2012-08-10T05:36:58-05:00 2011-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-01-01 541929580 CCRC INC CCRC 4342004708 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 LEWIS C ADDISON 4342004708 2012-08-10 1 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z LEWIS C ADDISON 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 4159933 0 X WWW.SUMMITLYNCHBURG.COM X 1998 VA CONTINUING CARE RETIREMENT CENTER 9 4 27 60 0 0 0 0 3640211 3778965 234576 380968 0 0 3874787 4159933 0 0 0 0 611045 603270 0 0 0 3220391 3219008 3831436 3822278 43351 337655 19092842 18611390 20730433 20181721 -1637591 -1570331 X THE SUMMIT IS A SENIOR LIVING COMMUNITY PROVIDING AN ENVIRONMENT FOR EACH RESIDENT TO BE ENGAGED IN LIFE. 0 0 3163809 3778965 CCRC, 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. 3163809 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 14 0 1 27 1 0 0 0 0 0 0 0 0 0 0 X 9 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X LEWIS C ADDISON 4342004708 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 X DAVID D ADAMS 2.00 X X 0 309439 58975 LEWIS C ADDISON 2.00 X X 0 446660 86514 DAVID COBB 2.00 X 0 0 0 GEORGE W DAWSON 2.00 X 0 1156668 19612 THOMAS C JIVIDEN 2.00 X X 0 526453 26638 WILLIAM MOORE 2.00 X X 0 0 0 LEE PARKER 2.00 X 0 0 0 L DARRELL POWERS 2.00 X 0 61327 0 W MICHAEL BRYANT 2.00 X 0 164246 28678 AMY G RAY 2.00 X 0 0 0 KENNETH BURGER 50.00 X 79815 0 17539 79815 2664793 237956 0 0 1 0 MERIWETHER GODSEY INC 4944 OLD BOONSBORO ROAD LYNCHBURG VA 24503 FOOD SERVICES 522176 1 NET PATIENT SERVICE RE 623000 3778965 3778965 3778965 14636 14636 366132 200 0 0 366132 200 366332 366332 4159933 3778965 0 380968 97354 97354 376503 266023 110480 129413 72652 56761 1180 1180 129000 129000 19223 19223 682289 612700 69589 72493 728 71765 244394 228650 15744 977764 969325 8439 1449 1449 8248 8248 1027593 1012282 15311 55375 55375 3822278 3163809 658469 0 123449 953470 7839 15106 123431 130554 20524217 9374933 11938748 11149284 4930598 4356853 1968777 2006123 19092842 18611390 467786 514619 9440921 9041270 10575000 10380000 246726 245832 20730433 20181721 X 4400000 4400000 0 0 -6037591 -5970331 -1637591 -1570331 19092842 18611390 X 337655 -270395 X 0 1 1 X 0 X X 0 0 0 CENTRA HEALTH INC 540715569 3 1 1 1 3163809 1 3163809 352816 352816 16308483 7549192 8759291 3178555 1378509 1800046 675456 447232 228224 8907 8907 11149284 UNAMORTIZED BOND FINANCING COSTS 445594 BOND FUNDS LIMITED TO USE 1381614 LAKE MAINTENANCE FUND 178915 2006123 DUE TO AFFILIATE, CENTRA HEALTH, INC. 66917 LAKE MAINTENANCE LIABILITY 178915 245832 4159933 3822278 337655 -270395 -270395 67260 4140710 0 4140710 19223 19223 4159933 3803055 0 3803055 19223 19223 3822278 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. X 0 1 0 0 0 0 0 0 0 DAVID D ADAMS 0 276811 0 0 0 32628 0 38834 0 20141 0 368414 0 32061 LEWIS C ADDISON 0 356020 0 0 0 90640 0 67533 0 18981 0 533174 0 54338 GEORGE W DAWSON 0 628727 0 0 0 527941 0 4502 0 15110 0 1176280 0 0 THOMAS C JIVIDEN 0 408343 0 0 0 118110 0 5582 0 21056 0 553091 0 101186 W MICHAEL BRYANT 0 146226 0 0 0 18020 0 25250 0 3428 0 192924 0 0 PART I, LINE 4B GEORGE 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. SUPPLEMENTAL INFORMATION PART III PART 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. FORM 990, PART VI, SECTION A, LINE 2 BOARD 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 6 THE 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 7A CENTRA 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 7B CENTRA 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 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. FORM 990, PART VI, SECTION B, LINE 12C ALL 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 15 CENTRA/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 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 CAN ALSO BE FOUND ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. AVERAGE HOURS WORKED: 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -270,395. CENTRA HEALTH INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 540715569 HEALTHCARE VA 501(C)(3) HOSPITAL N/A 0 CENTRA HEALTH FOUNDATION 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541604094 SUPPORTING ORGANIZATION VA 501(C)(3) 509(A)(3) N/A 0 LYNCHBURG FAMILY PRACTICE RESIDENCY PROGRAM INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541457983 HEALTHCARE VA 501(C)(3) 509(A)(3) N/A 0 SOUTHSIDE COMMUNITY HOSPITAL INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 540555201 HEALTHCARE VA 501(C)(3) HOSPITAL N/A 0 GENERAL BUSINESS CONCERNS INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541299682 REAL ESTATE - PHYSICIANS OFFICES VA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0