STRATEGY STUDIO / PUBLIC DATA EXPLORER

CCRC INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CCRC INC (EIN 54-1929580)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-10
IRS object ID
201212239349300401
Schema version
2011v1.2
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)
Timestamp2012-08-10T05:36:58-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560747981EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN541929580EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CCRC INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCCRCNameControl
Phone4342004708Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLEWIS C ADDISONName
TitleTREASURERTitle
Phone4342004708Phone
Date Signed2012-08-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
PTINP00445891PTIN
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLEWIS C ADDISONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4159933GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SUMMITLYNCHBURG.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionCONTINUING CARE RETIREMENT CENTERActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees27TotalNbrEmployees
Total Nbr Volunteers60TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3640211ProgramServiceRevenuePriorYear
Program Service Revenue CY3778965ProgramServiceRevenueCY
Investment Income Prior Year234576InvestmentIncomePriorYear
Investment Income Current Year380968InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year3874787TotalRevenuePriorYear
Total Revenue Current Year4159933TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year611045SalariesEtcPriorYear
Salaries Etc Current Year603270SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3220391OtherExpensePriorYear
Other Expenses Current Year3219008OtherExpensesCurrentYear
Total Expenses Prior Year3831436TotalExpensesPriorYear
Total Expenses Current Year3822278TotalExpensesCurrentYear
Revenues Less Expenses Prior Year43351RevenuesLessExpensesPriorYear
Revenues Less Expenses CY337655RevenuesLessExpensesCY
Total Assets BOY19092842TotalAssetsBOY
Total Assets EOY18611390TotalAssetsEOY
Total Liabilities BOY20730433TotalLiabilitiesBOY
Total Liabilities EOY20181721TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-1637591NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-1570331NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE SUMMIT IS A SENIOR LIVING COMMUNITY PROVIDING AN ENVIRONMENT FOR EACH RESIDENT TO BE ENGAGED IN LIFE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense3163809Expense
Revenue3778965Revenue
DescriptionCCRC, INC. IS A CONTINUING CARE RETIREMENT COMMUNITY INCORPORATED ON DECEMBER 8, 1998, TO BUILD AND ESTABLISH A SENIOR LIVING COMMUNITY, THE SUMMIT, DEDICATED TO PROVIDING AN ENVIRONMENT FOR EACH RESIDENT TO BE ENGAGED IN LIFE. THE SUMMIT CONSISTS OF 85 INDEPENDENT LIVING APARTMENTS, 11 GARDEN HOMES AND A COMMUNITY CENTER ON A CAMPUS THAT INCLUDES AN 8 1/2-ACRE LAKE, WALKING TRAILS AND OTHER LANDSCAPE FEATURES. AS SUCH, THE SUMMIT PROVIDES THE FACILITIES, SERVICES, AMENITIES AND PROGRAMS TO SUPPORT AN ACTIVE LIFESTYLE FOR RESIDENTS. THE SUMMIT HOSTS SEVERAL SUPPORT GROUPS THAT BENEFIT BOTH RESIDENTS AND MEMBERS FROM THE LARGER COMMUNITY, INCLUDING THE CENTRAL VIRGINIA ALZHEIMER'S SUPPORT GROUP, AND THE CENTRAL VIRGINIA PARKINSON'S SUPPORT GROUP. THE SUMMIT HOSTS A QUARTERLY EVENT COORDINATED BY THE LYNCHBURG REGIONAL CHAMBER OF COMMERCE, CALLED "BUSINESS AT BREAKFAST" AND AT LEAST ONE EVENT COORDINATED BY THE BEDFORD AREA CHAMBER OF COMMERCE CALLED "BUSINESS BEFORE BREAKFAST," BOTH OF WHICH ARE OPEN TO AREA BUSINESS PROFESSIONALS. THE SUMMIT HOSTS EDUCATIONAL EVENTS IN COOPERATION WITH AREA NONPROFIT AGENCIES SUCH AS AARP AND THE WYNDHURST ASSOCIATION. THE SUMMIT HOSTED THE CENTRA CHAPLAINCY INTERNS. SEVERAL OF THE SUMMIT ACTIVITY PROGRAMS ARE OPEN TO BOTH RESIDENT AND NON-RESIDENT, INCLUDING TAI CHI AND LINE DANCING. STAFF PROVIDE VOLUNTEER SUPPORT FOR EACH OF THE ABOVE ORGANIZATIONS AND OTHERS INCLUDING THE WYNDHURST ASSOCIATION, THE YOUTH PHILANTHROPY COMMITTEE OF THE GREATER LYNCHBURG COMMUNITY TRUST, VANHA, LEADINGAGE, THE GREATER LYNCHBURG CHAMBER OF COMMERCE,AND OTHERS. ADDITIONALLY, THE SUMMIT PROVIDES IN-KIND SERVICES TO EVENTS SPONSORED BY THE WYNDHURST ASSOCIATION. ADDITIONALLY, IN 2011 THE SUMMIT PROVIDED FINANCIAL SUBSIDY FOR A RESIDENT REQUIRING ASSISTANCE IN MAINTAING THEIR RESIDENCY AT THE SUMMIT.Description
Total Program Service Expense3163809TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
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 Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
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 Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109614NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees27NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
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 Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
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
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LEWIS C ADDISONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4342004708TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DAVID D ADAMS
SECRETARY2.00XX030943958975
LEWIS C ADDISON
TREASURER2.00XX044666086514
DAVID COBB
BOARD MEMBER2.00X000
GEORGE W DAWSON
BOARD MEMBER2.00X0115666819612
THOMAS C JIVIDEN
PRESIDENT AND CHAIRMAN2.00XX052645326638
WILLIAM MOORE
VICE CHAIRMAN2.00XX000
LEE PARKER
BOARD MEMBER2.00X000
L DARRELL POWERS
BOARD MEMBER2.00X0613270
W MICHAEL BRYANT
BOARD MEMBER2.00X016424628678
AMY G RAY
BOARD MEMBER2.00X000
KENNETH BURGER
EXECUTIVE DIRECTOR50.00X79815017539
FieldValueIRS element (for citing)
Total Reportable Comp From Org79815TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2664793TotalReportableCompFrmRltdOrgs
Total Other Compensation237956TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MERIWETHER GODSEY INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14944 OLD BOONSBORO ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24503ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesFOOD SERVICESDescriptionOfServices
Compensation522176Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REDescription
Business Code623000BusinessCode
Total Revenue Column3778965TotalRevenueColumn
Related Or Exempt Function Income3778965RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue3778965TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column14636TotalRevenueColumn
Exclusion$14,636ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities366132Securities
Other200Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities366132Securities
Other200Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column366332TotalRevenueColumn
Exclusion$366,332ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4159933TotalRevenueColumn
Related Or Exempt Function Income3778965RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$380,968ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total97354Total
Management And General97354ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total376503Total
Program Services266023ProgramServices
Management And General110480ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total129413Total
Program Services72652ProgramServices
Management And General56761ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1180Total
Management And General1180ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total129000Total
Management And General129000ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total19223Total
Management And General19223ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total682289Total
Program Services612700ProgramServices
Management And General69589ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total72493Total
Program Services728ProgramServices
Management And General71765ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total244394Total
Program Services228650ProgramServices
Management And General15744ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total977764Total
Program Services969325ProgramServices
Management And General8439ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1449Total
Program Services1449ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total8248Total
Management And General8248ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1027593Total
Program Services1012282ProgramServices
Management And General15311ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total55375Total
Management And General55375ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3822278Total
Program Services3163809ProgramServices
Management And General658469ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY123449BOY
EOY953470EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7839BOY
EOY15106EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY123431BOY
EOY130554EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis20524217LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9374933LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11938748BOY
EOY11149284EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4930598BOY
EOY4356853EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1968777BOY
EOY2006123EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19092842BOY
EOY18611390EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY467786BOY
EOY514619EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY9440921BOY
EOY9041270EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY10575000BOY
EOY10380000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY246726BOY
EOY245832EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY20730433BOY
EOY20181721EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY4400000BOY
EOY4400000EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY-6037591BOY
EOY-5970331EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-1637591BOY
EOY-1570331EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19092842BOY
EOY18611390EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses337655ReconcilationRevenueExpenses
Reconcilation Other Changes-270395ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1CENTRA HEALTH INCBusinessNameLine1
FieldValueIRS element (for citing)
EIN540715569EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$3,163,809Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts3163809SumOfAmounts

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis352816OtherCostOrOtherBasis
Book Value352816BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16308483OtherCostOrOtherBasis
Depreciation7549192Depreciation
Book Value8759291BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3178555OtherCostOrOtherBasis
Depreciation1378509Depreciation
Book Value1800046BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis675456OtherCostOrOtherBasis
Depreciation447232Depreciation
Book Value228224BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8907OtherCostOrOtherBasis
Book Value8907BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11149284TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
UNAMORTIZED BOND FINANCING COSTS445594
BOND FUNDS LIMITED TO USE1381614
LAKE MAINTENANCE FUND178915
FieldValueIRS element (for citing)
Total Book Value Other Assets2006123TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATE, CENTRA HEALTH, INC.$66,917
LAKE MAINTENANCE LIABILITY$178,915
FieldValueIRS element (for citing)
Total Of Amounts245832TotalOfAmounts
Total Revenue4159933TotalRevenue
Total Expenses3822278TotalExpenses
Excess Or Deficit For Year337655ExcessOrDeficitForYear
Net Unrealized GL On Investments-270395NetUnrealizedGLOnInvestments
Total Adjustments-270395TotalAdjustments
Excess Or Deficit Per FS67260ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt4140710TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal4140710RevenueSubtotal
Other Revenues Not Included19223OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt19223RevenueNotRptdOnFinStmt
Total Revenue Per Form9904159933TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3803055TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal3803055ExpensesSubtotal
Other Expenses Not Included19223OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt19223ExpensesNotRptdOnFinStmt
Total Expenses Per Form9903822278TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE COMPANY IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE COMPANY HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2011. THE COMPANY BELIEVES THEY ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2008.
PART XII, LINE 4B - OTHER ADJUSTMENTS:TRUSTEE FEES 19,223.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:TRUSTEE FEES 19,223.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
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 (5 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
DAVID D ADAMS
0276811000326280388340201410368414032061
LEWIS C ADDISON
0356020000906400675330189810533174054338
GEORGE W DAWSON
0628727000527941045020151100117628000
THOMAS C JIVIDEN
04083430001181100558202105605530910101186
W MICHAEL BRYANT
01462260001802002525003428019292400

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BGEORGE DAWSON, PRESIDENT/CEO OF CENTRA HEALTH, INC. (A RELATED ORGANIZATION): ACCRUED FOR 2011 $501,567 IN A NONQUALIFIED RETIREMENT PLAN, INCLUDED IN HIS W-2 WAGES.
PART IIIPART I LN 3 - THE ORGANIZATION'S EXECUTIVE DIRECTORS COMPENSATION IS ESTABLISHED IN ACCORDANCE WITH CENTRA HEALTH'S EXECUTIVE COMPENSATION PRACTICES WHICH INCLUDE THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, AND COMPENSATION STUDY OR SURVEY.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2BOARD MEMBERS DAVID ADAMS, LEWIS ADDISON, GEORGE DAWSON, TOM JIVIDEN, AND W. MICHAEL BRYANT ALL SERVE TOGETHER ON THE BOARD OF DIRECTORS FOR BEDFORD MEMORIAL HOSPITAL, A 50% JOINT VENTURE OF CENTRA HEALTH, INC. BOARD MEMBERS LEWIS ADDISON, GEORGE DAWSON, AND W. MICHAEL BRYANT ARE ON PIEDMONT COMMUNITY HEALTH PLAN'S BOARD OF DIRECTORS, A 50% JOINT VENTURE OF CENTRA HEALTH, INC. LEWIS ADDISON, GEORGE DAWSON, AND W. MICHAEL BRYANT ARE ON CENTRAL VIRGINIA IMAGING'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION IS A NOT-FOR-PROFIT, STOCK COMPANY. AS OF THE END OF 2011, THERE WERE 363 SHARES OF COMMON STOCK AND ZERO SHARES OF PREFERRED STOCK OUTSTANDING. CENTRA HEALTH, INC. OWNS 91% OF THE COMMON STOCK. THE REMAINDER IS OWNED BY THE RETIREMENT CENTER OF THE CHRISTIAN CHURCH IN VIRGINIA, INC.
FORM 990, PART VI, SECTION A, LINE 7ACENTRA HEALTH, INC., AS THE MAJORITY OWNER OF THE CCRC, INC. STOCK, HAS THE RIGHT TO APPOINT THE MAJORITY OF CCRC, INC BOARD.
FORM 990, PART VI, SECTION A, LINE 7BCENTRA HEALTH, INC., AS THE MAJORITY OWNER OF THE CCRC, INC. STOCK, HAS THE RIGHT TO REVIEW AND APPROVE DECISIONS MADE BY THE GOVERNING BODY OF CCRC, INC.
FORM 990, PART VI, SECTION B, LINE 11THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. COPIES OF THE FORM 990 HAVE BEEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS, AND ANY QUESTIONS RAISED BY THE BOARD OF DIRECTORS HAVE BEEN ADDRESSED.
FORM 990, PART VI, SECTION B, LINE 12CALL CENTRA/CCRC OFFICERS AND DIRECTORS MUST COMPLETE A "POSSIBLE CONFLICT OF INTEREST" QUESTIONNAIRE ON AN ANNUAL BASIS, CERTIFYING THAT NEITHER THEY NOR ANY OF THEIR IMMEDIATE FAMILY MEMBERS HAVE ENGAGED IN ANY ACTIVITIES THAT COULD LEAD TO A POTENTIAL CONFLICT OF INTEREST. ADDITIONALLY, ALL OFFICERS AND DIRECTORS MUST AGREE TO PROMPTLY REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR TO THE PRESIDENT OR CHAIRMAN OF CENTRA'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15CENTRA/CCRC HAS ESTABLISHED AN EXECUTIVE COMPENSATION COMMITTEE, WHICH CONSISTS OF THE CHAIRMAN OF CENTRA'S BOARD OF DIRECTORS PLUS AN ADDITIONAL FOUR MEMBERS OF CENTRA'S BOARD OF DIRECTORS. FOUR OF THESE FIVE MEMBERS MEET THE IRS FORM 990 INDEPENDENCE DEFINITION. MEMBERS OF THIS COMMITTEE REVIEW RELEVANT SALARY AND BENEFIT DATA FROM VARIOUS SOURCES AND MAKE RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE OF CENTRA'S BOARD OF DIRECTORS WITH RESPECT TO THE SALARY RANGE AND BENEFITS FOR THE CEO. THE EXECUTIVE COMMITTEE REVIEWS AND HAS FINAL APPROVAL OF THE CEO'S COMPENSATION. THE COMMITTEE IS ALSO RESPONSIBLE FOR THE REVIEW AND APPROVAL OF SALARY RANGES AND ADJUSTMENTS FOR OTHER OFFICERS AND KEY EMPLOYEES OF CENTRA, BASED ON THE RECOMMENDATIONS MADE BY THE CEO. METHODS USED TO DETERMINE SALARY RANGES AND ADJUSTMENTS INCLUDE, BUT ARE NOT LIMITED TO, INDEPENDENT COMPENSATION CONSULTANT(S) AS WELL AS THIRD PARTY COMPENSATION SURVEYS AND/OR STUDIES.
FORM 990, PART VI, SECTION C, LINE 18PHOTOCOPIES OF THE ORGANIZATION'S FORM 1023 AND RECENT FILINGS OF THE FORM 990 AND 990-T ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ADDITIONALLY, FILINGS OF THE FORM 990 CAN ALSO BE FOUND ONLINE AT WWW.GUIDESTAR.ORG.
FORM 990, PART VI, SECTION C, LINE 19PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART VII, LINE 1:DAVID ADAMS, LEWIS ADDISON, GEORGE DAWSON, W. MICHAEL BRYANT, AND THOMAS JIVIDEN EACH DEVOTE AN AVERAGE OF 50 HOURS PER WEEK TO CENTRA HEALTH, INC., A RELATED ORGANIZATION.AVERAGE HOURS WORKED:
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -270,395.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
CENTRA HEALTH INC
1920 ATHERHOLT ROADLYNCHBURGVA24501540715569HEALTHCAREVA501(C)(3)HOSPITALN/A0
CENTRA HEALTH FOUNDATION
1920 ATHERHOLT ROADLYNCHBURGVA24501541604094SUPPORTING ORGANIZATIONVA501(C)(3)509(A)(3)N/A0
LYNCHBURG FAMILY PRACTICE RESIDENCY PROGRAM INC
1920 ATHERHOLT ROADLYNCHBURGVA24501541457983HEALTHCAREVA501(C)(3)509(A)(3)N/A0
SOUTHSIDE COMMUNITY HOSPITAL INC
1920 ATHERHOLT ROADLYNCHBURGVA24501540555201HEALTHCAREVA501(C)(3)HOSPITALN/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1GENERAL BUSINESS CONCERNS INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode
FieldValueIRS element (for citing)
EIN541299682EIN
Primary ActivityREAL ESTATE - PHYSICIANS OFFICESPrimaryActivity
Legal Domicile StateVALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
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 Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg