cardiac care beds, 21 obstetric beds, 20 bassinets and special-care nursery beds, and 19 skilled nursing facility beds (subacute). HRH offers the region advanced diagnostic and treatment capabilities including clinical laboratory services, an on-site blood bank and direct access testing; diagnostic radiology, including nuclear medicine, computerized axial tomography (CAT); in-house MRI and mobile PET/CT combination scanning; computer-aided detection (CAD) mammography, including stereotactic and sentinel-node biopsy; non-invasive and nuclear cardiology; stress testing; interventional cardiology and inpatient dialysis. The hospital offers emergency medicine and inpatient and outpatient surgery, including general, ophthalmologic, gynecological, oral/maxillofacial, orthopedic and vascular surgery; and upper and lower GI endoscopies and total-joint replacement. Treatments for problem wounds such as those caused by diabetic complications, radiation tissue damage, crush injuries and infections can be addressed at the outpatient Center for Wound Care. Cardiopulmonary/respiratory therapy, physical, occupational and speech therapy, home health, hospice and bereavement services are also offered for inpatients, outpatients and for the homebound. The Center for Behavioral Health offers mental health services on an outpatient basis for adults, including geriatrics, and children, ages six and above. HRH is the only provider of inpatient and outpatient acute care services in a 30-40 mile radius and serves as a Regional Referral Center for neighboring counties in Virginia and North Carolina. The hospital extends its continuum of care into the home through Halifax Home Health and Halifax Regional Hospice. These agencies provide skilled care (nursing and physical, occupational, and speech therapy), hospice, and support services to homebound patients. More than 100 physicians representing 29 specialties serve on the HRHS medical staff, supported by a number of physician extenders. Four family practice groups operated by the Health System and located throughout the service region help to serve the primary care needs in the community. During FY13, Halifax Regional Hospital served 4,528 inpatients, including newborns, provided services to 86,321 outpatients and had 30,203 emergency department visits. Halifax Regional participates in both Medicare and Medicaid and, based upon its mission to the community, provides services to all individuals regardless of their ability to pay. The Woodview, a 180-bed dually certified (Medicaid and Medicare) nursing facility and MeadowView Terrace, a 150-bed dually certified nursing facility provide personal care, health care services and rehabilitation services for persons needing long term care and whose special needs cannot be met in independent living environments. Seasons at The Woodview is an 18-bed licensed assisted living facility providing specialized memory support services for individuals who have Alzheimer's disease or a related dementia. Both Seasons at The Woodview and MeadowView Terrace have evidence-based designed neighborhoods that serve the special needs of the memory impaired and the staff is specially trained to meet the unique needs of these residents and their families. The following statistics support the need for and value of this special care service offering: " Over 69% of long term care residents suffer from Alzheimer's Disease or a related dementia. " Nineteen percent of Halifax and Charlotte County residents are age 65+ and 20% of Mecklenburg County residents are age 65+ compared to the Virginia state average of 12%. " Statistically one out of 10 persons over the age of 65 will develop Alzheimer's disease or a related dementia as will 50% of those age 85+.
ORGANIZATION'S PURPOSE (CONTINUATION)	PART III, LINE 4	In FY13, 59.1 percent of The Woodview's revenues and 60.9 percent of MeadowView Terrace's revenues were reimbursable under the Medicaid program; and 18.4 percent of The Woodview's revenues and 18.1 percent of MeadowView Terrace's revenues were reimbursable under the Medicare program. The Halifax Regional Development Foundation is responsible for administering gifts, grants and contributions for Halifax Regional Health System and for providing other services that are exclusively charitable, educational or scientific in nature. The Foundation is also responsible for managing the investment of HRHS endowment funds and for management of the affiliated groups' educational assistance program. Halifax Regional Properties is organized to promote the general health and welfare of the community and is responsible for construction, acquisition, and management of HRHS's real estate holdings other than the hospital facility and the long term care facilities. These holdings are situated both on campus and in medically-underserved areas within the service area of Halifax Regional Hospital. Southside Health Services, Inc. is a for-profit corporation utilized to develop physician joint ventures or acquisitions and operates a management services organization for physician practices. The hospital and long-term care facilities, all part of Halifax Regional Health System (HRHS), utilize excess revenue over expenses to upgrade facilities, to purchase new equipment and to upgrade clinical and information technology in order to improve quality and patient safety. Halifax Regional Health System provides a variety of community benefit services to respond to identified community needs and to support the general health and welfare of approximately 80,000 persons in the region. As a community-owned, not-for-profit organization, Halifax Regional Hospital takes pride in its mission to provide care to all citizens regardless of their ability to pay. Halifax County uninsured and unemployed statistics, as well as those in the surrounding counties, are significantly higher than the percentages for the state of Virginia. Although the provision of healthcare services to a growing uninsured and underinsured population while maintaining fiscal responsibility is one of the greatest challenges that hospitals face, we believe that a lack of financial resources should never get in the way of a patient receiving essential health services. HRH's Patient Financial Assistance Policy is designed to offer low-income, uninsured and underinsured patients discounted charges at increased percentages of the Federal Poverty Guidelines (FPG). The hospital provides a 32 percent discount from charges for patients without insurance regardless of income. A Medically Indigent Discount is provided for individuals at the 226% to 275% FPG based upon total medical related bills. In addition to the ongoing communications of the hospital's financial assistance program through brochures, postings throughout the hospital and information provided directly to patients, the hospital places an ad in local newspapers quarterly to publicize the program. Although the charity care and uncompensated care provided by HRH increases annually, HRH consistently ranks by Virginia Health Information as one of the lowest charge hospitals in the Commonwealth. In FY13, the hospital provided $17,297,722 in uncompensated care (Charity and Bad Debt) or 6.9 percent of patient revenue. In FY13, charity and uncompensated care increased by 20.4 percent (FY12=$14,361,988; FY13=$17,297,722.) In addition, the un-reimbursed value of providing care to patients insured by the Medicare and Medicaid programs was $125,000,000 or 49.6 percent of patient revenue. HRHS takes pride in being a contributing member of the community and as such reaches out to the community in a variety of ways. Employees spend hundreds of hours volunteering their time and talents in schools and community organizations, speaking to civic groups, providing free health screenings, and serving on community and state organizations. In FY13, Halifax Regional Hospital, as part of Halifax Regional Health System, donated $217,423.84 through its Community Partnership Program to assist community groups and agencies in order to help promote all areas of health and wellness in the community, including physical, mental, vocational, emotional, intellectual and spiritual well-being. HRH also assists with fund raising activities for groups such as emergency medical services groups and co-sponsors public events planned by various clubs, schools and businesses. HRH provides a number of community health improvement services, health professions education services and community building activities. If Halifax Regional did not perform these essential roles-providing charity care, monetary contributions and wellness education, these obligations would most likely have to be assumed by government and supported by taxpayers.
Community Health Improvement Services & Education		Halifax Regional Hospital encourages its staff and volunteers to continue the caring traditions of those citizens who worked so diligently to establish the hospital in the early 1950s. Today, many employees, physicians and volunteers help strengthen the community by addressing various community health needs. Whether sponsoring a health fair, participating in a Chamber of Commerce project, sending a speaker to a school classroom or civic club, partnering with other healthcare providers to provide additional outreach services or donating to organizations with similar missions to help improve the quality of life for residents of all ages, Halifax Regional is proud to be a good corporate citizen and to take a leadership role in the well-being of all citizens in the region. Some of these activities, services, joint sponsorships and other programs are described below. Avoid the Flu Campaign This community awareness campaign is continued each year to educate the public before and during flu season. This year the infection control department utilized several venues for disseminating information to the public. Posters and flyers were placed throughout the hospital with the 'Protect Your Patients" and "It's OK to Ask" message and reminders to wash your hands and reconsider visiting patients when you are sick were placed on the television in the hospital lobby, on the health system Web site and in articles in local newspapers. Finally, a booth about proper hand washing is a consistent presence at the Healthy Living Expo each year and visitors actually have the opportunity to learn about the best techniques to ensure proper cleanliness. Food and Nutrition Services Community Service In addition to participating in Halifax Regional Hospital's health fairs, Food and Nutrition employees provided diet and nutrition information to the public (adults and children) in a variety of other venues including churches, local businesses, support groups, schools and special events. "Eating for a Healthy Weight" and "Eating for a Healthy Heart" classes, offered three times per month, have continued throughout FY13 as a part of the cardiopulmonary rehabilitation education classes. "Dishin' Nutrition with Your Kids," a free class, offered once a quarter, is designed for parents and children addressing nutrition and obesity, continued as well. The department also offered a "Food Label Literacy" class free to the community as part of Halifax Regional's Health Nite Out series of educational events. Healthy Living Expo Halifax Regional Health System holds annual community health fairs in its service area. Halifax Regional's annual signature event, the Healthy Living Expo, was held at Halifax County High School on March 10, 2013. In addition to the myriad of screenings and health and wellness educational activities and information provided by HRH at this event, HRH invites other health-related organizations to participate in the event in order to expand the offerings to the participants. Guest participants included the The Arc of Southern Virginia, The Lion's Club (vision and amblyopia screening), the Halifax County Cancer Association, the local Alzheimer's Association; the Social Security Administration, Halifax County Sheriff's Department (Project Lifesaver), Healthy Families; the YMCA; the South Boston Fire Department, the South Boston Library ("Exercise for the Mind"), and the South Boston Police Department and more. All health screenings provided were free, including blood pressure, blood glucose and cholesterol (140 screenings provided), vision and amblyopia, oral, BMI (body mass index), balance, grip strength and anxiety and depression screenings. Approximately 325 individuals attended the Expo. Again this year, The Woodview and Seasons at The Woodview participated in Halifax Regional Health System's Healthy Living Expo, an annual community health fair that provides a myriad of free health screenings and health and wellness educational activities and information to the public. In addition to assisting with planning for this event, The Woodview and Seasons at The Woodview provided long term care and Alzheimer's disease information. Approximately 325 people were reached through this event. Again this year, MeadowView Terrace participated in Halifax Regional Health System's Healthy Living Expo, an annual community health fair that provides a myriad of free health screenings and health and wellness educational activities and information to the public. In addition to assisting with planning for this event, MeadowView Terrace provided long term care information, nutrition counseling and information related to exercise for the elderly. More than 325 individuals were reached through this community health event.
Community Health Fairs/Screenings		Other community health fairs in which Halifax Regional participated and provided screenings (including blood pressure, body mass index, cholesterol and blood glucose) during FY13 included, Drakes Branch Fall Festival, Dollar General Health Fair, YMCA Active Older Adults Day, North Halifax Marathon, HRH physicians and providers speaking to Senior Engagement Group of South Boston each month. A prostrate screening was also held at Halifax Urology Associates. In FY13 Halifax Regional participated in eight health fair screening events with approximately 1200 individuals in attendance. Advanced Directives Day In April 2013, MeadowView Terrace participated in the Virginia Advance Directive Day by providing information on Advance Directives in the facility's front lobby with staff available to answer questions. Healthy Directions Wellness Program During FY13, a variety of wellness programs, classes and contests continued to be held regularly to help employees and their family members with weight loss, exercise, and nutrition to lower BMI, cholesterol, glucose, blood pressure and risks for heart attack, stroke and other complications of cardiovascular disease. Initiatives started in FY12, continued in FY13. A walking mileage reimbursement program continued where employees are rewarded twenty-five cents for every mile they walk. In FY13, at total of $5,512.53 was reimbursed to participants. A Wellness Champ program also continued which allows employees who are working toward achieving their wellness goals can nominate themselves each month to be recognized as HRHS Wellness Champ. By looking better and feeling better, employees "show" the community that good health is achievable and set a good example for the healthcare role the organization plays in the community. Weight Watchers Support Group Weight Watchers meets weekly at MeadowView Terrace to weigh in and for educational meetings covering nutrition, food buying and preparations, etc. Although this is a franchised program, MeadowView Terrace provided meeting space at a reduced rate. Childbirth Education Classes Through the Family Birthing Center, Halifax Regional offers a wide range of childbirth education classes for parents-to-be. All classes except Prepared Childbirth Classes are provided free. (Special arrangements for waiver of fee are made on an individual basis and no parents-to-be are refused.) Offered in FY13 were: " Prepared Childbirth Classes - nine classes, 57 participants " Breastfeeding Class - seven classes, 67 participants " Bereavement Counseling for loss of infant/child - given to all mothers and birthing partners in cases of childbirth loss (miscarriages and stillbirths) " Baby Basics and Beyond Classes - six classes, 80 participants Diabetes Education Classes Eighty-five people attended Halifax Regional's free Diabetes Group Classes in FY13. The Diabetes Education Department offers monthly classes (no December class) for those interested in learning about monitoring blood glucose, nutrition, stress management and the prevention of complications related to diabetes. Diabetes Group classes are offered at various times of day and evening and several all-day Saturday classes are scheduled each year to provide additional opportunities for persons who work during the week or prefer not to come at night. In FY13 the diabetes educator also provided forty-six either one-to-one sessions with individuals either referred by physician or self at no charge or telephone education sessions. A diabetes educator is also available to teach and demonstrate how to use a blood sugar monitor upon request. In March 2013 the diabetes education department, participated in the 2013 Healthy Living Expo, providing free dietary counseling and literature to interested individuals and to those having elevated blood sugars following free Expo blood glucose screenings. The dietitian at MeadowView Terrace worked in conjunction with Halifax Regional Hospital staff to teach Diabetes Education classes throughout the year. These classes are free of charge and offered monthly.
Other Health-related Programs, Seminars for the Public		In addition to Speakers Bureau presentations, Halifax Regional Hospital hosts a number of special seminars, called Health Nite Out, free of charge to the general public. HRH staff plan, promote, implement and provide refreshments for these programs. 1. Holiday Favorites Lightened Up - this Health Nite Out program, led by a HRH's nutrition and food services department, showed the chef preparing a healthy holiday meal which participants then sampled. An HRH registered dietitian then talked about the benefits of eating healthy during the holidays. Twenty-nine individuals attended. 2. How well do you know your child? - This Health Nite Out program was presented by a Licensed Professional Counselor from HRH's Center for Behavioral Health. Topics included learning the signs and symptoms of: Depression, Anxiety and Bullying. Ten individuals participated. 3. Super Tooth to the Rescue - This Health Nite Out, presented by one of Halifax Regional Dental Clinic's dentists discussed the importance of dental care for children. Twelve individuals attended. 4. Are you at risk for a heart attack or stroke? - This Health Nite Out, presented by one of Halifax Regional's cardiologists, discussed the risk factors of heart disease and stroke and how to help prevent them. Ten individuals participated. 5. Girls Nite Out: Heart Disease - This Health Nite Out, presented by Halifax Regional's interventional cardiologist, discussed women and heart disease with wine and cheese as refreshments. 68 individuals attended. 6. Head and Neck Cancer: Early Detection is the key - This Health Nite Out, presented by Southern Virginia Ear, Nose & Throat's otolaryngologist, discussed signs and symptoms of head and neck cancer and provided 25 free oral screenings. Thirty-three individuals attended. 7. The Impact of Mental Illness on the Family -This Health Nite Out, presented by a licensed professional counselor from Center for Behavioral Health, discussed mental illness and how to help family members cope with its symptoms. Seven individuals participated. 8. Food Label Literacy -- This Health Nite Out program, led by one of Halifax Regional's dietitians, focused on understanding how to read food labels and gave helpful tips for grocery shopping. Twenty-four individuals attended. 9. Love Your Limbs -- This Health Nite Out, presented by Halifax Regional's interventional cardiologist, discussed the signs and symptoms of peripheral arterial disease (PAD). Sixty-five free PAD screenings were provided to willing participants. Eighty individuals attended. Long Term Care Town Meetings, National Celebrations/Observances for Public Educational Family Night MeadowView Terrace periodically hosts free family night programs which are open to and promoted to the public. These meetings are programs of interest to the general public and feature an invited speaker. The Woodview welcomes the residents' families and the community into the facility for programs of interest to the general public. Programs during FY13 included Helping Families Under Responsibilities in Long Term Care with Judith Anderson FNP; Dinner With Santa; and a performance by Harold Young & Friends. Seasons hosted four family nights: Diabetic Awareness, Heart Healthy Eating, a Santa party and a family cookout. Other In FY13 Woodview staff provided information and presentations on careers in healthcare during Career Days at local elementary schools. Woodview staff also worked with Habitat for Humanity's "Pumpkin Patch" fundraiser to raise money for Habitat homes. Mentor Role Model Program Halifax Regional provided support and office space at below market rates for the Role Mentor Model Program (a community program providing adult mentors to local children) during FY13. Speakers Bureau Halifax Regional's Speakers Bureau provides free informational programs to schools, community groups, businesses and other organizations in Halifax, Mecklenburg and Charlotte counties. Topics range from diet and nutrition to risks for heart disease, drug interactions, stress management, wellness, disaster preparedness, and Alzheimer's disease, to name a few. Speakers include staff members and physicians. In FY13 presentations were made to 28 community organizations, civic clubs and churches. Approximately 1,400 individuals were reached through these presentations.
Support Groups		On a bi-monthly basis, Halifax Regional Hospital advertises meetings for support groups and information classes that the community is invited to attend. Many of these support groups have long-standing memberships and as new needs are identified, Halifax Regional works to ensure that new groups are added. Halifax Regional works with groups to serve as facilitators or identify facilitators in the community, obtains speakers for meetings and provides free meeting space for support groups. 1. Bosom Buddies Cancer Support Group, offers women who have or who have experienced breast cancer, an opportunity to share their feelings and exchange coping strategies. Five meetings were held during FY13 with a total of approximately 35 participants. 2. The Arc of Southern Virginia, meets monthly at HRH. The group gives parents and grandparents an opportunity to share successes with others who care for children with autistic tendencies. Approximately fifteen to twenty individuals attend the monthly meetings routinely. Halifax Regional advertises their monthly meetings in newspapers and on the Web site. 3. Better Breathers Support Group meets the fourth Thursday of the month at the hospital. During FY 2013, the group met eleven times with an average of six members at each meeting. Each session alternates between group discussions and programs provided by hospital employees, physicians, or guests from the community. 4. Stroke/Aphasia Support Group met 11 times during FY13 with a total of 44 participants. The meetings are held at Halifax Regional Hospital and are open to stroke survivors, stroke caregivers and friends, and anyone wishing to know more about stroke and aphasia. 5. Weight Watchers Although this is a franchised program, Halifax Regional Hospital provides space and encourages participation. The group meets every Monday with approximately 5 participants, including employees and community members. 6. R.I.S.E. (Resource Information Sessions of Encouragement) meets the fourth Tuesday of each month and serves as a bereavement support group for the community. Sessions are led by Halifax Regional Hospice staff and the 11 meetings held during FY13 reached 148 participants. Meetings are held at the hospital. Each session has a different topic, focusing on the different needs of those who have recently suffered a loss. Topics are presented by volunteer leaders from the community and include subjects like understanding grief, identifying the positives, journaling grief experiences and exploring resources available for people who are newly living alone. 7. Narcotics Anonymous - This group meets weekly at the hospital. The hospital provides free space and advertising. 8. Cancer Support Group (HOPE) - During FY2013, Halifax Regional continued to advertise this group's weekly meetings in its bi-monthly For Your Good Health advertisement. The group's weekly meetings take place at a local church. 9. Alzheimer's Support Group - Meeting monthly, this group is facilitated by a hospital employee. HRH advertises its meetings. Sessions are designed to provide education and support to individuals caring for someone with Alzheimer's disease or related dementias. For Your Good Health Calendar Ad Halifax Regional Hospital offers a bi-monthly calendar ad, "For Your Good Health," which advertises free events in four local newspapers in its service area. The ad is printed in each newspaper's first edition of the week and provides information and dates for childbirth and diabetes group classes, support group meetings and other community/health system-sponsored wellness programs. Contact persons and phone numbers are listed for access to registration and/or more information. Community Health News Magazine Halifax Regional's Life and Health magazine is mailed to more than 31,000 households in our service area four times a year. The 8-page magazine contains health and wellness information as well as articles and photos of events and activities at Halifax Regional Hospital, MeadowView Terrace, Seasons at The Woodview and The Woodview and our four family practice clinics and six specialty offices. The full-color publication features information on new services and technologies, special awards, accreditations, and lists classes and events. The Woodview and Seasons at The Woodview Newsletters In-house prepared newsletters from The Woodview and Seasons at The Woodview are distributed to over 520 families, businesses and individuals each month. The Woodview Whistle includes a special feature focusing on an employee and one or more residents and features other items of interest related to activities at The Woodview. Making The Woodview Whistle especially interesting, are drawings by residents that depict life and times and/or activities they fondly remember. Often the artist will include a handwritten explanation with the artwork. Also included are photos that depict residents involved in the life of the facility. The Seasons at The Woodview newsletter features educational information related to Alzheimer's disease and general information about the residents and facility events. Seasons' residents help in folding and inserting the newsletter, as well as labeling it.
Health Literature		A wide range of free health literature is available through Halifax Regional Health System's marketing and education departments. Information is placed in waiting rooms, on hospital nursing units or may be requested through the mail. Literature is also distributed by Speakers Bureau participants, at support group meetings, Health Nite Outs and at screening events. Halifax Regional is often asked to supply educational materials to churches, schools and community groups that hold health fairs in their respective facilities. This literature covers risk factors for heart attack and stroke; ways to identify hypertension, high cholesterol, diabetes and mental health problems as well as good nutrition and exercise. Halifax Regional's community newsletter references the HRHS website's medical library frequently, offering readers alternate ways to learn more about diseases and treatments currently available. Web site Visitors to www.hrhs.org can find a physician, learn about and register for classes and events, search for a job, search the health library, engage in interactive health screenings, take a virtual tour and learn about services. Online features include bill payment, job applications, charitable donations, event registration, physician CV submission, cheer cards and messages, registration for outpatient procedures, and visiting the secure online baby nursery. Visitors may also access online volunteer applications for both adults and juniors. The use of these online features continues to rise with a significant increase noted for online bill payment, event registration and cheer cards. Visitors to the site can subscribe to three online newsletters: the health e-newsletter, pregnancy e-newsletter, and the new-parent e-newsletter, a monthly electronic publication for parents with newborns and toddlers. The site receives approximately 8500 unique visits each month. Also on the HRHS website, visitors can access the System's Facebook page, YouTube channel and blog titled Just for the Health of It. The Woodview, Seasons at the Woodview and MeadowView Terrace each have their own Web site with unique URLs and which can also be entered from the HRHS Web site. The long term care sites include general information about the facilities and also include the monthly activity calendars with pages focusing on special events, awards and publications, as well as links to the Alzheimer's Association. Your Right to Decide; A Guide to Communicating Your Healthcare Choices This booklet encourages readers to consider end-of-life decisions while they are well enough to make these choices. Staff and chaplains have used the booklet, along with copies of advance directives, to present programs to their own congregations and community groups to make people aware of having a living will and designating someone to make healthcare decisions for them when they may be unable to speak for themselves. These free booklets and copies of the Virginia Advance Directive form are available at Healthy Living Expos, on our website, in our patient booklet, in the admissions area and through the Guest Relations Coordinator and Chaplain's Office. Your Hospital Stay Patient Booklet A new program was implemented toward the end of FY13, "Your Hospital Stay" is a publication offered by HRH, designed to educate patients both during and after their hospital stay while providing them a central location for paperwork, questions and notes. The publication was shaped out of an idea from HRH's Patient Partnership Council, a forum which includes former patients and patient family members. Similar to the service directory provided in every room of nice hotels and resorts, "Your Hospital Stay" provides valuable information such as how to order food, cafeteria hours, instructions for on telephone use in patient rooms, a list of television stations, and information on special programs for patients such as pet therapy, the Care Partner Program, financial assistance and much more. "Your Hospital Stay" is disseminated Monday through Friday by a specially chosen team of volunteers. Admissions during the weekend are done by the volunteer scheduled for Monday morning. Volunteers often tailor their brief discussions about the book based on what they feel may be most applicable to the patient or in answer to patient questions. In FY13, 964 booklets were given to patients.
Health Professions Education		The Project PRIME Scholarship Endowment Fund (Project PRIME), which provides financial assistance to those in the region who want to pursue a career in healthcare or a healthcare-related field is administered and promoted by Halifax Regional Hospital. In FY13 $77,000 was awarded to 53 individuals. The Dr. Jesse J. Bates Scholarship Program was started in 2002 in honor of Dr. Jesse J. Bates, one of twelve physicians on Halifax Regional Hospital's medical staff when the hospital opened in 1953. In FY13, the Bates Scholarship provided $5,000 in scholarship funds to six graduating high school seniors from the Halifax Regional Health System service area. The purpose of the scholarship is to encourage high school seniors to seek education to fill critical healthcare vacancies and acquire skills for use with technologically advanced equipment and treatment therapies. The scholarship endowment fund receives donations from the community and the late Dr. Bates' family. This scholarship is administered and promoted by Halifax Regional Hospital. Continuing Medical Education (CME) Program HRH is accredited by the Medical Society of Virginia to sponsor Continuing Medical Education (CME) for physicians. The CME program is open to all physicians and physicians extenders in our service area, as well as to our medical students. The mission of the CME Program is to provide physicians with the latest evidence-based medical knowledge and technical skills. Educational programs are planned based on identified educational needs that underlie the professional practice gaps of our learners. FINANCIAL AND IN-KIND CONTRIBUTIONS Halifax Regional Community Partnership Program As a cornerstone organization in our region, Halifax Regional takes seriously its responsibility to be an active corporate citizen. The Health System contributes to various organizations that share its mission to promote good health and wellness and to help improve the quality of life of all ages. As part of the Health System's continued active community involvement, the Halifax Regional Community Partnership Program was established in FY05 to enable Halifax Regional Health System to maximize its resources to provide the greatest benefit to citizens in Southside Virginia. Guidelines for requests help answer important questions that enable the program to disperse resources in the most effective manner. In FY13 $217,423.84 was donated to support community programs in our service area. Additionally, hundreds of health education brochures and giveaways were provided to community organizations to help support their events and programs. Medication Assistance Program With funding support from the Virginia Health Care Foundation, the Chastain Home and the Halifax Regional Development Foundation, MedAssist of Halifax provides medication assistance to low income, uninsured and underinsured residents in Halifax and Mecklenburg Counties. MedAssist of Halifax collaborates with other healthcare providers and agencies in the area to identify individuals who can benefit from this service. This program provides participants a stable process for receiving life sustaining and/or preventive medications. Halifax County has a higher incidence than the state median for health conditions for which hospitalizations can be prevented with consistent, available ambulatory care and good patient compliance with treatment/self-protocols, including hypertension, asthma and diabetes. Compliance with prescribed courses of medication improves the quality of life for patients, while decreasing the number of hospital visits of patients who return due to inability to comply. Emergency Department visits precipitated by conditions which could have been managed with compliance with the prescribed medication regimen are expected to also be reduced. This program is administered through the Halifax Regional Development Foundation, Inc. During FY13, 1,223 patients received medications valued at $5,611,020.
Center for Nursing Excellence		Recognizing the local, state and national nursing shortage, Halifax Regional Health System's CEO envisioned a nursing education center that would eliminate the traditional barriers for nursing students such as commuting, scheduling, waiting lists and inadequate career preparation. Directing the effort to establish such a site, Halifax Regional leadership worked to secure cooperation and additional funding from like-minded entities. The collaborative effort resulted in the September 2008 opening of the Center of Nursing Excellence at the Southern Virginia Higher Education Center - a state-of-the-art nursing education center where students acquire clinical and critical thinking skills in a safe environment utilizing advanced simulation technology. The center now offers education from nurse aide through the Doctorate of Nursing Practice utilizing six high-tech laboratories offering instructional technologies and high fidelity simulations which give students hands-on experience, boost confidence and prepare them to enter the workforce fully prepared for the rigors of professional nursing practice. In FY13, Halifax Regional contributed $139,194 to the center. In addition, one HRH employee served on the advisory board and another worked with the center exploring grant opportunities. Food Drives During FY13 employees, physicians and volunteers at Halifax Regional Hospital again participated in Sodexo Services' "Servathon," a nationwide food drive conducted each April to help put food on the tables of those having difficulty providing for their families. Staff members and others collected over $950 and nearly 250 pounds of canned goods, pastas, rice, sugar, flour, coffee, and other non-perishable foods. A check and the food were donated to the United Missionary Soup Kitchen in South Boston, a local organization that helps in the collection and distribution of food to needy individuals and families in Halifax County. In FY13 MeadowView Terrace coordinated a food drive and collected 700 pounds of cans and boxes of non-perishable food which were donated to the Clarksville Food Pantry during their annual food drive to help put food on the tables of those having difficulty providing for their families. Nine turkeys were also donated to Mecklenburg Social Services to be distributed during the holidays. Alzheimer's Memory Walks In FY2013 The Woodview and Seasons at The Woodview staff and volunteers planned, coordinated and hosted the annual Alzheimer's Support Walk. A number of fundraising events held throughout the year by The Woodview and Seasons lead up to walk day with 80 walkers participating. Funds raised in these events were donated to the Southeastern Virginia Chapter of the Alzheimer's Association. The money is used locally to support Alzheimer's related programs including family orientations, the 24-hour helpline, educational seminars and training sessions for both family and professional caregivers, the Safe Return program, local support groups and the speaker's bureau, all of which assist individuals and families affected by the disease. Nearly $4,000 was collected from fund-raising efforts throughout the year including bake sales, ice cream sundae sales, yard sales, donations and the Alzheimer's walk itself. In addition, The Woodview provided space and lunch for the area Alzheimer's Walk Team Committee Captain kick-off meeting. The MeadowView Terrace staff and volunteers organize, coordinate, advertise and host fundraising events to support the work of the Southeastern Virginia Chapter of the Alzheimer's Association. The money raised is used locally to support Alzheimer's related programs including family orientations, the 24-hour helpline, educational seminars and training sessions for both family and professional caregivers, the Safe Return program, local support groups and the speaker's bureau, all of which assist individuals and families affected by the disease. Nearly $3500 was collected from the fund-raising efforts throughout the year and donated to the Association. "Samantha Doll" Project "Samantha" dolls are part of a nationwide effort to distribute huggable, therapeutic dolls to terminally ill patients of all ages. Halifax Regional Hospice joins more than 2,500 hospice providers throughout the United States in distributing these free dolls to their patients. Halifax Regional Hospital distributes them as well. Women from local missionary unions in the Dan River Baptist Association sew the dolls and provide them for local Hospice and hospital patients. During FY13, approximately 102 dolls were distributed to patients in homes, the hospital and nursing facilities. Other Long Term Care In-Kind Contributions MeadowView Terrace held bake sales to raise money for the Mecklenburg County Department of Social Services Christmas program, (gifts for needy children). In addition, approximately 200 pounds of dog and cat food was collected and donated to the Clarksville SPCA. The facility also collected newspapers to donate to the SPCA. Through May, 2013 MeadowView Terrace sponsored the Backpack Buddies program at Clarksville Elementary School, providing students with school supplies. Long-term care residents are encouraged to become involved in the life of the facility as well as the life of the community, adding to their quality of life along with assisting those to whom their efforts are concentrated. With leadership and coordination from the staff, in FY13, the Woodview family - residents, volunteers and staff alike - co-hosted a Fall Bazaar which this year included vendors from the community. Funds raised were donated to the Halifax County Cancer Association. Again in FY13 Woodview residents prepared hand-made dolls and stuffed animals for the "Toys for Tots" program and made and donated cookies to the United Missionary Soup kitchen for Thanksgiving. Rescue Squad and Fire Department Training Halifax Regional Hospital provides supplies and other assistance to help local rescue squad members meet local, state and federal patient safety guidelines. The Health System also makes donations to local fire departments and rescue squads to help them with their respective fundraising activities. A Halifax Regional emergency room physician serves as an Operational Medical Director for EMS agencies. During National EMS Week, Halifax Regional awarded each rescue squad $250 through Halifax Regional Community Partnership. Sports Physicals Members of Halifax Regional Hospital's medical staff, including physicians, nurse practitioners and physician assistants, provide free sports physicals for Halifax County Middle School, Bluestone Middle School and Bluestone High School students who participate in fall, winter, spring and summer school sports programs. In FY13 providers completed approximately 160 physicals for middle and high school students in both the primary and extended service area for HRHS.
Facility Use		Halifax Regional Hospital and the long term care affiliates provide free space and available equipment for area wellness programs, community meetings and clinical training programs. Examples include: Economic Development Commission, Halifax County Public School Foundation, Weight Watchers, United Way Board meetings, Local Minister's Conference, Dixie Softball meeting, Credit Union, Arc of Southern Virginia, Southside Community College Nursing program, American Red Cross Bloodmobile, Beltone Hearing Clinics, AARP Safe Driving Classes and various support group meetings. Halifax Regional Hospital served as a clinical site for: * RN and LPN students, Southside Virginia Community College * Physical Therapy students from Regis University, Denver, Colorado * Physical Therapy Assistant students, Jefferson College Health Sciences * Speech Language Pathology students from Longwood College * Agreements are also held to serve as a training site for students from East Carolina University, University of North Carolina-Chapel Hill, Shenandoah, James Madison University, Appalachian State University, Medical University of South Carolina, Winston Salem State University, Elon, Lynchburg College and Radford University. * Respiratory Therapy students from J. Sergeant Reynolds Community College * Radiology Technologists Program, CVCC, Lynchburg, VA * EMS Students from local EMS classes completed their training at different levels. Other students from South Hill, Farmville and Richmond also performed their training at Halifax Regional Hospital. * Pharmacy students, Medical College of Virginia * Pharmacy Technician students, National Business College, Miller Mott Technical College * Doctor of Pharmacy students, Medical College of Virginia The Woodview and Seasons at The Woodview and MeadowView Terrace also provide free space and available equipment for clinical training programs. The Woodview serves as a clinical site for: * Halifax County High School Nurse Aide classes class; 20 students per semester * Southside Virginia Community College, SVCC; 50 nursing assistant students per year * SVCC; 20 LPN and RN students per year * Danville Community College Nurse Aide classes - 50 nursing assistant students per year. The Woodview also serves as a testing site for Beltone Hearing Aids. MeadowView Terrace serves as a clinical site for: * Bluestone High School, nursing assistant students (approximately 10 students per semester) * Bluestone High School Special Education students (five each semester) * Southside Virginia Community College, SVCC, (nursing assistant students at Estes Center, approximately 60 students) * SVCC, Estes Center, (approximately 20 LPN students). MeadowView Terrace provides free space and available equipment for area wellness programs, community meetings, support groups and clinical training programs. Free space is provided for various community groups to meet including the Gideons who hold their annual banquet at MeadowView Terrace, and space is provided at no charge for Beltone Hearing Clinics which are open to the public.
Community Building		Employees donate hundreds of hours and share their talents and expertise as members of various civic and religious organizations in their communities, as well as serving on rescue squads and fire departments. The hospital allows and encourages employees to provide service to the community during working hours also. Employees serve in various capacities including on boards and advisory committees of a number of community groups and state organizations advancing community health and wellness and workforce development including the following: Halifax County Chamber of Commerce; Charlotte County Chamber of Commerce; Clarksville Chamber of Commerce; Mecklenburg County Business Education Partnership; Tri-County Community Action Agency; Halifax Advocates for Substance Abuse Prevention; Southside Health Coalition, Halifax Vocational Education Foundation; Southside Virginia Community College School of Nursing Advisory Council; Committee for The Center for Nursing Excellence; Southern Virginia Higher Education Center; Virginia Community College System; Virginia Foundation for Community Colleges; Halifax Education Foundation; Halifax County Public Schools Education Foundation; Virginia Advanced Study on Strategies Board; Economic Development Committee; Workforce Investment Board; Halifax County United Way: Mentor Role Model Program and the Mecklenburg County YMCA. Employees at The Woodview and Seasons at The Woodview participate in and share their talents and expertise as members of various civic and religious organizations in their respective communities. They participate in the Chamber of Commerce in Halifax County; serve on Virginia Health Care Association Committees; and serve on various boards and advisory committees such as the, Lake Country Commission on Aging, the Southside Virginia Community College LPN School Advisory Council, Halifax Vocational Foundation Advisory Council, Lake Country Area Agency on Aging and the Halifax County Community Federal Credit Union. Other programs included a spa/relaxation day offered to residents, and a Black History Program given by volunteers Retha & Friends. The Woodview continued providing "Stress Free" days and The Woodview Resident Glee Club performed at Christmas and Easter. Employees of MeadowView Terrace participate in and share their talents and expertise as members of various civic and religious organizations in their respective communities. They participate in the Chamber of Commerce, in the Ruritan Club and the AARP, and they serve on advisory boards such as the Virginia Employment Commission, Southside Virginia Community College and other committees and boards including the Mecklenburg County Business Education Partnership. This year they participated in a spelling bee to raise money for scholarships. In FY13 the facility participated in the downtown Clarksville veterans program, the July 4th parade and the Christmas parade in both Clarksville and Chase City. The Activity Department also adopted five children for Christmas through Mecklenburg Social Services. Adopt a US Soldier program In FY13 Seasons at The Woodview continued support of the Adopt a US Soldier program, despite losing their soldier. The residents, their families and the Seasons staff remain involved in the project and continue to send cards to his platoon. Poetry Project During FY13 Virginia's Poet Laureate Kelly Cherry met regularly with residents in poetry workshops after which activity staff helped residents write their own poems. This project continued and the poems were compiled a small book of poems. Intergenerational Programs in the Long Term Care Facilities The Woodview visits the Dan River Wee School on a regular basis to provide learning experiences for both the young children and the residents. The children and residents visit together, work on crafts and enjoy various holiday presentations and projects. People of all ages from approximately 50 community groups-churches, dance groups, bands and various clubs-share their talents with residents, staff members, and families at both The Woodview and Seasons at The Woodview. Woodview residents often join other community groups to help with local events, too. Each year, The Woodview plans, coordinates and hosts community events especially for children. Approximately sixty children from the community enjoyed The Woodview's annual Easter Egg Hunt this year with children enjoying fun activities and delicious refreshments provided by the facility. Dinner with Santa was a treat for approximately 45 local youngsters and 25 family members, and approximately 150 children participated in the FY13 Safe Trick or Treat. The Woodview partnered with Clays Mill Elementary School for the Great Grands Program, where students adopt a great grandparent. In FY13 American Legion Post #8 provided the residents with a Veterans Day program and celebration and the Woman's Auxiliary of Post #8 and American Legion Post #99 provided gifts for residents at Christmas, Easter, Valentine's Day and Veteran's Day. At Christmas, The Salvation Army donated gifts to all 180 residents at The Woodview. In FY13 Seasons at The Woodview was visited by both Centerville Christian School students and We've Got Rhythm, students from a local dance company. In FY13 The Woodview partnered with Helping Hands, a service organization of Halifax County High School. Helping Hands assisted residents in a Bingo game and hosted a Valentines Program for them. Halifax County High School JROTC also hosted a Veterans Program and Valentines Program for residents. South Boston Early Learning Center hosted a spring program for residents. Each year, MeadowView Terrace plans, coordinates and hosts a community "Safe Trick or Treat" at the facility on Halloween. This event provides a safe haven for children to trick or treat, going from neighborhood to neighborhood in the facility and includes refreshments for all participants. The facility also plans, coordinates and hosts a Breakfast with Santa and an Easter Egg Hunt each year for the children of staff, and residents' grandchildren, complete with refreshments and prizes for all. The Boy Scout, Girl Scout and Cub Scout troops continue to visit and interact with residents as part of their Badge program. People of all ages from various community groups, clubs, churches and schools share their talents with residents, staff members and families throughout the year. In February, MeadowView Terrace employees participated in Read Across America Day and employees read to students at Clarksville Elementary.
Community Involvement Recognition for Long Term Care Affiliates		The Woodview and Seasons at The Woodview have been recognized for community involvement by the Virginia Health Care Association (VHCA) frequently over the years. The annual VHCA awards are presented to facilities that demonstrate a high degree of professionalism and creativity in implementing programs that encourage and support strong community relations. In FY13, The Woodview was again recognized, receiving first place for Year Round Public Relations. Season's was recognized with third place in Special Event and Year Round Community Involvement. Disaster Readiness Activities Halifax Regional Hospital continues to participate in regional and local exercises to test the Emergency Operations Plan and to conduct internal exercises. These initiatives help Halifax Regional Hospital prepare for and coordinate crisis response and recovery operations with state, local and federal agencies in the event of a bioterrorist event/disaster. Outside the realm of the grant funding, Halifax Regional Hospital supplied the employee time involved in training for community emergency preparedness as well as for community disaster training drills. Our focus continues to be on preparing the hospital staff and the community for "All Hazards." OTHER Volunteer Services Program The Volunteer Auxiliary of Halifax Regional Health System is a dedicated group of individuals whose helping hands extend even further than the walls of the hospital. In addition to the many services they provide to the hospital to support its programs and services, they generously donate proceeds from their fundraising events and sales from the hospital's gift shop and vending machines to support a number of internal and outward activities. The Tender Loving Care team provided many handmade items for the patients including 431 baby blankets, 194 bears, 74 fish, 26 walker bags and 12 Christmas stockings for newborns during the holiday season. In FY13 the group continued managing Planetree programs such as the Cookie Cutters and Pet Therapy, and the Care Cart program as well many other areas throughout the hospital. One hundred thirty-seven volunteers contributed more than 26,000 hours of service to the hospital and community. Twenty-one junior volunteers contributed over 600 hours to HRHS and the community. Volunteers in Halifax Regional Hospice visit Hospice patients where they live, providing life-enhancing assistance to patients and their families. During FY13, hospice volunteers provided companionship and respite for terminally ill patients and their caregivers, assisted with patients' daily activities and served as a compassionate presence. Volunteers also knit prayer shawls for Hospice Patients, and red, white and blue "lapghans" which are given to veterans. These volunteers are an important part of the hospice team and trainings sessions for new volunteers are held as needed. Volunteer services are coordinated and oversight is provided by an HRHS employee. More than 100 volunteers from the community, both individuals and groups, have donated their time at MeadowView Terrace during FY13, providing companionship, recreation and spiritual activities for residents. Volunteers coordinate bingo games, craft activities, chapel services, birthday observances and holiday celebrations. They also accompany residents on picnics and out-of-residence activities, including bus trips to county fairs, Lakefest, parades, Boydton Day and other community events/festivals. The volunteers assist with the annual Halloween "Safe Trick-or-Treat Night," "Breakfast with Santa," Easter egg hunts and cookouts for residents and families and provide one on one friendly visits to residents. MeadowView's volunteers also organize and implement the facility's fundraising events. Volunteers from the community, individuals and groups, have donated many hours at The Woodview and Seasons at The Woodview during FY13, providing companionship, recreation and spiritual activities for residents. Volunteers also include certified pet therapy dogs. Volunteers at The Woodview and Seasons at The Woodview, coordinate bingo games, craft activities, birthday observances and holiday celebrations. They also accompany residents on picnics and fishing excursions and out-of-residence activities, including bus trips to county fairs and other community events/festivals. The volunteers assist with the annual Easter Egg Hunt, Dinner with Santa, the Safe Trick-or-Treat and cookouts for residents and families. An annual volunteer recognition luncheon is hosted to recognize and honor volunteers for their service. Chaplaincy Program The Chaplain Program (Pastoral Care Services) led by Manager of Guest Services/Pastoral Care Services incorporates more than 20 volunteer Associate Chaplains to provide spiritual care to patients, their family members in the hospital setting as well as to residents in our long-term care facilities, hospice patients, and the community. In addition to spiritual care, chaplains lend their listening presence to employees and volunteers. Weekly Chapel services are available in the Sub-Acute area of our hospital as well as in Halifax Regional's long-term care facilities. The chaplain maintains a listening/educational presence for local clergy as well as the community on issues related to Spirituality and Health Care. In FY13 the Hospital Chaplain spoke to various community groups on Advance Directives, and led classes for local clergy. Access to Information The Marketing and Communication Department's phone number is listed on "Health Nite Out" and other wellness program ads promoting health education programs. This number is also listed in Halifax Regional Health System's Life and Health newsletter, which is mailed quarterly to more than 31,000 households in the system's three-county service area. The public can request free brochures, a physician directory and be directed to many sites on the Web site, including an extensive on-line health information library. Contact information is also given on the hospital's on-hold messaging system. When specific information is provided and individuals might like more information through a pamphlet or brochure, the phone number is listed and callers can have more information mailed to them. The Marketing and Communications office is often referenced when callers reaching the main hospital number are not sure who they need to talk to about their question. The department can also be sent email from the health system's Web site.
BUSINESS/FAMILY RELATIONSHIP	PART VI, LINE 2	FOLLOWING PERSONS HAVE A BUSINESS RELATIONSHIP: 1. LARRY SNEED, DAVID WHITE AND CHRIS LUMSDEN
SIGNIFICANT CHANGES TO ORGANIZING DOCUMENTS MADE PRIOR TO END OF TAX YEAR	PART VI, LINE 4	ON JULY 1, 2013, PURSUANT TO THE AFFILIATION AGREEMENT AMONG SENTARA HEALTHCARE (SENTARA), HALIFAX REGIONAL HEALTH SYSTEMS, INC. (HRHS), AND HALIFAX REGIONAL HOSPITAL, INC., SENTARA REPLACED HRHS AS THE SOLE MEMBER AND PARENT OF HALIFAX REGIONAL HOSPITAL, INC. SIMULTANEOUSLY, HALIFAX REGIONAL HOSPITAL, INC AND SUBSIDIARIES (THE HOSPITAL) REPLACED HRHS AS THE SOLE MEMBER OF HALIFAX REGIONAL DEVELOPMENT FOUNDATION, HALIFAX REGIONAL LONG-TERM CARE, INC., CLARKSVILLE SENIOR CARE, LLC, HALIFAX REGIONAL PROPERTIES, INC., AND SOUTHSIDE HEALTH SERVICES, INC. HRHS TRANSFERRED AND CONVEYED 100% OF THE ISSUED AND OUTSTANDING SHARES OF THE CAPITAL STOCK OF SOUTHSIDE TO HALIFAX REGIONAL HOSPITAL. HRHS TRANSFERRED, ASSIGNED AND CONVEYED TO HALIFAX REGIONAL HOSPITAL ALL TANGIBLE AND INTANGIBLE ASSETS OF HRHS INCLUDING ALL SHARES OF STOCK, MEMBERSHIP INTERESTS AND OTHER SECURITIES. HRHS ARTICLES OF INCORPORATION AND ITS BYLAWS WERE AMENDED AND RESTATED TO REFLECT THE FOLLOWING SIGNIFICANT CHANGES - " THE PURPOSE OF THE CORPORATION IS TO PROVIDE OVERSIGHT TO THE AFFILIATION AGREEMENT COMMITMENTS OVER THE COVENANT PERIOD " THE BOARD SHALL BE COMPOSED OF NO FEWER THAN SIX DIRECTORS, NOT LESS THAN ONE-HALF OF WHOM SHALL BE PERSONS THEN SERVING AS CLASS A DIRECTORS OF HALIFAX REGIONAL HOSPITAL. " THE CORPORATION SHALL TERMINATE ITS CORPORATE EXISTENCE AS THE LATER OF (I) ONE YEAR AFTER THE END OF THE COVENANT PERIOD (INCLUDING ANY EXTENSION THEREOF OR ONE YEAR AFTER ANY UNSPENT PORTION OF THE CAPITAL COMMITMENT AND REPLACEMENT AND MAINTENANCE COMMITMENT IS TRANSFERRED TO THE HALIFAX REGIONAL FOUNDATION AS PROVIDED IN THE AFFILIATION AGREEMENT AND HAS BEEN SPENT OR ENCUMBERED FOR THE SUPPORT OF THE HOSPITAL, AND THE TEN YEAR ANNIVERSARY OF THE CLOSING DATE; PROVIDED, HOWEVER, THAT THE CORPORATION SHALL NOT BE REQUIRED TO TERMINATE ITS CORPORATE EXISTENCE IF IT IS PURSUING ENFORCEMENT ACTION AGAINST SENTARA PURSUANT TO THIS AGREEMENT THAT HAD BEEN COMMENCED AND CONTINUING AS OF THE APPLICABLE FOREGOING DATE.
ORGANIZATION'S FORM 990 REVIEW PROCESS	PART VI, LINE 11B	THE RETURN IS PREPARED BY ORGANIZATION' INDEPENDENT ACCOUNTING FIRM, BASED ON INFORMATION PROVIDED BY ORGANIZATION AND IN CONSULTATION WITH ORGANIZATION STAFF. THE DRAFT PREPARED BY THE ACCOUNTING FIRM IS THEN CAREFULLY REVIEWED BY ORGANIZATION MANAGEMENT AND STAFF. CHANGES ARE MADE AS APPROPRIATE. THE FINAL VERSION IS MADE AVAILABLE TO ALL MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS.
CONFLICT OF INTEREST POLICY	PART VI, LINE 11B	ALL MEMBERS OF THE BOARDS OF DIRECTORS FOR ALL ENTITIES OF THE ORGANIZATION ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE IN JANUARY EVERY YEAR. A REPORT OF THE DISCLOSED POTENTIAL CONFLICTS IS PRESENTED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS TO THE BOARD IN EXECUTIVE SESSION ANNUALLY. IF IT IS DETERMINED BY THE BOARD SECRETARY, BOARD PRESIDENT, AND MEDICAL STAFF PRESIDENT THAT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE CIRCUMSTANCES OF THE CONFLICT OF INTEREST SHALL BE SET FORTH IN DETAIL BY THE AFFECTED PARTY. SUBSEQUENTLY, WHEN A RESOLUTION CANNOT BE FOUND TO THE SATISFACTION OF THE BOARD SECRETARY, BOARD PRESIDENT, AND MEDICAL STAFF PRESIDENT, THE MATTER WILL BE REVIEWED AND ADDRESSED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. A RECOMMENDATION WILL BE MADE TO THE AFFECTED PARTY ON HOW TO REMOVE THE CONFLICT. IF THE CONFLICT CANNOT BE RESOLVED TO THE SATISFACTION OF THE EXECUTIVE COMMITTEE, A RECOMMENDATION WILL BE MADE TO REMOVE THE AFFECTED BOARD MEMBER FROM THE BOARD OF DIRECTORS. IN SUCH CASE WHERE REMOVAL IS RECOMMENDED, PROVISIONS OF 4.6 OF THE CORPORATE BYLAWS WILL BE FOLLOWED. THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE ARE RETAINED BY THE SECRETARY TO THE BOARD OF DIRECTORS.
COMPENSATION	PART VI, LINE 15	FORM 990, PART VI, LINES 15A AND 15B WERE ANSWERED AS "NO" BECAUSE HALIFAX REGIONAL HEALTH SYSTEM DOES NOT COMPENSATE ITS EMPLOYEES. HOWEVER, HALIFAX REGIONAL HOSPITAL, INC. AND ITS RELATED ORGANIZATIONS SEEK TO PAY REASONABLE COMPENSATION UNDER SECTION 4958 TO ATTRACT AND RETAIN THE APPROPRIATE CALIBER OF EMPLOYEES DEDICATED TO CARRYING OUT THE EXEMPT MISSION. HALIFAX REGIONAL HOSPITAL PERIODICALLY CONDUCTS A REVIEW TO DETERMINE THE GOING FAIR MARKET COMPENSATION RANGES FOR COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE ORGANIZATION SETS COMPENSATION WITHIN THE RANGE OF THE GOING MARKET RATE. NO INDIVIDUAL HAVING A CONFLICT OF INTEREST UNDER ORGANIZATION' CONFLICT OF INTEREST POLICY IS PERMITTED TO PARTICIPATE IN THE REVIEW OR DECISION. THE ORGANIZATION MAINTAINS RECORDS REGARDING COMPENSATION. THE CHAIRMAN OF THE BOARD OF DIRECTORS ALSO SERVES AS CHAIRMAN OF THE EXECUTIVE (COMPENSATION) COMMITTEE, COORDINATING WITH THE CHIEF EXECUTIVE OFFICER TO REVIEW ANNUAL PERFORMANCE AND COMPARATIVE MARKET INFORMATION FOR THE POSITION OF CHIEF EXECUTIVE OFFICER (CEO), CHIEF OPERATING OFFICER (COO), AND CHIEF FINANCIAL OFFICER (CFO). A RECOMMENDATION IS PRESENTED TO THE EXECUTIVE COMMITTEE BY THE CHAIRMAN. THE EXECUTIVE COMMITTEE TAKES ACTION ON THE RECOMMENDATION. THE FULL BOARD OF DIRECTORS IS MADE AWARE THAT THE EXECUTIVE COMMITTEE HAS TAKEN ACTION OF COMPENSATION FOR THE CEO, COO, AND CFO WITH DETAILS AVAILABLE FOR THEIR REVIEW UPON REQUEST.
GOVERNING DOCUMENTS	PART VI, LINE 19	THE ORGANIZATION CURRENTLY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, THE HRHS BYLAWS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE ON THE ORGANIZATION'S WEBSITE.
OTHER CHANGES IN NET ASSETS	PART XI, LINE 9	TRANSFER OF EQUITY IN SUBSIDIARIES ............$(83,977,064)

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

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

HALIFAX REGIONAL HEALTH SYSTEM INC

Employer identification number

54-1801466

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

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?
(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	Yes	No
(1) HALIFAX REGIONAL HOSPITAL INCORPORATED 2204 WILBORN AVENUE SOUTH BOSTON,VA24592 54-0648699	HEALTHCARE	VA	501(C)	3	NA	Yes
(2) HALIFAX REGIONAL DEVELOPMENT FOUNDATION 2204 WILBORN AVENUE SOUTH BOSTON,VA24592 54-1801459	HLTH/WELFARE	VA	501(C)	11A TYPE I	NA	Yes
(3) HALIFAX REGIONAL LONG TERM CARE INC 2204 WILBORN AVENUE SOUTH BOSTON,VA24592 54-6074529	SENIOR CARE	VA	501(C)	11A TYPE I	NA	Yes
(4) HALIFAX REGIONAL PROPERTIES INC 2204 WILBORN AVENUE SOUTH BOSTON,VA24592 54-1801463	HLTH/WELFARE	VA	501(C)	11A TYPE I	NA	Yes
(5) CLARKSVILLE SENIOR CARE LLC 2204 WILBORN AVENUE SOUTH BOSTON,VA24592 54-1957066	SENIOR CARE	VA	501(C)	11A TYPE I	NA	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) none

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?
(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		Yes	No
(1) SOUTHSIDE HEALTH SERVICES 2204 WILBORN AVENUE SOUTH BOSTON,VA24592 54-1417772	HEALTH SERVIC	VA	NA	C Corp	1,690,234	177,436	100.000 %	Yes
(2) DOMINION HEALTH MEDICAL ASSOCIATES LTC 2204 WILBORN AVENUE SOUTH BOSTON,VA24592 54-1060357	PHYS PRACTICE	VA	NA	C CORP				Yes

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

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 . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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)	(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 VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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:

1	Briefly describe the organization’s mission or most significant activities: THE PURPOSE OF HALIFAX REGIONAL HEALTH SYSTEM IS TO PROVIDE THE HIGHEST QUALITY CARE BASED ON THE HEALTHCARE NEEDS OF THE PEOPLE WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	361
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	1,000,000
9	Program service revenue (Part VIII, line 2g) .........	0	0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	0	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	0	1,000,000
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	0	0
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	0	1,271
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	0	1,271
19	Revenue less expenses. Subtract line 18 from line 12.......	0	998,729
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	83,977,064	998,829
21	Total liabilities (Part X, line 26).............	0	100
22	Net assets or fund balances. Subtract line 21 from line 20.....	83,977,064	998,729

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 1,271 including grants of $ ) (Revenue $ )
	OVERSIGHT OF AFFILIATION AGREEMENT BETWEEN SENTARA AND HALIFAX REGIONAL HOSPITAL GROUP. FOR MORE INFORMATION, SEE SCHEDULE O.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	ACUTE, HOME HEALTH, HOSPICE AND OUTPATIENT CARE. FOR MORE INFORMATION, SEE SCHEDULE O.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	INTERMEDIATE AND ALZHEIMER'S CARE. FOR MORE INFORMATION, SEE SCHEDULE O.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses1,271

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	0	1,973,274	135,961

(A) Name and business address	(B) Description of services	(C) Compensation
NONE,




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 0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		1,000,000

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,000,000
			Business Code
2a
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			0
3	Investment income (including dividends, interest, and other similar amounts).......			0
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties...........			0
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......			0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........			0
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..			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...			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..			0
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions......			1,000,000

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	0
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 ....	0
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	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	0
10	Payroll taxes ...........	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	14	14
12	Advertising and promotion ....	0
13	Office expenses .......	0
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	0
17	Travel ............	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	0
23	Insurance ..............	1,257	1,257
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
b
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	1,271	1,271	0	0
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 if following SOP 98-2 (ASC 958-720).


			(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............		0	1	992,541
2	Savings and temporary cash investments .........		0	2	0
3	Pledges and grants receivable, net ...........		0	3	0
4	Accounts receivable, net .............		0	4	0
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 ..............		0	8	0
9	Prepaid expenses and deferred charges ..........		0	9	6,288
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation .....	10b	0	10c
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 .....		0	13	0
14	Intangible assets ...............		0	14	0
15	Other assets. See Part IV, line 11 ...........		83,977,064	15	0
16	Total assets. Add lines 1 through 15 (must equal line 34)......		83,977,064	16	998,829
17	Accounts payable and accrued expenses .........		0	17	100
18	Grants payable .................		0	18	0
19	Deferred revenue ................		0	19	0
20	Tax-exempt bond liabilities .............		0	20	0
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....................		0	25	0
26	Total liabilities. Add lines 17 through 25.........		0	26	100
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............		82,672,436	27	998,729
28	Temporarily restricted net assets ...........		1,304,628	28	0
29	Permanently restricted net assets ...........		0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........		83,977,064	33	998,729
34	Total liabilities and net assets/fund balances ........		83,977,064	34	998,829