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Nonprofiteer
← CLARKSVILLE SENIOR CARE LLC

Form 990 for tax year 2022

Filed by CLARKSVILLE SENIOR CARE LLC.

Totals

Total revenue
$4,127
Total expenses
$4,894
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$4,127
Investment income
$0
Other revenue
$0
Total assets, end of year
$0
Total liabilities, end of year
$433,507
Net assets or fund balances, end of year
-$433,507
Program services expenses (Part IX)
$4,085
Management and general expenses
$809
Fundraising expenses
$0
Program service expenses (Part III)
$4,085

Program services were 83.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: OTHER PROGRAM SERVICE

    total $4,127 · related or exempt $4,127

Functional expenses

Part IX, the statement of functional expenses.

  • 23 · Insurance

    total $4,833 · program services $4,034 · management and general $799

  • 24e · All other expenses

    total $61 · program services $51 · management and general $10

Balance sheet

Part X, book values.

  • 17 · Accounts payable and accrued expenses

    beginning of year $5,008 · end of year $0

  • 19 · Deferred revenue

    beginning of year $379,893 · end of year $379,893

  • 25 · Other liabilities

    beginning of year $53,614 · end of year $53,614

  • 27 · Net assets without donor restrictions

    beginning of year -$491,426 · end of year -$481,507

  • 28 · Net assets with donor restrictions

    beginning of year $52,911 · end of year $48,000

Mission and programs · 2022

Mission

CLARKSVILLE SENIOR CARE, LLC IS ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF HALIFAX REGIONAL HOSPITAL, INC. FOR MORE INFORMATION SEE SCHEDULE O.

Activities or mission (Part I)

TO SUPPORT THE CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF HALIFAX REGIONAL HOSPITAL.

  • THE ORGANIZATION OPERATED A NURSING HOME FACILITY PRIOR TO ITS SALE IN 2020.

    Expenses $4,085 · Revenue $4,127

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Megan R Perry

    DIRECTOR/TREASURER

    Total calculated
    $1,080,111
    From this org
    $0
    From related orgs
    $1,438,011
    Other
    -$357,900
    Hours/week
    0.1 + 41.3 related

    Schedule J breakdown matched by us

    Base
    $0 + $687,067 related
    Bonus
    $0 + $542,372 related
    Other
    $0 + $208,572 related
    Deferred
    $0 + -$388,488 related
    Nontaxable benefits
    $0 + $30,588 related
    Filer's total
    $0 + $1,080,111 related

  • Brian K Zwoyer

    DIRECTOR/PRESIDENT/SECRETARY

    Total calculated
    $495,285
    From this org
    $0
    From related orgs
    $429,339
    Other
    $65,946
    Hours/week
    1 + 43 related

    Schedule J breakdown matched by us

    Base
    $0 + $229,791 related
    Bonus
    $0 + $84,767 related
    Other
    $0 + $114,781 related
    Deferred
    $0 + $29,415 related
    Nontaxable benefits
    $0 + $36,531 related
    Filer's total
    $0 + $495,285 related

  • Carol C Thomas

    DIRECTOR/CHAIR

    Total calculated
    $40,000
    From this org
    $0
    From related orgs
    $40,000
    Other
    $0
    Hours/week
    0.1 + 5.7 related

  • Paul A Gaden

    DIRECTOR/VICE CHAIR

    Total calculated
    $1,108,884
    From this org
    $0
    From related orgs
    $985,869
    Other
    $123,015
    Hours/week
    0.1 + 46.3 related

    Schedule J breakdown matched by us

    Base
    $0 + $573,520 related
    Bonus
    $0 + $362,393 related
    Other
    $0 + $49,956 related
    Deferred
    $0 + $89,920 related
    Nontaxable benefits
    $0 + $33,095 related
    Filer's total
    $0 + $1,108,884 related

  • Michael V Gentry

    FORMER OFFICER

    Total calculated
    $3,439,169
    From this org
    $0
    From related orgs
    $3,479,384
    Other
    -$40,215
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,135,214 related
    Bonus
    $0 + $943,662 related
    Other
    $0 + $1,400,508 related
    Deferred
    $0 + -$71,826 related
    Nontaxable benefits
    $0 + $31,611 related
    Filer's total
    $0 + $3,439,169 related

  • Robert A Broermann

    FORMER OFFICER

    Total calculated
    $2,315,161
    From this org
    $0
    From related orgs
    $2,401,429
    Other
    -$86,268
    Hours/week
    0 + 51 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,136,501 related
    Bonus
    $0 + $969,392 related
    Other
    $0 + $295,536 related
    Deferred
    $0 + -$115,045 related
    Nontaxable benefits
    $0 + $28,777 related
    Filer's total
    $0 + $2,315,161 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
SENTARA HEALTH, THE 501(C)(3) TAX EXEMPT PARENT OF THE SENTARA HEALTH SYSTEM, ESTABLISHED THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL THROUGH THE USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND A COMPENSATION STUDY. SENTARA HEALTH RECOGNIZES THAT PROVIDING THE BEST POSSIBLE CARE REQUIRES US TO ATTRACT AND RETAIN THE VERY BEST EMPLOYEES. OUR ORGANIZATION IS COMMITTED TO INVESTING IN OUR PEOPLE BY OFFERING COMPETITIVE COMPENSATION OPPORTUNITIES AND A STRONG WORKPLACE ENVIRONMENT.
PART I, LINE 4B
ROBERT BROERMANN, MICHAEL GENTRY, MEGAN PERRY, PAUL GADEN, AND BRIAN ZWOYER PARTICIPATED IN THE SENTARA CAPITAL ACCUMULATION ACCOUNT PLAN. THE CAPITAL ACCUMULATION PLAN IS A NONQUALIFIED DEFERRED COMPENSATION PROGRAM. SUCH PLANS ARE COMMONLY OFFERED TO NOT-FOR-PROFIT HEALTH CARE EXECUTIVES TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO SUPPLEMENT LIMITATIONS IN QUALIFIED PLANS. PARTICIPATION IS LIMITED TO A SELECT GROUP OF CORPORATE EXECUTIVES AS APPROVED BY SENTARA HEALTH'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. TERMS OF THE PLAN CHANGED EFFECTIVE JANUARY 1, 2009, WHEREBY VESTING OF CONTRIBUTIONS MADE ON OR AFTER THAT DATE NOW OCCURS ON THE EARLIER OF FIVE YEARS FOR EACH YEARS' CONTRIBUTIONS OR AGE 55 WITH 10 YEARS OF SERVICE. UNDER THE OLD TERMS, VESTING OF CONTRIBUTIONS MADE PRIOR TO JANUARY 1, 2009 OCCURS ON THE EARLIEST OF ASSIGNED DISTRIBUTION DATE, DEATH, INVOLUNTARY TERMINATION WITHOUT CAUSE OR COMPLETION OF TWO-YEAR NON-COMPETE AFTER VOLUNTARY TERMINATION (REGARDLESS OF ORIGINAL ASSIGNED DISTRIBUTION DATE). DURING 2022, THE FOLLOWING CORPORATE EXECUTIVES RECEIVED VESTED DISTRIBUTIONS UNDER THE PLAN: ROBERT BROERMANN ($202,592); MICHAEL GENTRY ($172,528); AND MEGAN PERRY ($127,468). THESE AMOUNTS HAVE BEEN REPORTED IN COLUMN (B)(III) OF SCHEDULE J, PART II.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • MANAGEMENT SERVICES LLC

    HLTH MGT SV · VA

  • OBICI REAL ESTATE HOLDINGS LLC

    RE RENTAL · VA

  • PRINCESS ANNE AMB SURG MGT LLC

    HEALTHCARE · VA

  • VA BEACH AMBULATORY SURGERY CENTER

    HEALTHCARE · VA

  • CANCER CENTERS OF VA LLC

    HEALTHCARE · VA

  • HAMPTON ROADS LITHOTRIPSY LLC

    HEALTHCARE · VA

  • RADIOLOGY SERVICES OF HAMPTON ROADS LC

    HEALTHCARE · VA

  • SENTARA OBICI AMBULATORY SURGERY LLC

    HEALTHCARE · VA

  • POTOMAC INOVA HEALTHCARE ALLIANCE LLC

    HEALTHCARE · VA

  • CAREPLEX ORTHOPAEDIC ASC LLC

    HEALTHCARE · VA

  • PHYSICAL THERAPY ACACLLC

    HEALTHCARE · VA

  • MNS SUPPLY CHAIN NETWORK LLC

    GPO · DE · general or managing partner

  • LAKE RIDGE AMBULATORY SURGERY CENTER LLC

    HEALTHCARE · VA

  • CAHABA PARTNERS CORE FIXED INCOME FUND

    POOLED INV FD · DE

  • CAHABA PARTNERS PUBLIC INFLATION HEDGES FD

    POOLED INV FD · DE

  • LEIGH ORTHOPEDIC SURGERY CENTER LLC

    HEALTHCARE · VA

  • SURGICAL SUITES OF COASTAL VIRGINIA LLC

    HEALTHCARE · VA

  • PORT WARWICK SURGERY CENTER LLC

    HEALTHCARE · VA

  • CAHABA PARTNERS EQUITY PLUS FUND

    POOLED INV FD · VA

  • CAHABA PARTNERS TACTICAL EQUITY FUND

    POOLED INV FD · DE

  • HA INTL EQUITY CEF FD CL-A

    POOLED INV FD · DE

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • SENTARA HOLDINGS INC

    C · HOLDING COMPANY · VA · controlled entity

  • SENTARA HEALTH ADMINISTRATION INC (FORMERLY SENTARA HEALTH PLANS INC)

    C · TPA · VA · controlled entity

  • OPTIMA HEALTH GROUP

    C · HMO · VA · controlled entity

  • SENTARA HEALTH INSURANCE COMPANY (FORMERLY OPTIMA HEALTH INSURANCE COMPANY)

    C · HEALTH INSURANCE · VA · controlled entity

  • SENTARA BEHAVIORAL HEALTH SERVICES (FKA OPTIMA BEHAVIORAL HEALTH SERVICES)

    C · MENTAL HEALTH SVCS · VA · controlled entity

  • SENTARA VENTURES INC

    C · HOLDING COMPANY · VA · controlled entity

  • SENTARA HEALTH INSURANCE CO OF NC

    C · HEALTH INSURANCE · NC · controlled entity

  • SENTARA HEALTH PLANS OF NC INC

    C · TPA · NC · controlled entity

  • MANAGED CARE SERVICES INC

    C · ALT HEALTH DELIVERY · VA · controlled entity

  • SENTARA SOUTHSIDE HEALTH SERVICES INC

    C · HEALTH SERVICES · VA · controlled entity

  • DOMINION HEALTH MEDICAL ASSOCIATES LTD

    C · PHYS PRACTICE · VA · controlled entity

  • SMG INNOVATIONS INC

    C · HEALTH CARE · VA · controlled entity

  • POTOMAC VENTURES CORP

    C · HOLDING COMPANY · VA · controlled entity

  • ROCKINGHAM HEALTH SERVICES INC

    C · CONTRACTING SVCS · VA · controlled entity

  • MARTHA JEFFERSON MEDICAL ENTERPRISES INC

    C · MEDICAL BILLING SVCS · VA · controlled entity

  • BAY PRIMEX INSURANCE COMPANY LTD

    C · OTHER INSURANCE FUNDS · CJ · controlled entity

  • ALBEMARLE PHYSICIAN SERVICES-SENTARA INC

    C · PHYS PRACTICE · NC · controlled entity

  • THE PORT WARWICK MEDICAL ARTS BUILDING ASSOCIATION

    C · BUILDING ASSOCIATION · VA · controlled entity

  • MEDSTREAMING EGYPT SOFTWARE

    C · CONSULTING · EG · controlled entity

  • CAHABA PARTNERS TOTAL RETURN FUND LTD

    C · POOLED INV FD · CJ

  • FIVOS INC

    C · HEALTHCARE IT · DE · controlled entity

  • MEDICAL METRX HOLDING INC

    C · HOLDING COMPANY · DE · controlled entity

  • M2S INC

    C · DATA COLLECTION/AGGREGATION · DE · controlled entity

  • AVMED ADMINISTRATORS INC

    C · TPA SERVICES · FL · controlled entity

Provenance

Return type
form_990
Tax year
2022
Filed
2 November 2023
IRS schema version
2022v5.0
Source object
202303079349300005

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