2013-05-15T11:26:33-05:00 2012-06-30 621517792 PERSHING YOAKLEY & ASSOCIATES PC ONE CHEROKEE MILLS 2220 SUTHERLAND KNOXVILLE TN 379192363 990 2011-07-01 540794913 SMYTH COUNTY COMMUNITY HOSPITAL SMYT 2763781000 PO BOX 880 MARION VA 24354 JEFFREY HUNDMAN 2763781000 2013-05-15 1 DEBORAH O ERNSBERGER P00364912 8656730844 2011 2016-02-24 21:20:13Z LINDA P WHITE PO BOX 880 MARION VA 24354 42953023 0 X WWW.MSHA.COM X 1965 VA SEE SCHEDULE OSMYTH COUNTY COMMUNITY HOSPITAL IS A NONSTOCK CORPORATION THAT OWNS AND OPERATES AN ACUTE CARE FACILITY, A HOME HEALTH AGENCY, AND FRANCIS MARION MANOR, A LONG TERM CARE FACILITY. THE FACILITIES ARE LOCATED IN SMYTH COUNTY, VIRGINIA. THEY PROVIDE INPATIENT, OUTPATIENT, EMERGENCY SERVICES, AND LONG-TERM MEDICAL CARE TO THE GENERAL PUBLIC. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, RADIOLOGY, ELECTROCARDIOLOGY, LABORATORY, PHYSICAL THERAPY, SPEECH PATHOLOGY, HOME HEALTH, BLOOD BANK, LONG TERM CARE, AND NURSERY. 15 9 0 73 30251 10560 79030 38238 44879709 40449630 2500195 1340112 817381 1125043 48276315 42953023 7421 12821 0 0 28759854 23446103 0 0 32229 22117439 22877592 50884714 46336516 -2608399 -3383493 98026282 106754092 16754974 24852213 81271308 81901879 X SMYTH COUNTY COMMUNITY HOSPITAL IS COMMITTED TO BRINGING LOVING CARE TO HEALTHCARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTHCARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH. 0 0 38583338 12821 40825294 SMYTH COUNTY COMMUNITY HOSPITAL ("SCCH") HAS A 40-PLUS YEAR HISTORY OF PROVIDING HEALTHCARE SERVICES WITHIN THE COMMUNITY OF MARION, VIRGINIA. SCCH IS A 44-BED COMMUNITY-BASED HOSPITAL THAT OFFERS BOTH ACUTE CARE AND INPATIENT REHABILITATION. ADDITIONALLY, SCCH HAS A 109-BED NURSING CARE FACILITY THAT OFFERS BOTH SKILLED NURSING CARE AND NURSING CARE, FRANCIS MARION MANOR. SCCH HAS A VARIETY OF OUTREACH PROGRAMS INCLUDING HOMECARE.AS A NOT-FOR-PROFIT HOSPITAL, ALL OF SCCH'S NET INCOME IS INVESTED IN IMPROVING HEALTHCARE IN THE COMMUNITY. WITH A STRONG COMMITMENT TO QUALITY PATIENT CARE AND A HERITAGE OF SERVICES, SCCH CONTINUES TO MEET THE HEALTHCARE NEEDS OF SMYTH AND THE ADJOINING COUNTIES.PATIENT CARE SERVICES:AS A COMMUNITY FACILITY, SCCH IS DIRECTLY RESPONSIBLE FOR, AND RESPONSIVE TO, OUR FAMILIES, FRIENDS AND COMMUNITIES. HOW WILL IT IMPROVE PATIENT CARE? SHOULD WE MAKE AN INVESTMENT NOW, OR WAIT FOR AN IMMINENT BREAK-THROUGH? WHERE CAN WE BENEFIT THE MOST PEOPLE? THESE CONCERNS DIRECT OUR DOLLARS IN INTRODUCING NEW PROCEDURES, MORE IN-DEPTH SERVICES AND INNOVATION. CURRENTLY, SCCH SERVICES INCLUDE:24-HOUR EMERGENCY DEPARTMENTAUDIOLOGYBONE DENSITOMETRYCARDIAC REHABILITATIONCOMPUTERIZED TOMOGRAPHYHOMECAREINTENSIVE CARE UNIT (ICU)INTERMEDIATE CARE (FRANCIS MARION MANOR)LABORATORY SERVICESLIFELINE EMERGENCY RESPONSE SYSTEMLITHOTRIPSYMAGNETIC RESONANCE IMAGING (MRI)MAMMOGRAPHYMEDICAL AND SURGICAL SERVICESOCCUPATIONAL THERAPYPASTORAL CAREPEDIATRICSPHARMACYPHYSICAL THERAPYPRE-ADMISSION CENTERPULMONARY REHABILITATIONRADIOLOGY SERVICESRESPIRATORY THERAPYSAME DAY SURGERYSKILLED NURSING FACILITYSLEEPZONE DIAGNOSTIC CENTERSPEECH THERAPYTRANSRECTAL ULTRASOUNDULTRASONOGRAPHYHOMECARE SERVICES:SCCH UNDERSTANDS THE VALUE OF HOME HEALTHCARE AND THE RELIEF PATIENTS FEEL TO BE BACK IN FAMILIAR SURROUNDINGS WHILE CONTINUING TO RECEIVE EXPERT CARE. UNDER THE PHYSICIAN'S SUPERVISION, PATIENTS CONTINUE TO RECEIVE QUALITY MEDICAL TREATMENT FROM SKILLED NURSES, THERAPISTS AND HOME HEALTH AIDES WHO FOLLOW THE PATIENT'S INDIVIDUAL PLAN OF TREATMENT. HOMECARE SERVICES ALLOW PATIENTS THE CONVENIENCE OF:- TREATMENT IN THE COMFORT AND SECURITY OF HOME- CONTINUITY OF FAMILY RELATIONSHIPS- INDIVIDUAL PLAN OF TREATMENT- CONTINUING RELATIONSHIP WITH FAMILIAR PHYSICIAN- FREEDOM TO PARTICIPATE IN THE PLAN OF TREATMENT AT HOME- CARING, PERSONAL SERVICE BY EXPERIENCED, QUALIFIED HOME HEALTH PROFESSIONALS WORKING TOWARD THE SUCCESS OF THE PATIENT'S PLAN OF TREATMENT- AGENCY ACCEPTS ASSIGNMENT OF BENEFITS AND ASSISTS IN BILLING ISSUESFOR ELIGIBLE PATIENTS, CHARGES ARE 100 PERCENT REIMBURSABLE BY MEDICARE WHEN PRESCRIBED BY THE PHYSICIAN UNDER HOME HEALTH GUIDELINES.SCCH HOMECARE MEETS THE PHYSICIAN'S REQUIREMENTS THAT HIS OR HER PLAN OF TREATMENT IS CARRIED OUT BY QUALIFIED HOME HEALTH PROFESSIONALS. TRAINED HOME HEALTH NURSES CAREFULLY DOCUMENT PATIENTS' MEDICAL CHARTS AND PROVIDE THE PHYSICIAN WITH PROMPT AND ACCURATE INFORMATION ABOUT THE PATIENT'S CONDITION.OTHER HOME HEALTH BENEFITS WHICH SUPPORT THE PHYSICIAN IN QUALITY PATIENT CARE INCLUDE:- THOROUGH PRE-DISCHARGE ASSESSMENT BETWEEN THE PHYSICIAN, HOME HEALTH NURSE AND HOSPITAL DISCHARGE PLANNER TO EVALUATE THE PATIENT'S NEEDS BEFORE LEAVING THE HOSPITAL- ASSURED CONTINUITY OF THE PHYSICIAN'S PLAN OF TREATMENT- CONSISTENT, TIMELY COMMUNICATION ABOUT THE PATIENT'S CONDITION- LICENSED NURSES WHO MEET REGULATORY STANDARDS- DEDICATED TEAMWORK WITH THE PHYSICIAN AND RESPECT FOR THE PATIENT/PHYSICIAN RELATIONSHIP- CLEAR COMMUNICATION WITH THE PATIENT AND HIS OR HER FAMILY ABOUT REIMBURSEMENT AND COVERED HOME CARE SERVICESSCCH HOMECARE PROVIDES PROMPT ACCESS TO CARE FOR QUALIFIED PATIENTS. IT ASSISTS HOSPITAL DISCHARGE PLANNERS AND OTHER DECISION MAKERS IN DELIVERING ALTERNATIVES FOR PATIENTS AND THEIR FAMILIES OR CAREGIVERS, AS WELL AS THEIR PHYSICIAN - AN ALTERNATIVE THAT BRINGS FLEXIBILITY, SENSITIVITY, CONVENIENCE, AND DEPENDABILITY.OTHER BENEFITS OF HOME HEALTH CARE FOR THE HOSPITAL PROFESSIONAL STAFF INCLUDE: - PRE-DISCHARGE HOME CARE ASSESSMENT AND PLANNING BY OUR HOME CARE COORDINATOR- IMMEDIATE, RESPONSIVE ASSISTANCE WITH TRANSITION FROM HOSPITAL TO HOME- AN EXPANDED NETWORK OF SERVICES TO SERVE THE PATIENT- CONTINUOUS ASSESSMENT OF THE PLAN OF CARE WITH THE PHYSICIAN- COORDINATION OF COMMUNICATION AMONG PATIENTS AND THEIR FAMILIES/CAREGIVERS, THE PHYSICIAN AND THE REFERRAL SOURCE- COORDINATION AND EVALUATION OF REIMBURSEMENT WITH A MIX OF PAYERS, INCLUDING MEDICARE, MEDICAID AND PRIVATE/COMMERCIAL INSURANCE COMPANIESSKILLED NURSING:SCCH REGISTERED AND LICENSED NURSES ARE HIGHLY TRAINED AND EXPERIENCED IN PROVIDING NURSING SERVICES IN THE PATIENT'S HOME. THEY UNDERSTAND THE SPECIAL NEEDS OF HOMEBOUND PATIENTS AND MAINTAIN CONTINUOUS EDUCATION IN CLINICAL AND PSYCHOSOCIAL SKILLS DEVELOPMENT.THE POLICIES, PROCEDURES AND QUALITY ASSURANCE PROGRAMS SCCH NURSES FOLLOW MEET THE STANDARDS REQUIRED BY FEDERAL/STATE REGULATIONS; SCCH ROUTINELY SURVEYS PATIENTS AND PHYSICIANS TO ASSESS THE SATISFACTION LEVEL OF OUR NURSING SERVICES IN ORDER TO IMPROVE NURSING QUALITY.OUR NURSING SERVICES INCLUDE, BUT ARE NOT LIMITED TO:- COORDINATION AND IMPLEMENTATION OF PHYSICIAN'S PLAN OF TREATMENT- ROUTINE PATIENT EVALUATION AND COMMUNICATION WITH PHYSICIAN REGARDING PATIENT'S RESPONSES TO CARE AND CHANGES IN THE PATIENT'S CONDITION- INTERACTION WITH PATIENT'S FAMILY/CAREGIVER, CO-WORKERS AND OTHER DISCIPLINES TO PROVIDE OBSERVATION AND FEEDBACK REGARDING PATIENT'S CONDITION- REVIEW OF MEDICATION REGIMENT AND PATIENT TRAININGINFUSION THERAPY:OUR INFUSION THERAPY NURSES ARE SKILLED, REGISTERED NURSES WHO UNDERSTAND THE SPECIAL REQUIREMENTS OF INFUSION THERAPY.THE POLICIES, PROCEDURES AND QUALITY ASSURANCE PROGRAMS THEY FOLLOW MEET STANDARDS PUBLISHED BY THE INTRAVENOUS NURSES SOCIETY AND REGULARITY ORGANIZATIONS.OUR INFUSION THERAPY NURSING SERVICES INCLUDE, BUT ARE NOT LIMITED TO:- INITIAL AND ONGOING ASSESSMENT OF PATIENT AND FAMILY CAPABILITIES AND NEEDS- PATIENT AND FAMILY EDUCATION- PERIPHERAL INTRAVENOUS SITE ROTATION- CENTRAL VENOUS CATHETER CARE- BLOOD DRAWING- FOLLOW-UP REPORTS TO PHYSICIANS AND PHARMACY SERVICE PROVIDERS- PSYCHOSOCIAL SUPPORT FOR PATIENTS AND FAMILIES/CAREGIVERSHOME HEALTH AIDE:OUR HOME HEALTH AIDES ASSIST THE PROFESSIONAL NURSING STAFF BY PERFORMING ROUTINE DUTIES IN CARING FOR IN-HOME PATIENTS. THEY ARE QUALIFIED TO PROVIDE AN EXTENSION TO THERAPEUTIC SERVICES, PERSONAL CARE, AMBULATION, EXERCISE, AND HOUSEHOLD SERVICES ESSENTIAL TO HEALTH CARE AT HOME. HOME HEALTH AIDE SERVICES CAN ONLY BE OFFERED TO INDIVIDUALS QUALIFYING FOR SKILLED NURSING OR THERAPIST SERVICES.HOME HEALTH AIDE SERVICES INCLUDE, BUT ARE NOT LIMITED TO:- MAINTAINING ACCURATE CLINICAL RECORDS REGARDING ALL PATIENT OBSERVATIONS, CARE AND TREATMENT- ASSISTING PATIENT WITH AMBULATION AND/OR TRANSFER, USING PROPER BODY MECHANICS TO PROTECT PATIENT AND PERSONAL SAFETY- ASSISTING PATIENT IN MEETING PERSONAL HYGIENE NEEDS- PREPARING MEALS AND ASSISTING WITH EATING IF NECESSARY- PROVIDING SIMPLE HOUSEHOLD PROCEDURES ESSENTIAL TO HEALTH CARE AT HOMEPHYSICAL THERAPY:PHYSICAL THERAPISTS PROVIDED BY OUR HOME HEALTH AGENCY USE THE LATEST TECHNIQUES AND EQUIPMENT TO ASSIST PATIENTS IN ACHIEVING THE MOST COMPLETE RECOVERY POSSIBLE IN THE SHORTEST PERIOD OF TIME. PATIENTS WHO REQUIRE THESE SERVICES OFTEN BECOME FRUSTRATED IN THEIR ATTEMPTS AT RECOVERING SKILLS THAT WERE ONCE EASY FOR THEM. OUR PROFESSIONALS' ASSISTANCE CAN HELP OVERCOME THIS DOWNSIDE OF REHABILITATIVE THERAPY BY PROVIDING EXPERT AID WITH AN ENCOURAGING ATTITUDE THAT HELPS THE PATIENT ACHIEVE MORE IN LESS TIME.OUR PHYSICAL THERAPY SERVICES INCLUDE, BUT ARE NOT LIMITED TO:- ASSISTING THE PHYSICIAN WITH INITIAL AND ON-GOING PATIENT EVALUATION- DIRECTING AND AIDING PATIENTS IN VARIOUS EXERCISES AND ACTIVITIES- GAIT TRAINING- INSTRUCTING PATIENT AND CAREGIVER IN USE OF DURABLE MEDICAL EQUIPMENT AND PROSTHETIC AND ORTHOTIC DEVICES- THE APPLICATION OF VARIOUS DEVICES, SIMULATORS AND TRACTION- COORDINATING PHYSICAL THERAPY WITH OUR AGENCY'S NURSING SERVICESOCCUPATIONAL THERAPY:OUR OCCUPATIONAL THERAPIST IS HIGHLY TRAINED AND EXPERIENCED IN REHABILITATING PATIENTS. THE GOAL OF THERAPY IS TO IMPROVE AND RESTORE FUNCTION LOST OR IMPAIRED BY ILLNESS OR INJURY AND PROMOTE A RETURN TO INDEPENDENCE THROUGH TRAINING AND RE-EDUCATION IN SKILLS AND ACTIVITIES ASSOCIATED WITH DAILY LIVING.OUR OCCUPATIONAL THERAPY SERVICES INCLUDE, BUT ARE NOT LIMITED TO:- EVALUATION OF THE PATIENT'S LEVEL OF FUNCTION- GUIDING THE PATIENT IN THERAPEUTIC, CREATIVE AND SELF-CARE ACTIVITIES 38583338 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 1 107 0 1 0 1 1 0 0 0 0 0 0 1 1 0 X 15 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X JEFFREY HUNDMAN 2763781207 245 MEDICAL PARK DRIVE MARION VA 24354 X ALLEN ABEL 3.00 X 0 0 0 JIM BEAR JR 3.00 X 0 0 0 RUTH COX 3.00 X 0 0 0 BOB FEATHERS 3.00 X 0 0 0 ANN FLEMING 3.00 X 0 501320 66728 JOANNE GROSECLOSE 3.00 X 0 0 0 MARK GROSECLOSE 3.00 X 0 0 0 CHELSEA HAMMAN MD 3.00 X 21675 0 0 MAUREEN MACIVER 3.00 X 0 0 0 JIM MCDOWELL MD 3.00 X 3328 0 0 JIM PATTERSON MD 3.00 X 0 4639 0 CINDY SALYER 3.00 X 0 241894 42953 BOB SHULTS 3.00 X 0 0 0 JOHN SCHARIO 3.00 X 0 181919 24892 CLEM WILKES JR 3.00 X 0 0 0 LINDA WHITE 55.00 X 0 248644 39163 JOHN JETER 50.00 X 0 141277 20972 JEFFREY HUNDMAN 50.00 X 0 105109 12765 MATTHEW JUSTUS 40.00 X 0 204637 5344 PAMELA DELOACH 40.00 X 0 188787 15318 SAMUEL SMALL 40.00 X 0 175100 12441 ANTONIO DE LA ROSA 40.00 X 0 148377 21087 BELDON FLEMING 40.00 X 0 138356 23298 25003 2280059 284961 0 0 1 0 SKANSKA USA BUILDING INC 1633 LITTLETON ROAD PARSIPPANY NJ 07054 CONSTRUCTION 32446192 MCKESSON TECHNOLOGIES INC 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 SERVICE CONTRACTS 730037 SCYPHERS & AUSTIN PC 189 VALLEY STREET ABINGDON VA 24210 LEGAL SERVICES 462500 APPALACHIAN POWER COMPANY 13563 OWENS DRIVE GLADE SPRING VA 34340 UTILITIES 364448 TELEOPTICS COMMUNICATIONS 1041 TIDEWATER COURT KINGSPORT TN 37660 COMMUNICATIONS 352303 19 30674 7564 38238 PATIENT SERVICES 621990 40383511 40383511 P/S INC RELATED TO PRO 561000 66119 64918 1201 40449630 1297050 1297050 425192 0 425192 425192 425192 36686 6376 0 0 36686 6376 43062 43062 1905 0 1905 1905 OTHER REVENUE 621500 354925 325875 29050 CAFETERIA SALES 722210 219517 219517 MANAGEMENT FEE REVENUE 900099 73715 73715 49789 49789 697946 42953023 40824093 30251 2060441 12821 12821 437895 20011 417884 19015551 16275073 2728456 12022 573908 501553 71985 370 2228428 2237769 -10751 1410 1190321 1149288 41033 22283 22283 50499 50499 71227 71227 72765 72765 7214799 7192004 22795 212961 169866 43095 524809 452560 54572 17677 541825 530070 11755 1041974 936432 105542 162658 146734 15924 5919 5440 479 16311 16311 4791118 2493999 2297119 MEDICAL SUPPLIES & DRUG 4920974 5195003 -274029 MANAGEMENT FEES 1790645 150523 1640122 REPAIRS & MAINTENANCE 780101 769093 11008 UBI TAX 13125 13125 643599 345099 297750 750 46336516 38583338 7720949 32229 4743424 812382 588514 64910 6417679 8655192 975086 953670 332142 314696 122231744 49662316 37213493 72569428 26310961 18695346 202000 710615 21242983 3977853 98026282 106754092 12123566 4880379 16464093 4631408 3507741 16754974 24852213 X 81245506 81866036 25802 35843 81271308 81901879 98026282 106754092 X -3383493 4014064 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3090 0 1 1403 0 4493 0 3141729 3141729 65407654 14748202 50659452 65442 64433 1009 40902611 34849681 6052930 12714308 12714308 72569428 OTHER LONG-TERM LIABILITIES 298027 ASSET RETIREMENT OBLIGATION 711000 LEASE PAYABLE 3769 DUE TO THIRD-PARTY 1666879 DUE TO AFFILIATES 280104 DUE TO MSHA, NET 547962 3507741 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE HOSPITAL. SOUTHWEST COMMUNITY HEALTH SERVICES (SWCH) IS A TAXABLE ENTITY AND ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH FASB ASC 740, INCOME TAXES. AT JUNE 30, 2012, TAX RETURNS FOR FISCAL YEARS 2009 THROUGH 2011 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2012 AND 2011. AS SUCH, NO INTEREST OR PENALTIES WERE RECOGNIZED IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS RELATED TO UNRECOGNIZED TAX BENEFITS. 1 1 X 1 X 1 X 1 1 1 0 0 1154375 1154375 0.02490 5705552 4055399 1650153 0.03560 6859927 4055399 2804528 0.06050 121735 121735 0.00260 170588 170588 0.00370 11321 11321 0.00020 303644 303644 0.00650 7163571 4055399 3108172 0.06700 1305 1305 0.00000 1305 1305 1 1557693 1090385 13740016 13537115 202901 X 1 1 2 1 SMYTH COUNTY COMMUNITY HOSPITAL

PO BOX 880 MARION VA 24354

X X X 44-BEDS 2 FRANCIS MARION MANOR

100 FRANCIS MARION LANE MARION VA 24354

NURSING HOME SMYTH COUNTY COMMUNITY HOSPITAL 1 1 X X X X X X X X 11 1 1 1 X X X X X X X X 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X 1 0 1 X 0 0 FRANCIS MARION MANOR 2 1 X X X X X X X X 11 1 1 1 X X X X X X X X 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X X X 1 0 1 X 0 0 PART I, LINE 6A: MOUNTAIN STATES HEALTH ALLIANCE (MSHA) HAS HISTORICALLY PREPARED AND MADE PUBLIC A COMMUNITY BENEFIT REPORT TO INCLUDE INFORMATION FOR ALL OF THE HOSPITALS WITHIN THE HEALTH SYSTEM. DURING FY12, MSHA DID NOT ISSUE A COMMUNITY BENEFIT REPORT. HOWEVER, MSHA INTENDS TO PREPARE A COMMUNITY BENEFIT REPORT DURING FY13. SCCH, AS A MEMBER OF MSHA, IS INCLUDED IN MSHA'S REPORT. PART I, LINE 7: A COST TO CHARGE RATIO WAS DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PART II: THE ACTIVITIES REPORTED IN PART II SEEK TO ACHIEVE SPECIFIED OBJECTIVES, INCLUDING: IMPROVING ACCESS TO HEALTH SERVICES, ENHANCING PUBLIC HEALTH, AND RELIEF OF GOVERNMENT BURDEN. THE ACTIVITIES ARE AVAILABLE TO THE GENERAL PUBLIC, FOCUSING ON LOW-INCOME CONSUMERS. PART III, LINE 4: THE CALCULATED COST TO CHARGE RATIO (WORKSHEET 2) WAS APPLIED TO BAD DEBT CONTRA REVENUE AND PROVISION FOR BAD DEBT, IN DETERMINING LINE 2.THE VICE PRESIDENT OF PATIENT FINANCIAL SERVICES AND CFO ESTIMATE THAT 70% OF TOTAL BAD DEBT EXPENSE WAS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. WE HAVE MANY INSTANCES DURING THE YEAR OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE ARE SURE WOULD QUALIFY FOR CHARITY CARE. ALTHOUGH HOSPITAL TEAM MEMBERS ENCOURAGE THESE INDIVIDUALS TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION, MANY WILL NOT DO SO. EVEN WHEN THESE INDIVIDUALS ARE TOLD WE FEEL SURE THEY DO QUALIFY FOR FULL OR PARTIAL ASSISTANCE, THEY STILL REFUSE TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION.REGARDING LINE 3, IT IS IMPLAUSIBLE TO DETERMINE THE AMOUNT OF SCCH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETE FINANCIAL ASSESSMENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSESSMENT FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT MORE THAN 90% OF OUR PATIENTS WHO HAVE PROVIDED COMPLETED FINANCIAL ASSESSMENT FORMS HAVE BEEN APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE.FOOTNOTE DISCLOSURE FROM SCCH'S FY12 AUDITED FINANCIAL STATEMENT READS "NEW ACCOUNTING PRONOUNCEMENTS: IN JULY 2011, THE FASB ISSUED ACCOUNTING STANDARD UPDATE (ASU) 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES. THE ASU REQUIRES THE CHANGE OF PRESENTATION OF THE ESTIMATED PROVISION FOR BAD DEBTS IN THE CONSOLIDATED STATEMENTS OF OPERATIONS FROM AN OPERATING EXPENSE TO A DEDUCTION FROM PATIENT SERVICE REVENUE, NET OF CONTRACTUAL DEDUCTIONS AND DISCOUNTS, ALONG WITH ADDITIONAL DISCLOSURES ABOUT THE POLICIES FOR RECOGNIZING REVENUE AND ASSESSING BAD DEBTS, AND QUALITATIVE INFORMATION ABOUT CHANGES IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL RETROACTIVELY ADOPTED ASU 2011-07 IN FISCAL YEAR 2012. THE ADOPTION OF ASU 2011-07 DID NOT HAVE A MATERIAL IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS."THE FOOTNOTES TO THE AUDITED FINANCIAL STATEMENT REPORT THE AMOUNT OF ESTIMATED UNCOLLECTIBLE SELF-PAY AND EXPLAIN THAT UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE ESTIMATED RESERVES ARE BASED UPON PRIOR COLLECTION HISTORY FOR GROUPS OF RECEIVABLES, KNOWN COLLECTION RISKS AND OTHER ENVIRONMENTAL FACTORS, INCLUDING THE AGE OF THE RECEIVABLES. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE REPORTED USING SCCH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP DOWN METHOD. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS: TRANSPORTATION OF A PATIENT, COMFORT ITEMS TO INCLUDE A TELEVISION, MAGAZINES, OR A TELEPHONE. ADDITIONAL NON-ALLOWABLE COSTS INCLUDE THE RECRUITMENT OF PHYSICIANS, PHYSICIAN GUARANTEES AND A PORTION OF THE BAD DEBT (30%) ASSOCIATED WITH THE CARE OF THE PATIENT. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. AS A NOT-FOR-PROFIT ORGANIZATION, WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITY AND THE INDIVIDUAL WHILE MAINTAINING A HIGH LEVEL OF HEALTH CARE SERVICES WITHOUT LOSSES. SINCE LOSSES DO OCCUR THROUGH THE CMS SYSTEM OF REIMBURSEMENT, THESE LOSSES ARE A COST OF DOING BUSINESS FOR OUR COMMUNITY AND SHOULD BE CONSIDERED A COMMUNITY BENEFIT. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, SCCH IS REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR OUR MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW OUR COST. THEREFORE IT IS ONLY LOGICAL TO ALLOW SCCH TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT ON THIS DOCUMENT. BY MAKING THIS CHANGE, NON-PROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES ECONOMICALLY INJURIOUS. PART III, LINE 9B: SCCH PROVIDES A PATIENT FRIENDLY BILLING FLOW CHART ON ITS WEBSITE THAT GUIDES A PATIENT THROUGH THE PROCESS, BEGINNING WITH ADMISSION AND ENDING WITH THE PATIENT'S ACCOUNT BEING SUCCESSFULLY RESOLVED.SCCH FOLLOWS A STRONG COLLECTION PROGRAM THAT COMMUNICATES FINANCIAL RESPONSIBILITY TO THE PATIENT. COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY AND NON-CHARITY. IN ROUTINE CIRCUMSTANCES WHEN IT IS DETERMINED THAT A PATIENT HAS NOT RESPONDED TO REQUESTS FOR PAYMENT, AN ACCOUNT CAN BE REFERRED TO AN OUTSIDE COLLECTION AGENCY FOR COLLECTION ASSISTANCE. SCCH ENSURES THAT OUTSIDE COLLECTION AGENCIES FOLLOW HOSPITAL BILLING AND COLLECTION GUIDELINES. ONCE A DELINQUENT PATIENT ACCOUNT HAS BEEN SUBMITTED TO AN OUTSIDE COLLECTION AGENCY IT CAN BE RETRACTED IF IT IS DETERMINED THAT THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL REQUESTS FOR FINANCIAL ASSISTANCE MUST BE ACCOMPANIED BY A COMPLETED FINANCIAL ASSESSMENT FORM AND SUPPORTING DOCUMENTATION. SMYTH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES, INCLUDING SCCH, LOCATED IN NINE COUNTIES WITHIN MSHA'S CORE SERVICE AREA. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY IMPLEMENTATION PLAN. FRANCIS MARION MANOR PART V, SECTION B, LINE 3: MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE TEN HOSPITAL FACILITIES, INCLUDING JMH, LOCATED IN NINE COUNTIES WITHIN MSHA'S CORE SERVICE AREA. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. EACH GROUP RANGED IN ATTENDANCE FROM 6 TO 21 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE SPECIFIC NEEDS FOR EACH COUNTY WERE INCLUDED IN THE APPROPRIATE FACILITY IMPLEMENTATION PLAN. SMYTH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 4: EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. WE SURVEYED 21 INDIVIDUALS FROM WASHINGTON COUNTY IN ORDER TO DETERMINE HEALTH PRIORITIES. DICKENSON COUNTY COMMUNITY HOSPITAL AND NORTON COMMUNITY HOSPITAL ALSO HAS ONE COMMUNITY GROUP SURVEYED. THESE TWO COUNTIES SERVE SIMILAR COMMUNITIES AND HAVE SIMILAR HEALTH RANKINGS ACCORDING TO AMERICA'S HEALTH RANKINGS. EVEN THOUGH ONLY TWO COMMUNITY GROUPS SERVED ON BEHALF OF THE FOUR HOSPITALS LISTED, STATISTICAL DATA WAS COLLECTED FOR EACH INDIVIDUALLY.SCCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER, FRANKLIN WOODS COMMUNITY HOSPITAL, WOODRIDGE PSYCHIATRIC HOSPITAL, JAMES H. & CECILE C. QUILLEN REHABILITATION HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, AND NORTON COMMUNITY HOSPITAL. FRANCIS MARION MANOR PART V, SECTION B, LINE 4: EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. FOR THOSE HOSPITALS ARE LOCATED IN THE SAME COUNTY, ONLY ONE COMMUNITY GROUP WAS SURVEYED. FOR INSTANCE, JOHNSON CITY MEDICAL CENTER AND FRANKLIN WOODS COMMUNITY HOSPITAL ARE BOTH LOCATED IN WASHINGTON COUNTY, TENNESSEE. WE SURVEYED 21 INDIVIDUALS FROM WASHINGTON COUNTY IN ORDER TO DETERMINE HEALTH PRIORITIES. DICKENSON COUNTY COMMUNITY HOSPITAL AND NORTON COMMUNITY HOSPITAL ALSO HAS ONE COMMUNITY GROUP SURVEYED. THESE TWO COUNTIES SERVE SIMILAR COMMUNITIES, AND HAVE SIMILAR HEALTH RANKINGS ACCORDING TO AMERICA'S HEALTH RANKINGS. EVEN THOUGH ONLY TWO COMMUNITY GROUPS SERVED ON BEHALF OF THE FOUR HOSPITALS LISTED, STATISTICAL DATA WAS COLLECTED FOR EACH INDIVIDUALLY.JMH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER, FRANKLIN WOODS COMMUNITY HOSPITAL, WOODRIDGE PSYCHIATRIC HOSPITAL, JAMES H. & CECILE C. QUILLEN REHABILITATION HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, SMYTH COUNTY COMMUNITY HOSPITAL, DICKENSON COMMUNITY HOSPITAL, AND NORTON COMMUNITY HOSPITAL. SMYTH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 7: MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29 OF FY 12. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. NOW THAT THE IMPLEMENTATION PLANS HAVE BEEN ADOPTED, MSHA WILL BE ABLE TO BEGIN TAKING ACTION TO IMPROVE THE HEALTH PRIORITIES IN EACH COUNTY, THOUGH AT THIS POINT, NOT ALL OF THE PRIORITIES HAVE BEEN ADDRESSED. DUE TO LACK OF RESOURCES, SOME OF THE MSHA FACILITIES WERE UNABLE TO ADDRESS ISSUES THAT WERE IDENTIFIED. FRANCIS MARION MANOR PART V, SECTION B, LINE 7: MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29 OF FY 12. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2011 AND 2012. AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF MAY AND JUNE 2012. NOW THAT THE IMPLEMENTATION PLANS HAVE BEEN ADOPTED, MSHA WILL BE ABLE TO BEGIN TAKING ACTION TO IMPROVE THE HEALTH PRIORITIES IN EACH COUNTY, THOUGH AT THIS POINT, NOT ALL OF THE PRIORITIES HAVE BEEN ADDRESSED. DUE TO LACK OF RESOURCES, SOME OF MSHA FACILITIES WERE UNABLE TO ADDRESS ISSUES THAT WERE IDENTIFIED. SMYTH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 13G: DURING THE ADMISSION PROCESS, PATIENTS ARE TOLD THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY AND ADMISSION PAPERS ARE GIVEN TO EACH PATIENT ADVISING THEM OF THE POLICY. BILLING CORRESPONDENCE ALSO ADVISES THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. A COMMUNITY RESOURCE GUIDE REPORTS THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY. FRANCIS MARION MANOR PART V, SECTION B, LINE 13G: DURING THE ADMISSION PROCESS, PATIENTS ARE TOLD THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY AND ADMISSION PAPERS GIVEN TO EACH PATIENT ADVISE THEM OF THE POLICY. BILLING CORRESPONDENCE ALSO ADVISES THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. A COMMUNITY RESOURCE GUIDE REPORTS THAT THE HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY. SMYTH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 19D: UNINSURED PATIENTS RECEIVE A 50% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AN ADDITIONAL DISCOUNT. FRANCIS MARION MANOR PART V, SECTION B, LINE 19D: UNINSURED PATIENTS RECEIVE A 50% DISCOUNT; AND, BASED ON OTHER FACTORS SUCH AS INCOME OR MEDICAL INDIGENCY, MAY QUALIFY FOR AS ADDITIONAL DISCOUNT. PART VI, LINE 2: MSHA INCLUDED AMERICA'S HEALTH RANKINGS (AHR) IN ITS ASSESSMENT IN ORDER TO BETTER DEFINE THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. TENNESSEE RANKED 39TH AND VIRGINIA RANKED 20TH; HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE MSHA FACILITIES ARE LOCATED) CLOSELY RESEMBLES THE HEALTH RANKINGS FOR TENNESSEE. AMERICA'S HEALTH RANKINGS ARE BASED ON A SERIES OF MEASURES INCLUDING SEVERAL HEALTH OUTCOMES AND HEALTH FACTORS. A SURVEY WAS GIVEN TO 67 INDIVIDUALS REPRESENTING THE NINE COUNTIES IN WHICH MSHA OWNS A FACILITY. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH LEADERS, NON-PROFIT DIRECTORS, SCHOOL NURSES AND OFFICIALS, AND BUSINESS LEADERS. A SURVEY WAS GIVEN TO EACH INDIVIDUAL SEEKING FEEDBACK REGARDING AVAILABLE RESOURCES IN EACH AREA, THE HEALTH STATUS, HEALTH PRIORITIES, AND SUGGESTIONS FOR IMPROVEMENT. THE MAJORITY OF RESPONSES SUGGESTED FOCUSING ON EDUCATION IN ORDER TO PROMOTE HEALTHY HABITS. OTHER RESPONSES INCLUDED: MAKE PHYSICAL EDUCATION A REQUIREMENT AS PART OF SCHOOL CURRICULUM, IMPROVE NATURAL TRAILS AND WALKWAYS, INCREASE COMMUNITY SUPPORT FOR SMOKE-FREE AREAS, PARTNER WITH LOCAL FARMER'S MARKETS, SHARE HEALTH INFORMATION BETWEEN PHARMACIES, NETWORK WITH SMALL BUSINESSES AND NON-PROFITS IN ORDER TO AVOID DUPLICATING RESOURCES, AND PROVIDE EARLY SCREENINGS FOR THE UNINSURED OR UNDERINSURED. OVERALL, THE COMMUNITY MEMBERS GAVE MSHA'S CORE SERVICE AREA A HEALTH STATUS RANKING OF 4.24 OUT OF 10 (1 BEING THE LOWEST, 10 BEING THE HIGHEST). ALSO, ALL 67 PARTICIPANTS AGREED THAT OBESITY, CANCER, HEART DISEASE AND DIABETES WERE THE TOP HEALTH PRIORITIES IN EACH COUNTY. AHR REPORTS THAT TENNESSEE AND VIRGINIA BOTH SAW AN INCREASE IN DIABETES AND OBESITY WITHIN THE PAST TEN YEARS. TENNESSEE ALSO RANKED 44TH FOR CARDIOVASCULAR DISEASE AND 46TH FOR CANCER DEATHS. VIRGINIA OVERALL HAD A BETTER RANKING IN THESE TWO CATEGORIES, BUT AS STATED EARLIER, SOUTHWEST VIRGINIA CLOSELY RESEMBLES TENNESSEE. MSHA PLANS TO USE THE AVAILABLE RESOURCES TO START IMPROVING THE HEALTH STATUS OF NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. PART VI, LINE 3: SCCH PROVIDES COMMUNICATION OF FINANCIAL ASSISTANCE ON ITS WEB SITE AND ON POSTERS PLACED IN PROMINENT AREAS SUCH AS ADMITTING AREAS, EMERGENCY DEPARTMENTS AND PATIENT PAYMENT (CASHIER) LOCATIONS. PRINTED EDUCATIONAL MATERIALS INCLUDING FINANCIAL ASSISTANCE CONTACT INFORMATION ARE ALSO PROVIDED IN THE PATIENT'S ADMITTING PAPERWORK. POSTERS AND REFERENCE MATERIALS ARE WRITTEN IN BOTH ENGLISH AND SPANISH. ADMITTING STAFF ARE TRAINED TO EDUCATE PATIENTS ON SCCH'S FINANCIAL ASSISTANCE POLICY. SCCH ALSO HAS FINANCIAL COUNSELORS WHICH COMMUNICATE THE PATIENT'S FINANCIAL RESPONSIBILITY PRIOR TO SERVICE AS WELL AS PROVIDE EDUCATION ON SCCH'S FINANCIAL ASSISTANCE POLICY. THESE COUNSELORS ALSO HELP UNINSURED PATIENTS DETERMINE SOURCES OF PAYMENT FOR MEDICAL BILLS AND HELP PATIENTS DETERMINE ELIGIBILITY FOR PROGRAMS SUCH AS MEDICAID. IN ADDITION, SCCH CONTRACTS WITH THE COMPANY FIRSTSOURCE SOLUTIONS USA TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. FIRSTSOURCE SOLUTIONS USA DETERMINES A PATIENT'S ELIGIBILITY IN MEDICAL COVERAGE OPTIONS AND ASSISTS WITH THEIR ENROLLMENT. SCCH BEARS THE COST FOR THE FIRSTSOURCE SOLUTIONS USA PROGRAM. PART VI, LINE 4: SCCH IS LOCATED IN MARION, SMYTH COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. BOTH NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA (SWVA) ARE LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION AND TENNSSEE VALLEY. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION. SMYTH COUNTY IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA AND HAS A HIGH RATE OF INDIVIDUALS WHO ARE UNINSURED. THE POPULATION OF SMYTH COUNTY WAS 31,718 IN 2012 AND, ACCORDING TO THE U.S. CENSUS BUREAU, MARION HAS A POPULATION OF 5,936. THE MEDIAN AGE OF RESIDENTS OF SMYTH COUNTY IS 40, WHICH IS OLDER THAN THE MEDIAN AGE OF 36.8 IN THE UNITED STATES. SMYTH COUNTY HAS A MEDIAN HOUSEHOLD INCOME OF $34,533, WHICH IS WELL BELOW $52,762, THE MEDIAN HOUSEHOLD INCOME OF THE U.S. IT IS ESTIMATED THAT 20.3% OF SMYTH COUNTY'S RESIDENTS LIVE IN POVERTY COMPARED TO 10.7% STATEWIDE. PART VI, LINE 5: THE MAJORITY OF SCCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY SCCH.SCCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED AND SURPLUSES MAY BE APPLIED TO MAINTAINING ADEQUATE FACILITIES AND EQUIPMENT FOR THE CARE OF OUR PATIENTS. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. PART VI, LINE 6: SCCH IS A 44-BED, ACUTE CARE FACILITY OPERATED UNDER THE DIRECTION OF A 13-MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. ADDITIONALLY, SCCH HAS A 109-BED NURSING CARE FACILITY THAT OFFERS BOTH SKILLED NURSING CARE AND NURSING CARE. SCCH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE. MSHA IS INTEGRATED BOTH VERTICALLY AND HORIZONTALLY AND IS THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. SCCH SERVES AS THE COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM SCCH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS. REPORTS FILED WITH STATES PART VI, LINE 7 VA 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 ANN FLEMING 0 345309 0 116778 0 39233 0 47553 0 19175 0 568048 0 0 CINDY SALYER 0 179125 0 58693 0 4076 0 20647 0 22306 0 284847 0 0 JOHN SCHARIO 0 151737 0 0 0 30182 0 15358 0 9534 0 206811 0 0 LINDA WHITE 0 181225 0 54962 0 12457 0 20600 0 18563 0 287807 0 0 JOHN JETER 0 128011 0 7225 0 6041 0 3955 0 17017 0 162249 0 0 MATTHEW JUSTUS 0 204637 0 0 0 0 0 4822 0 522 0 209981 0 0 PAMELA DELOACH 0 188287 0 500 0 0 0 6324 0 8994 0 204105 0 0 SAMUEL SMALL 0 174850 0 250 0 0 0 5314 0 7127 0 187541 0 0 ANTONIO DE LA ROSA 0 126514 0 0 0 21863 0 7761 0 13326 0 169464 0 0 BELDON FLEMING 0 136781 0 1575 0 0 0 7010 0 16288 0 161654 0 0 PART I, LINE 1A FIRST-CLASS OR CHARTER TRAVEL IS NOT A COVERED TRAVEL EXPENSE FOR EXECUTIVES; THEY ARE LIMITED TO BUSINESS OR COACH CLASS FARES ON COMMERCIAL FLIGHTS. PART I, LINE 4B PART I, LINE 4B: SEVERANCE NON-QUALIFIED EQUITY-BASED ANN FLEMING 0 35,303 0 CINDY SALYER 0 9,411 0 JOHN SCHARIO 0 15,358 0 LINDA WHITE 0 9,364 0 THE ABOVE INDIVIDUALS PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE 457(F) PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE." IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON" OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24 MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3 CEO SALARY AND BENEFITS ARE SUBJECT TO THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) COMPENSATION COMMITTEE PROCESS, WHEREBY THE MSHA CEO RECOMMENDS THE SALARY AND IT IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE, BASED UPON MARKET DATA MADE AVAILABLE BY THIRD PARTY CONSULTANTS. THE COMPENSATION COMMITTEE HAS FINAL APPROVAL OF MSHA'S CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR THE SCCH CEO AND ALL OTHER EXECUTIVES WITHIN MSHA. BETTY KIRK FAMILY MEMBER OF JIM BEAR 76057 JIM BEAR, SCCH BOARD TREASURER, IS A FAMILY MEMBER OF BETTY KIRK, AN EMPLOYEE OF SCCH. 0 REBECCA SPARGER FAMILY MEMBER OF JAMES PATTERSON, M.D. 26495 JAMES PATTERSON, M.D., SCCH BOARD MEMBER, IS A FAMILY MEMBER OF REBECCA SPARGER, AN EMPLOYEE OF SCCH. 0 FORM 990, PART VI, SECTION A, LINE 6 MOUNTAIN STATES HEALTH ALLIANCE IS THE 80% MEMBER OF SMYTH COUNTY COMMUNITY HOSPITAL. SMYTH COUNTY COMMUNITY HOSPITAL FOUNDATION IS THE 20% MEMBER OF SMYTH COUNTY COMMUNITY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE SMYTH COUNTY COMMUNITY HOSPITAL CLASS IS ELECTED BY THE SMYTH COUNTY COMMUNITY HOSPITAL FOUNDATION BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT. FORM 990, PART VI, SECTION A, LINE 7B CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY, DAY TO DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990, WHICH WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, WAS REVIEWED BY FINANCIAL MANAGEMENT PRIOR TO FILING. COPIES OF THE RETURN WERE MADE AVAILABLE TO THE BOARD TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT PROVIDES THE POLICY AND CONFLICT OF INTEREST DISCLOSURE FORMS TO ALL COVERED PERSONS. EACH PERSON IS REQUIRED TO PROVIDE A COMPLETED DISCLOSURE FORM, NOTING ANY CONFLICTS OR ATTESTING THEY HAVE "NONE", AND RETURN THE FORMS TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND THEY ENGAGE IN A CONFLICTED TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A - COMPENSATION PROCESS FOR TOP OFFICIAL THE CEO COMPENSATION IS SUBJECT TO THE MSHA COMPENSATION COMMITTEE PROCESS, WHEREBY THE MSHA CEO RECOMMENDS THE SALARY AND IT IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE, BASED UPON MARKET DATA MADE AVAILABLE BY THIRD PARTY CONSULTANTS, JUST LIKE ANY OTHER MSHA EXECUTIVE BELOW THE MSHA CEO AND CFO LEVEL. LINE 15B - COMPENSATION PROCESS FOR OFFICERS THE BOARD ALSO APPROVES PAY AND BENEFITS FOR THE CFO. THE COMPENSATION COMMITTEE REVIEWS AND HAS FINAL APPROVAL OF CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR ALL OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY BASIS. TRUSTEE COMPENSATION: FORM 990, PART VII, SECTION A, HOSPITAL BOARD OF TRUSTEES MEMBERS ANN FLEMING, CHELSEA HAMANN, JOHN SCHARIO, CINDY SALYER, JIM PATTERSON, M.D., AND JIM MCDOWELL, M.D. HAVE FORM 990 REPORTABLE RELATED COMPENSATION DERIVED FROM SERVICES THEY PROVIDED TO RELATED ORGANIZATIONS. THEY DO NOT RECEIVE COMPENSATION FOR SERVICES AS HOSPITAL BOARD TRUSTEES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: WRITE-OFF OF INTERCOMPANY DEBT 5,086,979. CHANGE IN TEMP. RESTRICTED NET ASSETS 10,041. PARTNERSHIP INCOME NOT ON BOOKS -110,578. NET UNREALIZED LOSSES ON INVESTMENTS -1,012,082. PRIOR PERIOD ADJUSTMENTS 39,704. TOTAL TO FORM 990, PART XI, LINE 5: 4,014,064. 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