2013-08-12T08:11:44-05:00 2012-12-31 540504608 BROWN EDWARDS & COMPANY LLP 124 NEWMAN AVENUE HARRISONBURG VA 22801 990 2012-01-01 540505913 BATH COMMUNITY HOSPITAL BATH 5408397000 POST OFFICE DRAWER Z HOT SPRINGS VA 24445 JASON PARET 5408397000 2013-08-09 1 JAMES R FRIES P01320612 5404346736 2013-08-08 2012 2016-02-24 21:20:13Z JASON PARET POST OFFICE DRAWER Z HOT SPRINGS VA 24445 31677357 0 X WWW.BCCHOSPITAL.ORG X 1925 VA BATH COMMUNITY HOSPITAL ACCEPTS PRIMARY RESPONSIBILITY FOR IMPROVING THE HEALTH OF OUR AREA BY PROVIDING HIGH QUALITY, COMPASSIONATE, AND AFFORDABLE HEALTH CARE TO OUR REGION. 14 10 173 0 0 0 3011119 3274095 10636066 11740014 263325 739433 200995 540829 14111505 16294371 0 0 0 0 7175312 8089451 0 0 0 6356573 7457111 13531885 15546562 579620 747809 25472767 27142655 1357093 2279548 24115674 24863107 TO TAKE PRIMARY RESPONSIBILITY FOR IMPROVING THE HEALTH OF OUR AREA PROVIDING HIGH QUALITY, COMPASSIONATE AND AFFORDABLE HEALTH CARE TO OUR REGION. 0 0 11787698 12558784 BATH COMMUNITY HOSPITAL OPERATES A 25-BED CRITICAL ACCESS HOSPITAL, TWENTY-FOUR HOUR EMERGENCY SERVICES, PRIMARY CARE, AS WELL AS A SELECT RANGE OF DIAGNOSTIC SERVICES, REHABILITATIVE SERVICES AND SPECIALTY CLINICS. 11787698 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 1 1 1 0 0 1 56 0 1 173 1 0 0 0 0 0 0 0 0 0 0 X 14 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X THE ORGANIZATION 5408397000 106 PARK DR HOT SPRINGS VA 24445 AMORY MELLEN III 1.00 X 0 0 0 WILEY B KLING JR 1.00 X 0 0 0 PETER JUDAH 1.00 X 60140 0 0 WILLIAM A BRATTON 1.00 X 0 0 0 RENE DUFOUR 1.00 X 0 0 0 RUTH RODGERS 1.00 X 0 0 0 BARBARA HOWELL FNP 1.00 X 0 0 0 SUSAN PHILLIPS 1.00 X 0 0 0 GEORGE G PHILLIPS 1.00 X 0 0 0 DON KILLOREN 1.00 X X 0 0 0 DAVID TROAST 1.00 X X 2500 0 0 PETER FARAONE 1.00 X X 0 0 0 HENLEY CARTER 1.00 X X 0 0 0 DEBORAH LIPES RN 40.00 X X 180452 0 36135 JAMES REDINGTON 40.00 X X 173541 0 51632 MARK HALL 40.00 X 69298 0 19266 MARGARET FONTANA 40.00 X 25737 0 5808 JEFFREY MCCRAY 47.00 X 265906 0 35775 WILLIAM SHAVER 40.00 X 178663 0 24838 KYNA MOORE 40.00 X 128571 0 20002 ELIZABETH HUTCHINSON 40.00 X 126409 0 36090 PATRICIA FOUTZ 40.00 X 118698 0 39766 1329915 0 269312 8 0 1 0 HOSPICE DESIGN RESOURCE PLLC 85 PLANTATION DR HILTON HEAD SC 29928 ARCHITECT FOR REMODEL 497625 CPSI 6600 WALL ST MOBILE AL 36695 COMPUTER AND BILLING SERVICES 391603 THE ERX GROUP LLC 9724 KINGSTON PIKE KNOXVILLE TN 37922 ER CONTRACT DOCTORS 325235 BROWN EDWARDS & COMPANY LLP 124 NEWMAN AVENUE HARRISONBURG VA 22801 ACCOUNTING SERVICES 285187 AUGUSTA HEALTH CARE INC 78 MEDICAL CENTER DR FISHERSVILLE VA 22939 CONSULTING AND SUPPORT 179411 9 36000 37114 3200981 3274095 OTHER PROFESSIONAL SER 621300 11947020 11947020 OTHER NURSING SERVICES 621300 4090426 4090426 DAILY PATIENT SERVICES 621300 2771872 2771872 CHARITY CARE 621300 -709751 -709751 CONTRACTUAL ADJUSTMENTS 621300 -6359553 -6359553 11740014 434349 434349 40277 13134 27143 27143 27143 15663626 11310 15329370 40482 334256 -29172 305084 305084 MEANINGFUL USE REIMBURSEMENT 621300 458365 458365 PHARMACY MANAGEMENT 621300 48400 48400 CAFETERIA SALES 621300 5048 5048 1873 1873 513686 16294371 12558784 0 461492 X 561869 225173 336696 6019567 5222808 796759 278828 231715 47113 752688 625509 127179 476499 395986 80513 147575 147575 210267 210267 103831 103831 1879085 1135007 744078 29422 9743 19679 6899 6899 296762 122446 174316 62035 46747 15288 812134 812134 132533 6139 126394 SUPPLIES 1553071 1233098 319973 PROVISION FOR BAD DEBTS 1048320 1048320 EQUIPMENT RENTAL & MAIN 787750 569332 218418 TELEPHONE 107837 14548 93289 279590 88993 190597 15546562 11787698 3758864 0 1398561 2648766 2833910 1009995 2308193 2034495 317944 317944 296198 302700 162316 171222 14496004 9339560 5032615 5156444 12811829 15295151 205143 205143 106058 795 25472767 27142655 1353294 1274786 3799 1004762 1357093 2279548 X 22720855 23468288 1394819 1394819 0 0 24115674 24863107 25472767 27142655 747809 -376 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 648917 648917 7613764 5442768 2170996 529594 236308 293286 4649103 3262884 1386219 1054626 397600 657026 5156444 COST REPORT SETTLEMENT PAYABLE 1004762 1004762 X 15155354 13134 13134 15142220 103831 1048320 1152151 16294371 14407545 13134 13134 14394411 103831 1048320 1152151 15546562 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: N/A PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 13,134. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,048,320. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 13,134. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 1,048,320. 1 1 1 X 1 X 1 1 1 0 1 1 1 522353 522353 0.03630 1 66472 33388 33084 0.00230 2 588825 33388 555437 0.03860 204 2958 20957 20957 0.00150 2 30 153 10669 10669 0.00070 236 3111 31626 31626 0.00220 238 3111 620451 33388 587063 0.04080 2 510 510 0.00000 4 4 72 72 0.00000 5 59 494 494 0.00000 11 63 1076 1076 1 771524 543654 7569327 7535170 34157 X 1 1 1 1 BATH COUNTY COMMUNITY HOSPITAL

PO DRAWER Z HOT SPRINGS VA 24445

X X X X BATH COUNTY COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X 1 0 1 1 100.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 X X X 1 X X X X X X 1 X 0 0 2 BATH COMMUNITY REHAB & WELLNESS CENTER

PO DRAWER Z HOT SPRINGS VA 24445

REHAB AND WELLNESS HOT SPRINGS PHARMACY

PO BOX 1180 HOT SPRINGS VA 24445

PHARMACY PART III, LINE 4: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENT'S EVALUATION OF THE ACCOUNTS RECEIVABLE. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE. THE BAD DEBT EXPENSE REPORTED ON SCH H, PART III, LINE 2 IS THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS. THIS WAS DETERMINED USING THE RATIO OF PATIENT CARE COST TO CHARGES. BATH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: HELD COMMUNITY MEETINGS, DID RANDOM PHONE INTERVIEWS AND HELD MEETINGS WITH LEADERS OF THE COMMUNITY. CONSULTED WITH PEARL BUZZARD, JON TREES, BRUCE MCWILLIAMS, GEORGE PHILLIPS, DAVID TROAST, DON KILLOREN, TRUDY WOODZELL, JONAH WILLIAMS, DENNIS CROPPER, MICHAEL BELL, MARY ADDERTON, BOARD OF SUPERVISORS, VIRGINIA HEALTH DEPARTMENT, JACKIE BAUGHAN, PAT FOUTZ, AND DEBBIE LIPES. PHONE INTERVIEW NAMES NOT AVAILABLE. BATH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 4: AUGUSTA MEDICAL CENTER BATH COUNTY COMMUNITY HOSPITAL PART V, SECTION B, LINE 5C: HELD MEETING TO PROVIDE COMMUNITY WITH DATA. X 0 1 X X X 1 0 0 0 0 0 0 0 0 DEBORAH LIPES RN 180452 0 0 0 0 0 29625 0 6510 0 216587 0 0 0 JAMES REDINGTON 173541 0 0 0 0 0 29691 0 21941 0 225173 0 0 0 JEFFREY MCCRAY 265906 0 0 0 0 0 13834 0 21941 0 301681 0 0 0 WILLIAM SHAVER 178663 0 0 0 0 0 17197 0 7641 0 203501 0 0 0 ELIZABETH HUTCHINSON 126409 0 0 0 0 0 16224 0 19866 0 162499 0 0 0 PATRICIA FOUTZ 118698 0 0 0 0 0 27096 0 12670 0 158464 0 0 0 PART I, LINE 1A PROVIDED HOUSING TO MARK HALL AND MICHAEL BOST VIA A LETTER OF AGREEMENT AS PART OF A RECRUITING INCENTIVE. PART I, LINE 4A MARK HALL WAS PAID SEVERANCE OF $39,456. SUPPLEMENTAL INFORMATION PART III HOSPITAL USES THE VASHHRA REPORT FOR SALARY SURVEY PURPOSES. MIKE MORAN FORMER EMPLOYEE SCHOOL DEBTS X 286982 317944 0 1 1 317944 DR JAMES REDINGTON SERVES ON THE BOARD OF DIRECTORS OF THE HOSPITAL 162599 WORKED AS AN CONTRACT EMPLOYEE VIA BATH FAMILY PRACTICE. 0 PETER JUDAH SERVES ON THE BOARD OF DIRECTORS OF THE HOSPITAL 60140 PROVIDES LEGAL SERVICES TO THE HOSPITAL. 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBERS WILEY B. KLING, JR. AND AMORY MELLEN, III HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 ALL MEMBERS OF THE BOARD REVIEW A COPY OF THE 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM IS SIGNED ANNUALLY BY ALL MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS USED THE MCCRACKIN GROUP IN THE PAST TO LOOK AT REASONABLENESS OF COMPENSATION (LAST TIME ABOUT 5 YEARS AGO). THIS GROUP WAS RECOMMENDED BY VHHA, AND HAS BEEN CONTACTED ON AN AS-NEEDED BASIS SINCE, BY INDIVIDUAL BOARD MEMBERS. THE BOARD OF DIRECTORS ALSO USE THE VASHHRA REPORT FOR SALARY SURVEY PURPOSES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE ALL AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL AND CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,135,007. MANAGEMENT AND GENERAL EXPENSES 744,078. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,879,085. METHOD OF ACCOUNTING FORM 990, PART XII, LINE 1 THE ORGANIZATION USES INCOME TAX BASIS OF ACCOUNTING. THAT BASIS DIFFERS FROM GENERALLY ACCEPTED ACCOUNTING PRINCIPLES PRIMARILY BECAUSE THE HOSPITAL DOES NOT RECORD, AS A PERMANENTLY RESTRICTED ASSET, FUNDS HELD IN TRUST BY OTHERS. THE HOSPITAL ALSO DOES NOT RECORD ITS LONG-TERM INVESTMENTS AT FAIR VALUE AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE ORGANIZATION DID NOT CHANGE ITS ACCOUNTING METHOD IN CURRENT YEAR. AUDIT COMMITTEE FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS IS RESPONSIBLE FOR SELECTION OF AN AUDIT COMMITTEE THAT OVERSEES PREPARATION OF FINANCIAL STATEMENTS AND AUDIT PROCESS. THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS IN CURRENT YEAR. BATH COUNTY COMMUNITY HOSPITAL FOUNDATION PO DRAWER Z HOT SPRINGS VA 24445 571137401 SUPPORT FUNDRAISING EFFORTS OF BATH COMMUNITY HOSPITAL VA 501(C)(3) LINE 11B, II BATH COMMUNITY HOSPITAL 1 HOT SPRINGS PHARMACY INC PO BOX 1180 HOT SPRINGS VA 24445 541187343 RETAIL SALES OF PHARMACEUTICALS VA BATH COMMUNITY HOSPITAL C -48497 205143 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 BATH COUNTY COMMUNITY HOSPITAL FOUNDATION C 36000 CASH HOT SPRINGS PHARMACY INC L 26400 CASH HOT SPRINGS PHARMACY INC O 213693 CASH