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SMYTH COUNTY COMMUNITY HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
SMYTH COUNTY COMMUNITY HOSPITAL (EIN 54-0794913)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201211379349301036
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-15T13:25:30-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PERSHING YOAKLEY & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE CHEROKEE MILLS 2220 SUTHERLANDAddressLine1
CityKNOXVILLECity
StateTNState
ZIP Code379192363ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN540794913EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SMYTH COUNTY COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSMYTNameControl
Phone2767821234Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 880AddressLine1
CityMARIONCity
StateVAState
ZIP Code24354ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJEFFREY HUNDMANName
TitleCFOTitle
Phone2767821234Phone
Date Signed2012-05-16DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDEBORAH O ERNSBERGERName
Phone8656730844Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLINDA P WHITENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 880AddressLine1
CityMARIONCity
StateVAState
ZIP Code24354ZIPCode
FieldValueIRS element (for citing)
Gross Receipts48276315GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SCCHOSP.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1965YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionSMYTH 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers71TotalNbrVolunteers
Total Gross UBI64928TotalGrossUBI
Net Unrelated Business Txbl Income23487NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year221609ContributionsGrantsPriorYear
Contributions Grants Current Year79030ContributionsGrantsCurrentYear
Program Service Revenue Prior Year47128516ProgramServiceRevenuePriorYear
Program Service Revenue CY44879709ProgramServiceRevenueCY
Investment Income Prior Year3182738InvestmentIncomePriorYear
Investment Income Current Year2500195InvestmentIncomeCurrentYear
Other Revenue Prior Year625738OtherRevenuePriorYear
Other Revenue Current Year817381OtherRevenueCurrentYear
Total Revenue Prior Year51158601TotalRevenuePriorYear
Total Revenue Current Year48276315TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year7973GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY7421GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year31314322SalariesEtcPriorYear
Salaries Etc Current Year28759854SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year63766TotalFundrsngExpCurrentYear
Other Expense Prior Year22977592OtherExpensePriorYear
Other Expenses Current Year22117439OtherExpensesCurrentYear
Total Expenses Prior Year54299887TotalExpensesPriorYear
Total Expenses Current Year50884714TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3141286RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2608399RevenuesLessExpensesCY
Total Assets BOY89714998TotalAssetsBOY
Total Assets EOY98026282TotalAssetsEOY
Total Liabilities BOY8110078TotalLiabilitiesBOY
Total Liabilities EOY16754974TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY81604920NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY81271308NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSMYTH 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense41419390Expense
Grants7421Grants
Revenue45103027Revenue
DescriptionSMYTH COUNTY COMMUNITY HOSPITAL ("SCCH") HAS A 40-PLUS YEAR HISTORY OF PROVIDING HEALTHCARE SERVICES WITHIN THE COMMUNITY OF MARION, VIRGINIA. SCCH IS A 170-BED, ACUTE CARE, COMMUNITY-BASED HOSPITAL. 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 TOMOGRAPHYHOMECAREFAMILY BIRTHING CENTER (PREPARED CHILDBIRTH, ROOMING IN, SIBLING VISITATION)INTENSIVE 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 ACTIVITIESDescription
Total Program Service Expense41419390TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096101NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledVAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJEFFREY HUNDMANNamePerson
Telephone Number2763781207TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1245 MEDICAL PARK DRIVEAddressLine1
CityMARIONCity
StateVAState
ZIP Code24354ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (22 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
AC SQUIRES MD
DIRECTOR3.00X015968729441
JIM PATTERSON MD
DIRECTOR3.00X0762790
ALLEN J ABEL
DIRECTOR3.00X000
DAVID F JIM BEAR
CHAIRMAN3.00X000
RUTH RHEA COX
SECRETARY3.00X000
BOB FEATHERS
VICE CHAIRMAN3.00X000
ANN FLEMING
DIRECTOR3.00X044279565588
JOANNE GROSECLOSE
DIRECTOR3.00X000
MARK GROSECLOSE
DIRECTOR3.00X000
JIM MCDOWELL MD
DIRECTOR3.00X848600
CINDY SALYER
DIRECTOR3.00X023218241593
BOB SHULTS
TREASURER3.00X000
CHELSEA HAMMAN MD
TRUSTEE3.00X3098600
WESLEY ASBURY MD
DIRECTOR3.00X000
MAUREEN MACIVER
DIRECTOR3.00X000
LINDA P WHITE
VP/CEO55.00023397940783X
JOHN L JETER
ASST ADMIN/CFO50.00011340914196X
JEAN M MARINE MD
ORTHOPEDIST40.00046632023344X
ROBERT B EVANS MD
EMERGENCY PHYSICIAN40.00041710725338X
ERIC J SACKNOFF MD
UROLOGIST40.00044749636158X
RAMZI K HUMSI MD
OB/GYN40.00035117134955X
RALPH PARKS MD
ORTHOPEDIST40.00038823412229X
FieldValueIRS element (for citing)
Total Reportable Comp From Org39472TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3328659TotalReportableCompFrmRltdOrgs
Total Other Compensation323625TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HANCOCK DANIEL JOHNSON & NAGLE PC
PO BOX 72050RICHMONDVA23255LEGAL SERVICES238123
RYERSON MANAGEMENT ASSOCIATES
175 MONTROSE WEST AVE STE 110AKRONOH44321CONSULTING SERVICES106250
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants72955GovernmentGrants
All Other Contributions6075AllOtherContributions
Total Contributions79030TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICES6219904480272544802725
P/S INC RELATED TO PRO5610007698476786198
FieldValueIRS element (for citing)
Total Program Service Revenue44879709TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2302774TotalRevenueColumn
Exclusion$2,302,774ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real409602Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real409602Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column409602TotalRevenueColumn
Exclusion$409,602ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities155313Securities
Other42108Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities155313Securities
Other42108Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column197421TotalRevenueColumn
Related Or Exempt Function Income197421RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
CAFETERIA SALES722210199931$199,931
OTHER REVENUE621500906272589764730
MANAGEMENT FEE REVENUE90009961201$61,201

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column56020TotalRevenueColumn
Exclusion$56,020ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue407779TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column48276315TotalRevenueColumn
Related Or Exempt Function Income45102829RelatedOrExemptFunctionIncome
Unrelated Business Revenue64928UnrelatedBusinessRevenue
Exclusion$3,029,528ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total7421Total
Program Services7421ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total621940Total
Program Services215256ProgramServices
Management And General406684ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total23941502Total
Program Services21098713ProgramServices
Management And General2811602ManagementAndGeneral
Fundraising31187Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total659932Total
Program Services592122ProgramServices
Management And General66933ManagementAndGeneral
Fundraising877Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2057549Total
Program Services2035996ProgramServices
Management And General13321ManagementAndGeneral
Fundraising8232Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1478931Total
Program Services1433320ProgramServices
Management And General45611ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total23551Total
Management And General23551ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total33276Total
Program Services1000ProgramServices
Management And General32276ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total62232Total
Management And General62232ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total93559Total
Management And General93559ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3897034Total
Program Services3891864ProgramServices
Management And General5170ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total169551Total
Program Services134828ProgramServices
Management And General34723ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total565636Total
Program Services507729ProgramServices
Management And General41668ManagementAndGeneral
Fundraising16239Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total514693Total
Program Services506803ProgramServices
Management And General7890ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1277623Total
Program Services1188448ProgramServices
Management And General89175ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total171837Total
Program Services134138ProgramServices
Management And General30468ManagementAndGeneral
Fundraising7231Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total14300Total
Program Services13406ProgramServices
Management And General894ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total85100Total
Management And General85100ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5567613Total
Program Services2073657ProgramServices
Management And General3493956ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total596942Total
Program Services43627ProgramServices
Management And General553315ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
UBI TAX37503750
MEDICAL SUPPLIES & DRUG5327425165685310857
MANAGEMENT FEES14130081413008
OTHER EXPENSES101888357581961302
REPAIRS & MAINTENANCE87590110422865479

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total405525Total
Program Services403424ProgramServices
Management And General2101ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total50884714Total
Program Services41419390ProgramServices
Management And General9401558ManagementAndGeneral
Fundraising63766Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
EOY4743424EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY551393BOY
EOY588514EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6932193BOY
EOY6417679EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1036234BOY
EOY975086EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY415438BOY
EOY332142EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis84678061LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec47464568LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY18979209BOY
EOY37213493EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY23591544BOY
EOY26310961EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY202000BOY
EOY202000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY38006987BOY
EOY21242983EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY89714998BOY
EOY98026282EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6413210BOY
EOY12123566EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1696868BOY
EOY4631408EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8110078BOY
EOY16754974EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY81561102BOY
EOY81245506EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY43818BOY
EOY25802EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY81604920BOY
EOY81271308EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY89714998BOY
EOY98026282EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2608399ReconcilationRevenueExpenses
Reconcilation Other Changes2274787ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$2,544GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations1RalliesDemonstrations
Rallies Demonstrations$1,174RalliesDemonstrationsAmount
Other Activities0OtherActivities
Total Lobbying Expenditures IIB3718TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis3250416InvestmentCostOrOtherBasis
Book Value3250416BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis16228152InvestmentCostOrOtherBasis
Depreciation12326805Depreciation
Book Value3901347BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis130505InvestmentCostOrOtherBasis
Depreciation99580Depreciation
Book Value30925BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis41226023InvestmentCostOrOtherBasis
Depreciation35038183Depreciation
Book Value6187840BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis23842965InvestmentCostOrOtherBasis
Book Value23842965BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings37213493TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM SWCHS, NET12778582
OTHER ASSETS229735
DUE FROM MSHA, NET8090847
DUE FROM AFFILIATES143819
FieldValueIRS element (for citing)
Total Book Value Other Assets21242983TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
OTHER LONG-TERM LIABILITIES$2,941,654
LONG-TERM COMPENSATION PAYABLE$673,000
LEASE PAYABLE$11,553
DUE TO THIRD-PARTY$1,005,201
FieldValueIRS element (for citing)
Total Of Amounts4631408TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE HOSPITAL IS CLASSIFIED AS AN ORGANIZATION EXEMPT FOR 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. SWCH IS A TAXABLE ENTITY AND ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH FASB ASC 740, INCOME TAXES. AT JUNE 30, 2011, TAX RETURNS FOR FISCAL YEARS 2008 THROUGH 2010 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2011 AND 2010.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage380.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available0ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1190951TotalCommunityBenefitExpense
Net Community Benefit Expense1190951NetCommunityBenefitExpense
Percent Of Total Expense0.02350PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense7457832TotalCommunityBenefitExpense
Direct Offsetting Revenue6833210DirectOffsettingRevenue
Net Community Benefit Expense624622NetCommunityBenefitExpense
Percent Of Total Expense0.01230PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense8648783TotalCommunityBenefitExpense
Direct Offsetting Revenue6833210DirectOffsettingRevenue
Net Community Benefit Expense1815573NetCommunityBenefitExpense
Percent Of Total Expense0.03580PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense109661TotalCommunityBenefitExpense
Net Community Benefit Expense109661NetCommunityBenefitExpense
Percent Of Total Expense0.00220PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense335949TotalCommunityBenefitExpense
Net Community Benefit Expense335949NetCommunityBenefitExpense
Percent Of Total Expense0.00660PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense6610TotalCommunityBenefitExpense
Net Community Benefit Expense6610NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense452220TotalCommunityBenefitExpense
Net Community Benefit Expense452220NetCommunityBenefitExpense
Percent Of Total Expense0.00890PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense9101003TotalCommunityBenefitExpense
Direct Offsetting Revenue6833210DirectOffsettingRevenue
Net Community Benefit Expense2267793NetCommunityBenefitExpense
Percent Of Total Expense0.04470PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$1,755,059BadDebtExpenseAmount
Amount Attributable To1053035AmountAttributableTo
Amount Reimbursed By Medicare12784930AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare15474468CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2689538MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursOtherOther
SMYTH COUNTY COMMUNITY HOSPITAL
1565 RADIO HILL ROADMARIONVA24354XXX
FRANCIS MARION MANOR
2100 FRANCIS MARION LANEMARIONVA24354NURSING HOME

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumber
SMYTH COUNTY COMMUNITY HOSPITAL
1
FRANCIS MARION MANOR
2

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 6A: MOUNTAIN STATES HEALTH ALLIANCE (MSHA) PREPARED AN ANNUAL WRITTEN REPORT THAT DESCRIBES THE ORGANIZATION'S PROGRAMS AND SERVICES THAT PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. 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 I, L7 COL(F): BAD DEBT EXPENSE OF $285,421 IS INCLUDED IN STATEMENT OF FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, BUT HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING PERCENTAGES ON PART 1, LINE 7, COLUMN F.
PART III, LINE 4: WORKSHEET A WAS USED FOR PART III, LINES 2 AND 3 IN DETERMINING BAD DEBT AT COST. SCCH FOLLOWS THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION'S PRINCIPLES AND PRACTICES BOARD ISSUED STATEMENT 15: VALUATION AND FINANCIAL STATEMENT PRESENTATION OF CHARITY CARE AND BAD DEBTS BY INSTITUTIONAL HEALTHCARE PROVIDERS (THE "STATEMENT"). THE STATEMENT PROVIDES GUIDANCE ON COLLECTABILITY CRITERIA AND EMPHASIZES REVENUE RECOGNITION ONLY WHEN COLLECTIONS ARE REASONABLY ASSURED.
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 FOLLOWS A STRONG COLLECTION PROGRAM THAT COMMUNICATES FINANCIAL RESPONSIBILITY TO THE PATIENT PRIOR TO SERVICE. 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.
PART VI, LINE 2: SCCH IS A MEMBER OF MOUNTAIN STATES HEALTH ALLIANCE (MSHA). DURING FISCAL YEAR 2008 AND FISCAL YEAR 2009, MSHA CONDUCTED THE LARGEST COMMUNITY HEALTH NEEDS ASSESSMENT IN ITS HISTORY IN AN EFFORT TO PROFILE THE HEALTH OF THE RESIDENTS WITHIN THE LOCAL REGION. THE ASSESSMENT FOCUSED ON STATE, REGIONAL, AND COUNTY SPECIFIC DATA COLLECTION. THIS ASSESSMENT ALSO INCLUDED PRIMARY DATA COLLECTED THROUGH APPROXIMATELY 50 ONE-ON-ONE INTERVIEWS. THOSE INTERVIEWED WERE INDIVIDUALS FROM AROUND THE REGION WHICH INCLUDED LOCAL AND STATE GOVERNMENT OFFICIALS, HEALTH DEPARTMENT REPRESENTATIVES, PHYSICIANS, GENERAL PUBLIC, LOCAL INDUSTRY, CIVIC ORGANIZATIONS, EDUCATION OFFICIALS, AND COMMUNITY RESOURCE GROUPS. THIS INFORMATION WAS COLLECTED, AND THEN ANALYZED, AND A SUMMARY OF THE FINDINGS WAS LISTED IN AN EFFORT TO OBTAIN A MORE DETAILED SNAPSHOT SPECIFIC TO EACH COUNTY LOCATED THROUGHOUT THE MSHA SERVICE AREA. THIS INFORMATION WAS REVIEWED BY MSHA'S STRATEGIC PLANNING TEAM ALONG WITH GOVERNMENT RELATIONS AND QUALITY DEPARTMENTS. THE MSHA STEERING COMMITTEE IDENTIFIED CHILDHOOD OBESITY AS THE HEALTH DISPARITY TARGETED FOR IMPROVEMENT, INCLUDING THE COMMUNITY SERVED BY JMH.DURING FISCAL YEAR 2009, MSHA BEGAN COLLABORATIVE EFFORTS WITH EAST TENNESSEE STATE UNIVERSITY'S COLLEGE OF PUBLIC HEALTH TO DEVELOP THE MSHA-ETSU OBESITY COLLABORATIVE COMMITTEE. THE FOCUS OF THIS COMMITTEE IS TO PULL TOGETHER MANY PARTNERS AND ORGANIZATIONS IN COLLABORATION TO REDUCE THE LEVEL OF CHILDHOOD OBESITY THROUGHOUT NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. DURING FISCAL YEAR 2011, THE COMMITTEE OFFERED 25 SEED GRANTS OF $2,000 EACH TO LOCAL COMMUNITY ORGANIZATIONS SUCH AS CHURCHES, COMMUNITY GROUPS, SCHOOLS, AND EMPLOYERS THAT WANT TO EXPLORE OBESITY REDUCTION EFFORTS.IN ADDITION TO THE GRANTS PROGRAM, AN ANNUAL SYMPOSIUM IS PROVIDED FREE TO THE REGION AND AVAILABLE TO RESIDENTS AND COMMUNITY GROUPS. NATIONAL, REGIONAL, AND LOCAL EXPERTS SHARE INFORMATION ON TRENDS REGARDING CHILDHOOD OBESITY AND PROVEN COMMUNITY-BASED STRATEGIES TO REDUCE THE PREVALENCE.MOUNTAIN STATES HEALTH ALLIANCE DOCUMENTED ITS CORPORATE RESPONSIBILITY PROGRAMS, PARTNERSHIPS, AND ACTIVITIES FOR COMMUNITY BENEFIT AND SOCIAL RESPONSIBILITY IN THE 2011 SOCIAL RESPONSIBILITY PLAN (THE PLAN). THE PLAN PROVIDES THE STRATEGIC DIRECTION OF SOCIAL RESPONSIBILITY FOR THE ORGANIZATION. MSHA CREATED A SOCIAL RESPONSIBILITY COMMITTEE TO ENSURE A STRATEGIC COMMITMENT TO THE ORGANIZATION'S SOCIAL RESPONSIBILITY THROUGH NEEDS PRIORITIZED FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IDENTIFIES SEVERAL PRIORITIES TO FOCUS THE ORGANIZATION'S COMMUNITY BENEFIT, COMMUNITY BUILDING AND OTHER INITIATIVES TO IMPACT THE HEALTH OF INDIVIDUALS AND COMMUNITIES WITHIN THE DEFINED SERVICE AREA. THE COMMITTEE MEETS ON A QUARTERLY BASIS AND INCLUDES MSHA BOARD MEMBERS; THE DEAN OF PUBLIC HEALTH AT EAST TENNESSEE STATE UNIVERSITY; THE PRESIDENT AND CEO OF UNITED WAY OF WASHINGTON COUNTY, TENNESSEE; MSHA'S CEO AND OTHER EXECUTIVES AS WELL AS OTHER COMMUNITY LEADERS. THE FOUNDATION OF MSHA'S SOCIAL RESPONSIBILITY IS THE CHNA TO PRIORITIZE FUTURE HEALTH IMPROVEMENT INITIATIVES TO BE COMPLETED IN COLLABORATION WITH LOCAL RESOURCES. THE PROJECT FULLY SUPPORTS THE MSHA MISSION TO "IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH." THE ASSESSMENT FOCUSES ON MSHA'S THIRTEEN CORE COUNTIES. ACTIVITIES ASSOCIATED WITH THE DEVELOPMENT OF THIS ASSESSMENT INCLUDE STATE, REGIONAL AND COUNTY-SPECIFIC SECONDARY DATA COLLECTION AND PRIMARY DATA OBTAINED THROUGH OVER 56 SURVEYS WITH INDIVIDUALS FROM THE LOCAL COMMUNITIES.
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. 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 32,208 IN 2010 AND, ACCORDING TO THE U.S. CENSUS BUREAU, MARION HAS A POPULATION OF 5,968. THE MEDIAN AGE OF RESIDENTS OF SMYTH COUNTY IS 43.1, WHICH IS OLDER THAN THE MEDIAN AGE OF 37.2 IN THE UNITED STATES. SMYTH COUNTY HAS A MEDIAN HOUSEHOLD INCOME OF $34,864, WHICH IS WELL BELOW $50,046, THE MEDIAN HOUSEHOLD INCOME OF THE U.S. IT IS ESTIMATED THAT 19.1% OF SMYTH COUNTY'S RESIDENTS LIVE IN POVERTY COMPARED TO 10.3% STATEWIDE.
PART VI, LINE 6: 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 FOR 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 7: SCCH IS A 170-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 14 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.
VAREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained
No Grant More Than5000XNoGrantMoreThan5000

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses0WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
AC SQUIRES MD
0157760000192707967021474018912800
ANN FLEMING
0328461072944041390048481017107050838300
CINDY SALYER
0179548035558017076020422021171027377500
LINDA P WHITE
0180141041202012636019963020820027476200
JEAN M MARINE MD
0324608010163404007801415809186048966400
ROBERT B EVANS MD
035980204939107914013619011719044244500
ERIC J SACKNOFF MD
043176100015735016745019413048365400
RAMZI K HUMSI MD
030100301667048501015085019870038612600
RALPH PARKS MD
03686330100000960100012229040046300

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 1ATEMPORARY HOUSING WAS PROVIDED FOR A PORTION OF THE YEAR ENDING JUNE 30, 2011 TO AN EXECUTIVE FOR RECRUITMENT PURPOSES ONLY. MINIMAL AMOUNTS ARE REMITTED FOR ROTARY CLUB DUES, SUBJECT TO "BUSINESS USE ONLY" RESTRICTIONS.
PART I, LINE 1BNO WRITTEN POLICY EXISTS AT THIS TIME; HOWEVER, ALL EXPENSES MUST BE APPROVED ON AN INDIVIDUAL BASIS BY ADMINISTRATION, WITH SUFFICIENT SUBSTANTIATION TO BE PROVIDED AS DOCUMENTATION.
PART I, LINE 4BTHE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE: ANN FLEMING, CINDY SALYER, AND LINDA WHITE. 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.
PART IIILINDA P. WHITE, CEO OF SCCH, RECEIVED A DISTRIBUTION OF $9,283 AS A PARTICIPANT IN THE 457(F) RETIREMENT PLAN. ANN FLEMING, BOARD MEMBER OF SCCH, RECEIVED A DISTRIBUTION OF $33,462 AS A PARTICIPANT IN THE 457(F) RETIREMENT PLAN. CINDY SALYER, BOARD MEMBER OF SCCH, RECEIVED A DISTRIBUTION OF $9,283 AS A PARTICIPANT IN THE 457(F) RETIREMENT PLAN.SUPPLEMENTAL INFORMATION

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
BETTY KIRK
FAMILY MEMBER OF JIM BEAR73103JIM 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.35361JAMES PATTERSON, M.D., SCCH BOARD MEMBER, IS A FAMILY MEMBER OF REBECCA SPARGER, AN EMPLOYEE OF SCCH.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE 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 MEMBERS.
ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT PROVIDES THE POLICY AND THE 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 THOSE BACK TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY 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 ENGAGED IN A CONFLICTED TRANSACTION.FORM 990, PART VI, SECTION B, LINE 12C
THE CEO AND CFO ARE EMPLOYED AND COMPENSATED BY MOUNTAIN STATES HEALTH ALLIANCE ("MSHA"). MSHA'S COMPENSATION COMMITTEE, WHICH IS THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, OBTAINS THE SERVICES OF AN OUTSIDE, INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM COMPENSATION SURVEYS AND WITH ADVICE WHEN THE COMMITTEE MAKES RECOMMENDATIONS ON PAY AND BENEFITS FOR THE CEO. MSHA'S 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 B, LINE 15
GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE 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 AND ANNUAL BASIS.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 2,427,697. PARTNERSHIP INVESTMENT INCOME -134,891. CHANGE IN PERMANENTLY RESTRICTED NET ASSETS -18,019. TOTAL TO FORM 990, PART XI, LINE 5: 2,274,787.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
MOUNTAIN STATES HEALTH ALLIANCE
400 N STATE OF FRANKLIN ROADJOHNSON CITYTN37604620476282HOSPITALTN501(C)(3)LINE 3N/A0
SMYTH COUNTY COMM FOUNDATION
1 HEALTH WAYMARIONVA24354311650055SUPPORTING ORGANIZATION TO SCCHVA501(C)(3)LINE 11A, IN/A0
NORTON COMMUNITY HOSPITAL
100 15TH STREET NORTHWESTNORTONVA24273540566029HOSPITALVA501(C)(3)LINE 3N/A0
DICKENSON COMMUNITY HOSPITAL
PO BOX 1440CLINTWOODVA24228770599553HOSPITALVA501(C)(3)LINE 30NORTON COMMUNITY HOSPITAL
JOHNSTON MEMORIAL HOSPITAL
16000 JOHNSTON MEMORIAL DRIVEABINGDONVA24211540544705HOSPITALVA501(C)(3)LINE 3N/A0
ABINGDON PHYSICIAN PARTNERS
16000 JOHNSTON MEMORIAL DRIVEABINGDONVA24211205485346MEDICAL SERVICESVA501(C)(3)LINE 11A, I0JOHNSTON MEMORIAL HOSPITAL
JOHNSTON MEMORIAL HEALTHCARE FOUNDATION
16000 JOHNSTON MEMORIAL DRIVEABINGDONVA24211262870970SUPPORTING ORGANIZATION TO JMHVA501(C)(3)LINE 11B, IIN/A0
MOUNTAIN STATES FOUNDATION
2335 KNOB CREEK ROAD STE 101JOHNSON CITYTN37604581418862FUNDRAISING FOR MSHA HOSPITALSTN501(C)(3)LINE 11A, I0MOUNTAIN STATES HEALTH ALLIANCE
MSHA AUXILIARY
400 N STATE OF FRANKLIN ROADJOHNSON CITYTN37604581418345SUPPORTING ORGANIZATION TO MSHA HOSPITALSTN501(C)(3)LINE 11A, IN/A0
COMMUNITY HEALTHCARE FOUNDATION
100 15TH STREET NORTHWESTNORTONVA24273542002314SUPPORTING ORGANIZATION TO NCHVA501(C)(3)LINE 11A, IN/A0

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
INTEGRATED SOLUTIONS HEALTH NETWORK LLC
400 N STATE OF FRANKLIN ROADJOHNSON CITYTN37604621711997INVESTMENT COMPANYTNN/A(D)-3886-361000.00210
EMMAUS COMMUNITY HEALTHCARE PLLC
6070 HWY 11EPINEY FLATSTN37686200577483MEDICAL SERVICESTNN/A
MEDICAL SPECIALISTS OF JOHNSON CITY LLC
2528 WESLEY STREET STE 2JOHNSON CITYTN37604272199037MEDICAL SERVICESTNN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
SOUTHWEST COMMUNITY HEALTH SERVICES
PO BOX 880MARIONVA24354541460695HEALTH SERVICESVAN/AC47722612946461.00000
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37604621490616PHYSICIAN OFFICESTNN/AC
MEDISERVE MEDICAL EQUIP OF KINGSPORT
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37604621212286DURABLE MEDICAL EQUIPMENTTNN/AC
MOUNTAIN STATES PROPERTIES
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37604621845895PROPERTY MANAGEMENTTNN/AC
BLUE RIDGE PHYSICIAN GROUP
1021 W OAKLAND AVENUE STE 207JOHNSON CITYTN37604621700412HEALTHCARE SERVICESTNN/AC
COMMUNITY HOME CARE INC
1460 PARK AVENUENORTONVA24273541453810MEDICAL PRODUCTSVAN/AC
COMMUNITY PHYSICIANS SERV CORP
100 15TH STREET NWNORTONVA24273541641446PHYSICIAN SERVICESVAN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1SOUTHWEST COMMUNITY HEALTH SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeDTransactionType
Amount Involved12778582AmountInvolved
Method Of Amt DeterminationCOSTMethodOfAmtDetermination