2011-11-15T14:13:06-06:00 2010-12-31 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-01-01 540555201 SOUTHSIDE COMMUNITY HOSPITAL INC SOUT 4343152432 800 OAK STREET FARMVILLE VA 23901 WILLIAM L BASS JR 4343152432 2011-11-15 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z CENTRA SOUTHSIDE COMMUNITY HOSPITAL WILLIAM L BASS JR 800 OAK STREET FARMVILLE VA 23901 63615318 0 X HTTP://SCH.CENTRAHEALTH.COM X 1926 VA TO PROVIDE HEALTHCARE SERVICES FOR EIGHT COUNTIES IN CENTRAL VIRGINIA. 20 14 585 138 0 0 25324 20469 58982629 63433992 -13584 64600 134093 96257 59128462 63615318 34467 17000 0 0 30274385 32855693 0 0 0 32219656 38211101 62528508 71083794 -3400046 -7468476 56081652 52419468 26138610 29407837 29943042 23011631 WE ARE DEDICATED TO IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE BY PROVIDING HIGH QUALITY HEALTHCARE WITH A PERSONAL TOUCH. 0 0 64172959 17000 63433992 SOUTHSIDE COMMUNITY HOSPITAL IS A 501(C)(3) HOSPITAL COMMITTED TO OFFERING AFFORDABLE HEALTHCARE TO RESIDENTS OF SOUTHSIDE VIRGINIA. WE ARE DEDICATED TO IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE BY PROVIDING HIGH QUALITY HEALTHCARE. THE HOSPITAL HAS A LONG LIST OF PROGRAM SERVICE ACCOMPLISHMENTS FOR 2010. PLEASE SEE THE CONTINUATION ON SCHEDULE O. 64172959 1 1 0 1 0 0 0 0 1 1 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 70 0 1 585 1 0 0 0 0 0 0 0 0 0 0 X 20 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X X WILLIAM BASS 4343152433 800 OAK STREET FARMVILLE VA 23901 X STEPHEN C KEITH EDD 2.00 X X 0 0 0 SARAH E PUCKETT 2.00 X X 0 0 0 LEROY O PFEIFFER JR 2.00 X X 0 0 0 GEORGE W DAWSON 2.00 X 0 1131633 145311 KWABENA DONKOR MD 2.00 X X 0 0 0 LEWIS C ADDISON 2.00 X 0 566479 76508 CALVIN GRAY 2.00 X 0 0 0 BARBARA DUFFER 2.00 X 0 0 0 RODGER W FAUBER 2.00 X 0 0 0 SHARON L HARRUP 2.00 X 0 0 0 KIRSTEN L HUBER MD 50.00 X 297412 0 11740 CARLTON LAFOON 2.00 X 0 0 0 RICHARD P LASH 2.00 X 0 0 0 EARL MOORE 2.00 X 0 0 0 ODESSA PRIDE 2.00 X 0 0 0 LARRY ROACH 2.00 X 0 0 0 CHARLES TAYLOR MD 2.00 X 0 0 0 FRANCIS WOOD JR 2.00 X 0 0 0 GWENDOLYN S EDDLEMAN EDD 50.00 X X 337415 0 40039 WILLIAM MCGUIRE CPA 2.00 X 0 0 0 WILLIAM L BASS 50.00 X 167735 0 46032 DAVID E JOHNSEN 50.00 X 623881 0 7350 JOHN A KONA 50.00 X 475920 0 0 PHILLIP M LENOACH 50.00 X 459670 0 7350 JOHNATHAN R LOGAN 50.00 X 401363 0 6731 PATEL G PRAVINBHAI 50.00 X 383000 0 5584 3146396 1698112 346645 42 0 1 0 MEDICAL ASSOCIATES OF CENTRAL VIRGINIA PO BOX 11889 LYNCHBURG VA 24506 PHYSICIAN SERVICES 2252528 CROTHALL FACILITIES 955 CHESTERBROOK BLVD300 WAYNE PA 19087 HOUSEKEEPING 1149313 ENDURACARE PO BOX 52524 PHOENIX AZ 85072 PHYSICAL THERAPY 1061325 MORRISON MANAGEMENT PO BOX 102289 ATLANTA GA 30368 DIETARY SERVICES 955683 MED 3000 5 EAST ALVON ROAD STE 7 WHITE SULPHER SPRINGS WV 24986 PATIENT ACCOUNTING SERVICES 562396 18 11691 8778 20469 NET PATIENT SERVICE RE 621400 63387182 63387182 ANCILLARY SERVICES 900099 46810 46810 63433992 57777 57777 82324 82324 82324 82324 2823 4000 2823 4000 6823 6823 MISCELLANEOUS REVENUES 900099 13933 13933 13933 63615318 63433992 0 160857 17000 17000 900373 309152 591221 26706495 24452235 2254260 5248825 5248825 750000 750000 100214 100214 58559 58559 12075633 10715034 1360599 311005 311005 8273027 6995646 1277381 172705 172705 1263462 1263462 145245 135588 9657 132384 107150 25234 457083 457083 3785273 3785273 989529 989529 BAD DEBTS 9448132 9448132 COLLECTIONS EXPENSES 248850 248850 71083794 64172959 6910835 0 2204629 3929231 2298191 1427157 7587610 5982817 1102310 1138703 472205 364849 57699089 31277089 26437538 26422000 2243241 1623247 13581937 11490222 153991 41242 56081652 52419468 4046994 5417108 10523434 9945060 283964 251840 11284218 13793829 26138610 29407837 X 29865614 22929376 13279 18106 64149 64149 29943042 23011631 56081652 52419468 X -7468476 537065 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2997 2997 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF THE ORGANIZATION'S HOSPITAL ASSOCIATION DUES FOR THE 2010 WERE ATTRIBUTABLE TO LOBBYING EXPENSES. THIS AMOUNT WAS $2,997 64149 64149 63085 1064 64149 87610 1297 -25822 63085 1.00000 0 0 163194 163194 29076732 14370813 14705919 1784776 1086576 698200 26558456 15819700 10738756 115931 115931 26422000 INVESTMENT IN HEALTH NETWORK 49995 C DUE FROM RELATED PARTIES 11440227 C 11490222 DUE TO A RELATED PARTY 13290313 ESTIMATED THIRD PARTY SETTLEMENTS 503516 13793829 63615318 71083794 -7468476 106682 430383 537065 -6931411 64152383 106682 430383 537065 63615318 0 63615318 71083794 0 71083794 0 71083794 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THESE FUNDS WERE DONOR RESTRICTED FOR LPN NURSING SCHOLARSHIPS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIALS STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE HOSPITAL HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: CONTRIBUTED CAPITAL FROM AFFILIATE 430,383. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONTRIBUTED CAPITAL FROM AFFILATE 430,383. 1 1 1 X 1 X 1 1 1 0 1 1 2408392 2408392 0.03910 11384877 8414335 2970542 0.04820 42540 29108 13432 0.00020 13835809 8443443 5392366 0.08750 11000 11000 0.00020 11000 11000 0.00020 13846809 8443443 5403366 0.08770 11 426 772 772 0.00000 11 426 772 772 0 4098574 23834979 27245474 -3410495 X 1 1 1 1 SOUTHSIDE COMMUNITY HOSPITAL INC

800 OAK STREET FARMVILLE VA 23901

X X X NA FOR 2010 1 7 SARTORI MEDICAL CENTER

312 KINGS STREET KEYSVILLE VA 23947

FAMILY PRACTICE CENTRA SOUTHSIDE PROF SVC FARMVILLE

1705 EAST THIRD STREET FARMVILLE VA 23901

FAMILY & PEDIATRIC PRACTICE CENTRA SOUTHSIDE PROF SVC VICTORIA

1418 SIXTH STREET VICTORIA VA 23974

FAMILY PRACTICE BURKEVILLE MEDICAL GROUP

412 NAMOZINE STREET BURKEVILLE VA 23922

FAMILY PRACTICE SOUTHSIDE COMMHOSP HOMECARE SVC

713 OAK STREET FARMVILLE VA 23901

HOME HEALTH SERVICES CUMBERLAND MEDICAL CENTER

1758 ANDERSON HIGHWAY CUMBERLAND VA 23942

FAMILY PRACTICE FAMILY MEDICINE OF FARMVILLE

400 LONGWOOD AVENUE FARMVILLE VA 23901

FAMILY PRACTICE PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9448132. PART III, LINE 4: NOTE 1: "PATIENT ACCOUNTS RECEIVABLE ARE RECORDED WHEN SERVICES ARE RENDERED AND ARE PRESENTED IN THE CONSOLIDATED BALANCE SHEETS NET OF ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS AND CONTRACTUAL ADJUSTMENTS. THE HOSPITAL DOES NOT CHARGE FINANCE CHARGES ON OUTSTANDING PATIENT ACCOUNTS RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN THEY ARE DETERMINED TO BE UNCOLLECTIBLE. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED ON THE HOSPITAL'S HISTORICAL LOSSES, THE EXISTING ECONOMIC CONDITIONS IN THE SURROUNDING REGION, AND THE ASSESSMENT OF FINANCIAL STABILITY OF ITS PATIENTS."THE ORGANIZATION USED A COST-TO-CHARGE RATIO TO DETERMINE BAD DEBT EXPENSE AT COST. PART III, LINE 8: DURING THE BUDGET PROCESS SOUTHSIDE COMMUNITY HOSPITAL APPROPRIATES FUNDS FOR PATIENT CARE, RESEARCH, AND MEDICAL EDUCATION. ALSO, THE HOSPITAL SUPPORTS NUMEROUS HEALTH RELATED SUPPORT GROUPS WITH EDUCATIONAL MATERIALS AND PROFESSIONAL KNOWLEDGE. THROUGHOUT THE YEAR THE HOSPITAL REACHES OUT TO THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY HEALTH FAIRS OR EMPLOYER SPONSORED HEALTH FAIRS. PART III, LINE 9B: CHARITY AND FINANCIAL ASSISTANCE IS AVAILABLE TO ALL CENTRA SOUTHSIDE PATIENTS INCLUDING ACCOUNTS PLACED IN BAD DEBT. AFTER APPLYING FOR THE PATIENT'S MULTIPLE OPPORTUNITIES TO SEEK FINANCIAL ASSISTANCE, CENTRA SOUTHSIDE USES PRESUMPTIVE SOFTWARE INTELLIGENCE TO IDENTIFY PATIENTS WHO ARE LIKELY FINANCIALLY INDIGENT PRIOR TO BAD DEBT. CHARITY DISCOUNTS ARE EXTENDED TO THESE PATIENTS DESPITE THE ABSENCE OF A FINANCIAL ASSISTANCE APPLICATION. CENTRA SOUTHSIDE'S CHARITY POLICY UNDER SECTION F, PRESUMPTIVE CHARITY, REFERENCES THIS PROCESS. ACCOUNTS WITH BALANCES GREATER THAN $2,000 ARE MANUALLY REVIEWED FOR CHARITY QUALIFICATIONS PRIOR TO BAD DEBT PLACEMENT WHICH CAN BE FOUND IN CENTRA SOUTHSIDE'S BAD DEBT POLICY UNDER PROCEDURE STEP 3. PART VI, LINE 2: CENTRA SOUTHSIDE HAS DEVELOPED COMMUNITY ADVISORY BOARD CONSISTING OF 15 COMMUNITY MEMBERS FROM DIVERSE DEMOGRAPHIC BACKGROUNDS. THIS COMMITTEE WAS DEVELOPED FOR THE PURPOSE OF HAVING REGULAR OPEN DIALOGUE CONCERNING COMMUNITY HEALTH NEEDS WITH THE COMMUNITY IN OUR PRIMARY AND SECONDARY MARKET. THIS GROUP WILL MEET QUARTERLY.A CALL CENTER RECEIVES CALLS AND REPORTS TO THE MARKETING DEPARTMENT ADDITIONAL REQUESTS FROM THE COMMUNITY.CENTRASOUTHSIDE.COM PROVIDES CONSTANT FEEDBACK FROM THE COMMUNITY, AND IS ADDRESSED IMMEDIATELY. ALSO, EVALUATIONS ARE TAKEN AT COMMUNITY EVENTS. THIS PROVIDES NECESSARY AND VALUABLE FEEDBACK FOR FUTURE EDUCATIONAL EVENTS AND WORKSHOPS. PART VI, LINE 3: CENTRA SOUTHSIDE TAKES A MULTIDISCIPLINARY APPROACH TO INFORMING OUR PATIENTS AND COMMUNITY ABOUT FINANCIAL ASSISTANCE. INFORMATION ABOUT FINANCIAL ASSISTANCE AND CHARITY CAN BE FOUND ON CENTRA SOUTHSIDE'S INTERNET PAGE PROVIDING FULL DISCLOSURE ABOUT QUALIFICATIONS AND THE APPLICATION PROCESS. INDIVIDUALS MAY OBTAIN INFORMATION AND AN APPLICATION FROM ANY REGISTRATION POINT OR CUSTOMER SERVICE UNIT IN PERSON OR BY PHONE. SIGNS ARE POSTED IN CONSPICUOUS LOCATIONS ALERTING INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND WHERE TO OBTAIN ADDITIONAL INFORMATION. BROCHURES ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE IN REGISTRATION AND CUSTOMER SERVICE. WHILE PATIENTS ARE HOSPITALIZED, A FINANCIAL COUNSELOR PROVIDES FINANCIAL ASSISTANCE INFORMATION, SCREENS PATIENTS FOR FEDERAL AND STATE PROGRAMS AND GIVES AN OPPORTUNITY TO ASK QUESTIONS. ADDITIONALLY, AN INSERT ABOUT FINANCIAL ASSISTANCE IS MAILED IN EVERY UNINSURED BILL AND EVERY PATIENT BILL, WHETHER UNINSURED OR INSURED, REFERENCING AVAILABILITY OF FINANCIAL ASSISTANCE WITH CONTACT INFORMATION ON WHERE TO OBTAIN MORE INFORMATION. PART VI, LINE 4: SOUTHSIDE COMMUNITY HOSPITAL IS LOCATED IN FARMVILLE, VIRGINIA, WHICH IS 50 MILES EAST OF LYNCHBURG AND 50 SOUTHWEST OF RICHMOND. AS A SOLE COMMUNITY HOSPITAL IT IS CENTRALLY LOCATED TO SERVE THE RESIDENTS OF AMELIA, APPOMATTOX, BUCKINGHAM, CHARLOTTE, CUMBERLAND, LUNENBURG, NOTTOWAY, AND PRINCE EDWARD COUNTIES. THE HOSPITAL WAS ESTABLISHED TO PROVIDE HEALTHCARE TO THIS MOSTLY RURAL AREA. THE COUNTIES OF BUCKINGHAM, CHARLOTTE, AND LUNENBURG HAVE BEEN DESIGNATED AS MEDICALLY UNDERSERVED AREAS. PART VI, LINE 6: CENTRA SOUTHSIDE COMMUNITY HOSPITAL PLAYS AN IMPORTANT ROLE IN PROMOTING HEALTH IN THE COMMUNITIES IT SERVES. THE HOSPITAL HOSTS FREE WORKSHOPS AND EDUCATIONAL SEMINARS ON DIABETES, STROKE PREVENTION, HEART HEALTH AND MORE. CSCH ALSO PARTICIPATES IN APPROXIMATELY TWENTY HEALTH FAIRS ANNUALLY, PROVIDING FREE SCREENINGS TO THE PUBLIC. THE HEALTH EXPLORERS CAMP, HELD EVERY SUMMER, HOSTS MIDDLE SCHOOLS FOR A WEEK TO ALLOW THEM TO EXPLORE OPTIONS IN THE HEALTH CARE FIELD. SAFE SITTER BABYSITTING CLASSES, SIBLING CLASSES, BREAST-FEEDING CLASSES, ARE JUST A FEW OF THE CLASSES MADE AVAILABLE FOR COMMUNITY MEMBERS. CSCH ALSO HOSTS SEVEN SUPPORT GROUPS INCLUDING AA, DIABETES SUPPORT GROUP, CELIAC DISEASE SUPPORT GROUP, AND MS SUPPORT GROUP. WE HAVE A TEEN VOLUNTEER PROGRAM AND A COLLEGE VOLUNTEER PROGRAM FOR STUDENTS AT LONGWOOD UNIVERSITY, HAMPDEN-SYDNEY COLLEGE, AND SOUTHSIDE VIRGINIA COMMUNITY COLLEGE. PART VI, LINE 7: SOUTHSIDE COMMUNITY HOSPITAL'S AFFILIATION WITH CENTRA HEALTH BEGAN JANUARY 2006. IT ONLY SEEMED NATURAL THAT SOUTHSIDE COMMUNITY HOSPITAL WOULD PARTNER WITH CENTRA HEALTH, SINCE THE OTHER CENTRA HOSPITALS ARE LOCATED TO THE WEST ONLY 50 MILES. CENTRA HEALTH HAS A NATIONAL REPUTATION FOR CLINICAL EXCELLENCE AND PATIENT SATISFACTION. SOUTHSIDE COMMUNITY HOSPITAL AND CENTRA OFFICIALS BELIEVE THE COMBINED ORGANIZATIONS WILL BE STRENGTHENED THROUGH AN EXCHANGE OF BEST PRACTICES AND ECONOMIES OF SCALE. SOUTHSIDE PATIENTS HAVE AVAILABLE BETTER ACCESS TO A BROADER RANGE OF ADVANCED CLINICAL SERVICES THAT ARE AVAILABLE AT CENTRA HEALTH'S LYNCHBURG HOSPITALS. THE AFFILIATION IS ONE IN A SERIES OF STEPS IN WHICH SOUTHSIDE'S LEADERS RECOGNIZED THE NEED TO PARTNER WITH AN ORGANIZATION THAT SHARED A MISSION OF EXCELLENT CARE. DURING THE PAST FOUR YEARS, SOUTHSIDE HAS BEEN ABLE TO MAKE STRUCTURAL IMPROVEMENTS, REPLACE MEDICAL EQUIPMENT WITH NEWER MEDICAL TECHNOLOGY, AND UPDATE COMPUTER SYSTEMS. SOUTHSIDE HAS SUCCESSFULLY RECRUITED BOARD-CERTIFIED SURGEONS AND SPECIALISTS, NEW EMERGENCY PHYSICIANS, AND EXTEND THEIR HOSPITALIST PROGRAM.SCH HAS BEEN THE HEALTHCARE CENTER OF SOUTHSIDE VIRGINIA SINCE OPENING ITS DOORS NOVEMBER 9, 1927. SINCE THEN, IT HAS OPERATED ON A NON-PROFIT BASIS WITH THE GOAL OF HELPING TO HEAL THE ILL AND INJURED. THE HOSPITAL SERVES THE RESIDENTS OF AMELIA, APPOMATTOX, BUCKINGHAM, CHARLOTTE, CUMBERLAND, LUNENBURG, NOTTOWAY, AND PRINCE EDWARD COUNTIES. REPORTS FILED WITH STATES PART VI, LINE 7 VA 1 MARCH OF DIMES 10128 W BROAD STREET STE A GLEN ALLEN VA 23060 131846366 501(C)(3) 10000 N/A N/A GENERAL OPERATIONAL SUPPORT LONGWOOD UNIVERSITY 201 HIGH STREET FARMVILLE VA 23901 546001788 501(C)(3) 7000 N/A N/A GENERAL OPERATIONAL SUPPORT 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THROUGHOUT THE YEAR, GRANT REQUESTS ARE SUBMITTED TO THE EXECUTIVE COMMITTEE FOR THEIR REVIEW AND APPROVAL. X X X X 0 1 0 0 0 0 0 0 0 GEORGE W DAWSON 0 595865 0 0 0 535768 0 129956 0 15355 0 1276944 0 0 LEWIS C ADDISON 0 328394 0 0 0 238085 0 56847 0 19661 0 642987 0 29362 KIRSTEN L HUBER MD 296445 0 0 0 967 0 7350 0 4390 0 309152 0 0 0 GWENDOLYN S EDDLEMAN EDD 266924 0 30000 0 40491 0 33111 0 6928 0 377454 0 14784 0 WILLIAM L BASS 157093 0 0 0 10642 0 20827 0 25205 0 213767 0 5439 0 DAVID E JOHNSEN 623881 0 0 0 0 0 7350 0 0 0 631231 0 0 0 JOHN A KONA 475920 0 0 0 0 0 0 0 0 0 475920 0 0 0 PHILLIP M LENOACH 459670 0 0 0 0 0 7350 0 0 0 467020 0 0 0 JOHNATHAN R LOGAN 401363 0 0 0 0 0 6731 0 0 0 408094 0 0 0 PATEL G PRAVINBHAI 383000 0 0 0 0 0 5584 0 0 0 388584 0 0 0 PART I, LINE 4B GEORGE DAWSON, PRESIDENT/CEO OF CENTRA HEALTH, INC. (A RELATED ORGANIZATION): ACCRUED FOR 2010 $501,567 IN A NONQUALIFIED RETIREMENT PLAN, INCLUDED IN HIS W-2 WAGES. AMANDA HAYTASINGH FAMILY MEMBER OF OFFICER GWEN EDDLEMAN 18851 COMPENSATION AS EMPLOYEE OF SOUTHSIDE COMMUNITY HOSPITAL 0 HARRY ELAM FAMILY MEMBER OF BOARD MEMBER SARAH PUCKETT 123652 COMPENSATION AS EMPLOYEE OF CENTRA HEALTH, INC., A RELATED ORGANIZATION 0 SHARON TAYLOR FAMILY MEMBER OF BOARD MEMBER CHARLES TAYLOR, MD 72198 COMPENSATION AS EMPLOYEE OF SOUTHSIDE COMMUNITY HOSPITAL 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS LEWIS ADDISON, GEORGE DAWSON, AND RODGER FAUBER ALL SERVE AS DIRECTORS/OFFICERS OF PIEDMONT COMMUNITY HEALTH PLAN, A 50% JOINT VENTURE OF CENTRA HEALTH, INC. BOARD MEMBERS LEWIS ADDISON AND GEORGE DAWSON SERVE ON THE BOARDS OF DIRECTORS FOR THE BEDFORD MEMORIAL HOSPITAL AND CENTRAL VIRGINIA IMAGING, BOTH 50% JOINT VENTURES OF CENTRA HEALTH, INC. BOARD MEMBERS GWEN EDDLEMAN AND LEROY PFEFFIER SERVE ON THE BOARD OF DIRECTORS FOR THE WOODLANDS, INC, A NURSING HOME. FORM 990, PART VI, SECTION A, LINE 6 THROUGH AN AFFILIATION AGREEMENT, SOUTHSIDE HOSPITAL'S SOLE CORPORATE MEMBER IS CENTRA HEALTH, INC. FORM 990, PART VI, SECTION A, LINE 7A CENTRA HEALTH, INC. IS THE SOLE MEMBER CORPORATION OF SOUTHSIDE COMMUNITY HOSPITAL (SCH) AND HAS THE POWER TO ELECT/APPROVE THE BOARD OF DIRECTORS OF SCH'S GOVERNING BODY AND APPROVE DECISIONS MADE BY SCH'S BOARD. FORM 990, PART VI, SECTION A, LINE 7B SEE RESPONSE TO PART VI, LINE 7A. FORM 990, PART VI, SECTION B, LINE 11 THE 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. MANAGEMENT WILL ALSO REVIEW THE FORM 990 WITH THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS, WHO WILL THEN PRESENT IT TO THE BOARD OF DIRECTORS FOR THEIR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C ALL CENTRA SOUTHSIDE OFFICERS, DIRECTORS, AND KEY EMPLOYEES, MUST COMPLETE A CONFLICT OF INTEREST QUESTIONNIARE 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, DIRECTORS, AND KEY EMPLOYEES MUST AGREE TO PROMPTLY REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR TO THE PRESIDENT OR CHAIRMAN OF CENTRA SOUTHSIDE'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 CENTRA HEALTH, INC. (SOUTHSIDE'S SOLE MEMBER ORGANIZATION) 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. 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 18 PHOTOCOPIES 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 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY UPON REQUEST AT IT ADMINISTRATIVE OFFICE. AVERAGE HOURS WORKED: FORM 990, PART VII, LINE 1: GEORGE DAWSON AND LEWIS ADDISON DEVOTE AN AVERAGE OF 50 HOURS PER WEEK TO CENTRA HEALTH, INC., A RELATED ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 106,682. CONTRIBUTED CAPITAL FROM AFFILIATE 430,383. TOTAL TO FORM 990, PART XI, LINE 5: 537,065. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: FORM 990, PART III, LINE 4A: 2010 COMMUNITY BENEFIT HIGHLIGHTS - TRADITIONAL CHARITY CARE INCLUDES HEALTH CARE SERVICES TO PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY. DURING FISCAL YEAR 2010, $5,551,884 OF CHARGES AT AN ESTIMATED COST OF $2,408,392 WAS PROVIDED TO PATIENTS OF SOUTHSIDE COMMUNITY HOSPITAL. ELIGIBILITY FOR CHARITY IS BASED ON POVERTY INCOME LEVELS SET BY THE STATE. - UNPAID COST OF MEDICAID REFLECTS THE COST NOT REIMBURSED BY MEDICAID FOR CARE RENDERED TO MEDICAID PATIENTS, $2,970,542. - COMMUNITY EDUCATION INCLUDES COMMUNITY/PATIENT HEALTH EDUCATION PROGRAMS, HEALTH SCREENINGS, COUNSELING, AND SUPPORT GROUPS. - MEDICAL EDUCATION INCLUDES CONTINUING MEDICAL EDUCATION AND SCHOLARSHIPS FOR NURSES AND OTHER HEALTH CARE PROFESSIONALS. - CASH/IN KIND DONATIONS INCLUDE CONTRIBUTIONS MADE ON BEHALF OF SOUTHSIDE COMMUNITY HOSPITAL TO THE COMMUNITY AND IN-KIND DONATIONS, $11,000. - APPROXIMATELY 5,000 PEOPLE ATTENDED SOUTHSIDE COMMUNITY HOSPITAL'S COMMUNITY HEALTH EDUCATION AND HEALTH SCREENING EVENTS. - SOUTHSIDE COMMUNITY HOSPITAL'S AUXILIARY VOLUNTEERS DONATED OVER 10,639 HOURS OF SERVICE. COMMUNITY EDUCATION & HEALTH SCREENINGS SOUTHSIDE COMMUNITY HOSPITAL EMPLOYEES CONTINUALLY OFFER PROFESSIONAL HEALTH EDUCATION PROGRAMS, CLASSES, LECTURES, HEALTH FAIRS AND HEALTH SCREENINGS THROUGHOUT SOUTHSIDE VIRGINIA. SOUTHSIDE COMMUNITY HOSPITAL HAS AVAILABLE A SPEAKER BUREAU CONSISTING OF HEALTHCARE PROFESSIONALS, WHO ARE AVAILABLE TO SPEAK TO THE PUBLIC ON UPDATED HEALTHCARE ISSUES AND TOPICS. SOUTHSIDE COMMUNITY HOSPITAL IS DEDICATED TO IMPROVING THE HEALTHCARE OF ITS COMMUNITY. THE HOSPITAL IS EAGER TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY BY PROVIDING EDUCATIONAL MATERIALS AND HEALTH SCREENINGS. COMMUNITY EDUCATION & HEALTH SCREENINGS - BLOOD PRESSURE CHECKS - ANNUAL HEART OF VIRGINIA FESTIVAL - BREAST CANCER AWARENESS TEA PARTY - CAR SEAT SAFETY DAY - COAT AND BLANKET DRIVE - COMMUNITY DIABETES CLASSES - COMMUNITY HEART HEALTH DAY - COLORECTAL CANCER SCREENS - DIABETES AWARENESS DAY AT YMCA AND LIONS - EXPLORER CAMP - FAMILY-FOCUSED CLASSES - GEMINI HEALTH FAIR - HABITAT FOR HUMANITY FIRST AID TENT - HAMPDEN-SYDNEY COLLEGE HEALTH FAIR - HEARING SCREENINGS - LONGWOOD UNIVERSITY WELLNESS FAIR - LUNENBURG HEALTH FAIR - MARCH FOR BABIES WALK - MEALS ON WHEELS BANQUET SPONSOR - ROTC PHYSICALS AT NOTTOWAY HIGH SCHOOL - SAFE SITTER CLASS - SHRINER SCREENING - SOUTHSIDE ELECTRIC HEALTH FAIR - VIRGINIA BLOOD SERVICES BLOOD DRIVE - YMCA HEALTHY KIDS DAY SUPPORT GROUPS AT SOUTHSIDE COMMUNITY HOSPITAL - ALCOHOLICS ANONYMOUS - BRAIN INJURY SUPPORT GROUP - CELIAC SUPPORT GROUP - DIABETIC SUPPORT GROUP - FIBROMYALGIA/CFIDS SUPPORT GROUP - MULTIPLE SCLEROSIS SUPPORT GROUP - SLEEP DISORDER SUPPORT GROUP CENTRA SOUTHSIDE PROFESSIONAL SERVICES LLC 800 OAK STREET FARMVILLE VA 23901 260771274 PHYSICIAN OFFICES VA 8584594 1765416 N/A CENTRA SOUTHSIDE EMERGENCY SERVICES LLC 800 OAK STREET FARMVILLE VA 23901 270926346 ER PHYSICIAN OPERATION VA 4016208 1132513 N/A CENTRA HEALTH INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 540715569 HEALTHCARE VA 501(C)(3) LINE 3 N/A 0 CENTRA HEALTH FOUNDATION INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541604094 SUPPORTING ORGANIZATION VA 501(C)(3) LINE 11A, I N/A 0 LYNCHBURG FAMILY PRACTICE RESIDENCY PROGRAM INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541457983 HEALTHCARE VA 501(C)(3) LINE 11A, I N/A 0 CCRC INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541929580 CONTINUING CARE RESIDENCY VA 501(C)(3) LINE 11A, I N/A 0 GENERAL BUSINESS CONCERNS INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541299682 REAL ESTATE - PHYSICIAN OFFICES VA N/A C 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0