2016-11-11T11:46:32-06:00 2015-12-31 KPMG LLP 1676 International Drive Ste 1200 McLean VA 22102 990 2015-01-01 540555201 SOUTHSIDE COMMUNITY HOSPITAL INC % THOMAS L ANGELO SOUT 4343152776 800 OAK STREET FARMVILLE VA 23901 THOMAS L ANGELO SCH CEO 4342004712 2016-11-09 true MARGARET A BRADSHAW P00501222 7032868000 2015 2017-02-10 21:41:12Z CENTRA SOUTHSIDE COMMUNITY HOSPITAL THOMAS L ANGELO 800 OAK STREET FARMVILLE VA 23901 79172413 false X HTTP://SCH.CENTRAHEALTH.COM X 1926 VA TO PROVIDE HEALTHCARE SERVICES FOR EIGHT COUNTIES IN CENTRAL VIRGINIA. 18 15 684 61 0 0 9883 20598 69595098 78016445 213715 134732 1044100 868505 70862796 79040280 21440 3611 0 0 39105367 40950928 0 0 0 29964275 33205825 69091082 74160364 1771714 4879916 46599323 48476620 21667869 18531522 24931454 29945098 X WE ARE DEDICATED TO IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE BY PROVIDING HIGH QUALITY HEALTHCARE WITH A PERSONAL TOUCH. false false 66970330 3611 78016445 SOUTHSIDE COMMUNITY HOSPITAL IS A 501(C)(3) HOSPITAL COMMITTED TO OFFERING AFFORDABLE HEALTHCARE TO RESIDENTS OF SOUTHSIDE VIRGINIA. WE ARE DEDICATED TO IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE BY PROVIDING HIGH QUALITY HEALTHCARE. PLEASE SEE THE CONTINUATION ON SCHEDULE O. 66970330 true false false true false false false false false true true false false true true true false true false false false false false false false false true true false false true true false false false false false false false false true false false false false false true true false false false true 151 0 true 684 true false false false false false false false false false false X 18 15 true false true false true true true true true false false true true true true true true false false false VA X X THOMAS L ANGELO 4343152776 OAK STREET FARMVILLE VA 23901 X SHARON L HARRUP CHAIRMAN 2.0 0.0 X X 0 0 0 FRANCIS WOOD JR VICE CHAIRMAN 2.0 0.0 X X 0 0 0 LEROY O PFEIFFER JR SECRETARY/TREASURER 2.0 0.0 X X 0 0 0 LEWIS ADDISON DIRECTOR (UNTIL 4/2015) 2.0 50.0 X 0 499490 22724 WILLIAM BASS JR DIRECTOR (AS OF 5/2015) 2.0 50.0 X X 0 313427 39589 KWABENA DONKOR MD MEDICAL STAFF PRESIDENT 2.0 0.0 X 0 0 0 RHONDA B ALGEIER MD DIRECTOR 2.0 0.0 X 0 0 0 REV CALVIN GRAY DIRECTOR 2.0 0.0 X 0 0 0 HAROLD M HARRIS JR DIRECTOR 2.0 0.0 X 0 0 0 STEPHEN KEITH EDD DIRECTOR 2.0 0.0 X 0 0 0 WILLIAM MCGUIRE DIRECTOR 2.0 0.0 X 0 0 0 ODESSA PRIDE DIRECTOR 2.0 0.0 X 0 0 0 WILLIAM L ROACH DIRECTOR 2.0 0.0 X 0 0 0 TIMOTHY R THARPE DIRECTOR 2.0 0.0 X 0 0 0 PATRICIA TUCKER DIRECTOR 2.0 0.0 X 0 0 0 JULIE DIXON DIRECTOR 2.0 0.0 X 0 0 0 KIRSTEN HUBER MD DIRECTOR 50.0 0.0 X 248877 0 17509 EW TIBBS DIRECTOR/CENTRA PRESIDENT& CEO 2.0 50.0 X 0 1055428 222007 TERESITA DIONISIO MD DIRECTOR (AS OF 7/2015) 2.0 0.0 X 0 0 0 DR CHARLES TAYLOR DIRECTOR (UNTIL 6/2015) 2.0 0.0 X 155611 0 0 THOMAS ANGELO SCH CEO (AS OF 5/2015) 50.0 0.0 X 183344 0 40252 CLAUDIA A MEINHARD SCH CNO 50.0 0.0 X 185297 0 20252 BIKRAM S BAL MD PHYSICIAN 50.0 0.0 X 839174 0 11272 ROBERT W AH MD PHYSICIAN 50.0 0.0 X 479047 0 40762 JOHN A KONA MD PHYSICIAN 50.0 0.0 X 424969 0 17452 JERRY LUCAS MD PHYSICIAN 50.0 0.0 X 420628 0 7950 JONATHAN R LOGAN MD PHYSICIAN 50.0 0.0 X 412105 0 53826 3349052 1868345 493595 42 false true false MEDICAL ASSOCIATES OF CENTRAL VIRGI 2215 LANDOVER PLACE LYNCHBURG VA 24501 PHYSICIAN SERVICES 2588023 CROTHALL FACILITIES MGMTCROTHALL S 1500 LIBERTY RIDGE DR SUITE 210 WAYNE PA 19087 HOUSEKEEPING SVCS 1379899 MOORES ELECTRICAL MECH CONST IN PO BOX 119 ALTAVISTA VA 24517 ELECTRICAL CONTRACTO 740874 ROANOKE VALLEY INTERNISTS PC PO BOX 906 FARMVILLE VA 23901 PHYSICIAN SERVICES 502113 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PHYSICIAN SVCS 491406 13 7686 12912 20598 NET PATIENT REVENUE 621400 77238468 77238468 ANCILLARY SERVICES 900099 645703 645703 MEANINGFUL USE 900099 129752 129752 GRANT INCOME 900099 2522 2522 78016445 57131 57131 0 0 56021 56021 0 56021 56021 100180 109554 59883 72250 40297 37304 77601 77601 0 0 0 CAFETERIA 621400 249538 249538 MISCELLANEOUS REVENUE 900099 562946 562946 812484 79040280 78016445 0 1003237 3611 3611 0 0 0 773129 404488 368641 10603 10603 33935346 32223565 1711781 0 6231850 5814327 417523 0 2296362 2296362 63249 63249 39180 39180 0 0 0 12662878 11579483 1083395 374882 374882 3064724 2419232 645492 122177 122177 0 1778342 1778342 423478 377436 46042 0 119392 98082 21310 197894 197894 0 4188000 4188000 685643 685643 MEDICAL SUPPLIES 3992183 3992183 DRUGS 2932111 2932111 COLLECTIONS EXPENSES 265330 265330 74160364 66970330 7190034 0 2662223 3448961 126550 113248 0 0 7266549 9043277 0 0 0 0 0 0 1583549 1981496 280622 112011 76874388 51582655 25033372 25291733 2093383 2078524 49995 49995 0 0 0 0 7503080 6357375 46599323 48476620 5499831 4990267 0 0 130750 236198 6740980 5898357 0 0 0 0 194408 172432 0 0 9101900 7234268 21667869 18531522 X 24802878 29831522 64427 49427 64149 64149 24931454 29945098 46599323 48476620 X 4879916 -100180 233908 X false true X true false X false false false false false false false false true 3528 3528 false OTHER LOBBYING ACTIVITIES PART II-B, LINE 1(I) A PORTION OF THE ORGANIZATIONS HOSPITAL ASSOCIATION DUES FOR THE YEAR 2015 WERE ATTRIBUTABLE TO LOBBYING EXPENSES IN THE AMOUNT OF $3,528. 64149 64149 64149 64149 64149 64149 64149 64149 64149 64149 1.00000 false false 163194 163194 36077314 20392629 15684685 2712754 1937295 775459 37772712 29252731 8519981 148414 148414 25291733 DUE FROM RELATED PARTIES 5952857 EST. RECEIVABLE - 3RD PARTY 314650 OTHER ACCOUNTS RECEIVABLE 89868 6357375 0 PAYABLE TO ESTIMATED 3RD PARTY 602805 INTEREST RATE SWAP 228798 DUE TO RELATED PARTY 6402665 7234268 X PART V, LINE 4 THESE FUNDS WERE DONOR RESTRICTED FOR LPN NURSING SCHOLARSHIPS. PART X, LINE 2 FIN 48 FOOTNOTE SOUTHSIDE COMMUNITY HOSPITAL IS INCLUDED IN CENTRA HEALTH, INCS CONSOLIDATED AUDIT REPORT FOR YEAR ENDING DECEMBER 31, 2015. THE FOLLOWING FOOTNOTE REGARDING LIABILITY FOR UNCERTAIN TAX POSITIONS (FIN48) IS FOUND IN THIS CONSOLIDATED REPORT. "CENTRA HEALTH, INC., CENTRA HEALTH FOUNDATION, CCRC, INC., SOUTHSIDE COMMUNITY HOSPITAL, INC., BEDFORD MEMORIAL HOSPITAL, AND LYNCHBURG FAMILY PRACTICE RESIDENCY PROGRAM, INC. ARE EXEMPT FROM INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO INCOME TAXES HAVE BEEN PROVIDED FOR THESE ENTITIES IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS EXCEPT FOR TAXES RELATED TO CERTAIN UNRELATED BUSINESS INCOME ENGAGED IN BY CENTRA. CENTRA MEDICAL GROUP LLC, CENTRA HEALTH INDEMNITY COMPANY LLC, CENTRAL VIRGINIA HOSPITAL FOR RESTORATIVE AND REHABILITATIVE CARE, LLC, CENTRA PANORAMIC, LLC, CENTRAL VIRGINIA QUALITY CARE NETWORK, LLC, AND CENTRA OUTPATIENT REHABILITATION SERVICES, LLC ARE DISREGARDED FOR FEDERAL INCOME TAX PURPOSES AND, THEREFORE, ARE INCLUDED UNDER CENTRAS TAX RETURN. CENTRA HAS ADOPTED RELEVANT ACCOUNTING STANDARDS RELATED TO TAXES FOR ITS SUBSIDIARIES, GENERAL BUSINESS CONCERNS, INC., PCHP HOLDING INC. AND PIEDMONT COMMUNITY HEALTH PLAN, INC. UNDER THE ASSET AND LIABILITY METHOD FOR THESE STANDARDS, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS AND THE TAX BASIS OF THE SUBSIDIARYS ASSETS AND LIABILITIES AT INCOME TAX RATES EXPECTED TO BE IN EFFECT WHEN SUCH AMOUNTS ARE REALIZED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN EARNINGS IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. CENTRA HEALTH INDEMNITY COMPANY, LLC IS WHOLLY OWNED BY CENTRA HEALTH, INC. ANY LIABILITY FOR TAXES IS PASSED THROUGH TO CENTRA HEALTH, INC. A PROVISION WILL BE MADE WHEN OPERATIONS OF THIS SUBSIDIARY INDICATES A LIABILITY FOR TAXES. CENTRA HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2015. CENTRA BELIEVES THEY ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2012." true true X true X true X true true false true true 3163124 3163124 0.04260 13128426 9882164 3246262 0.04370 16291550 9882164 6409386 0.08630 118878 118878 0.00160 29511 29511 0.00030 148389 148389 0.00190 16439939 9882164 6557775 0.08820 7438 7438 0.00010 9709 9709 0.00010 8049 8049 0.00010 25196 25196 0.00030 true 9272175 26342554 30479012 -4136458 X true true NONE 1 1 SOUTHSIDE COMMUNITY HOSPITAL 800 OAK STREET FARMVILLE VA 23901 HTTP://SCH.CENTRAHEALTH.COM X X X SOUTHSIDE COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 13 true false false true X HTTP://SCH.CENTRAHEALTH.COM X X true 13 true HTTP://SCH.CENTRAHEALTH.COM false false true X 200. 400. X X X X true true X X X X true X HTTP://SCH.CENTRAHEALTH.COM X HTTP://SCH.CENTRAHEALTH.COM X HTTP://SCH.CENTRAHEALTH.COM X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5: CENTRA ORGANIZED THREE COMMUNITY HEALTH NEEDS ASSESSMENT COMMUNITY ADVISORY BOARDS ONE FOR THE CENTRA HEALTH, LYNCHBURG REGION, ONE FOR THE BEDFORD AND ONE FOR THE SOUTHSIDE COMMUNITY HOSPITAL, FARMVILLE REGION. THESE CHNA COMMUNITY ADVISORY BOARDS WERE COMPRISED OF COMMUNITY LEADERS REPRESENTING EDUCATION, BUSINESS, SOCIAL SERVICE AGENCIES, GOVERNMENT, PUBLIC HEALTH AUTHORITIES, COLLEGES (INCLUDING OUR LOCAL SCHOOL OF PUBLIC HEALTH), OTHER HEALTHCARE PROVIDERS, AND NEIGHBORHOOD CITIZEN ORGANIZATIONS IN AN EFFORT TO OBTAIN AS BROAD-BASED COMMUNITY INPUT AS POSSIBLE. PARTICIPANTS INCLUDED ORGANIZATIONS THAT REPRESENT THE NEEDS OF MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS. A LIST OF INDIVIDUAL PARTICIPANTS IS LISTED ON THE LAST PAGE OF THE CHNA ASSESSMENT & IMPLEMENTATION PLAN REPORTS. SCHEDULE H, PART V, SECTION B, LINE 7d: HARD COPIES OF THE CHNA ASSESSMENT & IMPLEMENTATION PLAN WERE SENT TO ALL CHNA COMMUNITY ADVISORY BOARD MEMBERS. SCHEDULE H, PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR CENTRA SOUTHSIDE COMMUNITY HOSPITAL IDENTIFIED THREE OVERARCHING ACTION PLAN PRIORITIES AIMED AT IMPROVING THE HEALTH OF THE VARIOUS COMMUNITIES SERVED. THESE PRIORITIES INCLUDED ACCESS TO CARE; HEALTH STATUS IMPROVEMENT; AND HEALTH DISPARITIES. WITH REGARD TO ACCESS TO CARE, CENTRA SOUTHSIDE HAS RECRUITED MANY NEW PRIMARY MEDICAL CARE PROVIDERS TO THEIR PRIMARY CARE CLINICS IN FARMVILLE, LUNENBURG, AND CHARLOTTE PRACTICES. ADDITIONALLY, FUNDING WAS PROVIDED TO THE LOCAL FEDERALLY QUALIFIED HEALTH CENTER TO PROVIDE FREE VACCINATIONS AND FREE PRESCRIPTIONS FOR PEOPLE WHO ARE UNABLE TO AFFORD SUCH SERVICES. LASTLY, THE HOSPITAL ESTABLISHED A SCHOLARSHIP PROGRAM FOR NURSE PRACTITIONERS AND PHYSICIANS ASSISTANTS TO WORK AS PROVIDERS IN THE MEDICALLY UNDERSERVED AREAS OF CENTRA SOUTHSIDES MARKET. ACCESS TO MENTAL HEALTHCARE WAS IMPROVED BY PROVIDING TELEPSYCHIATRY SERVICES TO HOSPITALS EMERGENCY ROOM AND INTEGRATING A NEW PSYCHIATRIST INTO THE FARMVILLE PRIMARY CARE PRACTICE. THE HOSPITAL CONTINUES TO PROVIDE FREE TRANSPORTATION TO THE PEARSON CANCER CENTER. HEALTH STATUS IMPROVEMENT ACTION PLAN PRIORITY INCLUDES A NUMBER OF PROGRAMS AND SERVICES ALL AIMED AT EXPANDING HEALTH EDUCATION AND WELLNESS. THESE PROGRAMS INCLUDE STROKE EDUCATION EVENTS ('STRIKE OUT STROKE'FAST IN A BOX'); FREE LACTATION CLINICS IN FARMVILLE AND CHARLOTTE; SUBSIDIZED MEALS-ON-WHEELS SERVICES; FUNDING TO SUPPORT THE LOCAL SHELTER FOR DOMESTIC VIOLENCE; FUNDING TO SUPPORT AN ANTI-VIOLENCE COMMUNITY CAMPAIGN; AND PROVIDING DIABETIC EDUCATION FOR THE SOUTHSIDE VIRGINIA REGION. LASTLY, PURCHASED BLOOD PRESSURE MONITORING EQUIPMENT, DIGITAL SCALES, AND GLUCOSE METERS TO SUPPORT THE PIEDMONT COMMUNITY IMPACT ORGANIZATION. OTHER INITIATIVES INCLUDE BEING A CORPORATE SPONSOR FOR THE ANNUAL PIEDMONT WALK AND ANNUAL HIGH BRIDGE HALF MARATHON. IN THE ACTION PLAN PRIORITY OF HEALTH DISPARITIES, A NUMBER OF NEW PROGRAMS AND SERVICES WERE INITIATED TO INCREASE ACCESS TO PRENATAL CARE FOR THE AFRICAN AMERICAN COMMUNITY. THESE SERVICES INCLUDE CONTINUATION OF CENTRAS COMMUNITY VOICE PROGRAM INTO THE SOUTHSIDE REGION, WHICH IS A LAY HEALTH EDUCATOR PROGRAM AIMED AT IMPROVING ACCESS TO PRENATAL CARE; EXPANSION OF THE HEALTHY FAMILIES PROGRAM INTO THE SOUTHSIDE REGION WHICH PROVIDES INTENSIVE HOME VISITATIONS WITH NEW AND EXPECTANT FAMILIES WHICH PROVIDES HEALTH EDUCATION SERVICES AND TRANSPORTATION TO APPOINTMENTS; PROVIDED FREE CARSEATS TO ELIGIBLE FAMILIES AT CAR SEAT SAFETY CLASSES; SPONSORSHIP OF FARMVILLES FARMERS MARKET, PROVIDING MATCHING DOLLARS FOR 'SNAP' PURCHASES; PROVIDED FUNDING TO PIEDMONT SENIOR SERVICES IN FARMVILLE AND SOUTHSIDE TO PURCHASE SOFTWARE TO TRACK AT-RISK POPULATIONS; THROUGH HEART OF VIRGINIA FREE CLINIC PROVIDED FUNDING FOR MEDICAL EQUIPMENT, MEDICAL SUPPLIES, SLEEP STUDY SUPPLIES, YMCA MEMBERSHIPS AND GAS CARDS TO THOSE IN NEED. FOUR SIGNIFICANT NEEDS WERE NOT IDENTIFIED FOR FITTING WITHIN THE CHNAS ACTION PLAN PRIORITIES. THESE INCLUDED SOCIAL AND ECONOMIC FACTORS; HIGH SCHOOL GRADUATION RATES; FAMILIES LIVING BELOW POVERTY AND DOMESTIC VIOLENCE. RATIONALE PROVIDED IS THAT THESE CRITICAL NEEDS ARE HIGHLY COMPLEX IN NATURE AND AFFECTED BY A WIDE VARIETY OF INFLUENCING FACTORS MANY WELL BEYOND THE CAPABILITY AND RESOURCES AVAILABLE THROUGH CENTRA SOUTHSIDE HOSPITAL. FURTHERMORE, IT WAS FELT THAT OTHER COMMUNITY BASED INITIATIVES WERE ALREADY ATTEMPTING TO ADDRESS THESE NEEDS (EG: UNITED WAYS COMMUNITY IMPACT FUND). 18 CMG SOUTHSIDE - KEYSVILLE 312 KINGS STREET KEYSVILLE VA 23947 FAMILY PRACTICE CMG SOUTHSIDE - FARMVILLE 935 SOUTH MAIN STREET FARMVILLE VA 23901 FAMILY PRACTICE CMG SOUTHSIDE - VICTORIA 1418 6TH STREET VICTORIA VA 23974 FAMILY PRACTICE CMG SOUTHSIDE - BURKEVILLE 412 NAMOZINE STREET BURKEVILLE VA 23922 FAMILY PRACTICE SOUTHSIDE COMMUNITY HOSP HOMECARE SVCS 711 OAK STREET FARMVILLE VA 23901 HOME HEALTH SERVICES CMG SOUTHSIDE - CUMBERLAND 1758 ANDERSON HIGHWAY CUMBERLAND VA 23942 FAMILY PRACTICE SOUTHSIDE CTR FOR GASTRO LIVER DISEASE 800 OAK STREET FARMVILLE VA 23901 GASTROLOGY SVCS CMG SOUTHSIDE ORTHOPEDIC 935 SOUTH MAIN STREET FARMVILLE VA 23901 ORTHOPEDIC SERVICES CMG SOUTHSIDE - SURGERY CENTER 800 OAK STREET FARMVILLE VA 23901 GENERAL SURGERY CMG SOUTHSIDE - WOMEN'S CENTER 800 OAK STREET FARMVILLE VA 23901 WOMEN'S HEALTH SVCS CMG SOUTHSIDE - EMERGENCY SERVICES 800 OAK STREET FARMVILLE VA 23901 EMERGENCY SERVICES SOUTHSIDE HOSPICE 713 OAK STREET FARMVILLE VA 23901 HOSPICE CMG SOUTHSIDE - NEPHROLOGY CENTER 935 SOUTH MAIN STREET FARMVILLE VA 23901 NEPHROLOGY SVCS CMG SOUTHSIDE - NEUROLOGY CENTER 800 OAK STREET FARMVILLE VA 23901 NEUROLOGY SVCS SOUTHSIDE PACE 1530 SOUTH MAIN STREET FARMVILLE VA 23901 CARE FOR ELDERLY CMG SOUTHSIDE - UROLOGY 800 OAK STREET FARMVILLE VA 23901 UROLOGY SVCS CMG SOUTHSIDE - CRNA 800 OAK STREET FARMVILLE VA 23901 CRNA SVCS CMG SOUTHSIDE - HOSPTIALISTS 800 OAK STREET FARMVILLE VA 23901 HOSPITALIST SVCS PART I, LINE 6A: INFORMATION ON COMMUNITY BENEFIT IS REPORTED ANNUALLY THROUGH A REPORT PREPARED BY CENTRA HEALTH, INC., SOLE MEMBER CORPORATION OF SOUTHSIDE COMMUNITY HOSPITAL. PART I, LINE 7: COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE EXPENSE. PART II: SOUTHSIDE COMMUNITY HOSPITAL CONTINUOUSLY WORKS ON IMPROVING ITS RELATIONSHIP WITH THE COMMUNITY IT SERVES BY OFFERING MANY SERVICES, SUCH AS, COMMUNITY SUPPORT, COMMUNITY HEALTH IMPROVEMENT, WORKFORCE DEVELOPMENT, ETC. SOUTHSIDE COMMUNITY HOSPITAL, ALSO, HOSTS AND/OR PARTICIPATES IN VARIOUS CAREER FAIRS IN ORDER TO REACH OUT TO YOUNG ADULTS WHO MAY BE INTERESTED IN THE HEALTHCARE PROFESSION. COMMUNITY SUPPORT: SOUTHSIDE COMMUNITY HOSPITAL CONTINUOUSLY WORKS ON IMPROVING ITS RELATIONSHIP WITH THE COMMUNITY IT SERVES BY PARTICIPATING IN NUMEROUS HEALTH FAIRS, CONDUCTING HEALTH EDUCATION SEMINARS, PROVIDING SCHOOL-BASED HEALTH PROGRAMS, ETC. IT SPONSORS AND/OR PARTICIPATES IN NUMEROUS EVENTS THROUGHOUT THE YEAR, INCLUDING, BUT NOT LIMITED TO: MARCH FOR BABIES WALK, HEALTHY KIDS DAY PROGRAM, MEALS ON WHEELS, ETC. WE FEEL AN ESSENTIAL PART OF BEING A GOOD NEIGHBOR WITHIN THE COMMUNITY IS TO PROMOTE HEALTH, SAFETY, AND WELL-BEING ACTIVITIES IN ORDER TO BENEFIT THOSE AROUND THE COMMUNITY. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: HELPING THE COMMUNITY IMPROVE THEIR HEALTH IS AN IMPORTANT MISSION OF SOUTHSIDE COMMUNITY HOSPITAL. WE FEEL PASSIONATE ABOUT IMPROVING ACCESS TO CARE, PUBLIC HEALTH, ETC. WE ARE EXCITED TO PARTICIPATE IN NUMEROUS EVENTS, SUCH AS THE MORTON COMMUNITY PRAYER BREAKFASTS, THROUGHOUT THE YEAR IN ORDER TO STAY CONNECTED TO THE COMMUNITY WE SERVE. BY STAYING CONNECTED WE ARE ABLE TO RECOGNIZE AND ADDRESS NEEDS THROUGHOUT OUR REGION. WORKFORCE DEVELOPMENT: THROUGHOUT THE YEAR, SOUTHSIDE COMMUNITY HOSPITAL HOSTS AND/OR PARTICIPATES IN VARIOUS CAREER FAIRS AND MEDICAL CAREER CAMP, IN ORDER TO REACH OUT TO YOUNG ADULTS WHO MAY BE INTERESTED IN THE HEALTHCARE PROFESSION. PART III, SECTION A, LINE 1 ON JANUARY 1, 2012, CENTRA HEALTH, INC. AND SUBSIDIARIES ADOPTED ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, WHICH CHANGED CENTRAS PRESENTATION OF PROVISION FOR DOUBTFUL ACCOUNTS TO A DEDUCTION FROM NET PATIENT SERVICE REVENUE. THIS HAS BEEN DISCLOSED IN THE FOOTNOTES OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THEREFORE, CENTRA HEALTH AND ITS SUBSIDIARIES, INCLUDING SOUTHSIDE COMMUNITY HOSPITAL AND BEDFORD MEMORIAL HOSPITAL, REPORT BAD DEBT IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. PART III, SECTION A, LINE 2: SEE DESCRIPTION FOR PART III, SECTION A, LINE 4. PART III, SECTION A, LINE 4: THE ORGANIZATION BELIEVES THAT ITS PROCEDURES CONCERNING THE APPLICATION OF ITS FINANCIAL ASSISTANCE POLICY ARE SUFFICIENTLY THOROUGH TO EXCLUDE ALL PATIENTS WHO ARE ELIGIBLE FOR CHARITY CARE FROM BAD DEBT. THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE FOLLOWING FOOTNOTE ABOUT BAD DEBT: "PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR BAD DEBTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, CENTRA ANALYZES HISTORICAL COLLECTIONS AND WRITE-OFFS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR BAD DEBTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, CENTRA ANALYZES CONTRACTUALLY AMOUNTS DUE AND PROVIDES AN ALLOWANCE FOR BAD DEBTS, ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS, PROVISION FOR BAD DEBTS, AND PROVISION FOR CONTRACTUAL ADJUSTMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS OR WITH BALANCES REMAINING AFTER THE THIRD-PARTY COVERAGE HAS ALREADY PAID, CENTRA RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS HISTORICAL COLLECTIONS, WHICH INDICATES THAT SOME PATIENTS ARE UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE DISCOUNTED RATES AND THE AMOUNTS COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR BAD DEBTS." (CENTRA HEALTH, INC. AND SUBSIDIARIES, FY 2015 AUDIT REPORT, PAGE 14) PART III, SECTION B, LINE 8: THE CALCULATION OF MEDICARE SHORTFALL DOES NOT REFLECT ALL OF THE ORGANIZATIONS REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN THE MEDICARE PROGRAM, PER IRS INSTRUCTIONS. MEDICARE ALLOWABLE COSTS ARE DETERMINED FROM THE MEDICARE COST REPORT USING THE COST TO CHARGE RATIO. THE TOTAL AMOUNT OF MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE SOUTHSIDE COMMUNITY HOSPITALS MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY OF OUR PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. WE ARE RELIEVING A GOVERNMENT BURDEN BY PROVIDING CARE TO MEDICARE PATIENTS EVEN THOUGH REIMBURSEMENTS WERE LESS THAN THE COST TO PROVIDE SERVICE. TOTAL MEDICARE SHORTFALL FOR 2015 WAS $4,136,458. PART III, SECTION C, LINE 9B: CENTRA SOUTHSIDE COMMUNITY HOSPITAL RECOGNIZES THAT MEDICAL EXPENSES ARE OFTEN UNEXPECTED AND CAUSE FINANCIAL HARDSHIP. ALL ACCOUNTS WITH SELF PAY BALANCES WILL FOLLOW THE SAME COLLECTION PROTOCOLS. THESE PROTOCOLS ARE ELECTRONICALLY ADMINISTERED THROUGH CENTRA'S HOSPITAL INFORMATION SYSTEM. WHEN AN ACCOUNT REACHES THE END OF THE SYSTEM GENERATED COLLECTION CYCLE AND MEETS SAID CRITERIA, THE ACCOUNT BALANCE WILL BE PROCESSED AS BAD DEBT AND REPORTED TO A COLLECTION AGENCY. CRITERIA FOR BAD DEBT WILL BE APPLIED CONSISTENTLY REGARDLESS OF AGE, RACE, OR RELIGION. CENTRA SOUTHSIDE COMMUNITY HOSPITAL APPLIES UNIFORM COLLECTION PROTOCOLS TO ALL UNPAID ELIGIBLE CHARGES REGARDLESS OF RACE, SEX, AGE, DISABILITY, NATIONAL ORIGIN OR RELIGION. PATIENTS KNOWN BY CENTRA TO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT SUBJECT TO COLLECTION PROTOCOLS. IF DURING COLLECTION PROTOCOLS, OR AFTER REFERRAL TO AN OUTSIDE COLLECTION AGENCY, IT IS DISCOVERED PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY, INCLUDING ANY AND ALL EXTRAORDINARY COLLECTION EFFORT, IS IMMEDIATELY STOPPED. FINANCIAL ASSISTANCE FOR ELIGIBLE CHARGES IS AVAILABLE TO ALL CENTRA PATIENTS WHO QUALIFY BASED ON ESTABLISHED INCOME AND ASSET CRITERIA. PART VI, LINE 2 NEEDS ASSESSMENT: IN LATE 2011, CENTRA CREATED AN ORGANIZATIONAL STRUCTURE AND PROCESS TO ALLOW US TO CONDUCT THE COMMUNITY HEALTH NEEDS ASSESSMENT AND TO ADOPT AN IMPLEMENTATION STRATEGY. THE ORGANIZATIONAL STRUCTURE INCLUDED CREATING AN INTERNAL STEERING GROUP; CONVENING AN EXTERNAL GROUP OF PARTICIPANTS REPRESENTATIVE OF THE COMMUNITIES SERVED BY CENTRA SOUTHSIDE COMMUNITY HOSPITAL (SOUTHSIDE COMMUNITY HEALTH NEEDS ADVISORY BOARD); AND ESTABLISHING A FORMAL ONGOING RELATIONSHIP WITH PIEDMONT HEALTH COALITION, A COMMUNITY-BASED COALITION DEDICATED TO IMPROVING THE HEALTH OF OUR COMMUNITY WHICH WAS FORMED UNDER THE LEADERSHIP OF THE LOCAL PUBLIC HEALTH AUTHORITY, THE PIEDMONT HEALTH DISTRICT. THE SOUTHSIDE COMMUNITY HEALTH NEEDS ADVISORY BOARD CONSISTS OF APPROXIMATELY 25 MEMBERS FROM DIVERSE DEMOGRAPHIC BACKGROUNDS. THE BOARD WAS DEVELOPED FOR THE PURPOSE OF HAVING REGULAR OPEN DIALOGUE AND BRAINSTORMING SESSIONS CONCERNING COMMUNITY HEALTH NEEDS WITHIN OUR COMMUNITY IN BOTH OUR PRIMARY AND SECONDARY SERVICE AREAS. OUR GOAL IS TO COLLABORATE WITH THESE LEADERS AND PUT PROGRAMS IN PLACE TO ADDRESS THESE NEEDS. SCH.CENTRAHEALTH.COM AND THE LOCAL MEDIA PROVIDE INFORMATION ON UPCOMING COMMUNITY EVENTS. ALSO, EVALUATIONS ARE GIVEN AT COMMUNITY EVENTS. THIS PROVIDES NECESSARY AND VALUABLE FEEDBACK FOR FUTURE EDUCATIONAL EVENTS AND WORKSHOPS. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: CENTRA SOUTHSIDE TAKES A MULTIDISCIPLINARY APPROACH TO INFORMING OUR PATIENTS AND COMMUNITY ABOUT FINANCIAL ASSISTANCE. INFORMATION ABOUT FINANCIAL ASSISTANCE AND CHARITY CAN BE FOUND ON CENTRA'S INTERNET PAGE PROVIDING FULL DISCLOSURE ABOUT QUALIFICATIONS AND THE APPLICATION PROCESS. INDIVIDUALS MAY OBTAIN INFORMATION AND AN APPLICATION FROM ANY REGISTRATION POINT OR CUSTOMER SERVICE UNIT, IN PERSON OR BY PHONE. SIGNS ARE POSTED IN CONSPICUOUS LOCATIONS ALERTING INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND WHERE TO OBTAIN ADDITIONAL INFORMATION. BROCHURES ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE IN REGISTRATION AND CUSTOMER SERVICE. WHILE PATIENTS ARE HOSPITALIZED, A FINANCIAL COUNSELOR PROVIDES FINANCIAL ASSISTANCE INFORMATION, SCREENS PATIENTS FOR FEDERAL AND STATE PROGRAMS AND GIVES AN OPPORTUNITY TO ASK QUESTIONS. ADDITIONALLY, AN INSERT ABOUT FINANCIAL ASSISTANCE IS MAILED IN EVERY UNINSURED BILL, REFERENCING AVAILABILITY OF FINANCIAL ASSISTANCE WITH CONTACT INFORMATION ON WHERE TO OBTAIN MORE INFORMATION. PART VI, LINE 4 COMMUNITY INFORMATION: CENTRA SOUTHSIDE COMMUNITY HOSPITAL IS LOCATED IN FARMVILLE, VIRGINIA, WHICH IS 50 MILES EAST OF LYNCHBURG AND 50 SOUTHWEST OF RICHMOND. AS A SOLE COMMUNITY HOSPITAL IT IS CENTRALLY LOCATED TO SERVE THE RESIDENTS OF AMELIA, APPOMATTOX, BUCKINGHAM, CHARLOTTE, CUMBERLAND, LUNENBURG, NOTTOWAY, AND PRINCE EDWARD COUNTIES, WHICH MAKES UP ITS PRIMARY SERVICE AREA (PSA). THE HOSPITAL WAS ESTABLISHED TO PROVIDE HEALTHCARE TO THIS MOSTLY RURAL AREA. THE COUNTIES OF BUCKINGHAM, CHARLOTTE, AND LUNENBURG HAVE BEEN DESIGNATED AS MEDICALLY UNDERSERVED AREAS. THE POPULATION FOR THE HOSPITALS PSA IS APPROXIMATELY 53,000. THE PERCENT OF THE PSA POPULATION THAT IS 65 YEARS OF AGE AND OLDER IS 18.0%. THE MEDIAN HOUSEHOLD INCOME IN THE PSA IS $39,207 AS COMPARED TO THE STATE MEDIAN OF $66,155. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: CENTRA SOUTHSIDE COMMUNITY HOSPITAL PLAYS AN IMPORTANT ROLE IN PROMOTING HEALTH IN THE COMMUNITIES IT SERVES. THE HOSPITAL HOSTS FREE WORKSHOPS AND EDUCATIONAL SEMINARS ON DIABETES, STROKE PREVENTION, AND HEART HEALTH, TO NAME A FEW. CSCH ALSO PARTICIPATES IN NUMEROUS HEALTH FAIRS ANNUALLY, PROVIDING FREE SCREENINGS TO THE PUBLIC. IN ADDITION TO THE FREE SCREENINGS AT HEALTH FAIRS, THE HOSPITAL PROVIDES FREE SERVICES, INCLUDING ALL LAB TESTS AND RADIOLOGY EXAMS AT NO CHARGE TO INDIVIDUALS AT THE "HEART OF VIRGINIA FREE CLINIC" LOCATED IN DOWNTOWN FARMVILLE. THE HOSPITALS HEALTH EXPLORERS CAMP, HELD EVERY SUMMER, HOSTS MIDDLE SCHOOL AGE STUDENTS FOR A WEEK TO ALLOW THEM TO EXPLORE OPTIONS IN THE HEALTH CARE FIELD. BREAST-FEEDING, CHILDBIRTH, AND CAR SEAT SAFETY ARE JUST A FEW OF THE CLASSES MADE AVAILABLE FOR COMMUNITY MEMBERS. CSCH ALSO HOSTS SEVERAL SUPPORT GROUPS INCLUDING ALCOHOLICS ANONYMOUS, CHRONIC PAIN SUPPORT GROUP, AND DIABETES SUPPORT GROUP. WE ALSO HAVE A TEEN VOLUNTEER PROGRAM AND A COLLEGE VOLUNTEER PROGRAM FOR STUDENTS AT LONGWOOD UNIVERSITY, HAMPDEN-SYDNEY COLLEGE, AND SOUTHSIDE VIRGINIA COMMUNITY COLLEGE. DURING THE YEAR, THE HOSPITAL ALSO SUPPORTS NUMEROUS HEALTH RELATED SUPPORT GROUPS WITH EDUCATIONAL MATERIALS AND PROFESSIONAL KNOWLEDGE. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: SOUTHSIDE COMMUNITY HOSPITALS AFFILIATION WITH CENTRA HEALTH BEGAN JANUARY 2006. IT ONLY SEEMED NATURAL THAT SOUTHSIDE COMMUNITY HOSPITAL WOULD PARTNER WITH CENTRA HEALTH, SINCE THE OTHER CENTRA HOSPITALS ARE LOCATED WITHIN 50 MILES WEST OF SOUTHSIDE COMMUNITY HOSPITAL. CENTRA HEALTH HAS A NATIONAL REPUTATION FOR CLINICAL EXCELLENCE AND PATIENT SATISFACTION. SOUTHSIDE COMMUNITY HOSPITAL AND CENTRA OFFICIALS BELIEVE THE COMBINED ORGANIZATIONS WILL BE STRENGTHENED THROUGH AN EXCHANGE OF BEST PRACTICES AND ECONOMIES OF SCALE. SOUTHSIDE PATIENTS HAVE AVAILABLE BETTER ACCESS TO A BROADER RANGE OF ADVANCED CLINICAL SERVICES THAT ARE AVAILABLE AT CENTRA HEALTHS LYNCHBURG HOSPITALS. THE AFFILIATION IS ONE IN A SERIES OF STEPS IN WHICH SOUTHSIDES LEADERS RECOGNIZED THE NEED TO PARTNER WITH AN ORGANIZATION THAT SHARED A MISSION OF EXCELLENT CARE. SOUTHSIDE HAS BEEN ABLE TO MAKE STRUCTURAL IMPROVEMENTS, REPLACE MEDICAL EQUIPMENT WITH NEWER MEDICAL TECHNOLOGY, AND UPDATE COMPUTER SYSTEMS. SOUTHSIDE HAS, ALSO, SUCCESSFULLY RECRUITED BOARD-CERTIFIED SURGEONS AND SPECIALISTS, NEW EMERGENCY PHYSICIANS, AND EXTENDED THEIR HOSPITALIST PROGRAM. SCH HAS BEEN THE HEALTHCARE CENTER OF SOUTHSIDE VIRGINIA SINCE OPENING ITS DOORS NOVEMBER 9, 1927. SINCE THEN, IT HAS OPERATED ON A NON-PROFIT BASIS WITH THE GOAL OF HELPING TO HEAL THE ILL AND INJURED. THE HOSPITAL SERVES THE RESIDENTS OF AMELIA, APPOMATTOX, BUCKINGHAM, CHARLOTTE, CUMBERLAND, LUNENBURG, NOTTOWAY, AND PRINCE EDWARD COUNTIES. PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT VA false true false false false false false false false LEWIS ADDISON DIRECTOR (UNTIL 4/2015) 0 300258 0 126660 0 72572 0 7950 0 14774 0 522214 0 58453 WILLIAM BASS JR DIRECTOR (AS OF 5/2015) 0 248452 0 37500 0 27475 0 7212 0 32377 0 353016 0 25000 KIRSTEN HUBER MD DIRECTOR 248339 0 0 0 538 0 7511 0 9998 0 266386 0 0 0 EW TIBBS DIRECTOR/CENTRA PRESIDENT& CEO 0 661548 0 264493 0 129387 0 175752 0 46255 0 1277435 0 50910 THOMAS ANGELO SCH CEO (AS OF 5/2015) 161160 0 10639 0 11545 0 4947 0 35305 0 223596 0 0 0 CLAUDIA A MEINHARD SCH CNO 157008 0 16619 0 11670 0 4804 0 15448 0 205549 0 0 0 BIKRAM S BAL MD PHYSICIAN 823396 0 0 0 15778 0 7950 0 3322 0 850446 0 0 0 ROBERT W AH MD PHYSICIAN 470794 0 7425 0 828 0 7950 0 32812 0 519809 0 0 0 JOHN A KONA MD PHYSICIAN 421471 0 0 0 3498 0 0 0 17452 0 442421 0 0 0 JERRY LUCAS MD PHYSICIAN 419869 0 0 0 759 0 7950 0 0 0 428578 0 0 0 JONATHAN R LOGAN MD PHYSICIAN 375428 0 11257 0 25420 0 7950 0 45876 0 465931 0 0 0 DR CHARLES TAYLOR DIRECTOR (UNTIL 6/2015) 155611 0 0 0 0 0 0 0 0 0 155611 0 0 0 SCHEDULE J, PART I, LINE 3 UNDER A MANAGEMENT ARRANGEMENT WITH CENTRA HEALTH, THE ORGANIZATIONS EXECUTIVE DIRECTORS COMPENSATION IS ESTABLISHED IN ACCORDANCE WITH CENTRA HEALTHS EXECUTIVE COMPENSATION PRACTICES WHICH INCLUDE THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT(S), AND COMPENSATION STUDY OR SURVEY. SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUALS RECEIVED A PAYOUT FROM A NONQUALIFIED RETIREMENT PLAN DURING FY 2015. THE AMOUNT WAS INCLUDED IN THEIR W-2 WAGES. NAME TITLE AMOUNT OF PAYOUT LEWIS ADDISON CENTRA SR VP & CFO 58,453 (A RELATED ORGANIZATION) WILLIAM L. BASS, JR. CENTRA VP COMMUNITY HOSP & REG CENTER 25,000 (A RELATED ORGANIZATION) E.W. TIBBS CENTRA PRESIDENT & CEO 50,910 (A RELATED ORGANIZATION) $134,363 ======== THE FOLLOWING INDIVIDUALS HAD AMOUNTS DEFERRED INTO A NONQUALIFIED RETIREMENT PLAN IN FY 2015: NAME TITLE AMOUNT DEFERRED LEWIS ADDISON CENTRA SR VP & CFO - (A RELATED ORGANIZATION) WILLIAM L. BASS, JR. CENTRA VP COMMUNITY HOSP & REG CENTER - (A RELATED ORGANIZATION) E.W. TIBBS CENTRA PRESIDENT & CEO 167,802 (A RELATED ORGANIZATION) $167,802 ======== A INDUSTRIAL DEVELOP AUTH OF THE TOWN OF FARMVILLE 546001272 999999999 2011-06-30 9619940 REFUND BONDS ISSUED IN 1997 & 1998 false false false A 3721583 0 9619940 0 0 0 0 0 0 0 9619940 0 2000 true false true true A false false true true false 0 false false false true A false true true true true BRANCH BANK & TRUST 11.5 false false false 0 false true A true SCHEDULE K, PART I, BOND ISSUES (A) ISSUER NAME: INDUSTRIAL DEVELOPMENT AUTHORITY OF THE TOWN OF FARMVILLE, VIRGINIA (F) DESCRIPTION OF PURPOSE: REFUND BONDS ISSUED ON 12/31/1997 AND 10/28/1998 SCHEDULE K, PART IV, LINE 2A The bond was issued in 2011 and therefore the first computation was performed on August 31, 2016. Schedule K, Part IV THE ORGANIZATION ADOPTED A FORMAL WRITTEN POLICY IN 2012 RELATING TO ITS PRACTICES AND PROCEDURES T OBE UTILIZED IN ENSURING THAT ANY POTENTIAL BOND VIOLATIONS ARE IDENTIFIED AND CORRECTED IN A TIMELY MANNER. Schedule K, Part IV, Line 7 POST ISSUANCE COMPLIANCE THE ORGANIZATION ADOPTED A FORMAL WRITTEN POLICY IN 2012 RELATING TO ITS PRACTICES AND PROCEDURES TO ENSURE BOND COMPLIANCE. MRS SHARON L TAYLOR SEE PART V 10603 SEE PART V false PART IV (A) NAME OF PERSON: MRS. SHARON L. TAYLOR (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: FAMILY MEMBER OF DR. CHARLES TAYLOR, BOARD MEMBER OF SOUTHSIDE COMMUNITY HOSPITAL (RESIGNED FROM BOARD JUNE 2015) (C) AMOUNT OF TRANSACTION: $10,603 (D) DESCRIPTION OF TRANSACTION: PAYMENT FOR CONTRACTED SERVICES RENDERED TO SOUTHSIDE COMMUNITY HOSPITAL (E) SHARING OF ORGANIZATION REVENUE?: NO STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A: COMMUNITY BENEFIT HIGHLIGHTS - " DURING FY 2015, $8,549,984 IN CHARGES AT AN ESTIMATED COST OF $3,163,124 WAS CONTRIBUTED AS TRADITIONAL CHARITY CARE TO PATIENTS WHO DID NOT HAVE THE ABILITY TO PAY. ELIGIBILITY FOR CHARITY CARE IS BASED ON POVERTY INCOME LEVELS SET BY THE STATE. " CHARGES OF $9,272,175 AT AN ESTIMATED COST OF $3,430,303 WERE CONTRIBUTED AS BAD DEBT TO PATIENTS WHO DID NOT HAVE THE ABILITY TO PAY. " LOSS FROM MEDICARE BASED ON COST TO CHARGE RATIO TOTALED $4,136,458. " LOSS FROM MEDICAID BASED ON COST TO CHARGE RATIO TOTALED $3,285,797 " CASH DONATIONS MADE BY SOUTHSIDE COMMUNITY HOSPITAL TO THE COMMUNITY DURING 2015 TOTALED $3,611. SOUTHSIDE COMMUNITY HOSPITAL IS EAGER TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY, WHICH CONSISTS OF ITS EIGHT SURROUNDING COUNTIES OF AMELIA, BUCKINGHAM, CHARLOTTE COUNTY, CUMBERLAND, LUNENBURG, NOTTOWAY, APPOMATTOX, AND PRINCE EDWARD COUNTIES. EMPLOYEES CONTINUALLY OFFER PROFESSIONAL HEALTH EDUCATION PROGRAMS, CLASSES, LECTURES, HEALTH FAIRS, HEALTH SCREENINGS, SUPPORT GROUPS, ETC., THROUGHOUT SOUTHSIDE VIRGINIA. SOUTHSIDE COMMUNITY HOSPITAL IS DEDICATED TO IMPROVING THE HEALTHCARE OF ITS COMMUNITY. SOME EXAMPLES ARE LISTED BELOW. COMMUNITY EDUCATION AND HEALTH SCREENINGS - ADVANCED DIRECTIVES DAY AMELIA COMMUNITY CAREER FAIR BURKEVILLE HEALTH DAY BUCKINGHAM COUNTY DAY LONGWOOD UNIVERSITY HEALTH FAIR LONGWOOD UNIVERSITY - ROCK THE BLOCK (BP SCREENINGS) FIRST FRIDAYS HEALTH FAIR (5) COMMUNITY HEART HEALTH FAIR SOUTHSIDE ELECTRIC COOPERATIVE COMMUNITY HEALTH FAIR SHRINERS HEALTH SCREENING FOR CHILDREN BLOOD DRIVES (7) FAMILY EDUCATION AND COMMUNITY CLASSES - BREASTFEEDING CLASSES CAR SEAT CLASSES CHILDBIRTH AND FAMILY EDUCATION BIRTHING CENTER TOURS NURSING CAREER DAY MEDICAL CAREER CAMP FOR MIDDLE SCHOOLERS SUPPORT GROUPS ALCOHOLICS ANONYMOUS CHRONIC PAIN/FIBROMYALGIA SUPPORT GROUP DIABETIC EDUCATION AND SUPPORT GROUP SPECIAL PROJECTS/ HEALTH MINISTRY ANNUAL PINK RIBBON TEA PARTY (BREAST CANCER AWARENESS) MARCH FOR BABIES MEDICAL CAREER CAMP FOR MIDDLE SCHOOLERS NURSING CAREER DAY SOUTHSIDE VIRGINIA COMMUNITY COLLEGE CAREER FAIR VOLUNTEER SERVICES WOMENS AUXILIARY OF SOUTHSIDE COMMUNITY HOSPITAL: FUNDRAISING FOR HOSPITAL - PROVIDES SCHOLARSHIPS FOR NURSING STUDENTS ($3,000 IN SCHOLARSHIPS WERE GIVEN IN 2015). CSCH VOLUNTEERS: FRONT DESK, REGISTRATION, AND TRANSPORT, TELE-MED-SURG, OB, SAME DAY SURGERY, ETC. HOSPICE VOLUNTEERS: CARE FOR END-OF-LIFE PATIENTS CARDIO-REHAB VOLUNTEERS: ASSISTANTS IN THE GYM FOR CARDIO PATIENTS PACE (PROGRAM FOR ALL INCLUSIVE CARE FOR THE ELDERLY) VOLUNTEERS: ASSISTS WITH ACTIVITIES FOR THE ELDERLY LONGWOOD UNIVERSITY/HAMPDEN-SYDNEY COLLEGE VOLUNTEERS: STUDENTS NEEDING SERVICE HOURS FOR INTERNSHIPS AND PROJECTS Summer Youth Volunteer Program Stories of Assistance to the Community Centra Southside Community Hospital serves its community and the surrounding eight counties in many ways. Our nurses and staff are enthusiastic about participating in community events by conducting blood pressure checks, providing free health education materials to the general public, and assisting in health screenings. Nurses from our Pediatric Unit teach breast feeding classes, child car seat classes and give free car seats to participants. Centra Southside Community Hospital employees are encouraged to share their professional health knowledge to the community by speaking to local organizations. We continually donate school supplies to area school supply drives and we have active members in many civic organizations, such as the Lions Club, the Rotary Club, Jaycees, Chamber of Commerce, and the Downtown Farmville Organization. During 2015, the hospital held many health fairs throughout the community offering cholesterol, glucose, BMI, and blood pressure screenings. In conjunction with the Shriners, we conducted annual free health screening at the hospital for all children with orthopedic or burn issues. Centra Southside Community Hospital had a number of teams walk in fundraising walks such as the Jingle Bell Run for Cancer, the March for Babies, and the Cumberland 5K Run for Scholarships. Centra Southside Community Hospital is the primary participating sponsor in the free monthly community "Moton Museum Prayer Breakfast" event, located in downtown Farmville. The hospital provides the breakfast, and sends employees from different departments each month to assist in serving the breakfast and participate in the prayer time. The hospital is eager to connect with and to help serve our community in this way. The hospital leadership continues to conduct meetings with local community leaders and community representatives to better understand the medical needs of our community. The hospital wants to ensure that members of the communities that we serve have the opportunity to voice their current medical care concerns and provide insight on how the hospital can better meet the medical needs of the community in the future. Centra Southside Community Hospital participates in the "Heart of Virginia Free Clinic", by providing all lab tests and radiology exams for free. In 2015, 625 tests and exams were provided to the community at no charge. This donated service resulted in a community benefit exceeding $58,475. Many of our staff volunteer at the clinic. We also provide food for the clinical workers at the clinic as a small token of appreciation for those individuals who volunteer their professional services to benefit those individuals who cannot afford medical care. The hospital is eager to help educate our community on the importance of preventive care. The SCOPE/Meals on Wheels program provides balanced, nutritious meals to the elderly, disabled, or homebound who have no reliable means of obtaining their daily food requirements. Our caring volunteers help alleviate the sense of isolation and worry of clients and observe their physical condition. In cooperation with the community and county agencies, we identify those in need of these services, prepare all meals, and get them ready for distribution by volunteers. During 2015, approximately 11,927 meals were provided by the hospital, at a cost of approximately $47,065. FORM 990, PART VI, SECTION A, LINE 2: DIRECTORS E.W. TIBBS AND LEWIS ADDISON SERVE AS BOARD MEMBER OF CENTRAL VIRGINIA IMAGING, A 50% JOINT VENTURE OF CENTRA HEALTH, INC. BOARD MEMBER WILLIAM MCGUIRE AND OFFICER LEROY PFEIFFER, JR. SERVE AS BOARD MEMBERS OF THE WOODLANDS, INC., A NURSING HOME. FORM 990, PART VI, SECTION A, LINE 4: SOUTHSIDE COMMUNITY HOSPITAL HAD THE BELOW LISTED CHANGE TO SECTION 5.6 OF SOUTHSIDE COMMUNITY HOSPITALS AMENDED AND RESTATED BYLAWS; THIS CHANGE WAS APPROVED AT THE SEPTEMBER 2015 BOARD OF DIRECTORS MEETING. "IN ADDITION, IF THE CHIEF EXECUTIVE OFFICER IS ABSENT OR UNAVAILABLE, THE DUTIES OF THE CHIEF EXECUTIVE OFFICER MAY BE PERFORMED BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE MEMBER AND/OR THE VICE PRESIDENT, COMMUNITY HOSPITALS AND REGIONAL MEDICAL CENTERS, OF THE MEMBER." FORM 990, PART VI, SECTION A, LINE 6: THROUGH AN AFFILIATION AGREEMENT, SOUTHSIDE HOSPITAL'S SOLE CORPORATE MEMBER IS CENTRA HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A & B: CENTRA HEALTH, INC. IS THE SOLE MEMBER CORPORATION OF SOUTHSIDE COMMUNITY HOSPITAL (SCH) AND HAS THE POWER TO ELECT/APPROVE THE BOARD OF DIRECTORS OF SCH'S GOVERNING BODY AND APPROVE DECISIONS MADE BY SCH'S BOARD. FORM 990, PART VI, SECTION A, LINE 8A & B: MINUTES ARE TAKEN AT EACH MEETING. FORM 990, PART VI, SECTION B, LINE 11B: THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. CENTRA SOUTHSIDE WILL PROVIDE ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS WITH A COPY OF THE FORM 990 PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C: ALL CENTRA SOUTHSIDE OFFICERS, DIRECTORS, AND KEY EMPLOYEES, MUST COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS, CERTIFYING THAT NEITHER THEY NOR ANY OF THEIR IMMEDIATE FAMILY MEMBERS HAVE ENGAGED IN ANY ACTIVITIES THAT COULD LEAD TO A POTENTIAL CONFLICT OF INTEREST. ADDITIONALLY, ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES MUST AGREE TO PROMPTLY REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR TO THE PRESIDENT OR CHAIRMAN OF CENTRA SOUTHSIDE'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15A & B: FORM 990, PART VI 15A & 15B WERE ANSWERED AS "NO", HOWEVER, UNDER A MANAGEMENT AGREEMENT WITH CENTRA HEALTH, INC., A RELATED PARTY, THE ORGANIZATIONS CHIEF EXECUTIVE OFFICERS COMPENSATION IS ESTABLISHED IN ACCORDANCE WITH CENTRA HEALTHS EXECUTIVE COMPENSATION PRACTICES WHICH INCLUDE THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT(S), AND COMPENSATION STUDY OR SURVEY. FORM 990, PART VI, SECTION C, LINE 18: PHOTOCOPIES OF THE ORGANIZATION'S FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.ADDITIONALLY, FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG . FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY UPON REQUEST AT ITS ADMINISTRATIVE OFFICE. FORM 990, PART XI, LINE 9: CONTRIBUTED CAPITAL FROM CENTRA HEALTH $186,194 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT $47,714 --------- TOTAL TO FORM 990, PART XI, LINE 9 $233,908 FORM 990, PART XII, LINE 2C: COMMITTEE RESPONSIBLE FOR AUDIT PROCESS OVERSIGHT THE AUDIT PROCESS OF THE ORGANIZATION INCLUDING THE OVERSIGHT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR IS OVERSEEN BY THE AUDIT & COMPLIANCE COMMITTEE OF CENTRA HEALTH, INC., SOLE MEMBER AND RELATED ORGANIZATION. FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN REMUNERATION TOTAL FEES:5947024 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PURCHASED SERVICES TOTAL FEES:152738 FORM 990 PART IX LINE 11G DESCRIPTION:CAPITATED MEDICAL CLAIMS TOTAL FEES:2257312 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:1804739 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:1923012 FORM 990 PART IX LINE 11G DESCRIPTION:RECRUITMENT TOTAL FEES:540 FORM 990 PART IX LINE 11G DESCRIPTION:BILLING FEES TOTAL FEES:544487 FORM 990 PART IX LINE 11G DESCRIPTION:CLEANING SERVICES TOTAL FEES:33026 CENTRA MEDICAL GROUP SOUTHSIDE LLC 800 OAK STREET FARMVILLE VA 23901 260771274 PHYS. OFFICES VA 12540309 3338759 SCH CENTRA HEALTH INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 540715569 HEALTHCARE VA 501(C)(3) 3 NA false CENTRA HEALTH FOUNDATION INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541604094 SUPPORTING OR VA 501(C)(3) 11A-1 NA false CCRC INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541929580 CONTINUE CARE VA 501(C)(3) 11A-1 NA false BEDFORD MEMORIAL HOSPITAL 1613 OAKWOOD STREET BEDFORD VA 24523 540566100 HEALTHCARE VA 501(C)(3) 3 NA false GENERAL BUSINESS CONCERNS INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541299682 REAL ESTATE/PHYS VA NA C Corp false PCHP HOLDING INC 2316 ATHERHOLT ROAD LYNCHBURG VA 24501 541749492 HOLDING COMPANY VA NA C Corp false PIEDMONT COMMUNITY HEALTH PLAN INC 2316 ATHERHOLT ROAD LYNCHBURG VA 24501 541755768 HEALTH INSURANCE VA NA C Corp false false false true true true false false false false false false false false false false true false false false