2012-11-14T16:13:24-06:00 2011-12-31 990 2011-01-01 540506331 ROCKINGHAM MEMORIAL HOSPITAL ROCK 5406891000 2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801 J MICHAEL BURRIS 5406891000 2012-11-14 2011 2016-02-24 21:20:13Z J MICHAEL BURRIS 2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801 388744871 0 X WWW.RMHONLINE.COM X 1908 VA NOT-FOR-PROFIT COMMUNITY HOSPITAL ORGANIZATION. 11 6 2728 418 0 0 2096638 8836589 308876991 357665123 -673912 3469884 7902021 4497165 318201738 374468761 69735 1295879 0 0 154281338 162513874 0 0 437201 182405058 189775805 336756131 353585558 -18554393 20883203 571441385 420450379 374877003 370823705 196564382 49626674 X OUR MISSION IS TO IMPROVE HEALTH AND PROMOTE WELLBEING AND TO BE AN INNOVATIVE, COMMUNITY-ORIENTED HEALTH CARE PROVIDER COMMITTED TO OFFERING ACCESSIBLE, PERSONALIZED, AND HIGH-QUALITY SERVICES IN A COST-EFFECTIVE MANNER.WE WILL WORK IN PARTNERSHIP WITH THE LOCAL MEDICAL COMMUNITY AND OTHER LOCAL AND REGIONAL HEALTH CARE RESOURCES TO ENSURE THAT NECESSARY HEALTH SERVICES ARE AVAILABLE TO ALL, REGARDLESS OF THEIR FINANCIAL STATUS. WITH OUT PARTNERS, WE WILL SEEK TO ENHANCE THE HEALTH STATUS OF THE COMMUNITY WE SERVE BY OFFERING AN APPROPRIATE RANGE OF SERVICES, INCLUDING SELECTED AREAS OF EXCELLENCE. WORKING WITH OUR LOCAL PHYSICIAN PARTNERS, WE WILL ACTIVELY PARTICIPATE IN THE FORMATION OF A LOCALLY CONTROLLED, INTEGRATED DELIVERY SYSTEM. IN OUR EFFORTS, WE WILL BE GUIDED BY THE SHARED VALUES, BELIEFS AND NEEDS OF OUR LOCAL COMMUNITY. 0 0 328389075 1295879 357665123 HOSPITAL SERVICES:THE HOSPITAL PROVIDES HIGH-QUALITY HEALTH CARE TO THE COMMUNITY BY OFFERING THE LATEST TECHNOLOGY AND THE BEST TECHNICAL EXPERTISE. THE HOSPITAL SERVES A SEVEN-COUNTY AREA WITH A POPULATION OF CLOSE TO 200,000 ADMITTING MORE THAN 16,300 INPATIENTS AND DELIVERING CLOSE TO 1,700 BABIES PER YEAR. THE HOSPITAL IS LICENSED AS A 238-BED HOSPITAL AND PROVIDES AN APPROPRIATE ARRAY OF REGIONAL COMMUNITY HOSPITAL SERVICES INCLUDING ONCOLOGY, CARDIOLOGY INCLUDING CARDIAC SURGERY, BEHAVIORAL HEALTH, OBSTETRICS AND WOMEN'S SERVICES, OUTPATIENT AND INPATIENT SURGERY, SLEEP MEDICINE, EMERGENCY CARE, SENIOR SERVICES, HOME AND HOSPICE CARE, PHYSICIAN PRACTICES AND A VARIETY OF OTHER OUTPATIENT SERVICES AS WELL AS EDUCATION AND OUTREACH. THE HOSPITAL IS HOME TO SCHOOLS OF RADIOLOGICAL TECHNOLOGY AND MEDICAL TECHNOLOGY. ALONG WITH TRADITIONAL HEALTH SERVICES, THE HOSPITAL MAKES ITS RESOURCES AVAILABLE TO SUPPORT MANY COMMUNITY HEALTH INITIATIVES AND PROGRAMS.IN 2011, THE HOSPITAL RECORDED 16,363 ADMISSIONS (INCLUDING NEWBORNS), 357,412 OUTPATIENT VISITS, 72,699 EMERGENCY DEPARTMENT VISITS, 191,985 REGISTERED OUTPATIENTS (LAB AND X-RAY), 7,440 CHEMOTHERAPY THERAPY VISITS, 6,963 RADIATION THERAPY TREATMENTS AND 18,576 SURGERY PATIENTS. 738960 FREE CLINIC:PROVIDES VOLUNTEER OUTPATIENT HEALTHCARE SERVICES TO THE UNINSURED IN A MANNER THAT PROMOTES DIGNITY, WHOLENESS, AND COORDINATION OF SERVICES WITH PRIORITY GIVEN TO WORKING PEOPLE WHOSE INCOME IS UNDER 175% OF FEDERAL POVERTY LEVEL. IN 2011, THE FREE CLINIC RECORDED APPROXIMATELY 20,000 PATIENT VISITS. 229692 HEALTHY FAMILIES OF BLUE RIDGE AND HAND-IN-HAND RESOURCES FOR MOTHERS:HEALTHY FAMILIES OF BLUE RIDGE IS A HOME VISITATION PROGRAM TARGETING HIGH-RISK FIRST TIME FAMILIES WHO VOLUNTARILY AGREE TO PARTICIPATE IN ONGOING HOME VISITS UNTIL THE CHILD IS FIVE YEARS OLD. HAND-IN-HAND IS A MENTORING PROGRAM FOR PREGNANT AND PARENTING TEENS AGE 19 AND YOUNGER. THE PROGRAM FOCUSES ON HELPING TEENS KEEP MEDICAL APPOINTMENTS, REMAIN IN SCHOOL, DEVELOP PLANS FOR BABY'S CARE, DELAY REPEAT PREGNANCIES UNTIL ADULTHOOD AND SOLVE THE DAILY CHALLENGES OF BEING A NEW PARENT. 1079472 COMMUNITY HEALTH EDUCATION AND AWARENESS PROGRAM:INCLUDES STRONG FAMILIES/GREAT YOUTH, PEAS, AND SAFE KIDS. AS A PARTNER IN THE STRONG FAMILIES/GREAT YOUTH COALITION, RMH WORKS WITH THE COALITION TO REDUCE RISK FACTORS AND INCREASE PROTECTIVE FACTORS IN YOUTH UNDER THE AGE OF 18 IN THE HARRISONBURG-ROCKINGHAM COMMUNITY. AREAS OF FOCUS INCLUDE REDUCING SUBSTANCE ABUSE, UNINTENTIONAL INJURY, TEEN PREGNANCY, AND VIOLENCE, INCREASING SCHOOL ATTENDANCE, AND INCREASING ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT IN YOUTH. THROUGH THE PARENTING EDUCATION AND SUPPORT (PEAS) PROGRAM, RMH OFFERED A SERIES OF CLASSES TO ADULTS INCLUDING THE INCREDIBLE YEARS, ALL ABOUT BABY, AND STAYING CONNECTED WITH YOUR TEEN IN BOTH ENGLISH AND SPANISH.EXPENSES $ 124,362. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTHQUEST:A FREE QUARTERLY HEALTH AND WELLNESS PUBLICATION THAT THE HOSPITAL PRODUCES TO HIGHLIGHT THE PRINCIPLES OF HEALTHY LIFESTYLE CHOICES, PREVENTATIVE CARE AND EARLY DETECTION AND SCREENING. IT ALSO FEATURES MEMBERS OF THE HOSPITAL MEDICAL AND CLINICAL STAFF, AND SERVES TO MARKET OUR PROGRAMS AND SERVICES. THE MAGAZINE IS MAILED PRIMARILY TO PEOPLE IN OUR LARGER SERVICE AREA AND IN 2011 THERE WERE MORE THAN 36,000 DISTRIBUTIONS.EXPENSES $ 223,154. INCLUDING GRANTS OF $ 0. REVENUE $ 0.CHILD CARE CONNECTION:A RESOURCE AND REFERRAL CENTER FOR CHILDCARE PROVIDERS AND PARENTS. THIS PROGRAM ENHANCES THE QUALITY OF CHILDCARE BY PROVIDING EDUCATION AND EDUCATIONAL MATERIALS, ALONG WITH TOYS AND GAMES RELATED TO SAFE, NURTURING CHILDCARE. IT ALSO SUPPORTS INCREASING THE QUANTITY AND QUALITY OF PROVIDERS IN THE AREA BY OFFERING CONSULTATION AND EDUCATION ON STARTING A CHILDCARE BUSINESS. CHILDCARE CONNECTION HAS CREATED A COORDINATED SYSTEM OF CHILDCARE WITH A CUSTOMIZABLE DATABASE OF CHILDCARE PROVIDERS THAT CAN BE ACCESSED BY PARENTS.EXPENSES $ 114,846. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTHSOURCE:PHYSICIAN REFERRAL, HEALTH INFORMATION AND CLASS REGISTRATION ARE PROVIDED FREE TO THE PUBLIC, ALONG WITH ASSISTANCE FOR COMMUNITY AND CORPORATE HEALTHCARE EVENTS.EXPENSES $ 33,825. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTH SCREENINGS:NUMEROUS FREE HEALTH SCREENINGS, SUCH AS SKIN CANCER, PROSTATE CANCER, CHOLESTEROL AND BLOOD GLUCOSE ARE OFFERED TO RESIDENTS AT LOCAL HEALTH FAIRS AND COMMUNITY EVENTS WITH WIDE-SPREAD PARTICIPATION.EXPENSES $ 16,129. INCLUDING GRANTS OF $ 0. REVENUE $ 0.FOUNDATION:GRANTS THROUGH THE RMH FOUNDATION SUPPORT INITIATIVES THAT WILL HAVE A POSITIVE IMPACT ON THE OVERALL HEALTH OF OUR COMMUNITY. EXPENSES $ 62,944. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTH SCIENCE LIBRARY:THE VIRGINIA FUNKHOUSER HEALTH SCIENCE LIBRARY IS A BIOMEDICAL REFERENCE SERVICE FOR HOSPITAL STAFF AND THE SURROUNDING COMMUNITY.EXPENSES $ 64,254. INCLUDING GRANTS OF $ 0. REVENUE $ 0.LIFE LINE:LIFELINE IS AN EMERGENCY RESPONSE SYSTEM THAT ENABLES THOSE WITH SAFETY ISSUES TO REMAIN INDEPENDENT AND IN THEIR OWN HOMES FOR AS LONG AS POSSIBLE.EXPENSES $ 13,735. INCLUDING GRANTS OF $ 0. REVENUE $ 0.MISCELLANEOUS PROGRAM SERVICES:IN ADDITION TO THE PROGRAM SERVICES HIGHLIGHTED ABOVE, THE HOSPITAL SUPPORTS VARIOUS OTHER PROGRAMS FOR THE BENEFIT OF THE COMMUNITY INCLUDING BUT NOT LIMITED TO GRIEF SUPPORT, FAMILY FAIR, WOMEN'S HEALTH EDUCATION, AND SENIOR ADVANTAGE.EXPENSES $ 426,223. INCLUDING GRANTS OF $ 0. REVENUE $ 0.TOTAL OTHER PROGRAM SERVICES, FORM 990, PAGE 2, LINE 4D 1079472 330437199 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 X 292 0 1 2728 1 0 1 CJ 0 0 0 0 0 0 0 0 X 11 6 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 VA X CORPORATE OFFICERS 5406891245 2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 228018679 X ANN E C HOMAN 2.00 X X 0 0 0 HOWARD P KERN 2.00 X X 0 1612156 910858 JAMES R MESSNER 2.00 X X 0 0 0 BARBARA B STOLTZFUS 2.00 X X 0 0 0 W CARLTON BANKS 2.00 X 0 0 0 A JERRY BENSON 2.00 X 0 0 0 DAVID L BERND 2.00 X 0 3838264 743146 LAWRENCE D BOWERS JR 2.00 X 0 0 0 MENSEL D DEAN JR 2.00 X X 0 0 0 DOUGLAS G DRIVER 2.00 X 0 0 0 JOSEPH K FUNKHOUSER II 2.00 X 0 0 0 C WAYNE GATES MD 2.00 X 0 0 0 ALDEN L HOSTETTER 2.00 X 0 0 0 ELMER E KENNEL 2.00 X 0 0 0 KENNETH M KRAKAUR 2.00 X 0 1003009 184819 ALLON H LEFEVER 2.00 X 0 0 0 W NEAL MENEFEE 2.00 X 0 0 0 GEORGE W PACE 2.00 X 0 0 0 STEWART G POLLOCK MD 2.00 X 0 0 0 MICHAEL R KING 40.00 X 336324 0 80969 JAMES D KRAUSS 40.00 X 633239 0 121323 DALE A CARROLL 40.00 X 438843 0 138738 DONNA HAHN 40.00 X 216425 0 69831 KATHERINE HARRISON 40.00 X 185200 0 77903 RICHARD L HAUSHALTER 40.00 X 390301 0 123361 JOHN MCGOWAN 40.00 X 319133 0 39504 P RICHARD PIERCE 40.00 X 248120 0 178018 MICHAEL ROZMUS 40.00 X 231994 0 94193 MERV WEBB 40.00 X 201746 0 137694 MARK ZIMMERMAN 40.00 X 245048 0 108431 WILLIAM LENNEN MD 40.00 X 768602 0 30476 STEVEN MARRA MD 40.00 X 694743 0 42088 OLUMIDE DANISA MD 40.00 X 531692 0 28177 THOMAS WEBER MD 40.00 X 512310 0 35792 HEIDI GORSUCH-RAFFERTY MD 40.00 X 493248 0 41859 6446968 6453429 3187180 156 0 1 0 AMERISOURCE BERGEN - RICHMOND PO BOX 5188 NEW YORK NY 100875188 PHARMACEUTICAL SVCS 20462479 HARRISONBURG MEDICAL ASSOCIATES 1871 EVELYN BYRD AVE HARRISONBURG VA 22801 MEDICAL SERVICES 13439422 HARRISONBURG PHYSICIANS ANETHESIOLOGY 1840 EAST MARKET ST HARRISONBURG VA 22801 MEDICAL SERVICES 8873556 SHENANDOAH SHARED HOSPITAL SERVICES 304 NEFF AVE HARRISONBURG VA 22801 MEDICAL SERVICES 8288836 CARDINAL HEALTH MEDICAL PRODUCTS & SERVI PO BOX 905867 CHARLOTTE NC 282905867 MEDICAL SERVICES 5065227 184 780 889701 7946108 8836589 NET PATIENT SRVC REV 621300 354869169 354869169 OTHER PROGRAM SERVICES 621300 2795954 2795954 357665123 2890680 2890680 109079 32643 76436 76436 76436 13394707 1175810 13830258 161055 -435551 1014755 579204 579204 399762 252154 147608 147608 OTHER 900099 2187529 2187529 EQUITY ALLOCATIONS 900099 2060917 2060917 DIETARY SALES 722210 24675 24675 4273121 374468761 357665123 0 7967049 1217084 1217084 78795 78795 4616338 4616338 127891644 119093978 8574130 223536 8158255 7597049 545777 15429 13284379 12370547 890902 22930 8563258 7974191 574385 14682 683558 568512 115046 215854 215854 26474 26474 53022257 50781895 2240362 1849266 1436965 356932 55369 5583531 3724028 1769014 90489 4334442 3709579 621239 3624 5458298 5456897 1401 410955 410698 257 800012 677116 114847 8049 11606909 11606909 17707868 17547576 160292 4706928 4431794 275134 MEDICAL SUPPLIES 53575684 53575684 BAD DEBT PROVISION 26273144 26273144 PURCHASED & CONTRACTED 2146559 653051 1493315 193 DUES, BOOKS & SUBSCRIPT 632826 631854 972 741240 619853 120860 527 353585558 330437199 22711158 437201 61370294 70359781 23360811 3293228 2126632 40457298 41951342 3500102 99231 4136934 5699308 5181378 5381819 2964890 2845419 141978332 7596335 366608189 134381997 36492911 102534027 15048046 34711284 0 1326477 9027304 19033062 571441385 420450379 37442881 25085416 231376 198697 300160065 181613508 37042681 163926084 374877003 370823705 X 166691561 15932801 15126649 18960064 14746172 14733809 196564382 49626674 571441385 420450379 X 20883203 -167820911 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16176 16176 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL IS INVOLVED IN INDIRECT LOBBYING ACTIVITIES THROUGH PAYMENT OF MEMBERSHIP DUES TO THE FOLLOWING ORGANIZATIONS: VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION. 29171837 7634593 119000 3231557 33693873 31098549 1334949 2080749 5342410 29171837 29446900 1310621 3427364 3086336 31098549 36688003 2014074 -6513327 11000 2730850 29446900 0.43730 0.56270 0 0 11780878 11780878 38283997 561843 37722154 84367008 6813349 77553659 7546449 221143 7325306 134381997 AIG PRIVATE EQUITY PORTFOLIO 1440500 F AUSTIN CAPITAL SAFE HARBOR 557549 F CMS ENTREPRENEURIAL REAL ESTATE FUND IV 145099 F K2 HIGHLAND OVERSEAS FUND 12547783 F OCM PRINCIPLE OPPORTUNITIES FUND III 1952678 F SILVER CREEK LOW VOLATILITY STRATEGIES 3801954 F UBS TRUMBULL PROPERTY INCOME FUND 6637670 F WELLINGTON CTF MID CAP GROWTH PORTFOLIO 7628051 F 34711284 PAYABLE TO AFFILIATES 89853383 ANNUITIES PAYABLE 497788 MARK-TO-MARKET LIABILITY 867699 PENSION LIABILITY 35353103 DUE TO THIRD PARTIES 2301647 OTHER CURRENT LIABILITIES 8808477 OTHER NON-CURRENT LIABILITIES 26243987 163926084 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES JOINT VENTURE AGREEMENT WITH VIRGINIA SOLUTIONS SPC, LTD - INSURANCE CAPTIVE THAT UNDERWRITES HOSPITAL AND PHYSICIAN LIABILITY AND WORKERS COMPENSATION POLICIES FOR ITS MEMBER HOSPITALS. THE HOSPITAL HAS A 16.67% OWNERSHIP INTEREST IN THE CAPTIVE. CENTRAL AMERICA AND THE CARIBBEAN - INVESTMENTS 16907286 0 0 0 0 0 0 16907286 0 16907286 1 0 1 0 1 0 METHOD USED TO ACCCOUNT FOR EXPENDITURES: SCHEDULE F, PART I, LINE 3: EQUITY 1 1 0 0 1 1 0 1 0 10346151 10346151 0.03160 20327493 15390745 4936748 0.01510 30673644 15390745 15282899 0.04670 596772 596772 0.00180 1625179 628964 996215 0.00300 96278243 76901316 19376927 0.05920 2511384 2511384 0.00770 101011578 77530280 23481298 0.07170 131685222 92921025 38764197 0.11840 5570 5570 0.00000 7484 7484 0.00000 13054 13054 1 26273144 0 87719671 103221508 -15501837 X 1 1 1 1 ROCKINGHAM MEMORIAL HOSPITAL

2010 HEALTH CAMPUS DR HARRISONBURG VA 22801

X X X OTHER MENTAL HEALTH AND SUBSTANCE ABUSE ROCKINGHAM MEMORIAL HOSPITAL 1 1 0 0 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 16 MEDICAL OFFICE BLDG - PHYSIC PRACT

2006 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801

PHYSICIAN OFFICES - SPECIALTY PRACTICES WOMEN'S CENTER

530 NEFF AVE HARRISONBURG VA 22801

MAMMOGRAPHY SERVICES, BREAST SURGERY CLINIC RMH SOUTH MAIN HEALTH CENTER

1661 S MAIN STREET HARRISONBURG VA 22801

FAMILY PRACTICE RMH EAST ROCKINGHAM HEALTH CENTER

13737 SPOTSWOOD TRAIL ELKTON VA 22827

FAMILY PRACTICE, LEAB, REHAB SERVICES HOME HEALTH AND HOSPICE

411 STONE SPRING ROAD HARRISONBURG VA 22801

IN-HOME AND END-OF-LIFE CARE REHAB SERVICES - PAVILION

501 STONE SPRING ROAD HARRISONBURG VA 22801

OUTPATIENT PHYSICAN THERAPY SERVICES RMH CANCER CENTER

2008 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801

SPECIALTY PHYSICIAN OFFICES RMH VALLEY BEHAVIOR MEDICINE

644 UNIVERSITY BLVD HARRISONBURG VA 22801

MENTAL HEALTH SERVICES RMH SPRINGBROOK FAMILY MEDICINE

173 E SPRINGBROOK ROAD BROADWAY VA 22815

FAMILY MEDICINE RMH OCCUPATIONAL HEALTH CENTER

1790-64B E MARKET STREET HARRISONBURG VA 22801

OCCUPATIONAL MEDICINE RMH LURAY HEALTH CENTER

135 GENERAL DRIVE LURAY VA 22835

FAMILY PRACTICE RMH NEW MARKET HEALTH CENTER

9626 S CONGRESS ST NEW MARKET VA 22844

FAMILY PRACTICE RMH MOUNT JACKSON HEALTH CENTER

120 MEDICAL AVENUE MT JACKSON VA 22842

FAMILY PRACTICE BRIDGEWATER REHAB

302 N SECOND STREET BRIDGEWATER VA 22812

OUTPATIENT PHYSICAL THERAPY IMAGE RECOVERY CENTER

2989 S MAIN STREET HARRISONBURG VA 22801

SALON & MASSAGE SERVICES FOR CANCER PATIENTS RMH CENTER FOR SLEEP MEDICINE

640 SOUTH MAIN ST HARRISONBURG VA 22801

SLEEP STUDIES PART I, LINE 3C: AND PART V, SECTION B LINES 9&10:UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, UNINSURED INDIVIDUALS RECEIVING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE CHARGED NO MORE THAN AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. IN ADDITION, AN INDIVIDUAL WHOSE INCOME IS AT OR BELOW 400% OF THE FPG MAY BE ELIGIBLE FOR ADDITIONAL FINANCIAL ASSISTANCE. WHEN AN INDIVIDUAL SUBMITS A FINANCIAL ASSISTANCE APPLICATION, THE ORGANIZATION USES A MULTI-FACETED REVIEW OF AN APPLICANT'S SITUATION TO DETERMINE BOTH ELIGIBILITY FOR FREE OR ADDITIONAL DISCOUNTED CARE, AND THE LEVEL OF DISCOUNT PROVIDED. AMONG THE FACTORS TAKEN INTO CONSIDERATION ARE WHETHER THE INDIVIDUAL HAS HEALTH INSURANCE COVERAGE, THE AMOUNT OF ASSETS AVAILABLE TO CONTRIBUTE TOWARDS THE COST OF CARE, THE AMOUNT OF INCOME AVAILABLE TO CONTRIBUTE TOWARDS THE COST OF CARE, EITHER THE INDIVIDUAL HAD THE ABILITY TO PURCHASE HEALTH INSURANCE THROUGH AN EMPLOYER AND DECLINED TO DO SO OR HAD ELIGIBILITY THROUGH A GOVERNMENT PROGRAM AND FAILED TO APPLY, FAMILY SIZE, AND WHETHER THE INDIVIDUAL HAS A HEALTH CONDITION THAT IS REASONABLY EXPECTED TO RESULT IN THEM BECOMING A RECURRING PATIENT WHO WILL CONTINUE TO ACCUMULATE HEALTH CARE EXPENSES. THE PROGRAM PROVIDES A SLIDING SCALE AMOUNT BASED ON THE ABOVE FACTORS, WHICH IS CAPPED BY A "MAXIMUM OUT OF POCKET" LIMIT THAT ALSO FOLLOWS A SLIDING SCALE. THE OUT-OF-POCKET MINIMUM COST FOR ALL FAP-ELIGIBLE INDIVIDUALS IS $25. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 26273144. PART I, LINE 7 A COST-TO-CHARGE RATIO, CALCULATED USING WORKSHEET 2, WAS USED TO CALCULATE COSTS REPORTED IN LINES 7A AND 7B. FOR LINE 7G, A DEPARTMENT COST-TO-CHARGE RATIO WAS CALCULATED FOR EACH SUBSIDIZED HEALTH SERVICE. PART I, LINE 7G $14,569,536 OF THE AMOUNT REPORTED IN COLUMN (E) IS ATTRIBUTABLE TO PHYSICIAN CLINICS. PART II: COMMUNITY BUILDING ACTIVITIES --COMMUNITY SUPPORT: RMH LEADERS SERVE ON VARIOUS COMMUNITY BOARDS BECAUSE OF THEIR ROLES AT RMH, INCLUDING THE HARRISONBURG COMMUNITY HEALTH CENTER, THE HARRISONBURG-ROCKINGHAM FREE CLINIC, THE COLLINS CENTER, THE MARCH OF DIMES, THE CENTER FOR MARRIAGE AND FAMILY COUNSELING, AND GENERATIONS CROSSING.--COALITION BUILDING: RMH STAFF PARTICIPATE ON VARIOUS LOCAL COALITIONS (INCLUDING STRONG FAMILIES GREAT YOUTH COALITION, WOMEN'S AND GIRL'S HEALTH COALITION, HEALTHY COMMUNITY COUNCIL STEERING COMMITTEE, SMART BEGINNINGS HARRISONBURG-ROCKINGHAM, SMART BEGINNINGS STAUNTON-AUGUSTA-WAYNESBORO, AND SEASONS PLUS) AS PART OF THEIR ROLES AT RMH. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. BALANCES NOT PAID WITHIN 30 DAYS ARE CONSIDERED PAST DUE. BALANCES ARE CONSIDERED DELINQUENT WHEN THEY ARE OUTSTANDING FOR 120 DAYS WITH NO ACTIVITY AT WHICH TIME THE BALANCES ARE TRANSFERRED TO A COLLECTION AGENCY AND THE BALANCE IS MOVED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENTS' EVALUATION OF THE COMPONENTS OF ACCOUNTS RECEIVABLE. PART III, LINE 8: INTERNAL COST ACCOUNTING CALCULATIONS WERE USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE WILL HAVE THEIR BALANCES DISCOUNTED BY THE APPLICABLE RATE AND ANY REMAINING BALANCES WILL BE BILLED TO THEM. THE COLLECTION PRACTICES OF STATEMENTS, LETTERS, PHONE CALLS, REFERRAL TO THIRD PARTY COLLECTION AGENCIES, ETC. ARE THE SAME FOR ALL PATIENTS WITH A BALANCE DUE. IF DURING A CALL THE PATIENT ASKS FOR FINANCIAL ASSISTANCE, AN APPLICATION IS MAILED TO THEM. THE ORGANIZATION DID NOT IMPOSE COLLECTION ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT WAS ELIGIBLE FOR FINANCIAL ASSISTANCE. ROCKINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 9: SEE EXPLANATION FOR PART I, LINE 3C ROCKINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 10: SEE EXPLANATION FOR PART I, LINE 3C ROCKINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 13G: NOTICES OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THE CONTACT INFORMATION FOR MORE INFORMATION OR TO APPLY IS POSTED ON THE HOSPITAL'S WEB SITE, POSTED IN ALL WAITING ROOMS AND REGISTRATION AREAS, AND ON ALL PATIENT BILLING STATEMENTS. PART VI, LINE 2 THE HEALTH OF THE RESIDENTS OF HARRISONBURG AND ROCKINGHAM COUNTY IS ASSESSED EVERY FIVE YEARS FOR ADULTS AND SENIORS AND EVERY TWO YEARS FOR YOUTH. THESE ASSESSMENTS ARE COMPLETED BY THE HEALTHY COMMUNITY COUNCIL, A PARTNERSHIP INCLUDING RMH AS WELL AS REPRESENTATIVES FROM GOVERNMENT, SCHOOLS, BUSINESS, HIGHER EDUCATION, HEALTH AND HUMAN SERVICES, FAITH COMMUNITY, LAW ENFORCEMENT, AND MEDIA. PART VI, LINE 3 THE HOSPITAL HAS POSTED INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY IN EACH REGISTRATION AND EATING AREA. BILLING STATEMENTS AND THE WEBSITE HAVE INSTRUCTIONS AND PHONE NUMBERS LISTED FOR ALL PATIENTS WHO MAY BE HAVING DIFFICULTY PAYING BILLS. SELF PAY PATIENTS ARE SCREENED IN PERSON TO DETERMINE IF THEY QUALIFY FOR FEDERAL OR STATE PROGRAMS THAT MAY OFFER INSURANCE. PATIENTS ARE ALSO SCREENED FOR AND GIVEN THE OPPORTUNITY TO APPLY FOR RMH FINANCIAL ASSISTANCE. THE HOSPITAL USES AN OUTSIDE VENDOR THAT SCREENS ALL PATIENTS WITHOUT INSURANCE FOR ELIGIBILITY FOR GOVERNMENT PROGRAMS, AND A FINANCIAL COUNSELOR WHO SCREENS THOSE THAT ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAMS TO DETERMINE WHETHER THEY MEET CRITERIA FOR CHARITY CARE. PART VI, LINE 4 THE HARRISONBURG-ROCKINGHAM COUNTY AREA COVERS 871 SQUARE MILES OF LAND AND IS HOME TO ABOUT 111,000 PEOPLE. THE MEDIAN AGE IS 32 YEARS WITH 22 PERCENT OF THE POPULATION FALLING UNDER THE AGE OF 18 AND 12 PERCENT OVER AGE 65. RMH IS A SOLE COMMUNITY HOSPITAL IN THE HARRISONBURG - ROCKINGHAM COUNTY AREA. THE AREA IS CONSIDERED RURAL. COMMUNITIES. PART VI, LINE 5 THE ORGANIZATION HAS A COMMUNITY-BASED BOARD COMPRISED OF A MAJORITY OF MEMBERS WHO ARE NEITHER EMPLOYEES, CONTRACTORS, NOR FAMILY MEMBERS THEREOF.GENERALLY, MEDICAL STAFF MEMBERSHIP IS OPEN TO ALL CARE PROVIDERS WHO MAY QUALIFY. THE ORGANIZATION'S SURPLUS FUNDS ARE USED FOR IMPROVEMENTS IN PATIENT CARE, PROVISION OF SERVICES TO THE UNINSURED AND UNDERINSURED, MEDICAL EDUCATION, AND COMMUNITY PROGRAMS. PART VI, LINE 6 IN A MOVE TO INCREASE ITS ABILITY TO PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES TO PATIENTS, THE ORGANIZATION AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM ("SENTARA") EFFECTIVE MAY 1, 2011. SENTARA, A NOT-FOR-PROFIT HEALTH SYSTEM, OPERATES MORE THAN 100 SITES OF CARE SERVING RESIDENTS ACROSS VIRGINIA AND NORTHEASTERN NORTH CAROLINA. THE SYSTEM IS COMPRISED OF 10 ACUTE CARE HOSPITALS, INCLUDING SEVEN IN HAMPTON ROADS, ONE IN NORTHERN VIRGINIA AND TWO IN THE BLUE RIDGE REGION, ADVANCED IMAGING CENTERS, NURSING AND ASSISTED-LIVING CENTERS, OUTPATIENT CAMPUSES, TWO HOME HEALTH AND HOSPICE AGENCIES, A 3,680-PROVIDER MEDICAL STAFF, AND THREE MEDICAL GROUPS WITH 618 PROVIDERS.THE ORGANIZATION, ALONG WITH ITS SUBSIDIARIES, HAS JOINED WITH SENTARA IN ORDER TO ENHANCE ITS ABILITY TO ACHIEVE BEST PRACTICES IN HEALTHCARE DELIVERY; ACQUIRE CUTTING EDGE TECHNOLOGY AND INTEGRATED INFORMATION SYSTEMS; AND PROVIDE A HIGHER LEVEL OF MEDICAL CARE TO VIRGINIA'S BLUE RIDGE REGION COMMUNITY. COMBINED, THESE ATTRIBUTES BETTER POSITION THE ORGANIZATION TO ADDRESS HEALTH CARE REFORM AND OTHER PROFOUND CHANGES AFFECTING THE HEALTHCARE ENVIRONMENT. 1 GENERATIONS CROSSING 3765 TAYLOR SPRING LANE HARRISONBURG VA 22801 542061192 501(C)(3) 7500 SCHOLARSHIPS FOR DAY CAER FOR ELDERLY AND DISABLED ADULTS BLUE RIDGE AREA HEALTH EDUCATION CENTER MSC 9009 JAMES MADISON UNIVERSITY HARRISONBURG VA 22807 546001756 501(C)(3) 14725 BEHAVIORAL HEALTH PROJECT FOR NON-ENGLISH SPEAKING POPULATION IN THE COMMUNITY OUR COMMUNITY PLACE 17 E JOHNSON STREET HARRISONBURG VA 22802 541835664 501(C)(3) 8090 HEALTH INITIATIVE FOR THOSE INDIVIDUALS WHO FIND OCP THEIR HOME AND COMMUNITY INSTITUTE OF HEALTH & HUMAN SERVICES MSC 9009 JAMES MADISON UNIVERSITY HARRISONBURG VA 22807 546001756 501(C)(3) 15000 HEALTHCARE FOR HOMELESS SUITCASE CLINIC HARRISONBURG COMMUNITY HEALTH CENTER 563 A NEFF AVE HARRISONBURG VA 22801 020813294 501(C)(3) 500000 HEALTHCARE FOR INDIGENTS HARRISONBURG ROCKINGHAM FREE CLINIC 25 WEST WATER STREET HARRISONBURG VA 22801 541568909 501(C)(3) 500000 HEALTHCARE FOR INDIGENTS EASTERN MENNONITE UNIVERSITY 1200 PARK ROAD HARRISONBURG VA 22802 540575812 501(C)(3) 10000 SPONSORSHIP 7 0 EMPLOYEE RELIEF FUND 38 47210 PATIENT MEDICAL EXPENSES 52 12212 FITNESS CENTER SCHOLARSHIPS 136 7873 SCHOLARSHIPS 11 11500 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ROCKINGHAM MEMORIAL HOSPITAL HAS A CAREFUL SCREENING PROCESS IN REVIEWING GRANT APPLICANTS. THE APPLICATIONS ARE FIRST REVIEWED BY A SMALL COMMITTEE USING ESTABLISHED CRITERIA SUCH AS 1) WHAT COMMUNITY NEED IS BEING ADDRESSED, 2) THE ROLE OF PARTNERS IN THE INITIATIVE, 3) AN ACTION PLAN WITH SPECIFIC ACTIVITIES, 4) MEASURABLE GOALS OR OUTCOMES, 5) BUDGET, AND 6) SUSTAINABILITY FOR THE PROJECT IN THE FUTURE. IF AWARDED THE GRANT, THE APPLICANT IS REQUIRED TO SUBMIT A WRITTEN REPORT OF THE OUTCOME WITHIN 12 MONTHS. NO GRANTS ARE MADE OUTSIDE OF THE UNITED STATES. SCHEDULE I, PART III -THE EMPLOYEE RELIEF FUND PROVIDES ASSITANCE TO EMPLOYEES WITH FINANCIAL NEED. -PATIENT MEDICAL EXPENSES IS THE PAYMENT OF MEDICAL COSTS FOR INDIGENT PATIENTS. -FITNESS CENTER SCHOLARSHIPS ARE SCHOLARSHIPS AWARDED TO INDIVUALS WHO HAVE AN IDENTIFIED MEDICAL NEED REQUIRING ONGOING PARTICIPATION IN AN EXERCISE PROGRAM. -SCHOLARSHIPS ARE AWARDED TO NURSING STUDENTS WITH FINANCIAL NEED. X 1 1 X X X X X X 1 1 0 0 0 0 0 1 0 HOWARD P KERN 0 726289 0 868885 0 16982 0 888823 0 22035 0 2523014 0 0 DAVID L BERND 0 1060556 0 1541673 0 1236035 0 718589 0 24557 0 4581410 0 0 KENNETH M KRAKAUR 0 453890 0 457834 0 91285 0 159233 0 25586 0 1187828 0 7755 MICHAEL R KING 252679 0 29700 0 53945 0 54859 0 26110 0 417293 0 0 0 JAMES D KRAUSS 480386 0 41400 0 111453 0 94814 0 26509 0 754562 0 0 0 DALE A CARROLL 345791 0 42462 0 50590 0 110239 0 28499 0 577581 0 0 0 DONNA HAHN 180899 0 27360 0 8166 0 45111 0 24720 0 286256 0 0 0 KATHERINE HARRISON 153088 0 23792 0 8320 0 62786 0 15117 0 263103 0 0 0 RICHARD L HAUSHALTER 294714 0 34572 0 61015 0 100569 0 22792 0 513662 0 0 0 JOHN MCGOWAN 284229 0 33320 0 1584 0 14700 0 24804 0 358637 0 0 0 P RICHARD PIERCE 71427 0 30764 0 145929 0 170141 0 7877 0 426138 0 0 0 MICHAEL ROZMUS 196682 0 29268 0 6044 0 66645 0 27548 0 326187 0 0 0 MERV WEBB 173943 0 26448 0 1355 0 116976 0 20718 0 339440 0 0 0 MARK ZIMMERMAN 202927 0 31537 0 10584 0 85682 0 22749 0 353479 0 0 0 WILLIAM LENNEN MD 529283 0 150099 0 89220 0 7350 0 23126 0 799078 0 0 0 STEVEN MARRA MD 652519 0 17100 0 25124 0 14700 0 27388 0 736831 0 0 0 OLUMIDE DANISA MD 489476 0 31856 0 10360 0 14700 0 13477 0 559869 0 0 0 THOMAS WEBER MD 247403 0 249012 0 15895 0 14700 0 21092 0 548102 0 0 0 HEIDI GORSUCH-RAFFERTY MD 334203 0 138607 0 20438 0 14700 0 27159 0 535107 0 0 0 PART I, LINE 1A PART I, LINE 1A: MEMBERSHIP TO VALLEY WELLNESS CENTER, A RELATED 501(C)(3) ORGANIZATION WAS PROVIDED AT REDUCED RATES. THIS BENEFIT IS AVAILABLE TO ALL ORGANIZATION'S EMPLOYEES. PART I, LINES 4A-B RECEIVED SEVERANCE PAYMENT AND/OR SUPPLEMENTAL NQ RETIREMENT P. RICHARD PIERCE, VICE PRESIDENT THROUGH 4/2011, RECEIVED $128,436 IN COMPENSATION RELATED TO HIS SEPARATION FROM SERVICE. THIS AMOUNT HAS BEEN INCLUDED IN COLUMN (B)(III) OF SCHEDULE J, PART II. HOWARD KERN PARTICIPATES IN THE SENTARA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. PARTICIPATION IN THE PLAN IS LIMITED TO SELECT INDIVIDUALS AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. THE PLAN IS CURRENTLY CLOSED TO ADDITIONAL MEMBERS. VESTING OCCURS UPON THE COMPLETION OF A TWO YEAR NON-COMPETE PERIOD FOLLOWING TERMINATION AFTER EARLY RETIREMENT DATE OR UPON DEATH. EARLY RETIREMENT DATE IS WHEN THE EXECUTIVE OBTAINS AT LEAST AGE 55 AND HAS 10 YEARS OF SERVICE AND BENEFITS ARE FORFEITED IF PARTICIPANT LEAVES PRIOR TO AGE 55 WITH 10 YEARS OF SERVICE. DAVID BERND PARTICIPATES IN AN INDIVIDUAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN SPONSORED BY SENTARA. VESTING OCCURS EACH DECEMBER 31 AND THE PRESENT VALUE OF THE ADDITIONAL ACCRUAL IS DISTRIBUTED IN A TAXABLE LUMP SUM. FOR 2011, MR. BERND RECEIVED A TOTAL LUMP SUM DISTRIBUTION OF $1,192,399. THIS AMOUNT HAS BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J, PART II. DAVID BERND AND HOWARD KERN PARTICIPATE IN THE SENTARA OPTION PLAN FOR EXECUTIVES. THIS PLAN IS UNRELATED TO "EQUITY" OF THE EMPLOYER. PARTICIPATION IS LIMITED TO SELECT INDIVIDUALS AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. VESTING IS DETERMINED BY THE GOVERNING BOARD OF SENTARA HEALTHCARE AND IS SEPARATELY STATED IN EACH PARTICIPANT'S OPTION AGREEMENT. THERE WERE NO OPTIONS GRANTED AFTER 2002. DAVID BERND, HOWARD KERN AND KENNETH KRAKAUR PARTICIPATE IN THE SENTARA CAPITAL ACCUMULATION ACCOUNT PLAN. PARTICIPATION IS LIMITED TO A SELECT GROUP OF CORPORATE EXECUTIVES AS APPROVED BY SENTARA HEALTHCARE'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 2011, KENNETH KRAKAUR RECEIVED VESTED DISTRIBUTIONS OF $71,345 UNDER THE PLAN. THIS AMOUNT HAS BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J, PART II. SENTARA HEALTHCARE OWNED A SPOUSAL SURVIVOR SPLIT-DOLLAR LIFE INSURANCE POLICY FOR KENNETH KRAKAUR. THE SPLIT DOLLAR PLAN PROVIDES FOR TRANSFER OF THE POLICY TO THE PARTICIPANT UPON CERTAIN EVENTS. AT TRANSFER (OR THE PARTICIPANT'S DEATH), THE ORGANIZATION RECOVERS THE PREMIUMS THAT IT HAS PAID. DURING 2011, THE SPOUSAL SURVIVOR SPLIT-DOLLAR LIFE INSURANCE POLICY FOR KENNETH KRAKAUR WAS SURRENDERED. THE POLICY VALUE REMAINING AFTER REDUCTION FOR CORPORATE RECOVERY OF PREMIUMS AND AFTER TAX ART AMOUNTS WAS $10,147. THIS AMOUNT WAS TREATED AS ADDITIONAL TAXABLE COMPENSATION AND HAVE BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J PART II. JAMES KRAUSS, DALE CARROLL, RICHARD HAUSHALTER AND MIKE KING PARTICIPATE IN THE ORGANIZATION'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. PARTICIPATION IS LIMITED TO THE CEO, CMO, COO, AND CFO POSITIONS. THE PLAN IS A DEFINED CONTRIBUTION PLAN WITH ANNUAL CONTRIBUTIONS EQUAL TO A FIXED PERCENT OF TOTAL COMPENSATION. THE FIXED PERCENT IS SET AT PLAN ENTRY AND NEVER ADJUSTED REGARDLESS OF WHETHER OR NOT ASSUMPTIONS ARE REALIZED. CONTRIBUTIONS ARE MADE AT THE END OF THE PLAN YEAR TO ACTIVE EXECUTIVES (NOT PAID IF SEPARATION OF SERVICE DURING YEAR.) DURING 2011, DISTRIBUTIONS UNDER THE PLAN WERE AS FOLLOWS: JAMES KRAUSS ($95,266); DALE CARROLL ($31,643); RICHARD HAUSHALTER (42,224); MIKE KING ($44,633). THESE AMOUNTS HAVE BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J, PART II. PART I, LINE 7 DURING 2011, THE ORGANIZATION MADE NON-FIXED PAYMENTS OF COMPENSATION UNDER THE FOLLOWING INCENTIVE PROGRAM: SHORT TERM INCENTIVE PLAN - EXECUTIVES AND SENIOR LEADERS ARE ELIGIBLE FOR ANNUAL AWARDS BASED ON SYSTEM AND INDIVIDUAL PERFORMANCE. INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VA 542000436 415669BN9 2006-12-28 196167653 FUND CONSTRUCTION OF NEW HOSPITAL FACILITY 0 0 0 INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VA 542000436 NONEAVAIL 2009-04-15 30000000 REFUNDED ISSUE DATED 4/4/2007 0 0 0 7117653 198951052 15036899 1336500 4253886 178323767 2011 0 0 1 1 10000000 30000000 30000000 2007 1 0 1 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 NA 0 0 1 JP MORGAN CHASE BANK 2.500000000000 1 0 0 0 1 1 SUNTRUST BANK 7.000000000000 1 0 0 0 1 X PART II, B, 1 $10M OF ORIGINAL REFUNDING ISSUE WAS NOTE SUBSTITUTED TO PARENT, SENTARA HEALTHCARE 52-1271901, IN 2011. THE NOTE IS REPORTED IN SENTARA'S 990, SCHEDULE K AS OF 12/31/2011. PART II, COLUMN A, LINE 3 TOTAL PROCEEDS OF THE BOND ISSUE = $190,000,000 PAR VALUE, $6,167,653 BOND PREMIUM, $11,069 EARNINGS ON THE INTEREST FUND AND $2,772,330 FROM EARNINGS ON DSRF. PART II, COLUMN A, LINE 4 GROSS PROCEEDS IN RESERVE INCLUDE $12,253,500 DEPOSITED INTO RESERVE ON CLOSING DATE PLUS $2,772,330 EARNINGS ON DSRF AND $11,069 EARNINGS ON INTEREST FUND. DR WILLIAM LENNEN HIGHEST COMPENS PHYS RECRUIT-INC GUAR X 150000 99231 0 0 1 99231 SHENANDOAH SHARED HOSPITAL SERVICES INC OVERLAP OF OFFICERS/DIRECTORS 8288836 CLINICAL SERVICES 0 PATHOLOGY ASSOCIATES OF HARRISONBURG >5%-OWNED BY DIRECTOR ALDEN HOSTETTER, M.D. 185232 PATHOLOGY SERVICES 0 HARRISONBURG MEDICAL ASSOCIATES >5%-OWNED BY DIRECTOR STEWART POLLACK, M.D. 13439422 PROFESSIONAL SERVICES 0 PAR-MED LLC >5%-OWNED BY DIRECTOR STEWART POLLACK, M.D. 360660 RENT EXPENSE 0 LANTZ CONSTRUCTION COMPANY >5%-OWNED BY DIRECTOR DOUGLAS DRIVER. 502268 CONSTRUCTION SERVICES 0 DIRECTORS/TRUSTEES/OFFICERS/KEY EMPLOYEES OF THE ORGANIZATION MAY ALSO SERVE AS DIRECTORS/TRUSTEES/OFFICERS OF RELATED TAXABLE ENTITIES WITHIN THE SENTARA HEALTHCARE SYSTEM. SEE SCHEDULE R FOR A LISTING OF TRANSACTIONS THE ORGANIZATION HAD WITH THESE RELATED TAXABLE ENTITIES. FORM 990, PART V, LINE 1A: FORM 1096 THE ORGANIZATION IS THE 501(C)(3) SOLE MEMBER OF ANOTHER 501(C)(3) ORGANIZATION FOR WHICH IT MAINTAINS AN AGENCY RELATIONSHIP AND ISSUES 1099S. THE NUMBER REPORTED IS A BEST ESTIMATE OF THE 1099S ATTRIBUTABLE TO THE ORGANIZATION. THE EXACT NUMBER CANNOT BE DETERMINED; AS SOME OF THE 1099S ISSUED BY THE ORGANIZATION ARE ATTRIBUTABLE TO MORE THAN ONE ENTITY, AND THERE IS NO REPORTING MECHANISM TO DETERMINE 1099S ATTRIBUTABLE SOLELY TO THE ORGANIZATION. FORM 990, PART I LINE 5 AND PART V LINE 2A THE ORGANIZATION IS THE 501(C)(3) SOLE MEMBER OF ANOTHER 501(C)(3) ORGANIZATION FOR WHICH IT ACTS AS COMMON PAY AGENT AND ISSUES ALL FORM W-2S. SINCE THE ORGANIZATION HAS NO REPORTING MECHANISM TO DETERMINE W-2S ATTRIBUTABLE SOLELY TO THE ORGANIZATION, THE NUMBER REPORTED APPROXIMATES THE NUMBER OF W-2S ISSUED BY THE ORGANIZATION ON ITS OWN BEHALF. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS OR FAMILY RELATIONSHIP OF OFFICERS, DIRECTORS, ETC. DAVID BERND AND HOWARD KERN HAVE A BUSINESS RELATIONSHIP THROUGH COMMON OWNERSHIP OF AN ENTITY UNRELATED TO THE ORGANIZATION. THE ORGANIZATION'S OFFICERS AND DIRECTORS SERVED TOGETHER ON THE BOARDS OF OTHER TAXABLE ORGANIZATIONS WITHIN THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), AS WELL AS JOINT VENTURES IN WHICH THE SYSTEM HAD AN OWNERSHIP INTEREST. SEE SCHEDULE R FOR A LISTING OF SUCH ENTITIES. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES MADE TO GOVERNING DOCUMENTS ON DECEMBER 6, 2010, THE ORGANIZATION ENTERED INTO AN AFFILIATION AGREEMENT WITH SENTARA HEALTHCARE, A 501(C)(3) ORGANIZATION ("SENTARA"), WHEREBY SENTARA REPLACED ROCKINGHAM HEALTH CARE, INC. ("RHC")AS SOLE MEMBER OF THE ORGANIZATION EFFECTIVE MAY 1, 2011. AS A RESULT OF THE AFFILIATION, THE ORGANIZING AND GOVERNING DOCUMENTS WERE CHANGED IN THE FOLLOWING MANNER: --RHC WAS REPLACED BY SENTARA AS SOLE MEMBER OF THE ORGANIZATION. --THE ORGANIZATION'S PURPOSE CLAUSE WAS EXPANDED TO INCLUDE THE PROVISION OF ANCILLARY AND RELATED MEDICAL AND OTHER HEALTHCARE SERVICES; THE PROVISION OF MANAGEMENT, ADVISORY, SERVICE ASSISTANCE AND OTHER SUPPORT TO HEALTH CARE ORGANIZATIONS HAVING THE SAME PURPOSES AS ITS OWN; AND THE ENGAGEMENT IN OTHER RELATED, EXCLUSIVELY CHARITABLE, SCIENTIFIC, EDUCATIONAL AND MEDICAL RESEARCH ACTIVITIES AS MAY BE AUTHORIZED FROM TIME TO TIME BY ITS BOARD OF DIRECTORS. --THE ELEVEN-TO EIGHTEEN-MEMBER BOARD OF DIRECTORS, WHICH WAS PREVIOUSLY SELECTED BY RHC, WAS REPLACED WITH A NINE-TO-ELEVEN MEMBER BOARD OF DIRECTORS COMPRISED OF TWO CLASSES: SIX-TO-EIGHT CLASS A DIRECTORS SELECTED BY THE ORGANIZATION'S NOMINATING COMMITTEE, AND THREE CLASS B DIRECTORS APPOINTED BY SENTARA. IN ADDITION, CLASS A DIRECTORS MUST BE SELECTED BY THE NOMINATING COMMITTEE FROM CURRENT MEMBERS OF RHC'S BOARD OF DIRECTORS; ELECTED BY A MAJORITY OF THE MEMBERS OF THE ORGANIZATION'S BOARD; AND RATIFIED BY SENTARA AS SOLE MEMBER. --SENTARA, AS SOLE MEMBER, HAS EXCLUSIVE AUTHORITY TO DIRECT AND MANAGE THE OPERATIONS AND AFFAIRS OF THE ORGANIZATION, SUBJECT TO BOARD OVERSIGHT TO THE EXTENT AND IN THE MANNER SET FORTH IN THE ORGANIZATION'S BYLAWS. THE BOARD OF DIRECTORS SHALL FUNCTION IN AN ADVISORY CAPACITY, PROVIDING RECOMMENDATIONS TO SENTARA REGARDING THE ESTABLISHMENT OF ORGANIZATION POLICIES, THE MAINTENANCE OF QUALITY PATIENT CARE, AND THE PROVISION OF INSTITUTIONAL PLANNING IN A MANNER RESPONSIVE TO LOCAL COMMUNITY NEEDS. --UPON ANY LIQUIDATION OR DISSOLUTION OF THE ORGANIZATION, ITS REMAINING ASSETS SHALL BE DISTRIBUTED TO SENTARA. --ORGANIZING OR ENABLING DOCUMENTS OR BYLAWS MAY BE AMENDED, RESTATED OR REPEALED THROUGH APPROVAL OF A MAJORITY OF THE ORGANIZATION'S BOARD, PROVIDED THAT A MAJORITY OF CLASS A DIRECTORS VOTE IN THE AFFIRMATIVE AND SUCH AMENDMENT, RESTATEMENT OR REPEAL IS APPROVED BY SENTARA. FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDERS THE ORGANIZATION HAD ONE CLASS OF MEMBER. EFFECTIVE MAY 1, 2011, THE SOLE MEMBER WAS SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION'S SOLE MEMBER PRIOR TO MAY 1, 2011, WAS ROCKINGHAM HEALTH CARE, INC., A VIRGINIA NONSTOCK CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION A, LINE 7A HOW MEMBERS OR SHAREHOLDERS ELECT GOVERNING BODY PRIOR TO THE ORGANIZATION'S AFFILIATION WITH SENTARA HEALTHCARE, BOARD MEMBERS WERE ELECTED BY ROCKINGHAM HEALTH CARE, INC., THE FORMER SOLE MEMBER OF THE ORGANIZATION. EFFECTIVE MAY 1, 2011, THE DATE OF AFFILIATION WITH SENTARA HEALTHCARE, CLASS B DIRECTORS OF THE ORGANIZATION ARE NOW APPOINTED BY SENTARA HEALTHCARE, THE 501(C)(3) SOLE MEMBER OF THE ORGANIZATION. THE SOLE MEMBER ALSO RATIFIES CLASS A DIRECTORS OF THE ORGANIZATION ONCE NOMINATED BY THE ORGANIZATION'S NOMINATING COMMITTEE AND ELECTED BY THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY APPROVAL BY MEMBERS OR SHAREHOLDERS THE ORGANIZATION MAY NOT TAKE OR ALLOW ANY OF THE FOLLOWING GOVERNANCE ACTIONS WITHOUT THE CONSENT OF ITS 501(C)(3) SOLE MEMBER, SENTARA HEALTHCARE: APPROVAL OR ADOPTION OF ANY PLAN OF MERGER OR CONSOLIDATION, ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE ORGANIZATION, THE VOLUNTARY DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION, REVOCATION OF AN SUCH VOLUNTARY DISSOLUTION PROCEEDINGS, OR ANY DECISION TO FILE A PETITION REQUESTING OR CONSENTING TO AN ORDER FOR RELIEF UNDER THE FEDERAL BANKRUPTCY LAWS OR SIMILAR STATE LAWS FOR THE ORGANIZATION; ELECTION OF NEW BOARD MEMBERS; OR AMENDMENT, RESTATEMENT OR REPEAL OF ANY ORGANIZING OR ENABLING DOCUMENTS OR BYLAWS. THE APPROVAL OF THE SOLE MEMBER IS ALSO REQUIRED FOR CERTAIN OPERATIONAL ACTIONS, AS OUTLINED IN THE ORGANIZATION'S BYLAWS. SUCH ACTIONS INCLUDE, BUT ARE NOT LIMITED TO, APPROVAL OF STRATEGIC PLANS AND ANNUAL OPERATING AND CAPITAL BUDGETS; TRANSACTIONS WITH INTERESTED PERSONS; CREATION OR ACQUISITION OF SUBSIDIARIES OR INTERESTS IN WHICH THE ORGANIZATION WILL BE A MEMBER; ENTRANCE INTO JOINT VENTURE OR OTHER SIMILAR ARRANGEMENTS; EMPLOYMENT MATTERS CONCERNING THE ORGANIZATION'S PRESIDENT; UNBUDGETED CAPITAL EXPENDITURES OR INDEBTEDNESS OVER SPECIFIED DOLLAR AMOUNTS; AND THE COMMENCEMENT OR SETTLEMENT OF LITIGATION. SENTARA HEALTHCARE HAS EXCLUSIVE AUTHORITY TO DIRECT AND MANAGE THE OPERATIONS AND AFFAIRS OF THE HOSPITAL, SUBJECT TO BOARD OVERSIGHT TO THE EXTENT AND IN THE MANNER SET FORTH IN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION WAS PART OF THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), AND AS SUCH, USED THE SYSTEM'S IN-HOUSE TAX DEPARTMENT, HEADED BY A LICENSED CERTIFIED PUBLIC ACCOUNTANT, TO BOTH PREPARE AND REVIEW ITS FORM 990. DURING THE PREPARATION AND REVIEW PROCESS, THE TAX DEPARTMENT WORKED CLOSELY WITH THE ORGANIZATION AND OTHER SYSTEM DEPARTMENTS, SUCH AS LEGAL, COMPENSATION AND BENEFITS, COMPLIANCE, FINANCE, AND MARKETING, TO ENSURE THAT A COMPLETE AND ACCURATE RETURN WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS WITH ANY CONFLICT OF INTEREST ARE MADE AWARE OF THE NEED TO EXCUSE THEMSELVES FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON ANY ISSUES WHERE THERE MAY BE A CONFLICT. OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE AWARE OF THEIR DUTIES AND RESPONSIBILITIES IN REGARDS TO THIS ISSUE. FORM 990, PART VI, SECTION B, LINE 15 PRESIDENT/CEO: AN INDEPENDENT COMPENSATION CONSULTING FIRM WAS RETAINED BY THE BOARD OF DIRECTORS (BOD) TO COMPLETE MARKET ANALYSIS AND RECOMMEND PRESIDENT/CEO COMPENSATION CHANGES. THE BOD APPROVES ALL COMPENSATION CHANGES FOR THE PRESIDENT/CEO. OFFICERS AND KEY EMPLOYEES: AN INDEPENDENT COMPENSATION CONSULTING FIRM WAS RETAINED BY THE BOARD OF DIRECTORS (BOD) TO COMPLETE MARKET ANALYSIS AND RECOMMEND OFFICER AND KEY EMPLOYEE COMPENSATION CHANGES. THE BOD APPROVES ALL COMPENSATION CHANGES FOR THE OFFICERS AND KEY EMPLOYEES. VICE CHAIRMAN: THE VICE CHAIRMAN ALSO SERVES AS THE COO/PRESIDENT OF THE SENTARA HEALTHCARE SYSTEM ("SENTARA"), WHICH AFFILIATED WITH THE ORGANIZATION EFFECTIVE MAY 1, 2011. SENTARA FOLLOWED PROCESSES AND PROCEDURES SET FORTH IN ITS GOVERNING DOCUMENTS TO ENSURE COMPLIANCE WITH ITS OBLIGATIONS AS A 501(C)(3) HEALTHCARE ORGANIZATION TO PAY DISQUALIFIED PERSONS REASONABLE COMPENSATION. SUCH PROCESSES AND PROCEDURES ARE INTENDED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERNAL REVENUE CODE SECTION 4958 REGULATIONS. THE COMPENSATION PHILOSOPHY OF SENTARA IS TO BASE OVERALL COMPENSATION AND BENEFITS FOR EXECUTIVES ON MARKET COMPARABLES, ADJUSTED AS APPLIED TO EACH EXECUTIVE, TAKING INTO CONSIDERATION THE INDIVIDUAL SKILLS, EXPERIENCE, TENURE AND PERFORMANCE OF THE EXECUTIVE BEING COMPENSATED AND OVERALL PERFORMANCE OF THE ORGANIZATION. IN LINE WITH THIS PHILOSOPHY, SENTARA PERFORMED SUBSTANTIAL DUE DILIGENCE AS TO MARKET COMPARABLES. SENTARA'S COMPENSATION COMMITTEE, WHICH CONSISTS OF BOARD MEMBERS WITHOUT CONFLICTS OF INTERESTS, ENGAGED AN OUTSIDE CONSULTANT, WHO REPORTS TO THE COMPENSATION COMMITTEE, TO CONDUCT A STUDY ASSESSING THE COMPETITIVENESS OF TOTAL COMPENSATION (INCLUDING CASH COMPENSATION, BENEFITS AND PERQUISITES) OF ITS SENIOR EXECUTIVES PRIOR TO MAKING DECISIONS REGARDING ANNUAL BASE SALARY ADJUSTMENTS, APPROVING INCENTIVE AWARDS, OR CONSIDERING PROGRAMMATIC CHANGES. THE STUDY COMPARED THE COMPENSATION OF THE SENTARA'S SENIOR EXECUTIVES TO COMPENSATION DATA FROM MULTIPLE PUBLISHED SURVEY SOURCES BASED ON THE SENIOR EXECUTIVES FUNCTIONAL RESPONSIBILITY. IN CONDUCTING THE STUDY, THE CONSULTANT TARGETED OTHER HEALTH SYSTEMS OF SIMILAR SIZE BASED ON NET REVENUE AND COMPLEXITY. FOR HEALTH PLAN POSITIONS, HEALTH PLANS WITH SIMILAR PREMIUMS, OR MEMBERS, WERE TARGETED. THE CONSULTANT ALSO CONDUCTS A REVIEW OF SENTARA'S PERFORMANCE RELATIVE TO A GROUP OF NOT-FOR-PROFIT HEALTH SYSTEMS OF COMPARABLE SIZE AND SCOPE OF OPERATIONS EVERY TWO TO THREE YEARS. THE MOST RECENT STUDY COMPARED SENTARA'S PERFORMANCE TO 19 HEALTHCARE SYSTEMS BASED ON NET REVENUE GROWTH, OPERATING MARGIN, BOND RATING, AND QUALITATIVE PERFORMANCE MEASURES BASED ON RANKINGS FROM SDI'S NATIONAL TOP INTEGRATED HEALTH NETWORKS. OVERALL, THE CONSULTANT DETERMINED THAT SENTARA'S PAY WAS ALIGNED WITH ITS RELATIVE PERFORMANCE. THE COMPENSATION STUDY WAS PRESENTED TO SENTARA'S COMPENSATION COMMITTEE, WHICH MADE ITS COMPENSATION DECISIONS BASED ON A)ITS REVIEW AND ANALYSIS OF THE PERFORMANCE OF BOTH THE ORGANIZATION AND ITS SENIOR EXECUTIVES AND, B) A REASONABLENESS OF COMPENSATION ANALYSIS AND OPINION FROM AN EXTERNAL EXPERT IN THE COMPENSATION OF EXECUTIVES IN THE TAX-EXEMPT HEALTH CARE FIELD. THE COMMITTEE'S BASES FOR ITS DECISIONS WERE DOCUMENTED IN COMMITTEE MINUTES TAKEN DURING THE MEETING AND THEN CIRCULATED FOR REVIEW AND APPROVAL. ALL DECISIONS REGARDING COMPENSATION WERE MADE BY THE COMMITTEE, WHICH CONSISTS OF BOARD MEMBERS WITHOUT CONFLICT OF INTERESTS. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST FORM 990, PART VII COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS. HOURS DEVOTED TO RELATED ORGANIZATIONS ANN E. C. HOMAN DEVOTED AN AVERAGE OF 3 HOURS PER WEEK TO RELATED ORGANIZATIONS. HOWARD P. KERN DEVOTED AN AVERAGE OF 50 HOURS PER WEEK TO RELATED ORGANIZATIONS. JAMES R. MESSNER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. BARBARA B. STOLTZFUS DEVOTED AN AVERAGE OF 1 HOUR PER WEEK TO RELATED ORGANIZATIONS. W. CARLTON BANKS DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. A. JERRY BENSON DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. DAVID L. BERND DEVOTED AN AVERAGE OF 51 HOURS PER WEEK TO RELATED ORGANIZATIONS. LAWRENCE D. BOWERS, JR. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. MENSEL D. DEAN, JR. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. DOUGLAS G. DRIVER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. JOSEPH K. FUNKHOUSER, II DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. C. WAYNE GATES, M.D. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. ALDEN L. HOSTETTER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. ELMER E. KENNEL DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. KENNETH M. KRAKAUR DEVOTED AN AVERAGE OF 48 HOURS PER WEEK TO RELATED ORGANIZATIONS. ALLON H. LEFEVER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. W. NEAL MENEFEE DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. GEORGE W. PACE DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. STEWART G. POLLOCK, M.D. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. MICHAEL R. KING DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. JAMES D. KRAUSS DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. P. RICHARD PIERCE DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,985,154. NET ASSET TRANSFER FROM ROCKINGHAM HEALTH CARE, INC. 88,050,937. PENSION COMPREHENSIVE LOSS -21,943,734. ASU 2010-07 FAIR MARKET VALUE ADJUSTMENTS -231,782,831. OTHER CHANGES -160,129. TOTAL TO FORM 990, PART XI, LINE 5: -167,820,911. CHANGES IN AUDITED FINANCIAL STATEMENT OVERSIGHT PROCESS FORM 990, PART XII, LINE 2C: DURING THE YEAR, THE ORGANIZATION AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM, WHO ASSUMED RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTED THE INDEPENDENT ACCOUNTANT. STATEMENT FILED PURSUANT TO TREASURY REGULATION SEC. 1.6038-2(J)(3): THE TAXPAYER IS A MEMBER OF THE SENTARA HEALTHCARE ("SHC") CONTROLLED GROUP. SHC, EIN 52-1271901, OWNS BAY PRIMEX INSURANCE COMPANY, LTD., A CONTROLLED FOREIGN CORPORATION. SHC FURNISHES ALL INFORMATION REQUIRED OF THE TAXPAYER BY IRC SECTION 6038 AND THE REGULATIONS THEREUNDER WITH RESPECT TO BAY PRIMEX INSURANCE COMPANY, LTD. THEREFORE, PURSUANT TO TREASURY REGULATION SEC. 1.6038-2(J)(2), THE TAXPAYER IS EXCEPTED FROM PROVIDING SUCH INFORMATION. THE REQUIRED INFORMATION IS E-FILED WITH SHC'S FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX. 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