2011-11-14T15:39:32-06:00 2010-12-31 BROWN EDWARDS & COMPANY LLP 124 NEWMAN AVENUE HARRISONBURG VA 22801 990 2010-01-01 540506331 ROCKINGHAM MEMORIAL HOSPITAL ROCK 5406891000 2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 228018679 MICHAEL KING 5406891245 2011-11-14 1 TOM DUNHAM 5404346736 2011-11-11 2010 2016-02-24 21:20:13Z MICHAEL KING 2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 228018679 320372360 0 X WWW.RMHONLINE.COM X 1908 VA NOT-FOR-PROFIT COMMUNITY HOSPITAL ORGANIZATION 16 16 2808 405 167466 -40846 1462566 2096638 290683548 308876991 3437461 -673912 9072769 7902021 304656344 318201738 42021 69735 0 0 142999350 154281338 0 0 436763 147944408 182405058 290985779 336756131 13670565 -18554393 527706374 571441385 347633718 374877003 180072656 196564382 X OUR MISSION IS TO IMPROVE HEALTH AND PROMOTE WELLBEING AND TO BE AN INNOVATIVE, COMMUNITY-ORIENTED HEALTH CARE PROVIDER COMMITTED TO OFFERING ACCESSIBLE, PERSONALIZED, AND HIGH-QUALITY SERVICES IN A COST-EFFECTIVE MANNER. WE WILL WORK IN PARTNERSHIP WITH THE LOCAL MEDICAL COMMUNITY AND OTHER LOCAL AND REGIONAL HEALTH CARE RESOURCES TO ENSURE THAT NECESSARY HEALTH SERVICES ARE AVAILABLE TO ALL, REGARDLESS OF THEIR FINANCIAL STATUS. WITH OUR PARTNERS, WE WILL SEEK TO ENHANCE THE HEALTH STATUS OF THE COMMUNITY WE SERVE BY OFFERING AN APPROPRIATE RANGE OF SERVICES, INCLUDING SELECTED AREAS OF EXCELLENCE. WORKING WITH OUR LOCAL PHYSICIAN PARTNERS, WE WILL ACTIVELY PARTICIPATE IN THE FORMATION OF A LOCALLY CONTROLLED, INTEGRATED DELIVERY SYSTEM. IN OUR EFFORTS, WE WILL BE GUIDED BY THE SHARED VALUES, BELIEFS AND NEEDS OF OUR LOCAL COMMUNITY. 0 0 307652336 0 308250325 HOSPITAL SERVICES:THE HOSPITAL PROVIDES HIGH-QUALITY HEALTH CARE TO THE COMMUNITY BY OFFERING THE LATEST TECHNOLOGY AND THE BEST TECHNICAL EXPERTISE. THE HOSPITAL SERVES A SEVEN-COUNTY AREA WITH A POPULATION OF CLOSE TO 200,000 ADMITTING MORE THAN 16,000 INPATIENTS AND DELIVERING CLOSE TO 1,750 BABIES PER YEAR. THE HOSPITAL IS LICENSED AS A 235-BED HOSPITAL AND PROVIDES AN APPROPRIATE ARRAY OF REGIONAL COMMUNITY HOSPITAL SERVICES INCLUDING ONCOLOGY, CARDIOLOGY INCLUDING CARDIAC SURGERY, BEHAVIORAL HEALTH, OBSTETRICS AND WOMEN'S SERVICES, OUTPATIENT AND INPATIENT SURGERY, SLEEP MEDICINE, EMERGENCY CARE, SENIOR SERVICES, HOME AND HOSPICE CARE, PHYSICIAN PRACTICES AND A VARIETY OF OTHER OUTPATIENT SERVICES AS WELL AS EDUCATION AND OUTREACH. THE HOSPITAL IS HOME TO SCHOOLS OF RADIOLOGICAL TECHNOLOGY AND MEDICAL TECHNOLOGY. ALONG WITH TRADITIONAL HEALTH SERVICES, THE HOSPITAL MAKES ITS RESOURCES AVAILABLE TO SUPPORT MANY COMMUNITY HEALTH INITIATIVES AND PROGRAMS.IN 2010, THE HOSPITAL RECORDED 16,317 ADMISSIONS (INCLUDING NEWBORNS), 295,493 OUTPATIENT VISITS, 70,301 EMERGENCY DEPARTMENT VISITS, 135,232 REGISTERED OUTPATIENTS (LAB AND X-RAY), 7,312 CHEMO THERAPY VISITS, 8,628 RADIATION THERAPY TREATMENTS AND 18,650 SURGERY PATIENTS. 675061 0 0 FREE CLINIC:PROVIDES VOLUNTEER OUTPATIENT HEALTHCARE SERVICES TO THE UNINSURED IN A MANNER THAT PROMOTES DIGNITY, WHOLENESS, AND COORDINATION OF SERVICES WITH PRIORITY GIVEN TO WORKING PEOPLE WHOSE INCOME IS UNDER 175% OF FEDERAL POVERTY LEVEL. IN 2010, RECORDED 20,000 PATIENT VISITS. 394314 0 303166 HEALTHY FAMILIES OF BLUE RIDGE AND HAND-IN-HAND RESOURCE FOR MOTHERS:HEALTHY FAMILIES OF THE BLUE RIDGE IS A HOME VISITATION PROGRAM TARGETING HIGH-RISK FIRST TIME FAMILIES WHO VOLUNTARILY AGREE TO PARTICIPATE IN ONGOING HOME VISITS UNTIL THE CHILD IS FIVE YEARS OLD. HAND-IN-HAND IS A MENTORING PROGRAM FOR PREGNANT AND PARENTING TEENS AGE 19 AND YOUNGER. THE PROGRAM FOCUSES ON HELPING TEENS KEEP MEDICAL APPOINTMENTS, REMAIN IN SCHOOL, DEVELOP PLANS FOR BABY'S CARE, DELAY REPEAT PREGNANCIES UNTIL ADULTHOOD AND SOLVE THE DAILY CHALLENGES OF BEING A NEW PARENT. 403251 0 297907 COMMUNITY HEALTH EDUCATION AND AWARENESS PROGRAM:INCLUDES STRONG FAMILIES/GREAT YOUTH, PEAS, AND SAFE KIDS. AS A PARTNER IN THE STRONG FAMILIES/GREAT YOUTH COALITION, RMH WORKS WITH THE COALITION TO REDUCE RISK FACTORS AND INCREASE PROTECTIVE FACTORS IN YOUTH UNDER THE AGE OF 18 IN THE HARRISONBURG-ROCKINGHAM COMMUNITY. AREAS OF FOCUS INCLUDE REDUCING SUBSTANCE ABUSE, UNINTENTIONAL INJURY, TEEN PREGNANCY, AND VIOLENCE, INCREASING SCHOOL ATTENDANCE, AND INCREASING ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT IN YOUTH. THROUGH THE PARENTING EDUCATION AND SUPPORT (PEAS) PROGRAM, RMH OFFERED A SERIES OF CLASSES TO ADULTS INCLUDING THE INCREDIBLE YEARS, ALL ABOUT BABY, AND STAYING CONNECTED WITH YOUR TEEN. 243312 0 0 HEALTHQUEST: FREE QUARTERLY HEALTH AND WELLNESS PUBLICATION THAT THE HOSPITAL PRODUCES TO HIGHLIGHT THE PRINCIPLES OF HEALTHY LIFESTYLE CHOICES, PREVENTATIVE CARE AND EARLY DETECTION AND SCREENING. IT ALSO FEATURES MEMBERS OF THE HOSPITAL MEDICAL AND CLINICAL STAFF, AND SERVE TO MARKET OUR PROGRAMS AND SERVICES. THE MAGAZINE MAILS PRIMARILY TO PEOPLE IN OUR LARGER SERVICE AREA AND IN 2010 THERE WERE MORE THAN 50,000 DISTRIBUTIONS. 177618 0 140676 CHILD CARE CONNECTION:A RESOURCE AND REFERRAL CENTER FOR CHILDCARE PROVIDERS AND PARENTS. THIS PROGRAM ENHANCES THE QUALITY OF CHILDCARE BY PROVIDING EDUCATION AND EDUCATIONAL MATERIALS, ALONG WITH TOYS AND GAMES RELATED TO SAFE, NURTURING CHILDCARE. IT ALSO SUPPORTS INCREASING THE QUANTITY AND QUALITY OF PROVIDERS IN THE AREA BY OFFERING CONSULTATION AND EDUCATION ON STARTING A CHILDCARE BUSINESS. CHILDCARE CONNECTION HAS CREATED A COORDINATED SYSTEM OF CHILDCARE WITH A CUSTOMIZABLE DATABASE OF CHILDCARE PROVIDERS THAT CAN BE ACCESSED FOR PARENTS. IN ADDITION, A SATELLITE OFFICE IN AN ADJOINING RURAL COUNTY OPERATES A VAN THAT DELIVERS EDUCATIONAL MATERIALS TO HOMES OF OUTLYING CHILDCARE PROVIDERS. 26388 0 0 HEALTH SCREENINGS:NUMEROUS FREE HEALTH SCREENING, SUCH AS SKIN CANCER, PROSTATE CANCER, CHOLESTEROL AND BLOOD GLUCOSE OFFERED TO RESIDENTS AT LOCAL HEALTH FAIRS AND COMMUNITY EVENTS WITH WIDE-SPREAD PARTICIPATION. 42021 0 0 FOUNDATION:GRANTS THROUGH THE RMH FOUNDATION SUPPORT INITIATIVES THAT WILL HAVE A POSITIVE IMPACT ON THE OVERALL HEALTH OF OUR COMMUNITY. 46881 0 600 HEALTH SCIENCE LIBRARY:THE VIRGINIA FUNKHOUSER HEALTH SCIENCE LIBRARY IS A BIOMEDICAL REFERENCE SERVICE FOR HOSPITALS STAFF AND THE SURROUNDING COMMUNITY. 6394 0 0 LIFE LINE:LIFELINE EMERGENCY RESPONSE SYSTEM THAT ENABLES WHOSE WITH SAFETY ISSUES TO REMAIN INDEPENDENT AND IN THEIR OWN HOMES FOR AS LONG AS POSSIBLE. 490484 0 0 OTHER PROGRAM SERVICES:IN ADDITION TO THE PROGRAM SERVICES HIGHLIGHTED ABOVE, THE HOSPITAL SUPPORTS VARIOUS OTHER PROGRAMS FOR THE BENEFIT OF THE COMMUNITY INCLUDING BUT NOT LIMITED TO GRIEF SUPPORT, FAMILY FAIR, WOMEN'S HEALTH EDUCATION, AND SENIOR ADVANTAGE. 55334 0 0 HEALTHSOURCE:PROVIDES PHYSICIAN REFERRAL, HEALTH INFORMATION AND CLASS REGISTRATION FREE TO PUBLIC. PROVIDES ASSISTANCE WITH COMMUNITY AND CORPORATE HEALTHCARE EVENTS. 1491683 439183 310213394 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 1 0 1 316 0 1 2808 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CHIEF FINANCIAL OFFICER 5406891245 2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 228018679 BARBARA B STOLTZFUS 6.00 X 0 0 0 MENSEL D DEAN JR 6.00 X 0 0 0 JAMES R MESSNER 6.00 X 0 0 0 A JERRY BENSON 6.00 X 0 0 0 W CARLTON BANKS 6.00 X 0 0 0 JOSEPH L FUNKHOUSER II 6.00 X 0 0 0 DOUGLAS G DRIVER 6.00 X 0 0 0 C WAYNE GATES MD 6.00 X 0 0 0 ANN E C HOMAN 6.00 X 0 0 0 ALDEN L HOSTETTER MD 6.00 X 0 0 0 ELMER E KENNEL MD 6.00 X 0 0 0 W NEAL MENEFEE 6.00 X 0 0 0 GEORGE W PACE 6.00 X 0 0 0 ALLON H LEFEVER 6.00 X 0 0 0 STEWART G POLLOCK MD 6.00 X 0 0 0 LAWRENCE D BOWERS JR 6.00 X 0 0 0 JAMES D KRAUSS 40.00 X 1107667 0 89514 RICHARD L HAUSHALTER 40.00 X 681284 0 91623 MICHAEL KING 40.00 X 586525 0 55673 DALE A CARROLL MD 40.00 X 767799 0 110108 DONNA HAHN 40.00 X 0 198678 45142 PAUL R PIERCE 40.00 X 0 223647 156709 MARK ZIMMERMAN 40.00 X 0 232162 77180 MICHAEL ROZMUS 40.00 X 0 215376 61477 MERV WEBB 40.00 X 0 190737 116797 MCGOWAN JOHN 40.00 X 248187 0 13967 STEPHEN MARRA MD 40.00 X 738473 0 29215 WILLIAM F CALE III MD 40.00 X 545915 0 119436 HEIDI GORSUCH-RAFFERTY MD 40.00 X 578103 0 29303 THOMAS WEBER MD 40.00 X 537686 0 28074 OLUMIDE DANISA MD 40.00 X 533876 0 23125 6325515 1060600 1047343 136 0 1 0 HARRISONBURG MEDICAL ASSOCIATES 1871 EVELYN BYRD AVE HARRISONBURG VA 22801 MEDICAL SERVICES 12587486 SHENANDOAH SHARED HOSPITAL SERVICES 304 NEFF AVENUE HARRISONBURG VA 22801 MEDICAL SERVICES 9465716 HARRISONBURG PHYSICIANS ANESTHESIOLOGY 1840 EAST MARKET STREET HARRISONBURG VA 22801 MEDICAL SERVICES 6117779 HARRISONBURG SURGICAL ASSOCCIATES 3320 EMMAUS RD HARRISONBURG VA 22801 MEDICAL SERVICES 2543750 HEMATOLOGYONCOLOGY ASSOCIATES 2008 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801 MEDICAL SERVICES 1871182 66 797577 1299061 2096638 OTHER PROFESSIONAL SER 621300 355334727 355334727 DAILY PATIENT SERVICES 621300 93282322 93282322 OTHER NURSING SERVICES 621300 92811933 92811933 LESS CHARITY CARE 621300 -20172906 -20172906 LESS CONTRACTUAL ADJUS 621300 -212379085 -212379085 308876991 502800 502800 94215 6000 88215 88215 88215 623758 1800470 -1176712 -1176712 -1176712 479835 364152 115683 115683 PHARMACY 446110 2960189 2960189 OTHER 900099 1777338 1621 1775717 EQUITY ALLOCATIONS 900099 1708599 1708599 1251997 165845 1086152 7698123 318201738 308992674 167466 6944960 69735 69735 5270250 5270250 119279285 111073983 7995565 209737 7653938 7127419 513061 13458 13832549 12880998 927228 24323 8245316 7678115 552703 14498 929064 800629 128435 304052 304052 25566 25566 59591 59591 39463350 37129868 2333482 727518 544239 183279 63938024 61477643 2326692 133689 5773958 1930113 3843845 3672906 3672906 341707 341631 76 450480 334589 111325 4566 5858353 5858353 19994218 19994218 3332639 3056321 275230 1088 BAD DEBTS 18195450 18195450 CONTRACT LABOR 8993769 8707188 286581 IMPUTED RENT - JMU 4080000 4080000 RENT 2159907 2196007 -37501 1401 OTHER 1974182 1505154 437587 31441 2130324 1533269 594493 2562 336756131 310213394 26105974 436763 48292506 61370294 23813177 23360811 4650541 3293228 38340648 40457298 3958102 3500102 9126856 4136934 4972415 5181378 2959146 2964890 444187048 77578859 323951596 366608189 34974286 36492911 18747632 15048046 13919469 9027304 527706374 571441385 51640240 37442881 259834 231376 267211274 300160065 28522370 37042681 347633718 374877003 X 147827152 166691561 17696661 15126649 14548843 14746172 180072656 196564382 527706374 571441385 X -18554393 35046119 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 25566 25566 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL IS INVOLVED IN INDIRECT LOBBYING ACTIVITIES THROUGH PAYMENT OF MEMBERSHIP DUES TO THE FOLLOWING ORGANIZATIONS: VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION. 31098549 1334949 2080749 5342410 29171837 29446900 1310621 3427364 3086336 31098549 36688003 2014074 -6513327 11000 2730850 29446900 0.00000 0.50550 0.49450 0 0 1744913 1744913 156675543 10136471 146539072 273831512 66388716 207442796 11935080 1053672 10881408 366608189 ANNUITIES PAYABLE 540522 PENSION LIABILITY 34715451 OTHER NON-CURRENT LIABILITIES 1055374 MARK-TO-MARKET LIABILITY 731334 37042681 318201738 336756131 -18554393 277728 34768391 35046119 16491726 317060078 6000 6000 317054078 59591 1088069 1147660 318201738 336645129 6000 6000 336639129 59591 57411 117002 336756131 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: N/A PART XI, LINE 8 - OTHER ADJUSTMENTS: OTHER CHANGES IN NET ASSETS 1,533,114. PENSION ADJUSTMENT -9,541,139. RATE SWAP MARK TO MARKET ADJUSTMENT -731,334. RATE LOCK SWAP ADJUSTMENT 197,061. INCREASE IN BENEFICIAL INTEREST IN TRUST HELD BY OTHERS 310,689. TRANSFER FROM ROCKINGHAM HEALTH CARE, INC.(PARENT COMPANY) 43,000,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 6,000. PART XII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY INCOME 82,655. NET ASSETS RELEASED FROM RESTRICTIONS 1,005,414. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 6,000. PART XIII, LINE 4B - OTHER ADJUSTMENTS: AUXILIARY EXPENSES 57,411. CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES JOINT VENTURE AGREEMENT WITH VIRGINIA SOLUTIONS SPC, LTD - INSURANCE CAPTIVE THAT UNDERWRITES HOSPITAL AND PHYSICIAN LIABILITY AND WORKERS COMPENSATION POLICIES FOR ITS MEMBER HOSPITALS. THE HOSPITAL HAS A 22.29% OWNERSHIP INTEREST IN THE CAPTIVE. 0 0 0 0 0 0 0 0 0 0 0 0 0 METHOD USED TO ACCCOUNT FOR EXPENDITURES: SCHEDULE F, PART I, LINE 3: EQUITY 1 1 1 X 1 X 1 1 0 1 1 11091288 11091288 0.03290 21162417 14327285 6835132 0.02030 32253705 14327285 17926420 0.05320 1466531 1466531 0.00440 1847131 606851 1240280 0.00370 65768935 51040229 14728706 0.04370 262468 262468 0.00080 69345065 51647080 17697985 0.05260 101598770 65974365 35624405 0.10580 1 11680250 0 89809639 117661576 -27851937 X 1 1 3 1 ROCKINGHAM MEMORIAL HOSPITAL

235 CANTRELL AVENUE HARRISONBURG VA 22801

X X X OTHER MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES 2 PARTIAL HOSPITALIZATION PROGRAM

752 OTT STREET HARRISONBURG VA 22801

BEHAVIORAL HEALTH 3 LIFE RECOVERY PROGRAM

752 OTT STREET HARRISONBURG VA 22801

BEHAVIORAL HEALTH ROCKINGHAM MEMORIAL HOSPITAL 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X 1 X X X 1 X X X X X X 1 X 0 1 10 MEDICAL OFFICE BDG - PHYSICIAN PRACTICES

2006 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801

PHYSICIAN OFFICES - SPECIALTY PRACTICES WOMEN'S CENTER

530 NEFF AVENUE HARRISONBURG VA 22801

MAMMGRAPHY SERVICES, BREAST SURGERY CLINIC RMH SOUTH MAIN HEALTH CENTER

1661 SOUTH MAIN ST HARRISONBURG VA 22801

FAMILY PRACTICE HOME HEALTH

706 SOUTH MAIN ST HARRISONBURG VA 22801

IN HOME NURSING CARE REHAB SEVICES - PAVILION

501 STONE SPRING RD HARRISONBURG VA 22801

OUTPATIENT PHYSICAL THERAPY SERVICES RMH EAST ROCKINGHAM HEALTH CENTER

13737 SPOTSWOOD TRAIL ELKTON VA 22827

FAMILY PRACTICE, LAB, REHAB SERVICES HOSPICE

2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801

END OF LIFE CARE RMH CENTER FOR SLEEP MEDICINE

640 SOUTH MAIN ST HARRISONBURG VA 22801

SLEEP STUDIES RMH VALLEY BEHAVIORAL MEDICINE

644 UNIVERSITY BLVD HARRISONBURG VA 22801

MENTAL HEALTH SERVICES RMH CANCER CENTER

2008 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801

SPECIALTY PHYSICIAN OFFICES PART II: AS OUR AREA'S LOCAL HEALTHCARE PROVIDER, ROCKINGHAM MEMORIAL HOSPITAL (RMH) EMBRACES A COUMMUNITYWIDE APPROACH TO HEALTH. THIS MEANS THAT IN ADDITION TO PROVIDING HIGH QUALITY PATIENT CARE, RMH IS COMMITTED TO EDUCATING THE COMMUNITY ABOUT PREVENTATIVE CARE MEASURES AND EARLY DETECTION OF POTENTIAL HEALTH RISKS. TO THAT END, RMH HAS ESTABLISHED MANY COMMUNITY OUTREACH PROGRAMS AND PARTNERSHIPS TO BUILD A HEALTHIER COMMUNITY IN WAYS THAT ARE MEANINGFUL AND MEASURABLE. IN 2010, OUR COMMUNITY BUILDING ACTIVITIES INCLUDED THE FOLLOWING:- CHILDCARE CONNECTION, A RESOURCE AND REFERRAL CENTER LINKING FAMILIES WITH CHILCARE PROVIDERS AND OFFERING CAREGIVER SUPPORT AND EDUCATION. OFFICES ARE LOCATED IN HARRISONBURG AND PAGE COUNTY.- FARM SAFETY DAY CAMP, A DAY CAMP FOR CHILDREN AND ADULTS TO INCREASE AWARENESS OF FARM SAFETY AND REDUCE THE NUMBER OF FARM INJURIES IN OUR REGION.- GRANTS THROUGH THE RMH FOUNDATION FOR INITIATIVES THAT WILL HAVE A POSTIVE IMPACT ON THE OVERALL HELATH OF OUR COMMUNITY.- HARRIOSNBURG-ROCKINGHAM FREE CLINIC, RMH PLAYS A MAJOR ROLE IN SUPPORTING THE FREE CLINIC WITH AN ESTIMATE VALUE OF SERVICES PROVIDED OF $675,000 IN 2010.- HEALTH SCREENINGS, SUCH AS SKIN CANCER, PROSTRATE CANCER, CHOLESTEROL AND BLOOD GLUCOSE OFFERED FREE OF CHARGE TO RESIDENTS AT LOCAL HEALTH FAIRS AND COMMUNITY EVENTS WITH WIDE-SPREAD PARTICIPATION.- HEALTHY FAMILIES OF THE BLUE RIDGE, A HOME VISITATION PROGRAM TARGETING HIGH-RISK FIRST TIME FAMILIES WHO VOLUNTARILY AGREE TO PARTICIPATE IN ONGOING HOME VISITS UNTIL THE CHILD IS FIVE YEARS OLD.- LIFELINE EMERGENCY RESPONSE SYSTEM THAT ENABLES THOSE WITH SAFETY ISSUES TO REMAIN INDEPENDENT AND IN THEIR OWN HOMES FOR AS LONG AS POSSIBLE.- RESOURCE MOTHERS, A PROGRAM FOR PREGNANT AND PARENTIN GTEENS. OUTCOME DATA FOR THIS PROGRAM REVEALS A YEARLY COST SAVINGS TO THE HELATH CARE SYSTEM OF AT LEAST $600,000 BY THE PREVENTATION OF LOW-BIRTH WEIGHT BABIES (WHEN COMPARED TO THE STATE'S RATE FOR TEENS), A SIGNIFICANTLY LOWER REPEAT PREGNANCY RATE THAN THE STATE (2% VS 20%), AND 90% OF THESE TEENS REMAIN IN SCHOOL OR THE WORKFORCE.- SENIOR ADVANTAGE, A HEALTHY AGING MEMBERSHIP PROGRAM FOR ADULTS AGE 55 OR BETTER OFFERING EDUCATIONAL OPPORTUNITIES, HEALTH SCREENS, AND SOCIAL EVENTS AND ACTIVITIES.- SUPPORT GROUPS AND CLASSES, RMH OFFERS FREE OR LOW-COST CLASSES, SEMINARS AND SUPPORT GROUPS ON A WIDE VARIETY OF HEALTH -RELATED TOPICS AND ISSUES. ROCKINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 13G: SIGNAGE INDICATING FINANCIAL ASSISTANCE IS AVAILABLE WITH THE PHONE NUMBER TO CALL FOR MORE INFORMATION IS POSTED IN ALL REGISTRATION AREAS. ADDITIONALLY THE SAME INFORMATION IS INCLUDED ON ALL BILLING INVOICES. ROCKINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 17E: SIGNAGE INDICATING FINANCIAL ASSISTANCE IS AVAILABLE IS WITH THE PHONE NUMBER TO CALL FOR MORE INFORMATION IS POSTED IN ALL REGISTRATION AREAS. ROCKINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: THE HOSPITAL BILLS GROSS CHARGES. ROCKINGHAM MEMORIAL HOSPITAL PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME, GROSS CHARGES LESS ANY APPLICABLE DISCOUNTS. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. BALANCES NOT PAID WITHIN 30 DAYS ARE CONSIDERED PAST DUE. BALANCES ARE CONSIDERED DELINQUENT WHEN THEY ARE OUTSTANDING FOR 120 DAYS WITH NO ACTIVITY AT WHICH TIME THE BALANCES ARE TRANSFERRED TO A COLLECTION AGENCY AND THE BALANCE IS MOVED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENT'S EVALUATION OF THE COMPONENTS OF ACCOUNTS RECEIVABLE. THE COST-TO-CHARGE RATIO WAS USED TO DETERMINE BAD DEBT EXPENSE AMOUNTS REPORTED ON LINES 2 AND 3. PART III, LINE 8: INTERNAL COST ACCOUNTING CALCULATIONS WERE USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: BALANCES ARE CONSIDERED DELINQUENT WHEN THEY ARE OUTSTANDING FOR 120 DAYS WITH NO ACTIVITY AT WHICH TIME THE BALANCES ARE TRANSFERRED TO A COLLECTION AGENCY. COLLECTOR'S REMINDERS CONSIST OF ACCOUNTS THAT ARE OVER $1000. A PHONE CALL IS PLACED TO THE PATIENT REGARDING THE SELF PAY BALANCE. EACH ACCOUNT NEEDS TO HAVE 3 CALLS MADE AND DOCUMENTED ON EACH ACCOUNT THAT IS IN THE REMINDER QUEUE. IF A CALL IS MADE FROM THE FIRST REMINDER AND THE PATIENT STATES THEY WILL MAKE A PAYMENT OR CALL BACK - A SECOND AND/OR THIRD CALL IS MADE TO BE SURE THEY FOLLOW THROUGH. IF DURING A CALL THE PATIENT ASKS FOR FINANCIAL ASSISTANCE, APPLICATION IS MAILED TO THEM. PART VI, LINE 2: THE HEALTH OF THE RESIDENTS OF HARRISONBURG AND ROCKINGHAM COUNTY IS ASSESSED EVERY FIVE YEARS FOR ADULTS AND SENIORS AND EVERY TWO YEARS FOR YOUTH. THESE ASSESSMENTS ARE COMPLETED BY THE HEALTHY COMMUNITY COUNCIL, A PARTNERSHIP INCLUDING RMH AS WELL AS REPRESENTATIVES FROM GOVERNMENT, SCHOOLS, BUSINESS, HIGHER EDUCATION, HELATH AND HUMAN SERVICES, FAITH COMMUNITY, LAW ENFORCEMENT AND MEDIA. THE 2006 COMMUNITY NEEDS ASSESSMENT REPORT IS AVAILABLE AT HTTP://WWW.HEALTHYCOMMUNITYCOUNCIL.ORG/HCC%20REPORT%202006.PDF. PART VI, LINE 3: THE HOSPITAL HAS POSTED PATIENT INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY AT EACH REGISTRATION AND WAITING AREAS. BILLING STATEMENTS AND THE WEBSITE HAS INSTRUCTIONS AND PHONE NUMBERS LISTED FOR ALL PATIENTS WHO MAY BE HAVING DIFFICULTY PAYING BILLS. SELF PAY PATIENTS ARE SCREENED IN PERSON TO DETERMINE IF THEY QUALIFY FOR FEDERAL OR STATE PROGRAMS THAT MAY OFFER INSURANCE. PATIENTS ARE ALSO SCREENED FOR AND GIVEN THE OPPORTUNITY TO APPLY FOR RMH FINANCIAL ASSISTANCE. THE HOSPITAL USES AN OUTSIDE VENDOR THAT SCREENS ALL PATIENTS WITHOUT INSURANCE FOR ELIGIBILITY FOR GOVERNMENT PROGRAM, AND A FINANCIAL COUNSELOR WHO SCREENS THOSE THAT ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAM TO DETERMINE WHETHER THEY MEET CRITERIA FOR CHARITY CARE. PART VI, LINE 4: THE HARRISONBURG-ROCKINGHAM AREA COVERS 871 SQUARE MILES OF LAND AND IS HOME TO ABOUT 111,000. THE MEDIA AGE IS 32 YEARS WITH 22 PERSENT OF THE POPULATION FALLING UNDER THE AGE OF 18 AND 12 PERCENT OVER AGE 65. RMH IS A SOLE COMMUNITY HOSPITAL IN THE HARRISONBURG-ROCKINGHAM AREA. THE AREA IS CONSIDERED RURAL. PART VI, LINE 7: N/A REPORTS FILED WITH STATES PART VI, LINE 7 VA 1 GENERATIONS CROSSING 3765 TAYLOR SPRING LANE HARRISONBURG VA 22801 542061192 501(C)(3) 15000 SCHOLARSHIPS FOR DAY CARE FOR ELDERLY AND DISABLED ADULTS CENTER FOR MARRIAGE & FAMILY 96 CAMPBELL ST HARRISONBURG VA 22801 540914625 12400 SUPERVISED VISITATION JAMES MADISON UNIVERSITY 302 WARREN HALL MSC 3516 HARRISONBURG VA 22807 546001756 501(C)(3) 9349 MEDICAL SUITCASE CLINIC BOYS & GRILS CLUB OF HARRISONBURGROCKINGHAM PO BOX 1223 HARRISONBURG VA 22803 541652418 501(C)(3) 7500 TRIPLE PLAY PROGRAM BLUE RIDGE AREA FOOD BANK MSC 9009 JAMES MADISON UNIVERSITY HARRISONBURG VA 22807 546001756 501(C)(3) 7140 SUPPORT FOR COMMUNITY HEALTH INTERPRETER SERVICES COLLINS CENTER PO BOX 1473 HARRISONBURG VA 22803 541478133 501(C)(3) 5675 CARE FOR KIDS PROGRAM DREAM COME TRUE 956 MOCKINGBIRD DRIVE HARRISONBURG VA 22802 546001343 5000 PLAYGROUND 6 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ROCKINGHAM MEMORIAL HOSPITAL HAS A CAREFUL SCREENING PROCESS IN REVIEWING GRANT APPLICANTS. THE APPLICATIONS ARE FIRST REVIEWED BY A SMALL COMMITTEE USING ESTABLISHED CRITERIA SUCH AS 1) WHAT COMMUNITY NEED IS BEING ADDRESSED 2) THE ROLE OF PARTNERS IN THE INITIATIVE 3) AN ACTION PLAN WITH SPECIFIC ACTIVITIES 4) MEASURABLE GOALS OR OUTCOMES 5) BUDGET AND 6) SUSTAINABILITY FOR THE PROJECT IN THE FUTURE. IF AWARDED THE GRANT, THE APPLICANT IS REQUIRED TO SUBMIT A WRITTEN REPORT OF THE OUTCOME WITHIN 12 MONTHS. NO GRANTS ARE MADE OUTSIDE OF THE UNITED STATES. X 1 1 X X X X X X 0 0 0 0 0 0 0 0 0 JAMES D KRAUSS 448888 0 532864 0 125915 0 71050 0 18464 0 1197181 0 0 0 RICHARD L HAUSHALTER 282785 0 337486 0 61013 0 77699 0 13924 0 772907 0 0 0 MICHAEL KING 240918 0 289676 0 55931 0 40151 0 15522 0 642198 0 0 0 DALE A CARROLL MD 331485 0 398481 0 37833 0 93309 0 16799 0 877907 0 0 0 DONNA HAHN 0 174068 0 24116 0 494 0 32761 0 12381 0 243820 0 0 PAUL R PIERCE 0 195388 0 26675 0 1584 0 144111 0 12598 0 380356 0 0 MARK ZIMMERMAN 0 194815 0 28542 0 8805 0 62452 0 14728 0 309342 0 0 MICHAEL ROZMUS 0 189792 0 25042 0 542 0 47164 0 14313 0 276853 0 0 MERV WEBB 0 167674 0 21750 0 1313 0 104810 0 11987 0 307534 0 0 MCGOWAN JOHN 247700 0 0 0 487 0 0 0 13967 0 262154 0 0 0 STEPHEN MARRA MD 622150 0 31000 0 85323 0 14685 0 14530 0 767688 0 0 0 WILLIAM F CALE III MD 360209 0 103705 0 82001 0 101097 0 18339 0 665351 0 0 0 HEIDI GORSUCH-RAFFERTY MD 271693 0 215972 0 90438 0 14700 0 14603 0 607406 0 0 0 THOMAS WEBER MD 228331 0 289139 0 20216 0 14700 0 13374 0 565760 0 0 0 OLUMIDE DANISA MD 454952 0 45000 0 33924 0 14700 0 8425 0 557001 0 0 0 PART I, LINE 1A MEMBERSHIP TO VALLEY WELLNESS CENTER, A RELATED 501(C)(3) ORGANIZATION PROVIDED AT REDUCED RATES. THIS BENEFIT IS AVAILABLE TO ALL ORGANIZATION'S EMPLOYEES. INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VIRGINIA 542000436 415675AX5 2005-12-07 50000000 REFUND 9/9/2005 ISSUE; PAY OFF COMMERCIAL NOTE; FINANCE CAPITAL EXPENDITURES 0 0 0 INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VIRGINIA 542000436 415669BN9 2006-12-28 196167653 FUND CONSTRUCTION OF NEW HOSPITAL FACILITY 0 0 0 INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VIRGINIA 542000436 NONEAVAIL 2009-04-01 30000000 PROVIDE FUNDS TO REFUND 4/4/2007 ISSUE 0 0 0 INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VIRGINIA 541222826 NONEAVAIL 2010-09-15 25000000 COST OF NEW HOSPITAL, EQUIPMENT AND MOB 0 0 0 208479998 12253500 570000 195656498 2010 0 0 1 1 30000000 1 0 1 1 25000000 25000000 1 0 1 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 0 0 0 1 JP MORGAN CHASE BANK 2.400000000000 1 0 0 0 1 0 0 0 1 0 1 0 0 0 1 INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VIRGINIA 541222826 NONEAVAIL 2010-09-15 25000000 COST OF NEW HOSPITAL, EQUIPMENT AND MOB 0 0 0 INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VIRGINIA 541222826 NONEAVAIL 2010-09-15 25000000 COST OF NEW HOSPITAL, EQUIPMENT AND MOB 0 0 0 25000000 25000000 1 0 1 1 25000000 25000000 1 0 1 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 0 1 0 0 0 1 MENSEL DEAN MEMBER OF PLEASANT RUN PURCHASE OF LAND X 4265842 3500102 0 1 1 3500102 SHENANDOAH SHARED HOSPITAL SERVICES INC 53% EQUITY ALLOCATED TO RMH & 3 PEOPLE SERVE AS OFFICERS/DIRECTORS FOR BOTH 9570886 ORGANIZATION MADE PAYMENTS TO SHENANDOAH SHARED HOSPITAL SERCICES, INC. FOR CLINICAL SERVICES INCLUDING COMPUTERIZED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, POSITRON EMISSION TOMOGRAPHY, LITHOTRIPSY, MOBILE MAMMOGRAPHY, PILL ENDOSCOPY, AND TECHNOLOGY MANAGEMENT. 0 ALDEN HOSTETTERMD BOD MEMBER; 33.3% OWNER OF PATHOLOGY ASSOCIATES OF HARRISONBURG 177247 ORGANIZARION MADE PAYMENTS TO PATHOLOGY ASSOCIATES OF HARRISONBURG FOR PROFESSIONAL SERVICES. 0 STEWART POLLACK MD BOD MEMBER; 7.69% OWNERSHIP IN HARRISONBURG MEDICAL ASSOCIATES 12587486 ORGANIZATION MADE PAYMENTS TO HARRISONBURG MEDICAL ASSOCIATES FOR PROFESSIONAL SERVICES. 0 DOUGLAS DRIVER BOD MEMBER; PRESIDENT AND 11% OWNER OF LANZ CONSTRUCTION CO. 598021 ORGANIZATION MADE PAYMENTS TO LANZ CONSTRUCTION CO. FOR CONSTRUCTION SERVICES. 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WAS PRESENTED AT THE BOARD OF DIRECTORS MEETING PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS WITH ANY CONFLICT OF INTEREST ARE MADE AWARE OF THE NEED TO EXCUSE THEMSELVES FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON ANY ISSUES WHERE THERE MAY BE A CONFLICT. OFFICERS OF THE ORGANIZATION ARE AWARE OF DUTIES AND RESPONSIBILITIES IN REGARDS TO THIS ISSUE. FORM 990, PART VI, SECTION B, LINE 15 OFFICERS: AN INDEPENDENT COMPENSATION CONSULTING FIRM IS RETAINED BY THE BOARD OF DIRECTORS (BOD) TO COMPLETE MARKET ANALYSIS AND RECOMMEND EXECUTIVE COMPENSATION CHANGES. THE BOD APPROVES COMPENSATION CHANGES FOR OFFICERS. DIRECTORS: AN INDEPENDENT COMPENSATION CONSULTING FIRM IS RETAINED TO CONDUCT MARKET ANALYSIS AND MAKE RECOMMENDATIONS FOR DIRECTOR LEVEL COMPENSATION CHANGES. COMPENSATION CHANGES ARE APPROVED BY THE VP OF HUMAN RESOURCES DEVELOPMENT AND THE COO. OTHER EMPLOYEES: HUMAN RESOURCES DEVELOPMENT CONDUCTS COMPENSATION SURVEYS AND MAKES RECOMMENDATIONS FOR COMPENSATION CHANGES. MERIT INCREASES AND MARKET ADJUSTMENTS ARE APPROVED BY SENIOR LEADERSHIP. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 277,728. OTHER CHANGES IN NET ASSETS 1,533,114. PENSION ADJUSTMENT -9,541,139. RATE SWAP MARK TO MARKET ADJUSTMENT -731,334. RATE LOCK SWAP ADJUSTMENT 197,061. INCREASE IN BENEFICIAL INTEREST IN TRUST HELD BY OTHERS 310,689. TRANSFER FROM ROCKINGHAM HEALTH CARE, INC.(PARENT COMPANY) 43,000,000. TOTAL TO FORM 990, PART XI, LINE 5: 35,046,119. OVERSIGHT OF AUDITED FINANCIAL STATEMENTS FORM 990, PART XI, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ROCKINGHAM HEALTH CARE INC 235 CANTRELL AVENUE HARRISONBURG VA 22801 521309259 PARENT ORGANIZATION FOR TWO NOT-FOR-PROFIT TAX-EXEMPT ORGANIZATIONS VA 501(C)(3) 11B TYPE II N/A 0 VALLEY WELLNESS CENTER 501 STONE SPRING ROAD HARRISONBURG VA 22801 521309257 PREVENTATIVE HEALTH CARE AND REHABILITATION SERVICES VA 501(C)(3) 3 ROCKINGHAM HEALTH CARE INC 0 ROCKINGHAM HEALTH SERVICES INC 2010 HEALTH CAMPUS DRIVE HARRISONBURG VA 22801 CONTRACTING SERVICES VA ROCKINGHAM HEALTH CARE INC C 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 VALLEY WELLNESS CENTER J 152609 ACTUAL VALLEY WELLNESS CENTER R 701507 ACTUAL